Massive hemoptysis due to retained rib fragment 40 years after thoracotomy.
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Bronchi↗
Biomedical subjects
A D Boyd
Publications and source records attributed to A D Boyd.
Intrathoracic extramedullary hematopoiesis simulating anterior mediastinal tumor.
Intrathoracic extramedullary hematopoiesis is a rare tumor occurring predominantly in the posterior mediastinum, most commonly in patients with congenital hemolytic anemias. The first reported case of this entity's occurring in the anterior mediastinum is described in a 68-year-old man with an incompletely characterized anemia. Definitive diagnosis was established only after median sternotomy and removal of the tumor.
Aged↗
Effects of polymethylmethacrylate on rabbit articular chondrocytes in monolayer culture.
The effects of polymethylmethacrylate (PMMA) on DNA, protein, and sulfated-proteoglycan synthesis by rabbit articular chondrocytes were observed in monolayer cultures. PMMA pellets in ratios of 1:1 and 1:2 (liquid monomer:powder) significantly reduced [3H]thymidine incorporation into DNA during the first 24 h of culture and less so after 48 and 72 h. The reduction in [3H]thymidine incorporation was restricted to the cohort of chondrocytes nearest the PMMA. Consequently, cellular proliferation was unaltered by PMMA. By contrast, PMMA failed to inhibit [3H]leucine or [3H]serine/35SO4 incorporation. Both control and PMMA (1:1)-treated chondrocyte CsCl density gradient medium fraction dA1 eluted as a retarded peak on Sepharose CL-2B under associative conditions. The average partition coefficient (Kav) of PMMA-treated fraction dA1 was 0.41, as compared with 0.27 for control cultures. The Kav of medium fraction dD1 (proteoglycan monomer) was unaltered. Both control and PMMA-treated dA1 fraction elution profiles on Sepharose CL-2B were altered by incubation with Streptomyces hyaluronidase, indicating the presence of proteoglycan aggregate. The PMMA-treated cultures synthesized smaller proteoglycan aggregates. Since PMMA has been a critical factor in the success of total joint arthroplasty, defining interactions of differentiated cells with the cement is imperative for an understanding of the effects of PMMA on the biology of cartilage and bone.
Animals↗
A prospective study of complications of pulmonary artery catheterizations in 500 consecutive patients.
Five hundred twenty-eight pulmonary artery catheters were inserted in 500 patients at the New York University Medical Center between May and November, 1981. Complications occurred in 126 of 528 catheterizations. Serious complications occurred in only 23 of these 528 catheterizations (4.4 percent). These complications, while serious, did not contribute directly to any of 31 deaths seen in these patients. Pulmonary artery catheters were reported by clinicians to have been of benefit in the management of 80 percent of these patients. We conclude, in view of this experience, that the wide use of these catheters is justified, but only if there is a probability that the catheters will significantly contribute to the management of the individual patient.
Adult↗
The operative management of acute post-pneumonectomy bronchopleural fistula after flush bronchial amputation.
Acute disruption of the bronchial closure after pneumonectomy causes severe problems in patient management. Radical attempts at closure of the fistula and space obliteration (thoracoplasty) carry a high mortality. The management of this condition by a series of staged operative procedures is described. Pneumonectomy has usually been performed for bronchogenic carcinoma and prognosis is therefore guarded. Several low-risk operative interventions, with discharge from hospital between procedures, provide a safe and effective management method in the case described.
Bronchi↗
Immediate reconstruction of full-thickness chest wall defects.
Twenty-one patients had full-thickness chest wall defects reconstructed at the New York University Medical Center in the last ten years. Marlex mesh provided chest wall stability in 5 patients. In 9 patients with radiation ulcers Marlex mesh was not required; a severe fibrotic reaction had obliterated the pleural space and prevented paradoxical motion. Partial sternal resections did not require Marlex stabilization, while a total sternectomy resulted in marked ventilatory insufficiency in a patient who would have benefited from the use of a stabilizing material. Random pattern flaps were used initially; more recently, axial pattern, myocutaneous, and myocutaneous free flaps were employed. Necrosis developed in 4 (36%) of the 11 patients with random pattern flaps, but was not seen with the newer flap techniques. Myocutaneous free flaps provided uncomplicated coverage of and stability to three large, potentially contaminated defects. It seems that with the currently available flap techniques and the methods of chest wall stabilization, immediate repair of all full-thickness chest wall defects is possible.
Adult↗
A special rongeur for removal of extensively calcified mitral valves.
A rare complication of advanced mitral valve disease occurs when calcium extends from the valve downward along the wall of the left ventricle into the ventricular cavity. This unusual condition can be recognized on fluoroscopy because the calcium is visible at right angles to the calcium in the valve. The surgeon faces a very difficult technical problem because it is hard to obtain adequate exposure and to remove the calcium without injury to adjacent tissues or loss of calcific fragments, with resulting embolization. Such difficulties were encountered a year ago in a patient undergoing mitral and aortic valve replacement and ultimately resulted in the patient's death. After this event, the special rongeurs described here were designed.
Calcinosis↗
The value of routine cranial computed tomography in neurologically intact patients with primary carcinoma of the lung.
The most common cerebral metastatic lesion is from carcinoma of the lung. Preoperative cranial computed tomography (CCT) with contrast enhancement was performed in 55 neurologically intact patients with a diagnosis of bronchogenic carcinoma; 3 patients (5%) demonstrated cerebral metastasis. CCT could spare a significant number of such patients from unnecessary surgery, with a net saving substantially greater than its cost.
Brain Neoplasms↗
A clinical evaluation of cricothyroidotomy.
Cricothyroidotomies were performed upon 147 patients at the New York University Medical Center and Booth Memorial Center from March 1976 through February 1978. Cricothyroidotomy was demonstrated to be a rapid and technically simple and precise procedure. The incidence of complications was 8.6 per cent. Catastrophic complications occurred in two patients who had severe laryngeal stenosis. Cricothyroidotomy was performed following prolonged endotracheal intubation in these two patients who had airway obstruction immediately following endotracheal extubation. In both patients, there was a glottic and subglottic component to the laryngeal stenosis suggesting that endotracheal intubation as well cricothyroidotomy played a critical part in the development of laryngeal stenosis. In view of these observations, we believe that cricothyroidotomy is useful, particularly in emergency situations and in patients with median sternotomy incisions but is contraindicated in patients having endotracheal intubation of more than seven days' duration or in patients having airway obstruction develop following removal of an endotracheal tube except as a temporary lifesaving procedure.
Adolescent↗
When to operate for carcinoma of the lung.
Surgical resection remains the accepted treatment of localized carcinoma of the lung. The present means of patient evaluation have made possible accurate tumor staging and have led to an appreciable increase in the rate of resectability. When the tumor is found at operation to be localized to the lung, the patient has a 35% to 50% chance of surviving for five years. This observation makes it imperative that patients with bronchogenic carcinoma be evaluated rapidly and operated on, if indicated, as quickly as possible.
Carcinoma, Bronchogenic↗
Surgery for chronic constrictive pericarditis. Does surgical approach and degree of pericardial resection significantly influence outcome?
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Chronic Disease↗
Does coronary bypass increase longevity?
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Adult↗
Long-term results in 1375 patients undergoing valve replacement with the Starr-Edwards cloth-covered steel ball prosthesis.
The two principal considerations with prosthetic valves are durability and thromboembolism. With the widespread interest in recently developed prosthetic valves (porcine, tilting disc, Cooley), the long-term results at one institution with a single prosthesis were considered of particular importance. Accordingly, a 97% follow-up has been completed on 1375 patients (pts) undergoing prosthetic valve replacement with the Starr-Edwards cloth-covered steel ball prosthesis at New York University between October 1967 and December 1975. Operative procedures were as follows: aortic valve replacement (AVR): 470 pts; mitral valve replacement (MVR): 362 pts; combined AVR and MVR: 129 pts; other combined procedures: 414 pts. Overall operative deaths were 13.7%, 9% for AVR, 10.8% for MVR, and 18.6% for combined AVR and MVR. At seven years, AVR survival was 64%, and MVR survival 64.5%. There has been widespread pessimism, usually without significant data, about the cloth-covered prosthesis, because of concern of cloth wear, hemolysis and other complications. Therefore, a particularly significant finding by actuarial analysis was that 85% of surviving patients with isolated AVR remained free of emboli for five years. In pts surviving isolated MVR, 80% remained free of emboli for five years. Of those having embolic episodes, 33% were not on anticoagulants. Fatal hemorrhage from anticoagulants occurred in 0.8% of pts. Endocarditis occurred in 5.7% of the entire group, with 1.3% requiring reoperation. Clinically significant hemolysis occurred in 5.1% of the group, with only 0.2% requiring reoperation. Hence, the total frequency of clinically significant cloth-wear was less than 0.5%. These data indicate both the reliability and the limitations of the Starr-Edwards cloth-covered steel ball valve and can be used in comparing experiences with the more recently developed prostheses.
Aortic Valve↗
Cricothyroidotomy - its healing and complications.
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Animals↗
Infective endocarditis. An analysis of 54 surgically treated patients.
One hundred seventy-seven patients were admitted to the New York University Medical Center from 1970 through 1975 with infective endocarditis. Fifty-four of these patients required surgical treatment. The over-all mortality rate was 28 per cent. Two thirds of the deaths were early (10 patients) and one third late (5 patients). The mortality rate was 90 per cent in 10 patients treated for 4 to 6 weeks in whom the infection was uncontrolled and the clinical condition was deteriorating. However of the 12 patients with uncontrolled infection who were operated upon promptly within 10 days, 83 per cent survived. The fact that fungal and gram-negative infections responded poorly to medical therapy suggests the need for prompt, early surgical intervention. The mortality rate in the 32 patients operated upon in whom the infection was controlled was 12.5 per cent. It is our conclusion that all patients with infective endocarditis who develop progressive congestive failure, recurrent embolization, or progressive sepsis, despite treatment, shold have prompt valve replacement within 7 days of the institution of appropriate antimicrobial therapy.
Adult↗
A comparison of the level of myocardial ischemia produced by three techniques employed for coronary revascularization.
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Animals↗
Myocardial injury associated with potassium arrest.
The relative efficacy of potassium-induced ischemic arrest using buffered, isosmotic potassium (25 mEq/liter) was compared with hypothermic arrest in an experimental protocol employing an intact canine heart preparation. Myocardial function (LVSW, dp/dt max), serum creatine phosphokinase levels, myocardial perfusion, and light and electron microscopical examination of the heart were assessed in five groups of 5 dogs each. There was one control group (90 minutes of bypass, no anoxia) and four experimental groups, each subjected to 1 hour of ischemic arrest and 30 minutes of reperfusion, comparing normothermic ischemic arrest (NIA), hypothermic ischemic arrest (myocardial temperature less than 25 degrees C) (HIA), normothermic potassium arrest (NKA), and hypothermic potassium arrest (HKA). Myocardial function decreased significantly following NIA and NKA but remained essentially equal in the control, HIA and HKA groups. Serum creatine phosphokinase analysis documented a significant increase in each group of animals: 2,250 mU after NIA, 1,778 mU after NKA, 1,388 mU after HIA, 1,220 mU after HKA, and 838 mU after control bypass. Left ventricular myocardial perfusion was unmeasurably low after NIA, reduced to 111 m/100 gm of tissue/min after NKA, and increased to 165 to 188 ml/100 gm/min in the control, HIA and HKA groups. Electron microscopical studies showed a range of myocardial changes, from probably irreversible damage after NIA to similar but less diffuse changes after NKA, and to potentially reversible changes after HKA and HIA with the least alteration from control after HIA. The results indicate that potassium arrest alone is not as effective as hypothermia in preventing ischemic injury, and the combination of hypothermia with a single 150 cc administration of potassium (25 mEq/liter) does not appear to provide significant additional protection.
Animals↗
Operative management of tricuspid regurgitation.
From January 1968 to June 1975 tricuspid regurgitation was encountered in 238 patients of a total of 1074 patients undergoing operations on the mitral valve. During this time tricuspid annuloplasty (TA) was performed in 137 patients and the tricuspid valve was replaced (TVR) in 101 patients. Comparison of hospital mortality of 15% (20 of 137) for TA as against 40% (40 or 101) for TVR suggests the superiority of repair over replacement. A new technique for repair makes this operation even more attractive. It satisfies the dual objectives of producing competency but not obstruction by creating a measured orifice. As experience with TA was gained, the incidence of valve replacement dropped from 69% (22 of 32) in the first 2 years of the study to 16% (11 of 70) for the last 2 years.
Adult↗