Jeffrey Milliken | University of California, Irvine (original) (raw)
Papers by Jeffrey Milliken
Asaio J, 2002
Cardiac preservation for transplantation is generally limited by ischemic hypothermic storage of ... more Cardiac preservation for transplantation is generally limited by ischemic hypothermic storage of 4-6 hours. Earlier studies in the authors' laboratory have demonstrated that hypothermic perfusion preservation using a novel oxygen carrying hemoglobin solution may extend preservation times to 8 hours and decrease ischemic injury. The purpose of this study was to compare extended cardiac function after 12 and 24 hours of continuous hypothermic perfusion with a polyethylene glycolated bovine hemoglobin perfusate (PEG-Hb) solution to the clinical standard of hypothermic ischemic preservation. The hearts of 54 anesthetized and intubated New Zealand White rabbits were harvested after cold cardioplegic arrest. Group I (n = 12) hearts were perfused with a PEG-Hb solution at 20 degrees C and 30 mm Hg for 24 hours. Group II (n = 10) hearts were preserved similarly with PEG-Hb for 12 hours. Group III (n = 12) hearts were preserved for 8 hours with PEG-Hb; Group IV (n = 10) were preserved by cold ischemic storage for 4 hours at 4 degrees C; and Group V (n = 10) were tested after fresh extirpation. Left ventricular (LV) function was measured in the nonworking state at 15 minute, 1 hour, and 2 hour intervals after transfer to a standard crystalloid Langendorff circuit. Developed LV pressure at 0.5 ml LV volume was superior in Group II at early time points, yet it was similar in all preserved groups at 2 hours. +dP/dt(max) at 0.5 ml LV volume was consistent at all time points and greater in PEG-Hb preserved groups compared with Group V. -dP/dt(max) at 0.5 ml LV volume was significantly greater in Groups II and III compared with Group V initially (p < 0.05), but all were similar at the end of testing. Continuous perfusion preservation of rabbit hearts for time increments up to 24 hours with this novel PEG-Hb solution at 30 mm Hg and 20 degrees C yields LV function that is similar to 4 hours of ischemic hypothermic storage. Extended cardiac perfusion preservation with this PEG-Hb solution deserves further investigation in large animal transplant models.
Asaio J, 2002
Cardiac preservation for transplantation is generally limited by ischemic hypothermic storage of ... more Cardiac preservation for transplantation is generally limited by ischemic hypothermic storage of 4-6 hours. Earlier studies in the authors' laboratory have demonstrated that hypothermic perfusion preservation using a novel oxygen carrying hemoglobin solution may extend preservation times to 8 hours and decrease ischemic injury. The purpose of this study was to compare extended cardiac function after 12 and 24 hours of continuous hypothermic perfusion with a polyethylene glycolated bovine hemoglobin perfusate (PEG-Hb) solution to the clinical standard of hypothermic ischemic preservation. The hearts of 54 anesthetized and intubated New Zealand White rabbits were harvested after cold cardioplegic arrest. Group I (n = 12) hearts were perfused with a PEG-Hb solution at 20 degrees C and 30 mm Hg for 24 hours. Group II (n = 10) hearts were preserved similarly with PEG-Hb for 12 hours. Group III (n = 12) hearts were preserved for 8 hours with PEG-Hb; Group IV (n = 10) were preserved by cold ischemic storage for 4 hours at 4 degrees C; and Group V (n = 10) were tested after fresh extirpation. Left ventricular (LV) function was measured in the nonworking state at 15 minute, 1 hour, and 2 hour intervals after transfer to a standard crystalloid Langendorff circuit. Developed LV pressure at 0.5 ml LV volume was superior in Group II at early time points, yet it was similar in all preserved groups at 2 hours. +dP/dt(max) at 0.5 ml LV volume was consistent at all time points and greater in PEG-Hb preserved groups compared with Group V. -dP/dt(max) at 0.5 ml LV volume was significantly greater in Groups II and III compared with Group V initially (p < 0.05), but all were similar at the end of testing. Continuous perfusion preservation of rabbit hearts for time increments up to 24 hours with this novel PEG-Hb solution at 30 mm Hg and 20 degrees C yields LV function that is similar to 4 hours of ischemic hypothermic storage. Extended cardiac perfusion preservation with this PEG-Hb solution deserves further investigation in large animal transplant models.
Radiology, 2008
To retrospectively evaluate the depiction of anatomic characteristics of the arterial supply to t... more To retrospectively evaluate the depiction of anatomic characteristics of the arterial supply to the sinuatrial node (SAN) and the atrioventricular node (AVN) with 64-section computed tomography (CT). The institutional review board approved this HIPAA-compliant study; informed consent was not required. Anatomic origin, number, course, and variants of the arteries to the SAN and AVN were examined with coronary multidetector CT in 102 patients (55 men, 47 women; mean age, 57 years +/- 13 [standard deviation]). Known accessory blood supplies to the AVN, including left and right Kugel anastomotic arteries, were investigated. Possible extension of the first septal perforating artery to the AVN was evaluated. Univariate and bivariate statistical data were reported. Means +/- standard deviations, 95% confidence intervals, and percentages were calculated. A single sinuatrial nodal artery originated from the proximal 40 mm of the right coronary artery (RCA) in 67 and from the proximal 35 mm of the left circumflex (LCX) artery in 28 patients. A dual blood supply to the SAN was seen in six patients. The sinuatrial nodal artery was not visualized in one patient. An S-shaped variant was seen in 18% of left sinuatrial nodal arteries and invariably traveled posteriorly in the sulcus between the left superior pulmonary vein and left atrial appendage. The sinuatrial nodal artery approached the nodal tissue by one of three routes-retrocaval (47.5%), precaval (42.6%), or pericaval (9.9%). The AVN was supplied by the RCA in 89 patients, the LCX artery in 11 patients, and by both arteries in two patients. Two left and six right Kugel anastomotic arteries were detected as supplying the AVN area. The first septal perforating artery had no detectable connection to the AVN. The arterial blood supply to the SAN and the AVN is variable and can be imaged with multidectector CT. http://radiology.rsnajnls.org/cgi/content/full/2461070030/DC1.
Radiology, 2008
To retrospectively evaluate the depiction of anatomic characteristics of the arterial supply to t... more To retrospectively evaluate the depiction of anatomic characteristics of the arterial supply to the sinuatrial node (SAN) and the atrioventricular node (AVN) with 64-section computed tomography (CT). The institutional review board approved this HIPAA-compliant study; informed consent was not required. Anatomic origin, number, course, and variants of the arteries to the SAN and AVN were examined with coronary multidetector CT in 102 patients (55 men, 47 women; mean age, 57 years +/- 13 [standard deviation]). Known accessory blood supplies to the AVN, including left and right Kugel anastomotic arteries, were investigated. Possible extension of the first septal perforating artery to the AVN was evaluated. Univariate and bivariate statistical data were reported. Means +/- standard deviations, 95% confidence intervals, and percentages were calculated. A single sinuatrial nodal artery originated from the proximal 40 mm of the right coronary artery (RCA) in 67 and from the proximal 35 mm of the left circumflex (LCX) artery in 28 patients. A dual blood supply to the SAN was seen in six patients. The sinuatrial nodal artery was not visualized in one patient. An S-shaped variant was seen in 18% of left sinuatrial nodal arteries and invariably traveled posteriorly in the sulcus between the left superior pulmonary vein and left atrial appendage. The sinuatrial nodal artery approached the nodal tissue by one of three routes-retrocaval (47.5%), precaval (42.6%), or pericaval (9.9%). The AVN was supplied by the RCA in 89 patients, the LCX artery in 11 patients, and by both arteries in two patients. Two left and six right Kugel anastomotic arteries were detected as supplying the AVN area. The first septal perforating artery had no detectable connection to the AVN. The arterial blood supply to the SAN and the AVN is variable and can be imaged with multidectector CT. http://radiology.rsnajnls.org/cgi/content/full/2461070030/DC1.
Journal of the National Medical Association, May 1, 1994
Video-thoracoscopy was used to diagnose and successfully treat a bronchogenic cyst in a patient w... more Video-thoracoscopy was used to diagnose and successfully treat a bronchogenic cyst in a patient who presented with a chronic cough and a right hilar mass.
Journal of the National Medical Association, May 1, 1994
Video-thoracoscopy was used to diagnose and successfully treat a bronchogenic cyst in a patient w... more Video-thoracoscopy was used to diagnose and successfully treat a bronchogenic cyst in a patient who presented with a chronic cough and a right hilar mass.
Data Revues 00029149 Unassign S0002914913021589, Aug 12, 2013
Coronary revascularization procedures decreased markedly in California after the introduction of ... more Coronary revascularization procedures decreased markedly in California after the introduction of drug-eluting stents and the initiation of public reporting in 2003, resulting in a large number of low-volume heart programs. California hospital discharge data were analyzed from 2006 to 2010 to study the impact of this change. In-hospital mortality and hospital readmission for major adverse events at 90 days and 365 days were determined for patients who underwent isolated coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) either with acute coronary syndrome (ACS) or PCI without acute coronary syndrome (PCI-noACS). Three terciles were chosen by case volume as follows: high-volume (747 ± 336 [SD]/yr total PCI, 210 ± 130 isolated CABG), intermediate volume (362 ± 47 PCI, 106 ± 27 CABG), and low-volume (211 ± 6 PCI, 53 ± 17 CABG) terciles were studied. PCI-noACS procedures decreased 33% and CABG 20%, whereas PCI-ACS procedures increased slightly. Risk-adjusted in-hospital mortality was slightly better in high-volume compared with low-volume terciles for CABG (2.0% vs 2.6%) and PCI-noACS (0.64% vs 0.85%). There was no difference in major adverse events at 90 days or 365 days among volume terciles within procedure groups, and no change in event rates was noted over the 5-year period. Wide variation in outcomes, associated with low volume, contributed to poor statistical discrimination among providers. In conclusion, lower volume hospitals had similar overall outcomes with wider variation. Conservative treatment strategies apparently contributed to decreased procedure volume. Collaboration among hospitals of similar structure and case volume may be the most appropriate performance improvement model to reduce variability among providers.
Lung cancer (Amsterdam, Netherlands), Jan 12, 2015
Many acquired resistant mutations to the anaplastic lymphoma kinase (ALK) gene have been identifi... more Many acquired resistant mutations to the anaplastic lymphoma kinase (ALK) gene have been identified during treatment of ALK-rearranged non-small cell lung cancer (NSCLC) patients with crizotinib, ceritinib, and alectinib. These various acquired resistant ALK mutations confer differential sensitivities to various ALK inhibitors and may provide guidance on how to sequence the use of many of the second generation ALK inhibitors. We described a patient who developed an acquired ALK F1174V resistant mutation on progression from crizotinib that responded to alectinib for 18 months but then developed an acquired ALK I1171S mutation to alectinib. Both tumor samples had essentially the same genomic profile by comprehensive genomic profiling otherwise. This is the first patient report that demonstrates ALK F1174V mutation is sensitive to alectinib and further confirms missense acquired ALK I1171 mutation is resistant to alectinib. Sequential tumor re-biopsy for comprehensive genomic profiling...
Clinical Cardiology, Dec 1, 1998
Brickground: Coronary artery disease (CAD) was not recognized as common among young patients unti... more Brickground: Coronary artery disease (CAD) was not recognized as common among young patients until the study by Yater in 1948. Subsequent studies flurther elucidated the nature of the disease, which had become more apparent in the younger groups.
Lung Cancer, 2015
Many acquired resistant mutations to the anaplastic lymphoma kinase (ALK) gene have been identifi... more Many acquired resistant mutations to the anaplastic lymphoma kinase (ALK) gene have been identified during treatment of ALK-rearranged non-small cell lung cancer (NSCLC) patients with crizotinib, ceritinib, and alectinib. These various acquired resistant ALK mutations confer differential sensitivities to various ALK inhibitors and may provide guidance on how to sequence the use of many of the second generation ALK inhibitors. We described a patient who developed an acquired ALK F1174V resistant mutation on progression from crizotinib that responded to alectinib for 18 months but then developed an acquired ALK I1171S mutation to alectinib. Both tumor samples had essentially the same genomic profile by comprehensive genomic profiling otherwise. This is the first patient report that demonstrates ALK F1174V mutation is sensitive to alectinib and further confirms missense acquired ALK I1171 mutation is resistant to alectinib. Sequential tumor re-biopsy for comprehensive genomic profiling (CGP) is important to appreciate the selective pressure during treatment with various ALK inhibitors underpinning the evolution of the disease course of ALK+NSCLC patients while on treatment with the various ALK inhibitors. This approach will likely help inform the optimal sequencing strategy as more ALK inhibitors become available. This case report also validates the importance of developing structurally distinct ALK inhibitors for clinical use to overcome non-cross resistant ALK mutations.
American Journal of Physiology - Heart and Circulatory Physiology, 2015
The extracellular matrix of the atrioventricular (AV) valves&... more The extracellular matrix of the atrioventricular (AV) valves' leaflets has a key role in the ability of these valves to properly remodel in response to constantly varying physiological loads. While the loading on mitral and tricuspid valves are significantly different, no information is available on how collagen fibers change their orientation in response to these loads. This study delineates the effect of physiological loading on AV valves' leaflets microstructures using Second Harmonic Generation (SHG) microscopy. Fresh natural porcine tricuspid and mitral valves' leaflets (n=12 per valve type) were cut and prepared for the experiments. Histology and immunohistochemistry were performed to compare the microstructural differences between the valves. The specimens were imaged live during the relaxed, loading, and unloading phases using SHG microscopy. The images were analyzed with Fourier decomposition to mathematically seek changes in collagen fiber orientation. Despite the similarities in both AV valves as seen in the histology and immunohistochemistry data, the microstructural arrangement especially the collagen fiber distribution and orientation in the stress-free condition were found to be different. Uniaxial loading was dependent on the arrangement of the fibers in their relaxed mode, which led the fibers to reorient in-line with the load throughout the depth of the mitral leaflet but only to reorient in-line with the load in deeper layers of the tricuspid leaflet. Biaxial loading arranged the fibers in between the two principal axes of the stresses independently from their relaxed states.
Texas Heart Institute Journal, 2009
Journal of the American College of Cardiology, 1990
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2009
Bronchopleural fistula and empyema are serious complications after thoracic surgical procedures, ... more Bronchopleural fistula and empyema are serious complications after thoracic surgical procedures, and their prevention is paramount. Herein, we review our experience with routine prophylactic use of the pedicled ipsilateral latissimus dorsi muscle flap. From January 2004 through February 2006, 10 surgically high-risk patients underwent intrathoracic transposition of this muscle flap for reinforcement of bronchial-stump closure or obliteration of empyema cavities. Seven of the patients were chronically immunosuppressed, 5 were severely malnourished (median preoperative serum albumin level, 2.4 g/dL), and 5 had severe underlying obstructive pulmonary disease (median forced expiratory volume in 1 second, 44% of predicted level). Three upper lobectomies and 1 completion pneumonectomy were performed in order to treat massive hemoptysis that was secondary to complex aspergilloma. One patient underwent left pneumonectomy due to ruptured-cavitary primary lung lymphoma. One upper lobectomy wa...
ASAIO Journal, 2000
... Serna, Dan L.; Powell, Ledford L.; Kahwaji, Chadi; Wallace, William C.; West, Justin; Cogert,... more ... Serna, Dan L.; Powell, Ledford L.; Kahwaji, Chadi; Wallace, William C.; West, Justin; Cogert, Greg; Smulowitz, Peter; Steward, Earl; Purdy ... pumphead, model 9154R, Medtronic Blood Systems, Inc., Anaheim, CA) and Bio-Console (Medtronic Bio-Medicus, Inc., Eden Prairie, MN ...
Transfusion, 2014
Cardiothoracic surgery places significant demands on blood bank resources. Measures aimed at redu... more Cardiothoracic surgery places significant demands on blood bank resources. Measures aimed at reducing intraoperative hemodilution were initiated as part of a blood conservation program. We initiated a series of measures aimed at reducing hemodilution volume: 1) reduction of intravenous fluid (IVF) volume, 2) reduction of circuit size, and 3) use of autologous priming techniques. All sources and volumes of IVF were obtained from the medical record. Intraoperative hematocrit (Hct) measurements were performed at the following intervals: first in operating room (OR), lowest on-pump, last on-pump, after protamine reversal, and immediately before discharge from OR. Red blood cell (RBC) transfusions were recorded. Intraoperative IVF, Hct levels, and transfusions were analyzed by cardiopulmonary bypass phase (prepump, on-pump, and off-pump), comparing preimplementation and postimplementation periods. Total intraoperative IVF volume was reduced by 973.7 mL (95% confidence interval, 671.6-127...
The Journal of Trauma: Injury, Infection, and Critical Care, 1997
ASAIO Journal, 2000
The current technique of cardiac preservation for clinical transplantation by infusion of cold ca... more The current technique of cardiac preservation for clinical transplantation by infusion of cold cardioplegia and immersion of the heart in an isotonic saline bath at 4 degrees C limits safe tissue preservation time to 4 to 6 hours. The myriad of benefits to be gained by extending cardiac preservation time has prompted the search for alternatives to hypothermic immersion of the heart, the most promising of which involves techniques of coronary artery perfusion. Countless studies have shown the benefits of long-term storage of donor hearts by perfusion rather than the immersion technique. Continuous perfusion preservation has three basic advantages over simple immersion. Perfusion preservation with oxygen carrying solutions has the advantage of preventing ischemia, anaerobic metabolism, and reperfusion injury. Second, nutritional supplementation and provision of substrate can be more effectively delivered to myocardial cells. Third, continuous perfusion preservation effects the clearance of metabolic waste products from the coronary circulation. The composition of the ideal perfusion solution and optimal preservation conditions remain incompletely defined.
Clinical Lung Cancer, 2001
Radiology, 2008
To investigate the feasibility of 64-section multidetector computed tomography (CT) by using CT a... more To investigate the feasibility of 64-section multidetector computed tomography (CT) by using CT angiography (a) to demonstrate anatomic detail of the interatrial septum pertinent to the patent foramen ovale (PFO), and (b) to visually detect left-to-right PFO shunts and compare these findings in patients who also underwent transesophageal echocardiography (TEE). In this institutional review board-approved HIPAA-compliant study, electrocardiographically gated coronary CT angiograms in 264 patients (159 men, 105 women; mean age, 60 years) were reviewed for PFO morphologic features. The length and diameter of the opening of the PFO tunnel, presence of atrial septal aneurysm (ASA), and PFO shunts were evaluated. A left-to-right shunt was assigned a grade according to length of contrast agent jet (grade 1, <or=1 cm; grade 2, >1 cm to 2 cm; grade 3, >2 cm). In addition, 23 patients who underwent both modalities were compared (Student t test and linear regression analysis). A difference with P < .05 was significant. A flap valve, seen in 101 (38.3%) patients, was patent at the entry into the right atrium (PFO) in 62 patients (61.4% of patients with flap valve, 23.5% of total patients). A left-to-right shunt was detected in 44 (16.7% of total) patients (grade 1, 61.4%; grade 2, 34.1%; grade 3, 4.5%). No shunt was seen in patients without a flap valve. Mean length of PFO tunnel was 7.1 mm in 44 patients with a shunt and 12.1 mm in 57 patients with a flap valve without a shunt (P < .0001). In patients with a tunnel length of 6 mm or shorter, 92.6% of the shunts were seen. ASA was seen in 11 (4.2%) patients; of these patients, a shunt was seen in seven (63.6%). In 23 patients who underwent CT angiography and TEE, both modalities showed a PFO shunt in seven. Multidetector CT provides detailed anatomic information about size, morphologic features, and shunt grade of the PFO. Shorter tunnel length and septal aneurysms are frequently associated with left-to-right shunts in patients with PFO.
Asaio J, 2002
Cardiac preservation for transplantation is generally limited by ischemic hypothermic storage of ... more Cardiac preservation for transplantation is generally limited by ischemic hypothermic storage of 4-6 hours. Earlier studies in the authors' laboratory have demonstrated that hypothermic perfusion preservation using a novel oxygen carrying hemoglobin solution may extend preservation times to 8 hours and decrease ischemic injury. The purpose of this study was to compare extended cardiac function after 12 and 24 hours of continuous hypothermic perfusion with a polyethylene glycolated bovine hemoglobin perfusate (PEG-Hb) solution to the clinical standard of hypothermic ischemic preservation. The hearts of 54 anesthetized and intubated New Zealand White rabbits were harvested after cold cardioplegic arrest. Group I (n = 12) hearts were perfused with a PEG-Hb solution at 20 degrees C and 30 mm Hg for 24 hours. Group II (n = 10) hearts were preserved similarly with PEG-Hb for 12 hours. Group III (n = 12) hearts were preserved for 8 hours with PEG-Hb; Group IV (n = 10) were preserved by cold ischemic storage for 4 hours at 4 degrees C; and Group V (n = 10) were tested after fresh extirpation. Left ventricular (LV) function was measured in the nonworking state at 15 minute, 1 hour, and 2 hour intervals after transfer to a standard crystalloid Langendorff circuit. Developed LV pressure at 0.5 ml LV volume was superior in Group II at early time points, yet it was similar in all preserved groups at 2 hours. +dP/dt(max) at 0.5 ml LV volume was consistent at all time points and greater in PEG-Hb preserved groups compared with Group V. -dP/dt(max) at 0.5 ml LV volume was significantly greater in Groups II and III compared with Group V initially (p < 0.05), but all were similar at the end of testing. Continuous perfusion preservation of rabbit hearts for time increments up to 24 hours with this novel PEG-Hb solution at 30 mm Hg and 20 degrees C yields LV function that is similar to 4 hours of ischemic hypothermic storage. Extended cardiac perfusion preservation with this PEG-Hb solution deserves further investigation in large animal transplant models.
Asaio J, 2002
Cardiac preservation for transplantation is generally limited by ischemic hypothermic storage of ... more Cardiac preservation for transplantation is generally limited by ischemic hypothermic storage of 4-6 hours. Earlier studies in the authors' laboratory have demonstrated that hypothermic perfusion preservation using a novel oxygen carrying hemoglobin solution may extend preservation times to 8 hours and decrease ischemic injury. The purpose of this study was to compare extended cardiac function after 12 and 24 hours of continuous hypothermic perfusion with a polyethylene glycolated bovine hemoglobin perfusate (PEG-Hb) solution to the clinical standard of hypothermic ischemic preservation. The hearts of 54 anesthetized and intubated New Zealand White rabbits were harvested after cold cardioplegic arrest. Group I (n = 12) hearts were perfused with a PEG-Hb solution at 20 degrees C and 30 mm Hg for 24 hours. Group II (n = 10) hearts were preserved similarly with PEG-Hb for 12 hours. Group III (n = 12) hearts were preserved for 8 hours with PEG-Hb; Group IV (n = 10) were preserved by cold ischemic storage for 4 hours at 4 degrees C; and Group V (n = 10) were tested after fresh extirpation. Left ventricular (LV) function was measured in the nonworking state at 15 minute, 1 hour, and 2 hour intervals after transfer to a standard crystalloid Langendorff circuit. Developed LV pressure at 0.5 ml LV volume was superior in Group II at early time points, yet it was similar in all preserved groups at 2 hours. +dP/dt(max) at 0.5 ml LV volume was consistent at all time points and greater in PEG-Hb preserved groups compared with Group V. -dP/dt(max) at 0.5 ml LV volume was significantly greater in Groups II and III compared with Group V initially (p < 0.05), but all were similar at the end of testing. Continuous perfusion preservation of rabbit hearts for time increments up to 24 hours with this novel PEG-Hb solution at 30 mm Hg and 20 degrees C yields LV function that is similar to 4 hours of ischemic hypothermic storage. Extended cardiac perfusion preservation with this PEG-Hb solution deserves further investigation in large animal transplant models.
Radiology, 2008
To retrospectively evaluate the depiction of anatomic characteristics of the arterial supply to t... more To retrospectively evaluate the depiction of anatomic characteristics of the arterial supply to the sinuatrial node (SAN) and the atrioventricular node (AVN) with 64-section computed tomography (CT). The institutional review board approved this HIPAA-compliant study; informed consent was not required. Anatomic origin, number, course, and variants of the arteries to the SAN and AVN were examined with coronary multidetector CT in 102 patients (55 men, 47 women; mean age, 57 years +/- 13 [standard deviation]). Known accessory blood supplies to the AVN, including left and right Kugel anastomotic arteries, were investigated. Possible extension of the first septal perforating artery to the AVN was evaluated. Univariate and bivariate statistical data were reported. Means +/- standard deviations, 95% confidence intervals, and percentages were calculated. A single sinuatrial nodal artery originated from the proximal 40 mm of the right coronary artery (RCA) in 67 and from the proximal 35 mm of the left circumflex (LCX) artery in 28 patients. A dual blood supply to the SAN was seen in six patients. The sinuatrial nodal artery was not visualized in one patient. An S-shaped variant was seen in 18% of left sinuatrial nodal arteries and invariably traveled posteriorly in the sulcus between the left superior pulmonary vein and left atrial appendage. The sinuatrial nodal artery approached the nodal tissue by one of three routes-retrocaval (47.5%), precaval (42.6%), or pericaval (9.9%). The AVN was supplied by the RCA in 89 patients, the LCX artery in 11 patients, and by both arteries in two patients. Two left and six right Kugel anastomotic arteries were detected as supplying the AVN area. The first septal perforating artery had no detectable connection to the AVN. The arterial blood supply to the SAN and the AVN is variable and can be imaged with multidectector CT. http://radiology.rsnajnls.org/cgi/content/full/2461070030/DC1.
Radiology, 2008
To retrospectively evaluate the depiction of anatomic characteristics of the arterial supply to t... more To retrospectively evaluate the depiction of anatomic characteristics of the arterial supply to the sinuatrial node (SAN) and the atrioventricular node (AVN) with 64-section computed tomography (CT). The institutional review board approved this HIPAA-compliant study; informed consent was not required. Anatomic origin, number, course, and variants of the arteries to the SAN and AVN were examined with coronary multidetector CT in 102 patients (55 men, 47 women; mean age, 57 years +/- 13 [standard deviation]). Known accessory blood supplies to the AVN, including left and right Kugel anastomotic arteries, were investigated. Possible extension of the first septal perforating artery to the AVN was evaluated. Univariate and bivariate statistical data were reported. Means +/- standard deviations, 95% confidence intervals, and percentages were calculated. A single sinuatrial nodal artery originated from the proximal 40 mm of the right coronary artery (RCA) in 67 and from the proximal 35 mm of the left circumflex (LCX) artery in 28 patients. A dual blood supply to the SAN was seen in six patients. The sinuatrial nodal artery was not visualized in one patient. An S-shaped variant was seen in 18% of left sinuatrial nodal arteries and invariably traveled posteriorly in the sulcus between the left superior pulmonary vein and left atrial appendage. The sinuatrial nodal artery approached the nodal tissue by one of three routes-retrocaval (47.5%), precaval (42.6%), or pericaval (9.9%). The AVN was supplied by the RCA in 89 patients, the LCX artery in 11 patients, and by both arteries in two patients. Two left and six right Kugel anastomotic arteries were detected as supplying the AVN area. The first septal perforating artery had no detectable connection to the AVN. The arterial blood supply to the SAN and the AVN is variable and can be imaged with multidectector CT. http://radiology.rsnajnls.org/cgi/content/full/2461070030/DC1.
Journal of the National Medical Association, May 1, 1994
Video-thoracoscopy was used to diagnose and successfully treat a bronchogenic cyst in a patient w... more Video-thoracoscopy was used to diagnose and successfully treat a bronchogenic cyst in a patient who presented with a chronic cough and a right hilar mass.
Journal of the National Medical Association, May 1, 1994
Video-thoracoscopy was used to diagnose and successfully treat a bronchogenic cyst in a patient w... more Video-thoracoscopy was used to diagnose and successfully treat a bronchogenic cyst in a patient who presented with a chronic cough and a right hilar mass.
Data Revues 00029149 Unassign S0002914913021589, Aug 12, 2013
Coronary revascularization procedures decreased markedly in California after the introduction of ... more Coronary revascularization procedures decreased markedly in California after the introduction of drug-eluting stents and the initiation of public reporting in 2003, resulting in a large number of low-volume heart programs. California hospital discharge data were analyzed from 2006 to 2010 to study the impact of this change. In-hospital mortality and hospital readmission for major adverse events at 90 days and 365 days were determined for patients who underwent isolated coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) either with acute coronary syndrome (ACS) or PCI without acute coronary syndrome (PCI-noACS). Three terciles were chosen by case volume as follows: high-volume (747 ± 336 [SD]/yr total PCI, 210 ± 130 isolated CABG), intermediate volume (362 ± 47 PCI, 106 ± 27 CABG), and low-volume (211 ± 6 PCI, 53 ± 17 CABG) terciles were studied. PCI-noACS procedures decreased 33% and CABG 20%, whereas PCI-ACS procedures increased slightly. Risk-adjusted in-hospital mortality was slightly better in high-volume compared with low-volume terciles for CABG (2.0% vs 2.6%) and PCI-noACS (0.64% vs 0.85%). There was no difference in major adverse events at 90 days or 365 days among volume terciles within procedure groups, and no change in event rates was noted over the 5-year period. Wide variation in outcomes, associated with low volume, contributed to poor statistical discrimination among providers. In conclusion, lower volume hospitals had similar overall outcomes with wider variation. Conservative treatment strategies apparently contributed to decreased procedure volume. Collaboration among hospitals of similar structure and case volume may be the most appropriate performance improvement model to reduce variability among providers.
Lung cancer (Amsterdam, Netherlands), Jan 12, 2015
Many acquired resistant mutations to the anaplastic lymphoma kinase (ALK) gene have been identifi... more Many acquired resistant mutations to the anaplastic lymphoma kinase (ALK) gene have been identified during treatment of ALK-rearranged non-small cell lung cancer (NSCLC) patients with crizotinib, ceritinib, and alectinib. These various acquired resistant ALK mutations confer differential sensitivities to various ALK inhibitors and may provide guidance on how to sequence the use of many of the second generation ALK inhibitors. We described a patient who developed an acquired ALK F1174V resistant mutation on progression from crizotinib that responded to alectinib for 18 months but then developed an acquired ALK I1171S mutation to alectinib. Both tumor samples had essentially the same genomic profile by comprehensive genomic profiling otherwise. This is the first patient report that demonstrates ALK F1174V mutation is sensitive to alectinib and further confirms missense acquired ALK I1171 mutation is resistant to alectinib. Sequential tumor re-biopsy for comprehensive genomic profiling...
Clinical Cardiology, Dec 1, 1998
Brickground: Coronary artery disease (CAD) was not recognized as common among young patients unti... more Brickground: Coronary artery disease (CAD) was not recognized as common among young patients until the study by Yater in 1948. Subsequent studies flurther elucidated the nature of the disease, which had become more apparent in the younger groups.
Lung Cancer, 2015
Many acquired resistant mutations to the anaplastic lymphoma kinase (ALK) gene have been identifi... more Many acquired resistant mutations to the anaplastic lymphoma kinase (ALK) gene have been identified during treatment of ALK-rearranged non-small cell lung cancer (NSCLC) patients with crizotinib, ceritinib, and alectinib. These various acquired resistant ALK mutations confer differential sensitivities to various ALK inhibitors and may provide guidance on how to sequence the use of many of the second generation ALK inhibitors. We described a patient who developed an acquired ALK F1174V resistant mutation on progression from crizotinib that responded to alectinib for 18 months but then developed an acquired ALK I1171S mutation to alectinib. Both tumor samples had essentially the same genomic profile by comprehensive genomic profiling otherwise. This is the first patient report that demonstrates ALK F1174V mutation is sensitive to alectinib and further confirms missense acquired ALK I1171 mutation is resistant to alectinib. Sequential tumor re-biopsy for comprehensive genomic profiling (CGP) is important to appreciate the selective pressure during treatment with various ALK inhibitors underpinning the evolution of the disease course of ALK+NSCLC patients while on treatment with the various ALK inhibitors. This approach will likely help inform the optimal sequencing strategy as more ALK inhibitors become available. This case report also validates the importance of developing structurally distinct ALK inhibitors for clinical use to overcome non-cross resistant ALK mutations.
American Journal of Physiology - Heart and Circulatory Physiology, 2015
The extracellular matrix of the atrioventricular (AV) valves&... more The extracellular matrix of the atrioventricular (AV) valves' leaflets has a key role in the ability of these valves to properly remodel in response to constantly varying physiological loads. While the loading on mitral and tricuspid valves are significantly different, no information is available on how collagen fibers change their orientation in response to these loads. This study delineates the effect of physiological loading on AV valves' leaflets microstructures using Second Harmonic Generation (SHG) microscopy. Fresh natural porcine tricuspid and mitral valves' leaflets (n=12 per valve type) were cut and prepared for the experiments. Histology and immunohistochemistry were performed to compare the microstructural differences between the valves. The specimens were imaged live during the relaxed, loading, and unloading phases using SHG microscopy. The images were analyzed with Fourier decomposition to mathematically seek changes in collagen fiber orientation. Despite the similarities in both AV valves as seen in the histology and immunohistochemistry data, the microstructural arrangement especially the collagen fiber distribution and orientation in the stress-free condition were found to be different. Uniaxial loading was dependent on the arrangement of the fibers in their relaxed mode, which led the fibers to reorient in-line with the load throughout the depth of the mitral leaflet but only to reorient in-line with the load in deeper layers of the tricuspid leaflet. Biaxial loading arranged the fibers in between the two principal axes of the stresses independently from their relaxed states.
Texas Heart Institute Journal, 2009
Journal of the American College of Cardiology, 1990
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2009
Bronchopleural fistula and empyema are serious complications after thoracic surgical procedures, ... more Bronchopleural fistula and empyema are serious complications after thoracic surgical procedures, and their prevention is paramount. Herein, we review our experience with routine prophylactic use of the pedicled ipsilateral latissimus dorsi muscle flap. From January 2004 through February 2006, 10 surgically high-risk patients underwent intrathoracic transposition of this muscle flap for reinforcement of bronchial-stump closure or obliteration of empyema cavities. Seven of the patients were chronically immunosuppressed, 5 were severely malnourished (median preoperative serum albumin level, 2.4 g/dL), and 5 had severe underlying obstructive pulmonary disease (median forced expiratory volume in 1 second, 44% of predicted level). Three upper lobectomies and 1 completion pneumonectomy were performed in order to treat massive hemoptysis that was secondary to complex aspergilloma. One patient underwent left pneumonectomy due to ruptured-cavitary primary lung lymphoma. One upper lobectomy wa...
ASAIO Journal, 2000
... Serna, Dan L.; Powell, Ledford L.; Kahwaji, Chadi; Wallace, William C.; West, Justin; Cogert,... more ... Serna, Dan L.; Powell, Ledford L.; Kahwaji, Chadi; Wallace, William C.; West, Justin; Cogert, Greg; Smulowitz, Peter; Steward, Earl; Purdy ... pumphead, model 9154R, Medtronic Blood Systems, Inc., Anaheim, CA) and Bio-Console (Medtronic Bio-Medicus, Inc., Eden Prairie, MN ...
Transfusion, 2014
Cardiothoracic surgery places significant demands on blood bank resources. Measures aimed at redu... more Cardiothoracic surgery places significant demands on blood bank resources. Measures aimed at reducing intraoperative hemodilution were initiated as part of a blood conservation program. We initiated a series of measures aimed at reducing hemodilution volume: 1) reduction of intravenous fluid (IVF) volume, 2) reduction of circuit size, and 3) use of autologous priming techniques. All sources and volumes of IVF were obtained from the medical record. Intraoperative hematocrit (Hct) measurements were performed at the following intervals: first in operating room (OR), lowest on-pump, last on-pump, after protamine reversal, and immediately before discharge from OR. Red blood cell (RBC) transfusions were recorded. Intraoperative IVF, Hct levels, and transfusions were analyzed by cardiopulmonary bypass phase (prepump, on-pump, and off-pump), comparing preimplementation and postimplementation periods. Total intraoperative IVF volume was reduced by 973.7 mL (95% confidence interval, 671.6-127...
The Journal of Trauma: Injury, Infection, and Critical Care, 1997
ASAIO Journal, 2000
The current technique of cardiac preservation for clinical transplantation by infusion of cold ca... more The current technique of cardiac preservation for clinical transplantation by infusion of cold cardioplegia and immersion of the heart in an isotonic saline bath at 4 degrees C limits safe tissue preservation time to 4 to 6 hours. The myriad of benefits to be gained by extending cardiac preservation time has prompted the search for alternatives to hypothermic immersion of the heart, the most promising of which involves techniques of coronary artery perfusion. Countless studies have shown the benefits of long-term storage of donor hearts by perfusion rather than the immersion technique. Continuous perfusion preservation has three basic advantages over simple immersion. Perfusion preservation with oxygen carrying solutions has the advantage of preventing ischemia, anaerobic metabolism, and reperfusion injury. Second, nutritional supplementation and provision of substrate can be more effectively delivered to myocardial cells. Third, continuous perfusion preservation effects the clearance of metabolic waste products from the coronary circulation. The composition of the ideal perfusion solution and optimal preservation conditions remain incompletely defined.
Clinical Lung Cancer, 2001
Radiology, 2008
To investigate the feasibility of 64-section multidetector computed tomography (CT) by using CT a... more To investigate the feasibility of 64-section multidetector computed tomography (CT) by using CT angiography (a) to demonstrate anatomic detail of the interatrial septum pertinent to the patent foramen ovale (PFO), and (b) to visually detect left-to-right PFO shunts and compare these findings in patients who also underwent transesophageal echocardiography (TEE). In this institutional review board-approved HIPAA-compliant study, electrocardiographically gated coronary CT angiograms in 264 patients (159 men, 105 women; mean age, 60 years) were reviewed for PFO morphologic features. The length and diameter of the opening of the PFO tunnel, presence of atrial septal aneurysm (ASA), and PFO shunts were evaluated. A left-to-right shunt was assigned a grade according to length of contrast agent jet (grade 1, <or=1 cm; grade 2, >1 cm to 2 cm; grade 3, >2 cm). In addition, 23 patients who underwent both modalities were compared (Student t test and linear regression analysis). A difference with P < .05 was significant. A flap valve, seen in 101 (38.3%) patients, was patent at the entry into the right atrium (PFO) in 62 patients (61.4% of patients with flap valve, 23.5% of total patients). A left-to-right shunt was detected in 44 (16.7% of total) patients (grade 1, 61.4%; grade 2, 34.1%; grade 3, 4.5%). No shunt was seen in patients without a flap valve. Mean length of PFO tunnel was 7.1 mm in 44 patients with a shunt and 12.1 mm in 57 patients with a flap valve without a shunt (P < .0001). In patients with a tunnel length of 6 mm or shorter, 92.6% of the shunts were seen. ASA was seen in 11 (4.2%) patients; of these patients, a shunt was seen in seven (63.6%). In 23 patients who underwent CT angiography and TEE, both modalities showed a PFO shunt in seven. Multidetector CT provides detailed anatomic information about size, morphologic features, and shunt grade of the PFO. Shorter tunnel length and septal aneurysms are frequently associated with left-to-right shunts in patients with PFO.