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Biomedical subjects

C S Thomas

Publications and source records attributed to C S Thomas.

At least 73 records · Page 4Linked to original sources
PubMed1985

Cryoprecipitate-topical thrombin glue. Initial experience in patients undergoing cardiac operations.

The use of fibrin glues as topical hemostatic agents is reported in the European literature. We have composed an analogous compound in our operating rooms using cryoprecipitate and topical thrombin (1000 units/ml) in equal volumes applied directly to the bleeding site. We have used cryoprecipitate-topical thrombin glue in 26 patients undergoing cardiac operations. Severe bleeding not responding to usual methods of control was encountered during or after coronary artery bypass (n = 17), valve replacement (n = 3), bypass plus valve replacement (n = 5), or repair of postinfarction ventricular septal defect (n = 1). Five patients were operated on emergently and four were undergoing their second cardiac operation. The glue was used in four patients while on bypass and fully heparinized and in 17 patients who continued to bleed after separation from bypass and administration of protamine. Hemostasis was achieved in all patients and none required reexploration for bleeding. In five patients undergoing reexploration for postoperative hemorrhage (none having received cryoprecipitate-topical thrombin glue during the initial operation), the glue provided hemostasis when other measures failed, and no additional reexplorations were needed. No patient exhibited hypersensitivity, fibrinolysis, or coagulopathy following the use of this glue. In 16 patients followed for 9 to 12 months postoperatively, no hepatitis has occurred. The highly concentrated fibrinogen in cryoprecipitate is activated by thrombin to form fibrin and bring about rapid hemostasis. Cryoprecipitate-topical thrombin glue is a readily available, reliable, and inexpensive topical hemostatic agent in the patient undergoing a cardiac operation.

Cardiac Surgical Procedures↗
PubMed1984

Dysmorphophobia: a question of definition.

Dysmorphophobia is an uncommon psychiatric syndrome characterized by a subjective feeling of ugliness or physical defect. Although appearance is within normal limits, the patient feels that this is noticeable to others. Views on the nature of this condition are illustrated by two case histories. It is proposed that dysmorphophobia is a discrete psychiatric illness. The symptoms arise in individuals with schizoid, narcissistic, or obsessional personality traits and should be distinguished from those phenomena which are secondary to morbid psychological processes.

Adolescent↗
PubMed1984

The fate of arm veins used for aorta-coronary bypass grafts.

Arm veins have been a common second choice conduit for those patients having insufficient saphenous veins for coronary bypass operations. To define the patency and durability of arm vein grafts, we reviewed our patients with one or more arm vein grafts used for coronary revascularization between 1974 and 1982. A total of 59 patients required at least one arm vein graft and 51 are presently alive. Postoperative arteriograms were obtained in 28 patients. Of 56 arm vein grafts used, 32 (57%) were patent and 24 (43%) had failed at 2 years. Seven of the patent grafts had a localized area of stenosis. Sixteen internal mammary artery grafts also had been used in this group of patients, and 15 (93%) were patent. We conclude that arm vein grafts have a high failure rate and are not as dependable as saphenous vein grafts or internal mammary artery grafts.

Adult↗
PubMed1983

A case of sarcoid arthritis in a child.

An 8-year-old girl presented with dyspnoea, weight loss, erythema nodosum, and an arthritis. A diagnosis of sarcoidosis with joint involvement was made. The clinical features of this unusual arthritis in a child and the response to corticosteroid therapy are described.

Arthritis↗
PubMed1982

Urgent operation for acquired ventricular septal defect.

Recent experience suggests that ventricular septal defect (VSD) secondary to myocardial infarction constitutes an indication for urgent operation. Acquired VSD at St. Thomas Hospital, Nashville, was reviewed to substantiate the obsolescence of protracted medical therapy designed to allow a late, technically less demanding, repair. Twenty-two acute VSDs (less than four weeks following onset of murmur) have been treated since 1970. Five patients died during medical therapy. Two patients survived for more than four weeks without operation. One never manifested significant cardiac decompensation. The other was operated on at 33 days, after progressive deterioration. No technical advantage from the delay was apparent, although survival was achieved. Ten of 15 patients (67%) operated on during the first four weeks survived. Fourteen had reached a level of marked instability prior to operation. Of the five deaths, four were technical and were the product of an initial lack of recognition of the necessity for patch replacement of the interventricular septum. The prosthetic patch is now considered essential to minimize suture-line stress in necrotic muscle. Potentially, only one of 15 patients operated on early using current methods would have expired. This experience supports an aggressive surgical approach to any unstable patient with postinfarction VSD. Early repair requires specific techniques. Results of early operation using these techniques are dramatically superior to past efforts designed to delay definitive repair.

Aged↗
PubMed1982

Psychiatrists, the public, and confidentiality.

This paper represents a comparative study of the attitudes of psychiatrists, people under the regular care of psychiatrists, and those who have never had any experience with psychotherapy toward confidentiality in the doctor-patient relationship. The role played by knowledge of and attitudes toward confidentiality in the seeking of health care is also assessed. The samples consisted of 192 psychiatrists, 76 patients, and 76 nonpatients of psychiatrists. The findings and their implications are discussed.

Adolescent↗
PubMed1982

Surgical procedures after percutaneous transluminal coronary angioplasty.

Since Gruentzig's introduction of percutaneous transluminal coronary angioplasty in 1974, there has been increasing clinical use of this technic. At St. Thomas Hospital in Nashville, 50 patients were selected for coronary angioplasty through December 1981. Twenty of the 50 have ultimately had coronary artery bypass surgery. Excellent dilatation of the selected coronary artery was accomplished in 19 patients. Fair dilatation was achieved six times, and four of these patients have had elective coronary artery bypass surgery. In 18 patients the vessels could not be dilated, and 12 of this group had coronary artery bypass, three on an urgent basis. In the remaining seven patients, the affected coronary stenosis was converted to 100% occlusion during the angioplasty, resulting in four emergency operations and one death. It appears that percutaneous transluminal coronary angioplasty is not as easy to master as had been anticipated, and that the results are just good enough in our hands to justify perseverence.

Angioplasty, Balloon↗
PubMed1981

Pulmonary embolectomy.

During the past 10 years, 20 patients at St. Thomas Hospital had pulmonary embolectomy; there were 12 survivors. Ten patients had a pulmonary arteriogram prior to operation and, of these, there were 7 survivors. The remaining 10 patients were seen with circulatory collapse and were taken immediately to the operating room without definitive diagnostic studies. Ten patients were undergoing cardiopulmonary resuscitation at the time of the embolectomy and, of these, there were 5 long-term survivors. This review indicates that immediate diagnostic studies, such as lung scan or pulmonary arteriogram, should be undertaken as soon as the diagnosis of pulmonary embolus is entertained. Patients with sudden collapse, in the appropriate clinical setting, should be transported to the operating room as soon as possible. It would also appear that patients who are unresponsive to the usual measures of cardiopulmonary resuscitation are still reasonable candidates for pulmonary embolectomy, and this may represent their only change for survival. Patients in whom massive pulmonary embolus is confirmed by angiography should be considered for early pulmonary embolectomy despite a relatively stable hemodynamic and clinical picture.

Adult↗
PubMed1980

Air embolism and other accidents using pump oxygenators.

A surgery of 349 cardiac surgeons showed that during a six-year period, a pump oxygenator accident serious enough to cause patient injury or death occurred one per 1,000 procedures. A total of 264 deaths occurred as a direct results of an accident. Air embolism and disseminated intravascular coagulation were the two most common problems. Low-level alarm systems were reported to be used by 42% of the respondents and activated clotting times were used by 63%. Rigorous use of alarm systems and heparin monitoring could reduce the incidence of pump-related accidents.

Aged↗
PubMed1980

A comparative study of the handling of confidentiality.

Increasing concern with the problem of confidentiality has prompted the authors to examine factors associated with the handling of confidentiality among a sample of psychiatrists, psychologists, and internists. Significant differences were found among the three groups of clinicians. The nature of professional training and the predominant approach to treatment were found to be related to attitudes toward confidentiality, as was previous professional experience with socially threatening behavior. Implications of the findings are discussed.

Adult↗
PubMed1980

Results of surgical management of acute left ventricular aneurysms.

Over an 8-year period, 20 patients underwent operative repair of ventricular aneurysms during the first 8 weeks after acute myocardial infarction. All patients with multivessel coronary occlusive disease underwent concomitant coronary artery bypass grafting. There was one hospital death, for an early mortality rate of 5%, and one late death during follow-up, which now extends over 8 years, for a predicted actuarial 5-year survival rate of 92%. Six of the patients underwent early study and operation because of recurrent ventricular arrhythmias, with resolution of the arrthymia in all. Seventy-five percent of the survivors are not limited by symptoms and 45% are presently working working full time. These results were significantly better than those in patients who underwent operation later after infarction, although the two groups were not strictly comparable. An aggressive approach to surgical therapy in severely symptomatic patients soon after myocardial infarction can afford excellent early and long-term results.

Actuarial Analysis↗
PubMed1979

Rheumatoid pericarditis. Clinical significance and operative management.

The incidence of subclinical pericarditis associated with rheumatoid pericarditis may be as high as 50 percent, but significant impairment of cardiac performance owing to this type of pericarditis rarely occurs. In the past 7 years, we have encountered eight men with congestive heart failure owing to rheumatoid pericarditis. Cardiac catheterization and echocardiography were useful in establishing the diagnosis of pericardial constriction. Pericardiocentesis was unsuccessful in relieving symptoms in the three patients in whom the procedure was performed. Seven patients underwent pericardiectomy; six had constrictive pericarditis and one patient had an acute pericarditis with the sudden onset of cardiac tamponade. The other patient died of cardiac tamponade prior to operation. All patients improved after operation and have remained free of cardiac symptoms 3 months to 4 1/2 years later. The frequent occurrence of adhesive and obliterative pericarditis with loculated effusions suggests the need for pericardiectomy rather than pericardiocentesis in the patient with rheumatoid arthritis and symptomatic pericardial involvement. Immediate and lasting relief of this unusual nonarticular manifestation of rheumatoid arthritis can be expected after pericardiectomy.

Adult↗
PubMed1978

The cost of coronary bypass procedures.

We reviewed the financial records of 200 succesive patients who had coronary artery bypass surgery in the first three months of 1976. The average hospital bill was $7,690 and the average length of stay was 18 days. The highest bill was $28,329 (79 days) and the lowest was $6,126 (11 days). The average total physician charge to the patient was $3,240. The total average hospital and physician cost was $10,930.

Coronary Artery Bypass↗
PubMed1978

Median sternotomy dehiscence.

Sternal dehiscence requiring reoperation occurred in 36 out of 4,531 patients who had a sternotomy incison within an eight-year period. Twisted sternal wire sutures were used for the first four years and a crimped steel plate fixation was used during the second four years with a marked and significant decrease in the incidence of dehiscence from 17 out of 1,000 patients to 3 out of 1,000 patients. Thirty-five of the 36 patients were men, and 4 required reoperation for bleeding. Other factors such as mammary artery dissection, tracheostomy, and body weight of more than 82 kg were not significant. Although infection was noted in 20 patients, it was thought to be secondary. Early reoperation with antibiotic irrigation achieved wound stability in the 34 survivors with only 3 patients requiring additional procedures for chronic osteomyelitis of the sternum.

Anti-Bacterial Agents↗