Search PubMed⌕ Search

Biomedical subjects

A S Coulson

Publications and source records attributed to A S Coulson.

At least 19 recordsLinked to original sources
PubMed2000

The subclavian and axillary arteries as inflow vessels for coronary artery bypass grafts--combined experience from three cardiac surgery centers.

BACKGROUND: The subclavian and axillary arteries represent reliable inflow vessels in peripheral vascular surgery. During recent years they have also been used for special situations in coronary artery bypass grafting. We report on a preliminary, triple center experience with subclavian/axillary artery to coronary artery bypass grafting. METHODS: Twenty-one patients (11 male, 10 female, median age 70 years) received subclavian artery/axillary artery to coronary artery bypass grafts. Indications for application of this bypass variation were internal mammary artery problems during minimally invasive coronary artery bypass grafting (n = 10), untouchable ascending aorta (n = 6), high risk reoperations (n = 3), severe chronic obstructive pulmonary disease (COPD) (n = 1) and right ventricular ischemia after ascending aortic replacement for acute aortic dissection type A (n = 1). Fourteen procedures were carried out via minithoracotomy, and seven via sternotomy. Inflow vessels were the left subclavian/axillary artery in 12 cases, the right subclavian/axillary artery in eight cases and bilateral subclavian/axillary artery in one case. Bypass conduits were the saphenous vein (n = 20 for revascularization of the left anterior descending artery, the right coronary artery and obtuse marginal branches) and the radial artery (n = 2 for revascularization of diagonal branches). RESULTS: The procedure was without major technical problems in all patients. Hospital mortality was 1/21. Neither brachial plexus injury nor arm ischemia occurred. Mean pre- and postoperative angina classification was 3.0 +/- 0.8 and 1.2 +/- 0.4 respectively (p < 0.001). After a mean follow-up period of seven months, one out of 14 axillocoronary vein grafts studied by ultrasonic duplex scan or angiography was found occluded. Graft patency could be demonstrated for an observation period of up to two years. CONCLUSION: Subclavian/axillary artery to coronary artery bypass is feasible and can be applied for complications in minimally invasive coronary artery bypass grafting, for redo operations and for management of the severely atherosclerotic ascending aorta. To reach the left anterior descending artery-system, the saphenous vein as well as the radial artery can be used. Complications concerning the infraclavicular incision seem to be no problem. Short-term patency rates are acceptable.

Aged↗
PubMed1998

Minimally invasive coronary bypass surgery: postoperative pain management using intermittent bupivacaine infiltration.

Minimally invasive direct coronary artery bypass grafting (MIDCAB) is becoming a popular adjunct to standard cardiac bypass surgery in selected patients with accessible single or double vessel disease. However, the limited anterior thoracotomy used to access the heart involves trauma to the muscle tissue during removal of the fourth costal cartilage and a small piece of connected rib, perhaps leading to more severe postoperative pain compared with patients undergoing routine sternotomy. Intrathecal opioids can be used but have limited therapeutic duration and there is concern regarding anticoagulation. We present a case where soft tissue catheters were placed into the depths of the surgical wounds and pain was diminished greatly by intermittent regular infiltration with bupivacaine.

Anesthetics, Local↗
PubMed1998

Minimally invasive reoperation through a lateral thoracotomy for circumflex coronary artery bypass.

We report 4 cases of redo coronary artery bypass grafting in which the circumflex coronary artery was successfully revascularized using a minimally invasive approach. In reoperative cases, it is easier to approach the circumflex coronary artery from the left side than from the front. Minimally invasive direct coronary artery bypass technology has made it possible to avoid using cardiopulmonary bypass. In our 4 cases, the revascularization procedure was performed via a small left thoracotomy, and without cardiopulmonary bypass. The patients made a good recovery and are free of angina 22 months after operation. We conclude that the thoracotomy approach provides the opportunity to avoid several hazards: a redo sternotomy, dissection of a hostile mediastinum, and manipulation of the heart.

Aged↗
PubMed1997

Minimally invasive direct coronary artery bypass surgery.

Traditional coronary artery bypass surgery involves a median sternotomy and the use of a heart-lung machine to stabilize the heart during suturing. Minimally invasive coronary artery surgery employs small incisions directly over the target vessels and avoids the use of a heart-lung machine, which can cause postoperative complications. The target coronary vessels are stabilized in alternative ways, potentially hazardous manipulation of the ascending aorta is avoided, and the subclavian and axillary arteries provide alternative inflow sources. Other new techniques used in minimally invasive procedures include a coronary artery cannula to avoid intraoperative ischemia and wound irrigation catheters to administer postoperative bupivacaine hydrochloride. Perioperative nurses need to become familiar with these new techniques to be able to plan and implement effective patient care.

Coronary Artery Bypass↗
PubMed1997

Right thoracotomy approach to mitral valve surgical procedures.

The right thoracotomy approach to mitral valve surgical procedures allows surgeons to achieve excellent, rapid exposures of mitral annuli; facilitates the excision of diseased mitral valves; avoids injury to previously placed coronary artery bypass grafts; and aids surgeons with the insertion of valve prostheses. This approach is especially appropriate for patients with anatomic deviations (e.g., deep chest cavities, counterclockwise rotations of the heart) and hostile mediastina (i.e., previously opened mediastina with severe adhesions around the heart and posterior side of the sternum). This article discusses mitral valve disease, compares the right thoracotomy approach to median sternotomy, describes perioperative nursing care of patients undergoing mitral valve surgical procedures, and presents a case study.

Female↗
PubMed1997

Detection of Chlamydia pneumoniae in atherosclerotic plaques in the walls of arteries of lower extremities from patients undergoing bypass operation for arterial obstruction.

PURPOSE: To study surgically excised vascular tissue from lower extremities for the presence of Chlamydia pneumoniae, to extend the previously described association of the organism with atherosclerosis. METHODS: Arterial biopsy specimens obtained from femoral and popliteal arteries during bypass operation for claudication were examined by immunocytochemical analysis and polymerase chain reaction for the presence of organisms. RESULTS: C. pneumoniae was detected in atherosclerotic plaques by either method in either artery of 11 of 23 patients (48%). Eight of 21 popliteal and three of 18 femoral arteries had positive results. CONCLUSIONS: Detection of C. pneumoniae in peripheral arteries indicates that the organism is widespread in atherosclerosis of the vascular system.

Adult↗
PubMed1995

Chlamydia pneumoniae (TWAR) in atherosclerosis of the carotid artery.

BACKGROUND: Chlamydia pneumoniae has been demonstrated in atherosclerotic lesions of coronary arteries and aorta. A seroepidemiological study found C pneumoniae-specific antibody more frequently in persons with significant carotid artery wall thickening than in matched control subjects. METHODS AND RESULTS: Fresh-frozen or formalin-fixed tissue obtained at carotid endarterectomy was examined by immunocytochemistry (ICC) and the polymerase chain reaction (PCR) for the presence of C pneumoniae. Five of five fresh-frozen and formalin-fixed carotid endarterectomy specimens were positive for C pneumoniae by ICC (three of five by PCR). A total of 56 archival formalin-fixed, paraffin-embedded carotid endarterectomy tissues from three hospitals were examined by ICC. Thirty-two were positive. Thirteen normal carotid artery tissue sections from six patients were negative for C pneumoniae. CONCLUSIONS: C pneumoniae organisms are frequently found in the advanced carotid atherosclerotic lesions of persons undergoing endarterectomy. Although these findings do not establish causality for C pneumoniae in carotid artery atherosclerosis, they should stimulate investigation of a possible causal or pathogenic role for the organism in the disease.

Aged↗
PubMed1977

Adenosine triphosphatase located on unstimulated human small lymphocyte cell membranes.

This study was undertaken to localize the enzyme sodium-potassium dependent adenosine triphosphatase in unstimulated human small lymphocytes using the histochemical technique of McClurkin [1964]. The substrate adenosine 5' triphosphate is hydrolyzed by the ATPase resulting in a lead phosphate precipitate at the site of enzyme action, subsequently visualized as lead sulphide. The enzyme was demonstrated in three different patterns, and for each donor the pattern was constant both on all four of the test slides, and on different occasions. The patterns observed were: clusters of granules related to the cell membrane; positive staining localized to portions of the cell membrane, and, less commonly, the whole cell circumference. The significance of this distribution may relate to areas with large numbers of antigen recognition sites on the lymphocyte membrane.

Adenosine Triphosphatases↗