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Biomedical subjects

C B Wright

Publications and source records attributed to C B Wright.

At least 73 records · Page 4Linked to original sources
PubMed1979

Combined multiple-valve procedures: a five-year experience with 125 patients.

One hundred twenty-five patients underwent 128 operations for combined multiple-valve procedures, with an overall early mortality of 16%. Highest mortality was associated with mitral and tricuspid valve disease (28.5%), followed by triple-valve disease (18.2%) and aortic and mitral valve disease (14%). Left ventricular end-diastolic pressure, cardiac index, mean pulmonary artery pressure, pulmonary artery wedge pressure, and arteriovenous oxygen difference were all significantly different in patients with regard to early mortality. Late follow-up of 94% has been achieved in 105 early survivors, with a late mortality rate of 11.2%. Analysis of late functional results reveal that 85% of survivors improved at least one Functional Class. Actuarial 5-year survival of 75% was achieved for early survivors of operation.

Adolescent↗
PubMed1979

Ventricular septal defect following myocardial infarction.

Review of the literature since 1970 revealed more than 200 patients who had a ventricular septal defect following myocardial infarction and underwnet operation. Pathogenesis and diagnosis are discussed. The primary therapy is operative repair, which is considered from the standpoint of approach, timing, technique, concomitant coronary artery bypass, mortality, and long-term survival. Operative mortality in those patients operated on less than 3 weeks following perforation remains high (40%) but when it is possible to wait 3 weeks, there is a marked decrease in mortality (6%). Several general principles have evolved for the care of these patients. (1) Operation should be deferred until 3 weeks after infarction if possible. (2) The intraaortic balloon allows preoperative evaluation of the patient with clinical hemodynamic deterioration in the early postinfarction period. (3) The incision should be placed through the infarct. (4) Associated coronary artery or mitral valve disease should be repaired as well.

Cardiac Catheterization↗
PubMed1979

Results of ophthalmosonometry and supraorbital photoplethysmography in evaluating carotid arterial stenoses.

A total of 263 patients underwent either periorbital ophthalmosonometry (Doppler ultrasound) or a combination of ophthalmosonometry and supraorbital photoplethysmography (SOPPG) to determine the presence or absence of a hemodynamically significant lesion (occlusion or greater than 50% reduction in lumen diameter). There were 522 vessels studied with Doppler ultrasound and 272 vessels with a combination of the two modalities. The tests were correlated with carotid arteriography to determine their accuracy. Overall accuracy of the Doppler ultrasound examination was 95%. A normal Doppler ultrasound examination was obtained in 367 vessels and arteriography confirmed the absence of a hemodynamically significant lesion in 93%. Of 155 vessels with an abnormal Doppler examination, 149 (96%) were proven on arteriography to have hemodynamically significant lesions. The Doppler ultrasound examination had a high incidence of false-negative examinations (26%) in those vessels that were between 50% and 99% stenotic, however. The SOPPG alone had a high incidence of false-positive examinations (19%); however, in 155 vessels with a normal SOPPG, 98% were proved to have no hemodynamically significant lesion. The combination of Doppler ultrasound and SOPPG was highly accurate in identifying patients with hemodynamically significant lesions. Of 97 vessels with such lesions, 96 (99%) had either an abnormal Doppler ultrasound examination or an abnormal SOPPG. In 240 vessels with concordant results of the Doppler ultrasound and SOPPG, the presence or absence of a hemodynamically significant lesion was accurately predicted in 235 (98%).

Arterial Occlusive Diseases↗
PubMed1979

Inferior mesenteric artery aneurysm: case report and discussion.

Although visceral artery aneurysms are uncommon, an isolated inferior mesenteric artery aneurysm is reported. A 55-year-old man underwent aortofemoral reconstruction with resection of the aneurysm and replantation of the artery into the Dacron graft. This unusual entity is discussed.

Aneurysm↗
PubMed1979

Management of of arteriosclerotic aneurysm of the innominate artery.

Arteriosclerotic aneurysm of the innominate artery is an unusual lesion. A review of the literature has revealed many approaches to this problem in the past, but the mortality rate has remained significant and serious complications have been frequent. Computerized axial tomography and noninvasive cerebrovascular methods can be useful in managing this lesion. Vein grafts from the ascending aorta to the common carotid and subclavian arteries were used to revascularize a patient following resection of an innominate aneurysm.

Aneurysm↗
PubMed1979

Successful management of popliteal arterial disruption in Ehlers-Danlos syndrome.

A review of the literature on Ehlers-Danlos syndrome with particular attention to vascular complications enabled us to outline an orderly diagnostic and therapeutic plan which has allowed salvage of an individual with a popliteal false aneurysm. In patients with Ehlers-Danlos syndrome and brachial, superficial femoral, or popliteal arterial disruption, the use of proximal tourniquet control to allow ligation of the disrupted artery under a no-flow, no-pressure situation is recommended. The ligations should be carried out with a large ligature or possibly with large hemoclips and/or reinforced with multiple fine atraumatic vascular sutures distally. These patients may be treated successfully for flexion contractures because of the laxness of their tissues.

Adolescent↗
PubMed1978

Aortic insufficiency requiring valve replacement in Whipple's disease.

Reviews of postmortem reports on patients with Whipple's disease (intestinal lipodystrophy) describe gross valvular deformity in more than 50% with characteristic histological findings of macrophages containing periodic acid-Schiff-positive, diastase-resistant granules. Frequently, congestive heart failure characterizes the terminal stages. In a 58-year-old man with well-documented Whipple's disease for 5 years, gastrointestinal, joint, and pericardial involvement apparently resolved with medical therapy. However, 10 years later, severe aortic insufficiency necessitated prosthetic valve replacement, at which time gross and histological examination of the excised valve demonstrated characteristic changes of Whipple's disease. Clinical recognition of the importance of cardiac valvular abnormalities and of possible late cardiac decompensation mandates close observation of patients with Whipple's disease. Corrective operation should improve the patient's chances of survival.

Angina Pectoris↗
PubMed1978

Aortocaval fistula associated with aneurysm of the abdominal aorta: current management using autotransfusion techniques.

Two patients with aortocaval fistula associated with abdominal aortic aneurysm were managed successfully using a patient care plan which includes proper monitoring of the hemodynamic state, careful dissection of the aneurysm, and return of blood loss by autotransfusion while the patient is fully anticoagulated with heparin. This unusual and serious problem in vascular surgery can be managed in an orderly and controlled fashion using these techniques.

Aged↗
PubMed1977

Ultrasonic blood flow assessment in colon esophageal bypass procedures.

Colonic serosal and mesenteric blood flows were assessed by use of the Doppler ultrasound device during three colon bypass procedures for obstructing esophageal carcinoma. The technique allowed confirmation of pulsatile blood flow in large and small vessels after mobilization of the colon and following completion of critical anastomoses. We recommend use of this technique to eliminate serious compromise of colonic blood flow in colon bypass procedures.

Adult↗
PubMed1977

A comparison of autografts and frozen, irradiated homografts in canine femoral venous reconstruction.

Autogenous veins are the ideal substitute for bridging venous defects. Experimentally, fresh homografts have patency rates comparable to autografts. However, a method of preservation must be employed if homografts become practical for clinical use. In this study, homografts were frozen, irradiated, and stored for a total of 6 weeks. Following femoral venous reconstruction, patency rates between frozen, irradiated homografts and fresh autografts were compared and found to be similar over a 6 month period. Recanalization of the frozen, irradiated homografts occurred at the same rate as did that of the autografts. This study concludes that cryopreservation and irradiation are suitable methods of preservation that do not adversely affect patency. In addition irradiation will sterilize tissue and may decrease the potential of the graft to stimulate the recipient's immunologic system.

Animals↗
PubMed1977

Adrenergic mechanisms in the hepatic arterial circulation of baboons.

The effects of intra-arterial injections and infusions of three adrenergic amines upon hepatic arterial blood flow were measured in anesthetized baboons before and after alpha and beta adrenergic blockade with intravenous phenoxybenzamine and propranolol. Injections of norepinephrine or epinephrine caused dose-dependent decreases in hepatic arterial blood flow. These responses were attenuated by alpha adrenergic blockade and were unchanged by beta adrenergic blockade. Injections of isoproterenol caused dose-dependent increases in hepatic arterial flow. These increases were relatively small and were reversed to constriction at low doses and attenuated at high doses of the agonist by beta adrenergic blockade. Intrahepatic arterial infusions of constrictors were unaccompanied by autoregulatory excape. The degree of constriction was attenuated by alpha adrenergic blockade but was not potentiated by beta adrenergic blockade. Intrahepatic arterial infusion of a relatively large dose of isoproterenol was required to evoke a relatively modest, but sustained, increase in hepatic arterial blood flow. This response was not potentiated by alpha adrenergic antagonism, but was attenuated by beta adrenergic blockade. These observations suggest an apparent and relative decrease in beta adrenergic receptor activity in the hepatic arterial bed of the baboon when compared to other regional circulations such as the mesenteric and femoral beds. These beta receptors are relatively resistant to both stimulation and blockade.

Animals↗