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Abstract
One hundred nine penetrating cardiac injuries were reviewed: 49 gunshot wounds and 60 stab wounds. They were classified into four groups: group 1 (lifeless), 38; group 2 (agonal), 16; group 3 (shock), 33; and group 4 (stable), 22. Thirty-six patients in group 1 (94%) and 8 of 16 patients in group 2 (50%) underwent emergency room thoracotomy; 24 of 33 in group 3 (73%) and 20 of 22 (90%) underwent thoracotomy in the operating room. Twenty-one (38%) of 55 patients undergoing emergency room thoracotomy survived, whereas 47 (87%) of 54 patients undergoing operating room thoracotomy survived. Survival was 12 of 38 (31%) in group 1, 11 of 16 (69%) in group 2, 26 of 33 (79%) in group 3, and 18 of 22 (82%) in group 4 with an overall survival of 67 of 109 (61%). Gunshot wounds of the heart portend a worse prognosis than stab wounds. Survival of gunshot wounds was 20 of 49 (40%) compared with 47 survivors of 60 stab wounds (78%). Aggressive treatment, including emergency room thoracotomy, is justified for lifeless and deteriorating cardiac injury victims.
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52
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Attar S, Hankins JR, Suter CM, Coughlin TR, Sequeira A, McLaughlin JS. Esophageal perforation: a therapeutic challenge. Ann Thorac Surg 1990; 50:45-9; discussion 50-1. [PMID: 2369229 DOI: 10.1016/0003-4975(90)90082-h] [Citation(s) in RCA: 159] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The records of 64 patients with esophageal perforation treated since 1958 were reviewed. There were 19 cervical perforations, 44 thoracic perforations, and one abdominal perforation. Thirty-one perforations (48%) were due to injury from intraluminal causes. Twenty (31%) resulted from extraluminal causes: penetrating wounds, 11; blunt trauma, 3; and paraesophageal operations, 6. Eleven (17%) were spontaneous perforations, and two (3%) were caused by perforation of an esophageal malignancy. Ten (91%) of 11 patients with cervical perforations treated less than 24 hours after injury survived compared with 6 (75%) of 8 patients treated more than 24 hours after injury; hence 16 (84%) of the 19 patients in the cervical group survived. In the thoracic group, 19 patients were treated within 24 hours with 16 survivors (84%) compared with 25 patients treated beyond 24 hours with 12 survivors (48%); hence 28 (64%) of the 44 patients in the thoracic group survived. The patient with an abdominal perforation survived. Thirty patients underwent primary suture closure of the perforation, and 25 (83%) lived. Seventeen patients had drainage, and 10 (59%) lived. Total esophagectomy was performed in 9 patients, 7 (78%) of whom survived. Exclusion-diversion procedures were performed in 5 patients, and 1 (20%) survived.
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53
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Mazumder S, Sequeira A. Multiple small-angle scattering from a bidisperse Markov medium. PHYSICAL REVIEW. B, CONDENSED MATTER 1990; 41:6272-6277. [PMID: 9992872 DOI: 10.1103/physrevb.41.6272] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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54
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Roul BK, Choudhary RNP, Rajagopal H, Sequeira A. A neutron diffraction study of deuterated semicarbazide hydrochloride. Errata. Acta Crystallogr C 1989. [DOI: 10.1107/s0108270189002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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55
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Sequeira A, Rajagopal H, Ramanadham M. A neutron study on the structure of DL-aspartic acid. Acta Crystallogr C 1989. [DOI: 10.1107/s010827018801412x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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56
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Mazumder S, Sequeira A. Multiple small-angle scattering from a polydispersed random medium. PHYSICAL REVIEW. B, CONDENSED MATTER 1989; 39:6370-6373. [PMID: 9947272 DOI: 10.1103/physrevb.39.6370] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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57
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Gundry SR, Sequeira A, Coughlin TR, McLaughlin JS. Postoperative conduction disturbances: a comparison of blood and crystalloid cardioplegia. Ann Thorac Surg 1989; 47:384-90. [PMID: 2784664 DOI: 10.1016/0003-4975(89)90378-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Conduction system disturbances after cardioplegia are well described. Our four-man group changed in mid-1987 from standard crystalloid cardioplegia (35 mEq/L of KCl) to blood cardioplegia (4 parts blood to 1 part cardioplegia) (18 mEq/L of KCl) based on experimental and clinical evidence that blood cardioplegia provides better myocardial protection. Shortly thereafter, we anecdotally noted increased conduction abnormalities. This prompted us to compare serially all patients undergoing coronary artery bypass grafting during 1987 for perioperative and late conduction system disturbances after either crystalloid or blood cardioplegia. Surgeons and techniques including topical cooling did not differ. Forty-one (23%) of 179 patients with crystalloid cardioplegia had conduction disturbances versus 141 (49%) of 289 patients with blood cardioplegia (p less than 0.001). Perioperative complete heart block requiring atrioventricular sequential pacing occurred in 20 patients with crystalloid cardioplegia versus 67 patients with blood cardioplegia (p less than 0.002), and atrioventricular block requiring permanent pacing was present in 4 and 12 patients (p less than 0.001), respectively. Left bundle-branch block was found in 8 patients given crystalloid cardioplegia and 28 patients with blood cardioplegia (p less than 0.05); right bundle-branch block, 12 and 68 patients (p less than 0.001); left anterior hemiblock, 8 and 37 patients (p less than 0.001); and interventricular conduction delay, 15 and 53 patients (p less than 0.005), respectively. Bifascicular block occurred in 4 patients receiving crystalloid cardioplegia versus 23 receiving blood cardioplegia (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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58
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Sequeira A, Rajagopal H, Ganapathi L, Rao C. A neutron diffraction study of LaBa2Cu3O7−δ. J SOLID STATE CHEM 1988. [DOI: 10.1016/0022-4596(88)90213-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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59
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Roul BK, Choudhary RNP, Rajagopal H, Sequeira A. A neutron diffraction study of deuterated semicarbazide hydrochloride. Acta Crystallogr C 1988. [DOI: 10.1107/s0108270188002586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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60
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Applebaum RE, Sequeira A, McLaughlin JS. A technique to repair type I left ventricular rupture following mitral valve replacement. Ann Thorac Surg 1988; 45:216-9. [PMID: 3277557 DOI: 10.1016/s0003-4975(10)62442-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Rupture of the posterior left ventricle is a serious complication following mitral valve replacement. A successful method of repair is illustrated. The causes, other methods of repair, and means to prevent this complication are discussed.
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61
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Mazumder S, Sequeira A. On multiple small-angle scattering. Acta Crystallogr A 1987. [DOI: 10.1107/s0108767387078942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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62
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Sequeira A, Rajagopal H, Gupta MP. A precision neutron study of the structure of tetraaquabis(hydrogen maleato)zinc(II). Acta Crystallogr A 1987. [DOI: 10.1107/s0108767387080437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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63
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Roul BK, Choudhary RNP, Rajagopal H, Sequeira A. A neutron structural study of semicarbazide hydrochloride. Acta Crystallogr C 1987. [DOI: 10.1107/s0108270187094587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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64
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Abstract
A simplified technique to gain repeated access to the median sternotomy incision is presented. The technique involves the use of a sterile polyester zipper attached to the skin edge. The sternum remains open. Unzipping the zipper allows for repeated relief of cardiac tamponade and viewing of cardiac action. Other advantages include prevention of cardiac compression or kinking of assist device cannulas from sternal closure, ease in changing of dressings, and quick removal of ventricular assist devices without reopening the sternum.
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65
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Tavares S, Hankins JR, Moulton AL, Attar S, Ali S, Lincoln S, Green DC, Sequeira A, McLaughlin JS. Management of penetrating cardiac injuries: the role of emergency room thoracotomy. Ann Thorac Surg 1984; 38:183-7. [PMID: 6476939 DOI: 10.1016/s0003-4975(10)62233-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Sixty-four consecutive patients with penetrating cardiac injuries were treated between January, 1977, and January, 1983, at the University of Maryland Hospital. Twenty-eight patients had major associated injuries of other organs. The patients were divided into groups according to their clinical status on arrival. An aggressive approach was utilized including early emergency room (ER) thoracotomy for "lifeless" or deteriorating patients. Three patients required immediate cardiopulmonary bypass for repair of their injuries. Twenty-one (57%) of the 37 patients undergoing ER thoracotomy survived; most of the deaths occurred in patients arriving "lifeless" from gunshot wounds. Twenty-four (89%) of the 27 patients who were in stable enough condition to undergo initial repair in the operating room (OR) survived. Overall survival was 45 patients (70%). Though superficial wound infections developed in 18 patients, there were no deep or systemic infections. None of the survivors sustained severe neurological sequelae. Five patients underwent late reoperations for closure of a ventricular septal defect (2), mitral valve replacement (1), and pericardiectomy (2) with no deaths. Though repair of penetrating cardiac injuries should preferably be carried out in the OR, immediate thoracotomy for "lifeless" or deteriorating patients can be performed in the ER with a low incidence of direct surgical complications and with high patient survival.
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66
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Bhakay-Tamhane S, Sequeira A, Chidambaram R. Low-temperature phase transitions in LiKSO4: a neutron diffraction study. Acta Crystallogr A 1984. [DOI: 10.1107/s0108767384096008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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67
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Sequeira A, Ramanadham M, Rajagopal H, Padmanabhan VM. A neutron diffraction study of glycyl-L-threonine dihydrate. ACTA ACUST UNITED AC 1981. [DOI: 10.1107/s0567740881007371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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68
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Bhakay-Tamhane S, Sequeira A, Chidambaram R. Neutron diffraction refinement of the structure of a push–pull ethylene C 13H 14OSN 2. Acta Crystallogr A 1981. [DOI: 10.1107/s0108767381093525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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69
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Bhakay-Tamhane S, Sequeira A, Chidambaram R. X-ray and neutron study of LiKSO4at room temperature – search for disorder. Acta Crystallogr A 1981. [DOI: 10.1107/s0108767381096311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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70
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Bhakay-Tamhane SN, Sequeira A, Chidambaram R. Disorder of ammonium ions in diammonium tetrachlorocuprate dihydrate, (NH4)2CuCl4.2H2O: a high-precision neutron diffraction study. ACTA ACUST UNITED AC 1980. [DOI: 10.1107/s0567740880010539] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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71
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Al-Karaghouli AR, Abdul-Wahab B, Ajaj E, Sequeira A. A precision neutron diffraction study of tetragonal RbH2PO4. ACTA ACUST UNITED AC 1978. [DOI: 10.1107/s0567740878004811] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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72
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Sequeira A, Bernal I, Brown ID, Faggiani R. The structure of lithium perchlorate trihydrate Li(H2O)3ClO4 – an X-ray and neutron diffraction study. ACTA ACUST UNITED AC 1975. [DOI: 10.1107/s0567740875006000] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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73
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Gupta SC, Sequeira A, Chidambaram R. A neutron diffraction study of the structure of L-cystine.2HCl. ACTA ACUST UNITED AC 1974. [DOI: 10.1107/s0567740874003311] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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74
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Bugayong RR, Sequeira A, Chidambaram R. A neutron diffraction study of the structure of L-lysine monohydrochloride dihydrate. ACTA ACUST UNITED AC 1972. [DOI: 10.1107/s0567740872007769] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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75
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Sequeira A, Rajagopal H, Chidambaram R. A neutron diffraction study of the structure of L-glutamic acid.HCl. ACTA ACUST UNITED AC 1972. [DOI: 10.1107/s0567740872006399] [Citation(s) in RCA: 72] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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