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Biomedical subjects

A B Lee

Publications and source records attributed to A B Lee.

At least 37 records · Page 2Linked to original sources
PubMed1982

The clinical and laboratory correlates of nasal polyps in cystic fibrosis.

The clinical histories, chest X-ray appearances, skin prick test results, pulmonary function and IgE levels of 20 patients with cystic fibrosis (C.F.) complicated by nasal polyps have been compared with those of 97 C.F. controls. The patients who had developed polyps had a different clustering of symptoms to the controls with heavier birthweights, later presentations, milder gastrointestinal symptoms in infancy, less infection with Staphylococcus aureus and better vital capacities. There was no evidence on history, skin testing or IgE levels that the polyps patients were more allergic. It is likely, therefore, that nasal polyps in C.F. are due to a primary effect of the C.F. gene, although they could also be the effect of chronic nasal infection.

Birth Weight↗
PubMed1981

Long-term survival after coronary bypass surgery. Comparison of various subsets of patients with general population.

Life-table analysis consecutive cases of isolated coronary bypass surgery at the Buffalo Hospital between 1973 and 1977 showed an estimated survival of 94 per cent at five years, equal to that of an age- and sex-matched group of the US population. Subsets of these patients divided according to sex, age, number of vessels narrowed, number of segments grafted, history of myocardial infarction, ejection fraction, and presence of unstable angina have estimated survivals not statistically less in any of these subsets than that of matched cohorts of the general population.

Adult↗
PubMed1980

Cold blood--potassium cardioplegia.

A technique is described for providing myocardial protection utilizing oxygenated blood that is drawn from the pump oxygenator and passed through two disposable cardioplegic cooling coils, which are joined in series and submerged in ice slush. A potassium-containing cardioplegic solution is run into the oxygenated blood at the level of the cooling coils. The amount of blood used in the blood-potassium cardioplegic mixture is controlled using a screw clamp. This method has been used with excellent results in 150 consecutive patients undergoing aortocoronary saphenous vein bypass grafting.

Blood↗
PubMed1980

Refinements in coronary artery surgery contributing to improved survival.

Reviews of the literature and controlled studies of medical versus surgical treatment of coronary artery disease that include surgical results from 3 or 4 years ago may not be pertinent to therapeutic decisions made today. The results in our patients operated during 2 two-year periods (1974--1976, Group I and 1976--1978, Group II) are compared. The Group II patients had more severe coronary artery disease. They had significantly more grafts per patient (p less than .001), their cardiopulmonary bypass time was significantly reduced (p less than .001), they received less inotropic support (p less than .005) and spent less time in the intensive care unit (p less than .001). There was a significant decrease in the overall perioperative mortality (30-day) in the patients of Group II (p less than .055). The second two-year period coincided with the adoption of refinements in the intraoperative preservation of myocardium and also in surgical technique. These refinements are discussed in detail.

Adult↗
PubMed1980

Left ventricular laceration due to stented prosthesis.

Complications following open chest massage in patients with porcine xenografts in the mitral location have not been previously described. The authors report a case of cardiac resuscitation following mitral valve replacement with a stented porcine valve. The patient died following brief closed chest, and then, prolonged open chest, cardiac massage. Autopsy showed laceration of the left ventricle by the prosthetic valve stents. Physicians involved in the postoperative care of patients with stented prosthetic valves should be aware of this complication and should exercise caution when applying manual compression in the region of the posterolateral base of the heart.

Bioprosthesis↗
PubMed1980

Hormonal bioassay of gonadotropin-producing hepatoblastoma.

Hepatoblastoma was associated with signs of isosexual precocity in an 11-month-old boy. Circulating gonadotropic hormone levels were elevated. Gonadotropic activity was demonstrated by bioassay in extracts of primary and metastatic tumor, and in media surrounding long-term tissue culture of the primary tumor. Morphology of the endocrine glands and bioassay of the pituitary gland obtained at autopsy indicated the presence of gonadotropins and other tropic hormones despite the physiologically abnormal hormone status. These ae the first direct studies of pituitary hormone content in this syndrome.

Biological Assay↗
PubMed1979

The revival of the horseshoe graft (side-to-side saphenous-vein-to-aorta anastomosis).

The technique of the horseshoe graft, side-to-side saphenous-vein-to-aorta anastomosis, using a long saphenous vein harvested from the leg is described in this communication. The lack of valves between the ankle and the knee and the high caliber natural Y distributions make this technique attractive. Constructing a double set of vein graft provides, in particular, unlimited possibilities for the construction of six to eight grafts if this appears anatomically feasible.

Coronary Artery Bypass↗
PubMed1978

Decompression of the heart with siphon drainage.

A simple technique for inducing intracavitary hypothermic cardioplegia and decompressing the left heart through the ascending aorta is presented. The technique is based on siphon drainage, which eliminates the dangers of air embolism.

Cardiac Catheterization↗
PubMed1977

Detection of creatine kinase BB isoenzyme in sera of patients undergoing aortocoronary bypass surgery.

Creatine kinase BB isoenzyme (CK-BB) was detected intraoperatively in 22 of 25 patients undergoing aortocoronary bypass surgery, both in the coronary sinus and in the mixed venous blood. In a group of 10 patients in whom selective intracavitary profound hypothermic arrest was used, CK-BB values were lower than in another group of 10 patients, in whom controlled ventricular fibrillation with moderate total body hypothermia was instituted. This latter group also had higher levels of CK-MB. Patients who developed acute myocardial infarction immediately prior to or during the surgical intervention had the highest CK-BB values. This enzyme appeared as early as 15 minutes after the institution of cardiopulmonary bypass and disappeared within 6 hours. It is considered that part of the BB isoenzyme in serum of patients undergoing heart surgery is of myocardial origin.

Adult↗
PubMed1977

Early and long-term effects on direct myocardial revascularization on cardiac function: a prospective study using multivariable physiological analysis.

Perioperative and late follow-up hemodynamic cardiovascular studies to assess the effects of direct myocardial revascularization on cardiac function objectively have been completed on 51 patients. Analysis of the data delineated three distinct groups basedon the patterns of their early postoperative recovery. Group I patients (12) had a hyperdynamic cardiovascular response to operation and returned to a normal physiological range of cardiac function within 24 hours. Group II patients (24) initially had moderate to severe myocardial decompensation postoperatively but responded to inotropic support and moved into the normal physiological range within 24 to 48 hours. Group III patients (15) had severe, prolonged myocardial decompensation with little response to inotropic support. There were no early deaths in Group I, 1 early iatrogenic death in Group II, and 2 deaths from sepsis, 1 in Group I and 1 in Group II. All 7 cardiogenic deaths occurred in Group III patients. Late follow-up studies 4 to 23 months postoperatively have been completed on 29 patients. These showed cardiovascular stability in the mean values in Groups I and II. Significant improvement in mean cardiac function was seen in surviving Group III patients.

Adult↗
PubMed1977

Selective intracavitary and coronary profound hypothermic cardioplegia for myocardial preservation: a new technique.

A technique is described for selective intracavitary and coronary hypothermic perfusion during cardiac bypass with cardioplegia to facilitate cardiac operations. A cold perfusate (Plasmalyte 148 and mannitol, 12.5 gm/L at 8 degrees to 10 degrees C) is administered with the aid of a low-flow perfusion pump into the left ventricular cavity and coronary circulation through an apical perfusion-venting (Per-Vent) catheter. This perfusate cools the myocardium rapidly and homogeneously to a temperature of 15 degrees to 20 degrees C. Within this temperature range, complete cardioplegia occurs and the safe ischemia period can be extended to 120 minutes. This method was applied in 50 unselected consecutive adult patients undergoing aortocoronary saphenous vein bypass grafting or aortic or mitral valve replacement. All patients survived and had excellent recovery of ventricular function.

Coronary Artery Bypass↗
PubMed1976

Free internal mammary artery for coronary bypass.

An improved technique of free internal mammary artery (IMA) to ascending aorta anastomosis for coronary bypass is described. A small patch vein with a suitable side branch or branches is interposed, connecting the proximal end of a detached IMA to the ascending aorta. A single or double free IMA alone or in combination with an additional saphenous vein graft was performed in 77 patients. A total of 125 free IMA grafts were done. The hospital mortality was 2-7% and late mortality 1-4%. Seventy-one of the 74 surviving patients had no angina and returned to a normal life. Postoperative coronary arteriography in 65 patients showed a patency rate of 96%. On year's experience with this technique is very encouraging. However, prolonged follow-up is necessary to determine if free IMA, as used by us, will increase the long-term patency rate.

Adult↗
PubMed1976

Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery.

Mediastinal sepsis following open heart surgery is a significant cause of death. Open drainage of the mediastinumalone was employed originally in management of this problem. More recently, debridement, drainage, and reclosure have been used. Various irrigation solutions, such as antibiotics and Betadine, have been advocated to control severe mediastinal sepsis. Three principles of management in patients unresponsiveness to the above techniques have proved successful in two patients with life-threatening mediastinal sepsis: (1) radical, complete excision of the sternum and adjacent costal cartilages; (2) transposition of the greater omentum on a vascular pedicle to the mediastinum; and (3) primary closure with full-thickness rotational skin flaps. The radical excision of the sternum removes residual foci of sepsis in cartilage and sternal bone marrow. The transposition of the omentum provides a highly vascular, rapidly granulating covering for the contaminated great vessels and hase been successfully to prevent recurrence of suture line bleeding of an exposed ascending aortic anastomosis site. Primary closure of the wound with full-thickness skin flaps provides a suprisingly satisfactory covering for the heart. Preoperative and postoperative measurements of ventilatory mechanics have shown relatively small ventilatory impairment after the alteration of the thoracic cage imposed by excision of the sternum. Two patients have returned to active lives. A treatment failure probably due to incomplete adherence to these guidelines also is presented.

Adult↗