Dilip S. Nath

Outcomes of pancreas transplants for patients with type 2 diabetes mellitus

Abstract:u2002 Background:u2002 The objective of this study was to examine how effectively pancreas transplants provide long‐term glucose control in patients with type 2 diabetes mellitus (DM). We used guidelines from the American Diabetes Association (ADA) and the World Health Organization (WHO) to appropriately classify recipients with type 2 DM (vs. type 1 DM).

Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors

Abstract:u2002 Background:u2002 Anastomotic leaks after pancreas transplants usually occur early in the postoperative course, but may also be seen late post‐transplant. We studied such leaks to determine predisposing factors, methods of management, and outcomes.

Is distal aortic perfusion in traumatic thoracic aortic injuries necessary to avoid paraplegic postoperative outcomes

OBJECTIVESnTraumatic thoracic aorta injuries account for nearly 8,000 deaths annually in the United States. Clamp-and-sew techniques can lead to high rates of paraplegia. Use of distal aortic perfusion can lead to heparin-related complications, particularly with associated head trauma. Our objective was to evaluate whether or not an individualized approach to operative management provides acceptable neurologic outcomes.nnnMETHODSnA retrospective review (1991-2004) of patients with a traumatic thoracic aortic injury at a Level I trauma center was performed.nnnRESULTSnA total of 67 patients fit the study criteria. Ninety-one percent of patients had concomitant injuries. Median time from injury to evaluation was 38.0 minutes and from evaluation to operating room (OR) 111.0 minutes. Fifty-three percent of patients died before definitive repair could be undertaken; 29% were in the emergency department and 24% were in the OR. When definitive repair occurred, distal aortic perfusion was used in 81% of cases (75% left heart bypass, 6% cardiopulmonary bypass). The remaining 19% underwent clamp-and-sew technique without heparinization. There were no spinal cord deficits or adverse cerebral events related to repair. If definitive repair was completed, the mortality was 16%. Male sex and increasing time, both to evaluation and to OR, were the only risk factors associated with increased mortality.nnnCONCLUSIONSnJudicious use of clamp-and-sew techniques can achieve excellent neurologic outcomes, equivalent to distal aortic perfusion. Prompt evaluation leads to improved survival. Factors such as age, mechanism of injury, site of aortic injury, or operative technique did not affect mortality.

Cardiopulmonary bypass in revascularization and fluid management of exercise-induced acute myocardial infarction.

Abstractu2003 A 52‐year‐old man was resuscitated from a cardiac arrest during a marathon run. During initial evaluation, he received a significant amount of crystalloid fluid to maintain end‐organ perfusion. Based on electrocardiogram findings, myocardial infarction was suspected and an angiogram was performed. An acute thrombosis of the left anterior descending vessel was noted, angioplastied, and stented. Given that he was in cardiogenic shock, acidotic, and hemodynamically labile, an emergent coronary artery bypass grafting with cardiopulmonary bypass was performed to simultaneously revascularize the myocardium and remove intravascular fluid.