5 results on '"James D. Rawn"'
Search Results
2. Ventricular Assist Device in Patients With Prosthetic Heart Valves
- Author
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R. Morton Bolman, James D. Rawn, Prem Shekar, Lawrence S. Lee, Suyog A. Mokashi, Gregory S. Couper, Jan D. Schmitto, and Frederick Y. Chen
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Heart transplantation ,Aortic valve ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Biomedical Engineering ,Medicine (miscellaneous) ,Mechanical Aortic Valve ,Bioengineering ,General Medicine ,Surgery ,Biomaterials ,Right Ventricular Assist Device ,medicine.anatomical_structure ,Mechanical Mitral Valve ,Ventricular assist device ,Internal medicine ,medicine ,Cardiology ,Ventricular Assist Device Placement ,Heart valve ,business - Abstract
Ventricular assist device (VAD) support inpatients with a prosthetic heart valve had previously been considered a relative contraindication due to an increased risk of thromboembolic complications. We report our clinical experience of VAD implantation in patients with prosthetic heart valves, including both mechanical and bioprosthetic valves. The clinical records of 133 consecutive patients who underwent VAD implantation at a single institution from January 2002 through June 2009 were retrospectively reviewed. Six of these patients had a prosthetic valve in place at the time of device implantation. Patient demographics,operative characteristics, and postoperative complications were reviewed.Of the six patients,four were male.The mean age was 57.8 years (range 35–66 years). The various prosthetic cardiac valves included a mechanical aortic valve (n = 2), a bioprosthetic aortic valve (n = 3), and a mechanical mitral valve (n = 1).The indications for VAD support included bridge to transplantation (n = 2), bridge to recovery (n = 1), and postcardiotomy ventricular failure(n = 3). Three patients underwent left ventricular assist device placement and three received a right ventricular assist device. Postoperatively, standard anticoagulation management began with a heparin infusion (if possible)followed by oral anticoagulation.The 30-day mortality was50% (3/6). The mean duration of support among survivors was 194.3 days (range 7–369 days) compared with 16.0 days(range 4–29 days) for nonsurvivors. Of the three survivors,two were successfully bridged to heart transplantation and one recovered native ventricular function.Among the three nonsurvivors,acute renal failure developed in each case, and two developed heparin-induced thrombocytopenia. This study suggests that VAD placement in patients with a prosthethic heart valve, either mechanical or bioprosthetic,appears to be a reasonable option.
- Published
- 2010
3. Malnutrition, Critical Illness Survivors, and Postdischarge Outcomes: A Cohort Study
- Author
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Kenneth B. Christopher, James D. Rawn, Malcolm K. Robinson, Takuhiro Moromizato, Clare Horkan, Kris M. Mogensen, and Steven W. Purtle
- Subjects
Adult ,Male ,0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,Critical Illness ,Medicine (miscellaneous) ,Patient Readmission ,law.invention ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Weight loss ,law ,Sepsis ,Odds Ratio ,Humans ,Medicine ,Survivors ,030212 general & internal medicine ,Wasting ,Aged ,030109 nutrition & dietetics ,Nutrition and Dietetics ,Wasting Syndrome ,business.industry ,Malnutrition ,Absolute risk reduction ,Odds ratio ,Middle Aged ,Prognosis ,medicine.disease ,Intensive care unit ,Patient Discharge ,Intensive Care Units ,Treatment Outcome ,Cohort ,Female ,medicine.symptom ,business ,Cohort study - Abstract
We hypothesized that preexisting malnutrition in patients who survived critical care would be associated with adverse outcomes following hospital discharge.We performed an observational cohort study in 1 academic medical center in Boston. We studied 23,575 patients, aged ≥18 years, who received critical care between 2004 and 2011 and survived hospitalization.The exposure of interest was malnutrition determined at intensive care unit (ICU) admission by a registered dietitian using clinical judgment and on data related to unintentional weight loss, inadequate nutrient intake, and wasting of muscle mass and/or subcutaneous fat. The primary outcome was 90-day postdischarge mortality. Secondary outcome was unplanned 30-day hospital readmission. Adjusted odds ratios were estimated by logistic regression models adjusted for age, race, sex, Deyo-Charlson Index, surgical ICU, sepsis, and acute organ failure. In the cohort, the absolute risk of 90-day postdischarge mortality was 5.9%, 11.7%, 15.8%, and 21.9% in patients without malnutrition, those at risk of malnutrition, nonspecific malnutrition, and protein-energy malnutrition, respectively. The odds of 90-day postdischarge mortality in patients at risk of malnutrition, nonspecific malnutrition, and protein-energy malnutrition fully adjusted were 1.77 (95% confidence interval [CI], 1.23-2.54), 2.51 (95% CI, 1.36-4.62), and 3.72 (95% CI, 2.16-6.39), respectively, relative to patients without malnutrition. Furthermore, the presence of malnutrition is a significant predictor of the odds of unplanned 30-day hospital readmission.In patients treated with critical care who survive hospitalization, preexisting malnutrition is a robust predictor of subsequent mortality and unplanned hospital readmission.
- Published
- 2017
4. Subunit Interactions in the Sodium Pump
- Author
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M. Hamrick, Douglas M. Fambrough, T. Colonna, M. Kostich, B. Hwang, and James D. Rawn
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Models, Molecular ,Transcription, Genetic ,Macromolecular Substances ,Protein subunit ,Molecular Sequence Data ,Saccharomyces cerevisiae ,Transfection ,Protein Structure, Secondary ,General Biochemistry, Genetics and Molecular Biology ,Mice ,L Cells ,Text mining ,History and Philosophy of Science ,Animals ,Humans ,Amino Acid Sequence ,Cloning, Molecular ,business.industry ,Chemistry ,General Neuroscience ,Sodium ,Recombinant Proteins ,Biochemistry ,Mutagenesis, Site-Directed ,Sodium pump ,Sodium-Potassium-Exchanging ATPase ,business ,Chickens ,Sequence Alignment ,HeLa Cells - Published
- 1997
5. Delayed Presentation of Totally Avulsed Right Superior Vena Cava After Extraction of Permanent Pacemaker Lead
- Author
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John G. Byrne, Marzia Leacche, James D. Rawn, Hassan Arshad, Tomislav Mihaljevic, Michael O. Sweeney, and Yan Katsnelson
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Pacemaker, Artificial ,Superior Vena Cava Syndrome ,medicine.medical_specialty ,Prosthesis-Related Infections ,Vena Cava, Superior ,Delayed presentation ,Hematoma ,medicine ,Humans ,Lead (electronics) ,Device Removal ,Venous Thrombosis ,Superior vena cava syndrome ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Right superior vena cava ,Surgery ,Venous thrombosis ,Female ,Laser Therapy ,Permanent pacemaker ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Lateral wall ,business - Abstract
Pacemaker lead extraction has been shown to be an effective and safe treatment for infected permanent pacemaker leads, however, they may lead to potentially serious complications, usually occurring during the extraction procedure. This report describes a case of a 48-year-old woman with a patent persistent left SVC and an infected permanent pacemaker lead of a DDD pacing system who underwent transvenous laser-assisted lead extraction using a combined SVC and femoral approach. Two days after the procedure the patient developed symptoms of SVC obstruction requiring surgical intervention. The right SVC was found to be almost completely destroyed with only a thin strip of the lateral wall intact and active bleeding. The probable causative mechanisms and surgical management are discussed.
- Published
- 2004
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