Abstract:
:Recommendations concerning postoperative extubation after thymectomy for myasthenia gravis are presently based upon retrospective chart reviews. We present the results of a prospective investigation of time to extubation after thymectomy for 14 patients over a 12-month period based upon a protocol that included preoperative immunologic therapy, combined epidural and general anesthesia, postoperative epidural narcotic analgesia, and a standardized approach to discontinuation of ventilatory support. After a neurologist took measures to optimize preoperative neuromuscular function, all 14 patients received agents to produce lumbar epidural anesthesia and light general anesthesia. Muscle relaxants were avoided in all but one patient. Postoperative analgesia was initially maintained with epidural hydromorphone, then therapy was switched to patient-controlled intravenous morphine sulfate. Criteria for weaning from mechanical ventilation, first measured at the end of anesthesia, were partial pressure of oxygen (arterial) greater than or equal to 90 mm Hg (fraction of inspired oxygen = 0.40), partial pressure of carbon dioxide (arterial) less than or equal to 50 mm Hg, pH greater than or equal to 7.30, and respiratory rate less than or equal to 30 breaths/min. If these criteria were not met, ventilatory support was continued postoperatively with intermittent mandatory ventilation, and the patient was weaned gradually from this support. Criteria for extubation included meeting the criteria for weaning, vital capacity greater than or equal to 10 mL/kg, and inspiratory pressure better than -30 cm H2O. Criteria for reintubation included tachypnea (respiratory rate greater than 40 breaths/min), respiratory acidosis not due to narcotics, or vital capacity less than or equal to 8 mL/kg. The mean time to extubation was 9 hours (range, 0.75 to 25 hours). Mean preoperative vital capacity was 2.59 +/- 0.64 L (range, 1.90 to 4.20), which decreased approximately 50% to 1.19 +/- 0.39 L (range, 0.70 to 2.0) at the time of extubation. No patient required reintubation. Half of the patients required postoperative anticholinesterase therapy based upon serial neurologic examinations; there were no instances of cholinergic crisis. Thirteen patients returned to the ward on the first postoperative day, and one on the second day. Thirteen patients preferred epidural analgesia to patient-controlled analgesia. The time to extubation and average length of stay in an intensive care setting were markedly reduced compared to those reported in previous retrospective studies. We conclude that a multidisciplinary approach that optimizes neuromuscular function and decreases poststernotomy pulmonary insult will shorten the time to extubation and decrease the length of stay in the intensive care or recovery room after thymectomy.
journal_name
South Med Jjournal_title
Southern medical journalauthors
Gorback MS,Moon RE,Massey JMdoi
10.1097/00007611-199106000-00007subject
Has Abstractpub_date
1991-06-01 00:00:00pages
701-6issue
6eissn
0038-4348issn
1541-8243journal_volume
84pub_type
杂志文章abstract::The macerated stillborn fetus represents at least one third of all perinatal deaths. Microscopic examination of these specimens is often unrewarding. We have reported a clinically unsuspected cytomegalovirus infection in a second trimester macerated fetus. Cells suggestive of CMV inclusions were identified by light mi...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199011000-00036
更新日期:1990-11-01 00:00:00
abstract::Based upon the cases reported in this paper and upon a literature review encompassing 1,783 patients having received HAIC, it is our opinion that upper gastrointestinal tract ulceration is a potentially significant complication of hepatic artery infusion chemotherapy. In addition, we believe that the mechanism respons...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198606000-00026
更新日期:1986-06-01 00:00:00
abstract::Retrospective review of eight years' experience with the Mallory-Weiss syndrome emphatically supports the need for accurate, early localization of the site of upper gastrointestinal hemorrhage. Pertinent aspects of the history and physical and laboratory evaluation of this group of patients were analyzed to determine ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1979-10-01 00:00:00
abstract::A 64-year-old woman had the syndrome of inappropriate ADH secretion (SIADH) after surgical repair of a ruptured aneurysm of the anterior communicating artery. SIADH began while the intracranial pressure was elevated, and resolved when the pressure returned to normal. Whether this syndrome was caused by direct hypothal...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198007000-00030
更新日期:1980-07-01 00:00:00
abstract::Payment systems in the US healthcare system have rewarded physicians for services and attempted to control healthcare spending, with rewards and penalties based upon projected goals for future spending. The incorporation of quality goals and alternatives to fee-for-service was introduced to replace the previous system...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.14423/SMJ.0000000000000626
更新日期:2017-04-01 00:00:00
abstract::A unique case of Sheehan's syndrome is characterized by deficiencies of growth hormone, prolactin, thyrotropin, and ACTH. Clinically, it was manifested by adrenal and thyroid insufficiency with regular cyclical menses. Normal menstrual cycles do not preclude extensive hypothalamic-pituitary destruction. ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198308000-00040
更新日期:1983-08-01 00:00:00
abstract::Between 1975 and 1978, over 200 knee arthroscopies were performed at the Emory University Hospitals; the findings were totally correct in 91%. During the same period, arthrograms were performed on 79 different patients, 39 of whom had confirming arthrotomies. The arthrograms were totally correct in 38%. Fifteen totall...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198111000-00009
更新日期:1981-11-01 00:00:00
abstract::Of five patients with hypernephroma who were maintained on hemodialysis after nephrectomy, four died with metastic disease after having been on hemodialysis for an average of 13.7 months (range 8 to 19). The fifth patient had no evidence of malignancy after 21 months of dialysis; he then received a renal allograft fro...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197908000-00019
更新日期:1979-08-01 00:00:00
abstract::One hundred consecutive patients admitted to our cardiology service with the suspected diagnosis of acute myocardial infarction were evaluated with serical enzyme and isoenzyme determinations in an attempt to develop the medically and financially optimal combination of enzyme tests. In patients with onset of chest pai...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197812000-00004
更新日期:1978-12-01 00:00:00
abstract::We present the first two known cases of infantile botulism in Oklahoma. The first case was due to type B toxin; the second was due to type A toxin. Both cases demonstrate most of the classic features of what now appears to be the most common form of botulism. Infantile botulism is an underrecognized but reversible cau...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198804000-00012
更新日期:1988-04-01 00:00:00
abstract::The majority of abnormalities at the foramen of Monro identified by computed tomography (CT) are colloid cysts, but a number of other diseases in this location may produce a similar CT appearance. In a series of 21 patients the radiologic findings included six colloid cysts, two neoplasms, five vascular lesions, three...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198312000-00016
更新日期:1983-12-01 00:00:00
abstract::During the spring term of 1975, rubella was diagnosed in 23 students at Georgetown University in Washington, DC. The cases were concentrated among students from the School of Foreign Service and their close contacts; outbreaks did not appear in other divisions of the university. Rubella immunization of susceptible fem...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1976-08-01 00:00:00
abstract::The 15th case of maternal death associated with sepsis in pregnancy in a patient using the Dalkon Shield intrauterine device is reported. Intrauterine sepsis appears to be a complication of the use of this device. B acteria enter the uterus during pregnancy through the multifilament tail of the device. The management ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197702000-00042
更新日期:1977-02-01 00:00:00
abstract:BACKGROUND:This study was performed to examine the effect of stress on pregnancy outcome in women who underwent assisted reproductive technology (ART) procedures. METHODS:In a controlled clinical study of healthy volunteers in an academic research environment, stress was measured subjectively by administering patient ...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000054567.79881.E9
更新日期:2003-06-01 00:00:00
abstract::We reviewed the operative complications in 333 living related donor nephrectomies done at our institution over the past 12 years. The overall complication rate was 17.1%; only three patients (0.9%) had major complications, and none died. The major complications were a delayed splenectomy because of bleeding, an adrena...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199401000-00013
更新日期:1994-01-01 00:00:00
abstract::An elderly man with previous tuberculosis exsanguinated from esophageal rupture of an atherosclerotic thoracic aneurysm. Because the patient refused angiography, the source of bleeding was discovered only at autopsy. Selected clinical and pathologic aspects of the case are discussed in relation to the different causes...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197907000-00042
更新日期:1979-07-01 00:00:00
abstract::Six patients with classical transient ischemic attacks that were not directly related to extracranial carotid disease are presented. These cases were selected to include a variety of pathologic conditions: one case each of brain tumor, arteriovenous malformation, chronic subdural hematoma, cervical spondylosis, and tw...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-197606000-00015
更新日期:1976-06-01 00:00:00
abstract::Transchondral talar dome fractures are a rare but not unknown cause of continued disability following a "sprained ankle." The diagnosis is made with standard ankle roentgenograms and an awareness of the lesion. Surgical treatment is recommended in acute and chronic cases, based on the amount of displacement of the fra...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198405000-00007
更新日期:1984-05-01 00:00:00
abstract:BACKGROUND:Smokeless tobacco (ST) use is associated with significant health risks and is increasing in prevalence in the United States. This study examined the prevalence of ST use among patients seen in two family practice centers and the documentation of that ST use in the medical record. METHODS:A survey of 209 pat...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199712000-00012
更新日期:1997-12-01 00:00:00
abstract:BACKGROUND:Psychiatric emergency room (ER) patients are thought to be at increased risk of suicide. The prevalence and characteristics of suicidal behavior in a recent sample of patients who came to the ER for psychiatric evaluation were examined. METHODS:Charts of 311 consecutive psychiatric ER patients were reviewed...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:2000-03-01 00:00:00
abstract::We have described a patient with fatal Corynebacterium hemolyticum endocarditis on a native bicuspid aortic valve. This is the first report of endocarditis and the first fatal infection of any kind caused by Corynebacterium hemolyticum. This organism and other nondiphtheria corynebacteria must be considered as potenti...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198510000-00030
更新日期:1985-10-01 00:00:00
abstract::Dietary advice based on saturated versus unsaturated fatty acids for the purpose of controlling the plasma cholesterol level has for many years plagued the American public with unpalatable diets that are difficult to adhere to. Stearic acid, an 18-carbon saturated fatty acid, does not share the hypercholesterolemic ef...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/00007611-199201000-00007
更新日期:1992-01-01 00:00:00
abstract::We evaluated a perinatal outreach education program to determine its "transportability" (usefulness to other regional centers). Three kinds of data were available from seven regional centers: (1) participation in the program by health care providers, (2) changes in cognitive knowledge, and (3) changes in neonatal care...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198312000-00009
更新日期:1983-12-01 00:00:00
abstract::We have reviewed 60 consecutive cases, occurring in 57 patients, of intramedullary fixation of fractures of the midshaft of the tibia done over a ten-year period with the Lottes nail. Of 50 acute fractures, 38 were open fractures, nailed after adequate irrigation and debridement; the other 12 were closed fractures. Th...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198104000-00015
更新日期:1981-04-01 00:00:00
abstract::In 32 patients with the onset of myasthenia gravis after age 50, myasthenic crisis occurred in 53% and persisted for a mean of 33 days (range six to 84 days). Three of the patients had a second crisis. Precipitating factors were found in 60% of the episodes. Treatment of 20 episodes of crisis resulted in excellent rec...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-198510000-00017
更新日期:1985-10-01 00:00:00
abstract::Restorative proctocolectomy with ileal pouch anal anastomosis has become the most commonly used procedure for elective treatment of patients with mucosal ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in an attempt to obtain optimal functional res...
journal_title:Southern medical journal
pub_type: 杂志文章,评审
doi:10.1097/01.SMJ.0000047720.97917.03
更新日期:2003-01-01 00:00:00
abstract::Tramadol (Ultram) is a new analgesic agent with a dual mechanism of action that includes weak agonistic effects at the mu-opioid receptor as well as inhibition of neurotransmitter (serotonin, norepinephrine) re-uptake. Although it has proven to be a safe and effective agent for the control of pain, adverse effects can...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199708000-00010
更新日期:1997-08-01 00:00:00
abstract::The application of 70% helium-30% oxygen mixtures by tight-fitting face mask in the emergency management of large airway obstruction is well known. We present the case of an infant with severe large airway obstruction and respiratory failure that was unresponsive to the more traditional approaches of airway management...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:
更新日期:1991-05-01 00:00:00
abstract:OBJECTIVES:Peripheral vascular disease (PVD) is underdiagnosed in primary care due to the absence of established criteria to warrant diagnostic testing. Our goal was to establish a risk factor hierarchy to enable earlier diagnosis of PVD. METHODS:Data sets of 142 patients with abnormal ankle brachial indices (ABI) wer...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/01.SMJ.0000141303.47034.46
更新日期:2004-10-01 00:00:00
abstract::We report the case of an 18-year old man with hemolytic-uremic syndrome (HUS) having a classic clinical presentation and diagnostic renal pathology without evidence of microangiopathic hemolytic anemia (MAHA) by peripheral blood smear. Indirect evidence of hemolysis was suggested by mild anemia, elevation of serum lac...
journal_title:Southern medical journal
pub_type: 杂志文章
doi:10.1097/00007611-199603000-00018
更新日期:1996-03-01 00:00:00