Saturday, April 30, 2016

OF THE HEART




In surgery there have been certain periods when advancement in knowledge and technical inventions have had a marked effect on our life and the surgeon’s ability.

Two "quantum leaps" occurred in the late 19th century, which together allowed the transition to modern surgery. The first great advancement was the discovery and use of anesthesia especially Ether to enable the surgeon to work without causing pain and the inevitable accompanying shock which would be life threatening. Subsequent new agents and newer delivery methods have eliminated the bad effects of the original drugs.

An appreciation of the germ theory of disease led rapidly to the development and application of antiseptic techniques in surgery. Antisepsis, which soon gave way to asepsis, reduced the overall morbidity and mortality of surgery to a far more acceptable rate than in previous eras.

The next major advancement was as the result of the Spanish Civil War when an understanding of shock and its treatment in traumatic injuries proved to be lifesaving.

In the post WWII era starting in the late 50s a combination of better anesthesia techniques and shock support plus a better understand of the body’s hemostasis led to greater surgical advances to the point where we can now even transplant organs. Included in these advancements were the use of new visual tools as well as the computer and micro-surgical development; so called minimal or non-invasive.

The first Heart valve replacement happen in the 1960’s It was a rather brutal procedure and took a such a great toll on the body that the majority who needed the operation the most; especially the elderly (over 70) had little chance of surviving the operation. I am unawares of anyone in the 80s being offered the procedure.

The operation was done by splitting the sternum (breast bone) down the middle. Then the heart is exposed, the pericardium is opened, and the patient is put on a cardiopulmonary bypass machine, also known as the heart-lung machine. This machine takes over the task of breathing for the patient and pumping their blood around while the surgeon replaces the heart valve. Before its invention the heart continued to beat and made it difficult to place the valve. A further advancement was the addition of the use of hypothermia; lowering the body temperature.

Early adoption of this technique proceeded slowly based on the limitations of available replacement valves and relatively primitive techniques for protecting the heart during surgery which were available at the time. With the evolution of mechanical heart valves and gradual developments in cardiopulmonary bypass (the heart lung machine) and cardioplegia which allow the heart to be stopped safely during surgery, aortic valve replacement became accepted therapy for patients with severe aortic insufficiency and /or regurgitation.

Once the patient is on bypass, a cut is made in the aorta and a cross clamp applied. The surgeon then removes the patient's diseased aortic valve and a mechanical or tissue valve is put in its place. Once the valve is in place and the aorta has been closed, the patient is taken off the heart-lung machine. Transesophageal echocardiogram (TEE, an ultra-sound of the heart done through the esophagus) can be used to verify that the new valve is functioning properly. Pacing wires are usually put in place, so that the heart can be manually paced should any complications arise after surgery. Drainage tubes are also inserted to drain fluids from the chest and pericardium following surgery. These are usually removed within 36 hours while the pacing wires are generally left in place until right before the patient is discharged from the hospital.

Recovery from this operation usually takes about 3 months or more.

As medical procedures evolved cardiac cauterization became standard and not only could the heart’s blood vessels be visualized but the placing of stents instead of open heart coronary heart surgery became possible and a common treatment.

In 2011 only 5 years ago, the first aortic valve was replaced by using a catheter inserted through the femoral artery and passed into the heart. Hospitalization was now no more than 5 days if there were no complications which were much less than in open heart replacement. Now those in the 80s could be treated instead of facing rapid progressive heart failure. Within a week or two the patient could depending on his/heir’s status resume normal life.

These valves folded up so that they could be passed through the catheter and were then open when in the area of the valve to be replaced and anchored into position. They consisted of a metal framework covered with a “plastic" and the valve itself was usual from pig tissue. The metal frame help anchor the valve in place.

The operation is called Trans Aortic Valve replacement (TAVR).

Today a new and better valve for many reasons is undergoing clinical trial in the USA although it has been in use in Europe for about 2 years. It has no metal and is secured in place by expanding it as if it were a balloon and then hardening polymer is injected to fix it in place. If the surgeon does not like its initial positioning he deflates the balloon and reposition it under the ultrasound and fluoroscope guidance before injecting the fixing agent.

It will be only be a matter of time when all valve replacement will be done by this less traumatic method.

COUNCIL AGENDA




Monday’s Council meeting’s agenda standing alone seems to be one without controversy. However there is one resolution to reject the awarding of bid for the sale of city owned property at 216-218 West Front St.per:The City of Plainfield in accordance with Ordinance No. MC 2014-26 offered 216-18 West Front Street, Block 249 Lot 5 to the contiguous owners. It was later determined that the successful bidder did not meet the City's bid requirements.

It is now 16 months since the property was offered for sale and the question is why did the City accept the bid in the first place? What bid requirement was not met?

The time consuming events on May 2 will be the discussion with PMUA. Also the preceding Special Meeting to adopt the 2016 budget and the amending resolutions Since I cannot attend I will have to rely on other bloggers and citizen’s email information to understand (and comment) on these portions of the evening’s happenings.

Friday, April 29, 2016

JUST POTPOURRI

A very busy  week and will be so for at least past Wdenesday.  Will post as often as I can.

 I often receive a request through blog comments for answers to questions. Since all comments are filtered by the domain before I see them the email address of the writer is not available. If the individual is addressing a previous blog any reply will go to that blog's commentary not the present one. If you wish a reply to a sensitive question please include your email address and ask me not to publish your comment.

The best I can do for a hectic weekend is these recent political cartoons.





CLEAN OUT OLD MEDICINES

Saturday April 30 from 10am to 2;30 PM YOU CAN SAFELY RID YOUR HOUSEHOLD OF OLD OR UNUSED MEDICINES  BY DROPPING OFF AT THE FOLLOWING LOCATIONS. UNFORTUNATELY THERE IS NONE LOCATED IN PLAINFIELD?

PARTICIPANTS NAME COLLECTION SITE ADDRESS CITY STATE, ZIP ~DISTANCE
If you do not find a collection site near you, please check back frequently, sites are added every day.
NORTH PLAINFIELD POLICE DEPT. NORTH PLAINFIELD P D FRONT LOBBY 263 SOMERSET STREET PLAINFIELD NJ, 07060 2 miles. Map
WATCHUNG POLICE DEPARTMENT WATCHUNG POLICE DEPARTMENT
908-756-3663
840 SOMERSET ST. WATCHUNG NJ, 07069 2 miles. Map
BERKELEY HEIGHTS POLICE DEPARTMENT BERKELEY HEIGHTS POLICE DEPARTMENT
908-464-1111
29 PARK AVE. BERKELEY HEIGHTS NJ, 07922 3 miles. Map
NEW PROVIDENCE PD NEW PROVIDENCE MUNICIPAL BUILDING 360 ELKWOOD AVE NEW PROVIDENCE NJ, 07974 5 miles. Map
SOUTH PLAINFIELD POLICE DEPARTMENT SOUTH PLAINFIELD POLICE DEPARTMENT
908-226-7688
2480 PLAINFIELD AVE. SOUTH PLAINFIELD NJ, 07080 5 miles. Map
CHATHAM BOROUGH POLICE DEPARTMENT CVS PHARMACY 471 MAIN STREET CHATHAM NJ, 07928 7 miles. Map
MOUNTAINSIDE PD MOUNTAINSIDE POLICE DEPT. 1385 ROUTE 22 EAST MOUNTAINSIDE NJ, 07092 5 miles. Map
GARWOOD POLICE DEPARTMENT GARWOOD POLICE DEPARTMENT
908-789-1500
403 SOUTH AVE. GARWOOD NJ, 07027 5 miles. Map
WARREN TOWNSHIP POLICE DEPT. WARREN TWP DPW 1 BARDY ROAD WARREN NJ, 07059 6 miles. Map
GREEN BROOK GREEN BROOK POLICE DEPT. 109 GREENBROOK POLICE DEPT GREEN BROOK NJ, 08812 5 miles. Map
EDISON POLICE DEPARTMENT EDISON POLICE DEPARTMENT
732-248-6442
100 MUNICIPAL BLVD. EDISON NJ, 08817 9 miles. Map
LONG HILL TWP. POLICE DEPARTMENT LONG HILL TWP. POLICE DEPARTMENT
908-647-1800
264 MERCER ST. STIRLING NJ, 07980 6 miles. Map
PISCATAWAY POLICE DEPARTMENT PISCATAWAY POLICE DEPARTMENT
732-562-1100
555 SIDNEY ROAD PISCATAWAY NJ, 08854 7 miles. Map
FLORHAM PARK POLICE DEPARTMENT FLORHAM PARK POLICE DEPARTMENT
973-377-2200
111 RIDGEDALE AVE. FLORHAM PARK NJ, 07932 11 miles. Map
RAHWAY PD RAHWAY PD 1 CITY HALL PLAZA RAHWAY NJ, 07065 7 miles. Map
MIDDLESEX POLICE DEPARTMENT MIDDLESEX POLICE DEPT. 1001 MOUNTAIN AVE MIDDLESEX NJ, 08846 7 miles. Map
HIGHLAND PARK POLICE DEPARTMENT HIGHLAND PARK SENIOR/YOUTH RECREATION CENTER
732-572-3800
222 SOUTH 6TH AVE. HIGHLAND PARK NJ, 08904 10 miles. Map
HARDING TOWNSHIP PD PD HQ 21 BLUE MILL RD NEW VERNON NJ, 07976 9 miles. Map
NEW BRUNSWICK POLICE DEPARTMENT NEW BRUNSWICK POLICE DEPARTMENT
732-745-5200
25 KIRKPATRICK ST. NEW BRUNSWICK NJ, 08901 11 miles. Map
WOODBRIDGE POLICE DEPARTMENT WOODBRIDGE POLICE DEPARTMENT
732-634-7700
1 MAIN STREET WOODBRIDGE NJ, 07095 9 miles. Map
SOUTH BOUND BROOK SOUTH BOUND BROOK POLICE DEPARTMENT 12 MAIN STREET SOUTH BOUND BROOK NJ, 08880 10 miles. Map
CARTERET POLICE DEPARTMENT CARTERET POLICE DEPARTMENT
732-541-4181
230 ROOSEVELT AVE. CARTERET NJ, 07008 11 miles. Map
PERTH AMBOY POLICE DEPT. PERTH AMBOY POLICE DEPT. 365 NEW BRUNSWICK AVE. PERTH AMBOY NJ, 08861 11 miles. Map
MANVILLE POLICE DEPARTMENT MANVILLE POLICE DEPARTMENT
908-725-1900
2 NORTH MAIN ST. MANVILLE NJ, 08835 13 miles. Map
DEA NEW YORK DIVISION NEW YORK CITY POLICE DEPARTMENT STATEN ISLAND
123RD PRECINCT
116 MAIN STREET (TOTTENVILLE) STATEN ISLAND NY, 10307 13 miles. Map
ORANGE POLICE DEPARTMENT ORANGE POLICE DEPARTMENT
973-266-4111
29 PARK ST. ORANGE NJ, 07050 14 miles. Map
If you do not find a collection site near you, please check back frequently, new sites are added every day.