Mary Njoku - Academia.edu (original) (raw)

Papers by Mary Njoku

Research paper thumbnail of Post-Anesthesia Care

Critical Care Medicine, 2017

Research paper thumbnail of Successful Emergency Transplantation of a Liver Allograft from a Donor Maintained on Extracorporeal Membrane Oxygenation

Transplantation, 1997

The critical shortage of cadaveric donors for organ transplantation has led many transplant cente... more The critical shortage of cadaveric donors for organ transplantation has led many transplant centers to accept life-saving organs from donors who would have previously been refused for transplantation. We report a novel case of the use of a liver allograft from a donor whose oxygen delivery was maintained by extracorporeal membrane oxygenation (ECMO) for 29 days before suffering an anoxic brain injury from ECMO dysfunction. Liver transplantation was successfully performed in a patient with fulminant hepatic failure. Immediate graft function was obtained in the recipient, with full neurologic recovery and return to gainful employment 4 months after transplantation. ECMO may provide an intriguing option for the maintenance of organ function in the critically unstable brain-dead organ donor to salvage organs for transplantation. Further studies are currently underway.

Research paper thumbnail of Haemoglobin-based oxygen carriers: indications and future applications

British Journal of Hospital Medicine, 2015

This article describes current oxygen-carrying solutions, four new products and new indications t... more This article describes current oxygen-carrying solutions, four new products and new indications to increase the benefit/risk ratio of haemoglobin-based oxygen carriers compared to blood. Indications include when blood is not available, if blood is contaminated, is refused or contraindicated, and for organ preservation.

Research paper thumbnail of Intraoperative Fluid Management

Survey of Anesthesiology, 1994

Research paper thumbnail of Big data' approaches to trauma outcome prediction and autonomous resuscitation

British journal of hospital medicine (London, England : 2005), 2014

Massive clinical digital data routinely collected by high throughput biomedical devices provide o... more Massive clinical digital data routinely collected by high throughput biomedical devices provide opportunities and challenges for optimal use. This article discusses how such data are used in learning prediction models at level 1 trauma centres to support decision making in trauma patients.

Research paper thumbnail of Extending the boundaries of acceptable organ donors: A means of expanding the donor pool for liver Transplantation

Transplantation Proceedings, 1997

Research paper thumbnail of Successful Use of Chronic Epoprostenol as a Bridge to Liver Transplantation in Severe Portopulmonary HYPERTENSION1

Transplantation, 1998

Portopulmonary hypertension, defined as mean pulmonary artery pressure >25 mmHg in the pre... more Portopulmonary hypertension, defined as mean pulmonary artery pressure >25 mmHg in the presence of a normal pulmonary capillary wedge pressure and portal hypertension, is a known complication of end-stage liver disease that has been associated with high morbidity and mortality at the time of liver transplantation. We have recently reported the successful treatment of portopulmonary hypertension with chronic intravenous epoprostenol and now report the first patient with severe portopulmonary hypertension successfully treated with epoprostenol who subsequently underwent successful liver transplantation. A patient with severe portopulmonary hypertension was treated with intravenous epoprostenol, 23 ng/kg/min, for a 4-month period, after which the portopulmonary hypertension resolved and the patient underwent successful liver transplantation. The patient was discharged, continues to do well, and at 3 months is off epoprostenol with near normal pulmonary artery pressures. Chronic epoprostenol, in conjunction with a multidisciplinary, well-planned perioperative evaluation and treatment plan, may be the answer to a heretofore untreatable disease.

Research paper thumbnail of Cytoablative therapy with combined resection and cryosurgery for limited bilobar hepatic colorectal metastases

The American Journal of Surgery, 1997

Cryosurgery can be employed in patients with unresectable hepatic metastases when the tumor size ... more Cryosurgery can be employed in patients with unresectable hepatic metastases when the tumor size and the number of metastases are limited. However, local recurrence can result from incomplete ablation. We proposed a trial of complete cytoablation with a combined approach of cryosurgery and hepatic resection for patients with bilobar hepatic metastases. Seven patients underwent cryosurgery alone (CRYO). Seven additional patients underwent combined resection and cryosurgery (CRYO+RES) for bilobar metastases. In the CRYO group, 5 of 7 patients had at least one centrally located tumor. All 5 of these patients had early recurrence at the site of ablation. In the CRYO+RES group complete ablation was achieved in 7 of 7. Two (28.6%) of these patients developed local recurrence. Cytoablation of hepatic metastases can be safely achieved with combined hepatic resection and cryosurgery in selected patients. Long-term survival data are necessary before advocating widespread application of this approach.

Research paper thumbnail of Cryosurgical debulking of unresectable liver metastases for palliation of carcinoid syndrome

Research paper thumbnail of Patients with Chronic Endocrine Disease

Medical Clinics of North America, 2013

Research paper thumbnail of Methemoglobinemia associated with dapsone treatment in solid organ transplant recipients: A two-case report and review

Liver Transplantation and Surgery, 1997

Research paper thumbnail of The evolution of a successful liver transplant program in 1996: The clinical and administrative role of the anesthesiologist

Liver Transplantation and Surgery, 1997

Research paper thumbnail of Dobutamine stress echocardiography for the preoperative evaluation of patients undergoing lung volume reduction surgery

The Journal of Thoracic and Cardiovascular Surgery, 1999

Research paper thumbnail of Effects of trendelenburg and reverse trendelenburg postures on lung and chest wall mechanics

Journal of Clinical Anesthesia, 1996

Research paper thumbnail of Lung and Chest Wall Properties in Mechanically Ventilated Patients

Critical Care Medicine, 1995

Research paper thumbnail of The Coexistence of Portopulmonary Hypertension and Hepatopulmonary Syndrome

Anesthesiology, 1999

... Jones, Frederick D. MD; Kuo, Paul C. MD; Johnson, Lynt B. MD; Njoku, Mary J. MD; Dixon‐Fergus... more ... Jones, Frederick D. MD; Kuo, Paul C. MD; Johnson, Lynt B. MD; Njoku, Mary J. MD; Dixon‐Ferguson, Mary K. CCVT; Plotkin, Jeffrey S. MD. Article Outline. Collapse Box Author Information. ... (Dixon‐Ferguson) Echo Tech, Department of Anesthesiology, University of Maryland. ...

Research paper thumbnail of The Effects of Increased Abdominal Pressure on Lung and Chest Wall Mechanics During Laparoscopic Surgery

Anesthesia & Analgesia, 1995

Research paper thumbnail of Changes in Lung and Chest Wall Properties with Abdominal Insufflation of Carbon Dioxide Are Immediately Reversible

Anesthesia & Analgesia, 1996

Previously we have reported that large increases in lung and chest wall elastances as well as lun... more Previously we have reported that large increases in lung and chest wall elastances as well as lung resistance occur with abdominal insufflation of carbon dioxide during laparoscopic surgery. To examine whether these effects were reversible with abdominal deflation, we calculated lung and chest wall elastances and resistances from measurement of airway flow and pressure and esophageal pressure in 17 anesthetized/paralyzed patients undergoing laparoscopic surgery. Measurements were made immediately prior to abdominal insufflation and after deflation. Lung and chest wall elastances and resistances were not changed from baseline (P > 0.05), although total respiratory elastance remained slightly increased compared to baseline (P < 0.05). The change in total respiratory elastance did not correlate with abdominal insufflation time, surgical site, smoking history, or physical characteristics of the patients. There were no differences in frequency and tidal volume dependences of the elastances and resistances before and after abdominal insufflation (P > 0.5). We conclude that residual changes in respiratory mechanics caused by carbon dioxide insufflation during laparoscopic surgery are minor, and that the reported compromise of respiratory function indicated by pulmonary function tests after laparoscopy does not appear to be due to changes in passive mechanical properties of the lungs or chest wall.

Research paper thumbnail of Post-Anesthesia Care

Critical Care Medicine, 2017

Research paper thumbnail of Successful Emergency Transplantation of a Liver Allograft from a Donor Maintained on Extracorporeal Membrane Oxygenation

Transplantation, 1997

The critical shortage of cadaveric donors for organ transplantation has led many transplant cente... more The critical shortage of cadaveric donors for organ transplantation has led many transplant centers to accept life-saving organs from donors who would have previously been refused for transplantation. We report a novel case of the use of a liver allograft from a donor whose oxygen delivery was maintained by extracorporeal membrane oxygenation (ECMO) for 29 days before suffering an anoxic brain injury from ECMO dysfunction. Liver transplantation was successfully performed in a patient with fulminant hepatic failure. Immediate graft function was obtained in the recipient, with full neurologic recovery and return to gainful employment 4 months after transplantation. ECMO may provide an intriguing option for the maintenance of organ function in the critically unstable brain-dead organ donor to salvage organs for transplantation. Further studies are currently underway.

Research paper thumbnail of Haemoglobin-based oxygen carriers: indications and future applications

British Journal of Hospital Medicine, 2015

This article describes current oxygen-carrying solutions, four new products and new indications t... more This article describes current oxygen-carrying solutions, four new products and new indications to increase the benefit/risk ratio of haemoglobin-based oxygen carriers compared to blood. Indications include when blood is not available, if blood is contaminated, is refused or contraindicated, and for organ preservation.

Research paper thumbnail of Intraoperative Fluid Management

Survey of Anesthesiology, 1994

Research paper thumbnail of Big data' approaches to trauma outcome prediction and autonomous resuscitation

British journal of hospital medicine (London, England : 2005), 2014

Massive clinical digital data routinely collected by high throughput biomedical devices provide o... more Massive clinical digital data routinely collected by high throughput biomedical devices provide opportunities and challenges for optimal use. This article discusses how such data are used in learning prediction models at level 1 trauma centres to support decision making in trauma patients.

Research paper thumbnail of Extending the boundaries of acceptable organ donors: A means of expanding the donor pool for liver Transplantation

Transplantation Proceedings, 1997

Research paper thumbnail of Successful Use of Chronic Epoprostenol as a Bridge to Liver Transplantation in Severe Portopulmonary HYPERTENSION1

Transplantation, 1998

Portopulmonary hypertension, defined as mean pulmonary artery pressure >25 mmHg in the pre... more Portopulmonary hypertension, defined as mean pulmonary artery pressure >25 mmHg in the presence of a normal pulmonary capillary wedge pressure and portal hypertension, is a known complication of end-stage liver disease that has been associated with high morbidity and mortality at the time of liver transplantation. We have recently reported the successful treatment of portopulmonary hypertension with chronic intravenous epoprostenol and now report the first patient with severe portopulmonary hypertension successfully treated with epoprostenol who subsequently underwent successful liver transplantation. A patient with severe portopulmonary hypertension was treated with intravenous epoprostenol, 23 ng/kg/min, for a 4-month period, after which the portopulmonary hypertension resolved and the patient underwent successful liver transplantation. The patient was discharged, continues to do well, and at 3 months is off epoprostenol with near normal pulmonary artery pressures. Chronic epoprostenol, in conjunction with a multidisciplinary, well-planned perioperative evaluation and treatment plan, may be the answer to a heretofore untreatable disease.

Research paper thumbnail of Cytoablative therapy with combined resection and cryosurgery for limited bilobar hepatic colorectal metastases

The American Journal of Surgery, 1997

Cryosurgery can be employed in patients with unresectable hepatic metastases when the tumor size ... more Cryosurgery can be employed in patients with unresectable hepatic metastases when the tumor size and the number of metastases are limited. However, local recurrence can result from incomplete ablation. We proposed a trial of complete cytoablation with a combined approach of cryosurgery and hepatic resection for patients with bilobar hepatic metastases. Seven patients underwent cryosurgery alone (CRYO). Seven additional patients underwent combined resection and cryosurgery (CRYO+RES) for bilobar metastases. In the CRYO group, 5 of 7 patients had at least one centrally located tumor. All 5 of these patients had early recurrence at the site of ablation. In the CRYO+RES group complete ablation was achieved in 7 of 7. Two (28.6%) of these patients developed local recurrence. Cytoablation of hepatic metastases can be safely achieved with combined hepatic resection and cryosurgery in selected patients. Long-term survival data are necessary before advocating widespread application of this approach.

Research paper thumbnail of Cryosurgical debulking of unresectable liver metastases for palliation of carcinoid syndrome

Research paper thumbnail of Patients with Chronic Endocrine Disease

Medical Clinics of North America, 2013

Research paper thumbnail of Methemoglobinemia associated with dapsone treatment in solid organ transplant recipients: A two-case report and review

Liver Transplantation and Surgery, 1997

Research paper thumbnail of The evolution of a successful liver transplant program in 1996: The clinical and administrative role of the anesthesiologist

Liver Transplantation and Surgery, 1997

Research paper thumbnail of Dobutamine stress echocardiography for the preoperative evaluation of patients undergoing lung volume reduction surgery

The Journal of Thoracic and Cardiovascular Surgery, 1999

Research paper thumbnail of Effects of trendelenburg and reverse trendelenburg postures on lung and chest wall mechanics

Journal of Clinical Anesthesia, 1996

Research paper thumbnail of Lung and Chest Wall Properties in Mechanically Ventilated Patients

Critical Care Medicine, 1995

Research paper thumbnail of The Coexistence of Portopulmonary Hypertension and Hepatopulmonary Syndrome

Anesthesiology, 1999

... Jones, Frederick D. MD; Kuo, Paul C. MD; Johnson, Lynt B. MD; Njoku, Mary J. MD; Dixon‐Fergus... more ... Jones, Frederick D. MD; Kuo, Paul C. MD; Johnson, Lynt B. MD; Njoku, Mary J. MD; Dixon‐Ferguson, Mary K. CCVT; Plotkin, Jeffrey S. MD. Article Outline. Collapse Box Author Information. ... (Dixon‐Ferguson) Echo Tech, Department of Anesthesiology, University of Maryland. ...

Research paper thumbnail of The Effects of Increased Abdominal Pressure on Lung and Chest Wall Mechanics During Laparoscopic Surgery

Anesthesia & Analgesia, 1995

Research paper thumbnail of Changes in Lung and Chest Wall Properties with Abdominal Insufflation of Carbon Dioxide Are Immediately Reversible

Anesthesia & Analgesia, 1996

Previously we have reported that large increases in lung and chest wall elastances as well as lun... more Previously we have reported that large increases in lung and chest wall elastances as well as lung resistance occur with abdominal insufflation of carbon dioxide during laparoscopic surgery. To examine whether these effects were reversible with abdominal deflation, we calculated lung and chest wall elastances and resistances from measurement of airway flow and pressure and esophageal pressure in 17 anesthetized/paralyzed patients undergoing laparoscopic surgery. Measurements were made immediately prior to abdominal insufflation and after deflation. Lung and chest wall elastances and resistances were not changed from baseline (P > 0.05), although total respiratory elastance remained slightly increased compared to baseline (P < 0.05). The change in total respiratory elastance did not correlate with abdominal insufflation time, surgical site, smoking history, or physical characteristics of the patients. There were no differences in frequency and tidal volume dependences of the elastances and resistances before and after abdominal insufflation (P > 0.5). We conclude that residual changes in respiratory mechanics caused by carbon dioxide insufflation during laparoscopic surgery are minor, and that the reported compromise of respiratory function indicated by pulmonary function tests after laparoscopy does not appear to be due to changes in passive mechanical properties of the lungs or chest wall.