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Biomedical subjects

A Starr

Publications and source records attributed to A Starr.

At least 271 records · Page 15Linked to original sources
PubMed1978

Late results of triple valve replacement: a 14-year review.

Forty-eight patients have undergone simultaneous triple valve replacement at our institution over the past 14 years. This series was reviewed as a baseline for comparison with more recent tricuspid valve reparative procedures and to assess the natural history of advanced rheumatic heart disease with surgically corrected valvular lesions. Survival was 81% at one month and 32% at 14 years, not significantly different from results with double valve replacement during the same period, and not related to whether the tricuspid involvement was organic or functional. Forty-three percent of the late deaths were clearly valve related, a percentage which would undoubtedly be lowered with currently available prostheses. Functional class was determined in 13 of the 17 current survivors (mean follow-up, 10.3 years), and was improved over preoperative functional class in all but 3 patients. Three patients died of progressive congestive heart failure despite normally functioning prostheses; the reasons for these deaths are open to speculation.

Adult↗
PubMed1978

The natural history of papillary transitional cell carcinoma of the bladder and its treatment in an unselected population on the basis of histologic grading.

Between 1950 and 1965, 365 patients were treated for transitional cancer of the bladder at our hospitals. A retrospective study was done, using clinical records and a histopathologic review to determine the long-term natural history of this population when treated conservatively. The natural history of 3 separate patient populations was discovered, based solely on the grading of the transurethrally resected fragments. Based on the grade on initial presentation these patients were divided into grades I, II and III. Of the patients 5 per cent in grade I, 16 per cent in grade II, 28 to 35 per cent in grade III not involving muscle and 83 per cent in grade III involving muscle died of bladder cancer. Ninety-seven patients (26 per cent) died of bladder cancer, 110 (31 per cent) died of other causes and 158 (43 per cent) have been alive more than 5 years (104 more than 10 years). Grade I tumors that progressed to a higher grade did so within 2 years of the initial diagnosis. Of the bladder cancer deaths 83 per cent occurred within 2 years of the initial diagnosis. Of 64 patients dying more than 5 years after presentation only 7 died of bladder cancer.

Biopsy↗
PubMed1978

Long latency event-related components of the auditory evoked potential in dementia.

Long-latency auditory evoked potentials were recorded from two groups of patients, with and without dementia, and were compared with those from a population of normal subjects ranging in age from 15 to 76 years. A sequence of tones of two different frequencies (1000 Hz and 2000 Hz) was presented and each patient was asked to count the occurrences of the rare (P = 0.15) tones in the sequence. Evoked potential waveforms were averaged separately for the rare and frequent tone. Of the various evoked potential components elicited by the tones, the P3 component (latency 300-500 ms) was found to be the most sensitive to aging in normal subjects. It was also the only component which could be used to differentiate between the demented patients and the normal subjects or non-demented patients. The non-demented patients did not differ from normal in any waveform measure. The magnitude of the latency change of the P3 component in dementia relative to normal was sufficiently large that it may provide a practical and objective measure of dementia in a clinical setting.

Acoustic Stimulation↗
PubMed1978

Technical considerations in patients undergoing combined aortic valve replacement and aortocoronary bypass surgery.

Forty-nine patients have undergone combined aortic valve replacement and aortocoronary saphenous vein bypass graft surgery using a technique of distal coronary perfusion. Vein grafts are placed before replacement of the aortic valve, and continuously perfused by siting the proximal anastomoses high on the aortic root or individually perfusing the grafts before proximal anastomosis. Continuous coronary ostial perfusion is used as well during aortic valve replacement. There were 3 (6.1%) operative deaths and 1 (2%) perioperative myocardial infarction. A comparison of this technique with other reported results suggests that attention to myocardial perfusion distal to significant coronary artery stenosis may decrease the incidence of perioperative myocardial infarction in patients requiring both aortic valve replacement and coronary bypass graft operation.

Adult↗
PubMed1978

Cardioplegic solutions for myocardial preservation: analysis of hypothermic arrest, potassium arrest, and procaine arrest.

Separate effects of perfusion hypothermia, potassium arrest, and procaine arrest were studied in 150 hearts using the isolated rat heart preparation. Aortic flow rate (AFR), coronary flow rate (CFR), and heart rate (HR) were measured before and after ischemic periods of 90 to 300 min. Prior to the ischemic period, the aortic root was infused with Krebs-Henseleit buffer (KHB), buffer with 30 mEq KCl/L (KHB + K), or buffer with 0.2% procaine (KHB + P), at 15 degrees or 5 degrees C. During the ischemic period the hearts were maintained at 15 degrees or 5 degrees C in a hypothermic chamber. The three solutions had similar recoveries of AFR at 15 degrees and 5 degrees C following ischemic periods of 90, 180, and 240 min. The KHB + K and KHB + P had better recoveries of AFR than KHB at 5 degrees C and 300 min of ischemia. The KHB + K and KHB + P also caused more rapid arrest and a higher incidence of spontaneous recovery of sinus rhythm. Arrest at 5 degrees C was equal to or superior to arrest at 15 degrees C. Perfusion hypothermia is the main component of cold cardioplegia. The addition of procaine or potassium results in increased functional recovery at extended ischemic times at 5 degrees C, more rapid arrest, and better electrical recovery.

Animals↗
PubMed1978

Early and late results of resection of ventricular aneurysm.

Fifty-seven patients have undergone ventricular aneurysm resection with a mortality rate of 10 percent. Recent surgical trends have been toward complete revascularization and treatment of concomitant disorders when present. Although the early mortality rate may be favorable influenced by these maneuvers, analysis of survivors reveals no significant difference in survival between the group that had concomitant coronary artery bypass and the group that had aneurysm resection alone (84 percent versus 78 percent). There were significantly more asymptomatic patients in the revascularized group, however (74 percent versus 53 percent). Analysis of hospital deaths revealed nearly all to be seconary to low output syndrome, arrhythmia, myocardial infarction, or a combination of the three. Late death was due to either congestive heart failure or a myocardial infarction in all but one case. Seventy-seven percent of operative survivors are asymptomatic. Late morbidity is usually related to ungrafted or progressive coronary artery disease and generally has been successfully managed by reoperation.

Adult↗
PubMed1978

Aortic valve replacement and aorta-coronary bypass surgery. Results with perfusion of proximal and distal coronary arteries.

The results in 80 patients undergoing simultaneous aortic valve replacement and aorta-coronary saphenous vein bypass grafting were analyzed to assess the effect of operative technique. The over-all operative mortality rate of 6.3% (five of 80) did not differ significantly from our results with aortic valve replacement alone. All patients who had isolated aortic valve replacement were operated upon with moderate hypothermia. The combined operation was performed in two ways. Thirty-one patients had aortic valve replacement prior to bypass grafting with intermittent coronary ostila perfusion. There were two deaths (6.5%), and five myocardial infarctions (16.1%) were diagnosed by standard electrocardiographic and enzyme criteria. More recently, 49 patients have undergone bypass grafting prior to aortic valve replacement. The proximal ends of the grafts were either anastomosed high on the aortic root or else individually cannulated to provide continuous distal perfusion during subsequent aortic valve replacement, with continuous coronary ostial perfusion. There were three operative deaths (6.1%) and one myocardial infarction (2.0%). The risk of combined aortic valve replacement and coronary bypass need be no greater than the risk of aortic valve replacement alone. Our experience suggests that myocardial perfusion distal to significant coronary artery stenoses reduces the risk of myocardial infarction in patients with coronary artery disease requiring aortic valve replacement.

Adult↗
PubMed1978

Experimental use of fluoroalkyl cyanoacrilate in ureteral anastomosis.

A fluorinated tissue adhesive Fluoroalkyl Cyanoacrilate has been used in end-to-end ureteral anastomoses as an adjunct to suture material to avoid urinary extravasation in seven dogs. A similar number of dogs served as controls. The urinary tracts were evaluated grossly, radiographically, and histologically after 3 to 12 months. Better anatomical results and less inflammatory reaction and fibrosis were found in the group submitted to the tissue adhesive.

Animals↗
PubMed1978

Pulmonary embolectomy.

Embolectomy was carried out in eight patients with pulmonary emboli. Angiographic diagnosis was obtained in six, and in two cases pulmonary angiography could not be done because of the very critical condition of the patients. In the latter two, diagnosis was made based only on clinical findings. Two patients died in the operating room (25 percent). Six patients were discharged in good condition. It is emphasized that pulmonary embolectomy should be done in cases of pulmonary emboli when a clinical status of shock is present (systolic blood pressure less than 80 mm of mercury and the patient in low cardiac output syndrome) and when there is no response to medical treatment regardless of the degree of obstruction in the pulmonary arterial tree.

Adult↗
PubMed1978

Non--cloth-covered caged-ball prostheses. The second decade.

The Starr-Edwards Models 6120 mitral and 1200/60 aortic valves are caged-ball prostheses with cloth-covered sewing rings and bare-metal struts. Introduced in 1965, they have been in continuous clinical use longer than any other currently available heart valve prostheses. Late results with this valve are analyzed and compared with recent series employing other current valve prostheses. One hundred thirty-four mitral 6120 prostheses were inserted at the University of Oregon Health Sciences Center from 1965 through 1977, with 118 operative survivors followed for a mean of 5.4 years. Twelve-year survival rate (+/- standard error) was 50 (+/-8) percent. Twelve percent of late deaths were valve related. Eighty-eight (+/-5) percent of valves were still in place at 12 years. The embolic rate was 5.8 (+/-1.0) percent per patient-year for all emboli and 2.2(+/-0.6) percent per patient-year for serious emboli. Two hundred forty-nine operative survivors among 282 patients undergoing aortic valve replacement during the same period of time were followed for a mean of 4.3 years. Twelve-year survival was 61 (+/-6) percent and the removal-free rate was 92(+/-5) percent. Six percent of late deaths were valve related. Embolic rates were 5.0 (+/-.7) percent and 1.8 (+/-.4) percent per patient-year for all emboli and serius emboli, respectively. Structural failure, specifically ball variance, was not encountered with this prosthesis. Ninety percent of 10 year survivors are in N.Y.H.A. Functional Class I or II. There was one anticoagulant-related death in 1,698 patient-years of follow-up. The current non--cloth-covered caged-ball valves provide unquestionable durability and well-documented results into their second decade of use. They provide a base line for comparison with newer prostheses and offer a valid, current choice for both aortic and mitral valve replacement.

Aortic Valve↗
PubMed1977

Facial myokymia in the Guillain-Barré syndrome.

Facial myokymia, a unique involuntary movement of facial muscles, is described in a patient with Guillain-Barré syndrome. Although this involuntary movement is most often described with intramedullary lesions of the brain stem, it may also appear with lesions external to the neuraxis. We review the literature and propose a more widespread distribution of potential lesions along the facial nerve pathway, which may produce facial myokymia.

Adult↗
PubMed1977

Actuarial analysis of surgical results: rationale and method.

The use of time-related methods of statistical analysis is essential for valid evaluation of the long-term results of a surgical procedure. Accurate comparison of two procedures or two prosthetic devices is possible only when the length of follow-up is properly accounted for. The purpose of this report is to make the technical aspects of the acturial, or life table, method easily accessible to the surgeon, with emphasis on the motivation for and the rationale behind it. This topic is illustrated in terms of heart valve prostheses, a field that is rapidly developing. Both the authors and readers of articles must be aware that controversies surrounding the relative merits of various prosthetic designs or operative procedures can be settled only if proper time-related methods of analysis are utilized.

Follow-Up Studies↗
PubMed1977

Correction of aortic coarctation in neonates: mortality and late results.

To determine those factors that affect mortality and to analyze long-term results, the records of 44 infants who underwent repair of aortic coarctation at less than 90 days of age were examined. There were 14 operative and 8 late deathes (mean, 4.3 months postoperatively). Subsequent operation, generally to repair or palliate associated anomalies, was required 22 times in 20 patients and was a source of considerable mortality. There is evidence that earlier total repair of associated anomalies might improve survival. Sufficient data were available on 17 of the 22 survivors to assess long-term results. The outcome was considered excellent in 8 patients, fair in 4, and poor in 5. Revision of the coarctation repair due to growth failure of the anastomosis was required in 1 patient. Aggressive surgical management is recommended in these infants because, despite a high early mortality, a considerable proportion of excellent results can be anticipated in what is otherwise a hopeless situation.

Aortic Coarctation↗