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Biomedical subjects

D W Miller

Publications and source records attributed to D W Miller.

At least 199 records · Page 11Linked to original sources
PubMed1980

Selection of patients for coronary artery bypass operations.

Bypass operations have proved to be an effective treatment for advanced coronary artery disease. Randomized clinical trials have now shown that compared with medical treatment, bypass operations enhance survival in patients who have three-vessel disease or left main coronary stenosis. The goals of both medical and surgical treatment should be to improve a patient's quality of life, extend survival and reduce medical care costs. Preliminary data suggest that bypass operations may be less costly than medical treatment in patients with severe angina that requires repeated or prolonged stays in hospital.

Coronary Artery Bypass↗
PubMed1980

Membrane versus bubble oxygenator for cardiac operations. A prospective randomized study.

The advantages of membrane oxygenators over bubble oxygenators for cardiopulmonary bypass during clinical cardiac operations are controversial. A prospective randomized double-blind experimental design was utilized in 64 adult patients undergoing elective cardiac operations with either the Travenol microporous polyprolyene membrane oxygenator or the Bentley Q-100 bubble oxygenator. Sixteen patients in each group underwent coronary artery bypass grafting (CABG) and 16 underwent valvular or other types of operation. The two oxygenator groups were comparable in terms of patient characteristics and perioperative management. Both oxygenators functioned acceptably for an average duration of 115 minutes. Higher relative platelet counts (percent of control) were observed immediately after bypass in CABG patients in whom the membrane oxygenator was used. Otherwise, no significant differences were noted in objectively assessed results between the two oxygenators in regards to bleeding, pulmonary, renal, cardiac, and neurologic function, duration of ICU stay, and postoperative hospital stay. Thus no significant advantages in terms of clinical results could be detected with this type of membrane oxygenator versus another type of bubble oxygenator for elective cardiac operations in adults.

Adult↗
PubMed1979

Does preservation of the posterior chordae tendineae enhance survival during mitral valve replacement?

During a 30-month period, 51 patients underwent mitral valve replacement. There were 3 hospital deaths (5.9%), 2 of which were due to ventricular rupture. The 3 patients who died were among 13 patients in whom mitral valve replacement was combined with tricuspid or aortic valve operation or both. Postmortem findings in the 2 patients who died of ventricular rupture showed that the ventricular tears were located between the atrioventricular groove and the unresected papillary muscle stumps, in an area of ventricle formerly tethered by the posterior chordae tendineae. In the last 14 patients in the series, the posterior leaflet of the mitral valve and its chordae tendineae were left intact, and there was no mortality or prosthetic valve dysfunction. In patients with myxomatous or ischemic disease, the posterior leaflet was left completely intact. For patients with fibrocalcific rheumatic disease, we have developed a technique of partial excision and debridement of the posterior leaflet, preserving the intermediate and basal chordae tendineae attachments. With the techniques described, preservation of all or part of the posterior leaflet and its chordae tendineae does not appear to interfere with prosthetic valve function and, by reducing the risk of ventricular rupture, should enhance survival after mitral valve replacement.

Adult↗
PubMed1979

Absorbed radiation dose in mammography.

Radiation dose from mammographic techniques was determined as a function of surface exposure, beam quality, and depth. Relative exposure vs. depth was measured in tissue-substitute materials by thermoluminescent dosimetry. The f-factors were calculated from elemental compositions of mastectomy specimens. Dose at depth depends on beam quality as well as exposure and tissue composition. Analysis of data from the ACS/NCI Screening Centers shows current average midbreast doses to be 25 times lower (film/screen) and 3 times lower (Xerox) than the 2 rads previously estimated. Quantitative risk indicators other than midbreast dose are also discussed.

Adipose Tissue↗
PubMed1978

Retropubic urethropexy by the vaginal wall technique in stress urinary incontinence.

In our opinion retropubic urethropexy via the vaginal wall technique should be considered the primary operation to correct female stress urinary incontinence. The urethrovesical junction is elevated to the midsymphysis and supported by the vaginal wall and endopelvic fascia. Failure is related to not completing the basic objective of the operation, postoperative breakdown due to faulty selection or placement of sutures, and improper patient selection. This operation has proven to be simple, free of disturbing complications, and with durable results. Patients themselves attest to satisfaction with the results of the procedure.

Evaluation Studies as Topic↗
PubMed1978

Physiologic improvement following coronary artery bypass surgery.

In this study the effects of coronary artery bypass surgery on ventricular function were evaluated at rest by quantitative analysis of segmental wall motion on cineventriculography, and during maximal treadmill exercise by measurement of serial cardiac outputs (Fick method) with the use of indwelling pulmonary artery and radial artery catheters. The patient had single vessel coronary disease and exertional angina. Following placement of a bypass graft to the proximally occluded left anterior descenting coronary artery, and despite the presence of arterial hypoxemia secondary to interstitial pulmonary fibrosis, a striking increase in maximal cardiac output occurred, mediated by a rise in both maximal heart rate and stroke volume. In this patient, resting ventricular volumes and ejection fraction were normal both before and after surgery, but preoperative abnormalities in extent of segmental wall motion, identified quantitatively, were restored to normal after bypass grafting. These investigations indicate that bypass surgery can provide substantial physiologic benefits in addition to providing subjective relief of anginal symptoms.

Aged↗
PubMed1977

Surgical obliteration and silastic arthroplasty of the canine cricoarytenoid joint.

The effects of surgical trauma on the cricoarytenoid joint were analyzed using canine models. The cricoarytenoid joints of seven dogs were surgically disrupted. In four of the dogs an arthroplasty with silastic implantation was simultaneously performed. The histologic findings and the unsuccessful functional results are presented and discussed.

Animals↗
PubMed1977

Benefits of coronary artery bypass surgery.

More than 150,000 Americans have undergone coronary artery bypass surgery since this operation was first available on a nationwide scale in 1968. From data now available, we can better evaluate the various mechanisms by which bypass surgery has been thought to relieve anginal symptoms, and whether or not this operation improves ventricular function and increases survival. Most individuals have substantial or complete relief of angina after surgery, no longer require nitroglycerin or beta blocking agents, and are able to return to full physical and sexual activity. A bypass graft restores the capacity of a proximally obstructed coronary artery to increase its blood flow level up to fourfold more than resting levels with exertion. Also, evidence is now appearing that bypass surgery can improve survival in patients with advanced coronary artery disease.

Angina Pectoris↗
PubMed1977

Current practice of coronary artery bypass surgery. Results of a national survey.

A survey of techniques used in coronary artery bypass graft (CABG) surgery by 400 experienced cardiac surgeons is presented. These surgeons performed 41,000 CABG operations in 1975. A seventy-question survey form was answered by each surgeon on their techniques for cardiopulmonary bypass and myocardial preservation, choice of bypass conduit, and grafting techniques. We found that extracorporeal circulation is almost always used in CABG surgery. A wide divergence of practice exists in the use of left ventricular vents and in methods of myocardial protection during coronary artery grafting. A spectrum of graft suture techniques is employed, the most common being a running double-ended suture anastomosis with the end of the vein initially fixed only at its heel to the coronary artery. Only 23 surgeons (6 per cent) prefer the internal mammary artery (IMA) rather than saphenous vein, when feasible, as the bypass conduit of choice for CABG surgery.

Aorta↗
PubMed1976

Facial rehabilitation: surgical reconstruction following temporal bone resection.

Facial reconstruction and cosmetic surgery following extensive bone and soft tissue resection for carcinoma of the ear has not been emphasized in the past. Poor long term survival and local recurrence rates previously recluded considering extensive rehabilitative effort. A patient is presented, illustrating the problems resulting from major ablative surgery of the temporal bone. The surgical concepts and techniques used in this patient's facial rehabilitation are enumerated and described from both the functional of the principles used to other aspects of facial reconstruction are mentioned.

Adenocarcinoma↗