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Biomedical subjects

E P Todd

Publications and source records attributed to E P Todd.

At least 19 recordsLinked to original sources
PubMed1989

Eighteen to 37 hours' preservation of major organs using a new autoperfusion multiorgan preparation.

A new autoperfusion preparation was used to preserve six major organs simultaneously. In 7 Yorkshire white swine, the heart and lungs were separated and removed with the liver, pancreas, duodenum, and both kidneys en bloc while they were self-perfused. Fresh blood, glucose, electrolytes, heparin sodium, methylprednisolone, and a fat emulsion (Soyacal) were infused through the portal vein. No inotropic drugs were necessary. The organs survived for 18 to 37 hours (average survival, 24.6 +/- 2.7 hours [+/- standard error of the mean]). Aortic systolic pressure ranged from 78.5 +/- 5.5 to 98.7 +/- 11.8 mm Hg. Arterial oxygen tension ranged from 206 +/- 23 to 266 +/- 15 mm Hg and arterial carbon dioxide tension, from 20.1 +/- 2.7 to 32.1 +/- 4.9 mm Hg. Blood lactic acid levels decreased from 8.75 +/- 2.06 to 5.50 +/- 2.45 mmol/L at 24 hours. Urine output ranged from 25 to 82 mL/h. Blood urea nitrogen levels decreased from 9.17 +/- 0.59 to 4.67 +/- 1.08 mg/dL. Blood creatinine levels decreased from 1.34 +/- 0.10 to 0.57 +/- 0.22 mg/dL. Serum glutamicoxaloacetic transaminase levels increased from 73.4 +/- 26.3 to 194 +/- 179.5 U/L and serum glutamic-pyruvic transaminase levels, from 44.8 +/- 5.7 to 91 +/- 66.4 U/L. Red blood cell count ranged from 6.94 +/- 0.58 to 13.23 +/- 2.30 x 10(6)/microliters. Lung wet/dry weight ratios changed from 5.79 +/- 0.17 at the beginning to 6.25 +/- 0.16 at 24 hours. The technique for simultaneous multiorgan preservation presented here is simple, effective, and highly reproducible. This study appears to have produced one of the longest average survival times for autoperfusion.

Animals↗
PubMed1988

Ventriculocoronary connections in hypoplastic right heart syndrome: autopsy serial section study of six cases.

Myocardial sinusoids communicating with the coronary systems occur in pulmonary atresia with intact ventricular septum. To test the hypothesis that the extent of ventriculocoronary connections correlates with the degree of right ventricular outflow obstruction as evidenced by clinical, angiographic and gross anatomic findings, a serial section study of six human autopsy hearts representing a spectrum of hypoplastic right heart was undertaken. Slides were evaluated for the presence and extent of ventriculocoronary connections, associated developmental abnormalities and secondary changes in the ventricular walls. Whereas extensive blind-ended deep sinusoids were a feature of all five cases with unrelieved obstruction, ventriculocoronary connections were identified in three. Changes that suggested ongoing remodeling provide new evidence for the postnatal temporal evolution of these anomalous communications. The regional distribution of myofiber disarray in hypoplastic right heart supports the concept that vascularization parallels myocardial organization in the developing human heart.

Coronary Vessels↗
PubMed1988

New autoperfusion preparation for long-term organ preservation.

The problems in long-term organ preservation are ischemia and toxicity from metabolic waste. A simple self-perfusing self-cleaning system has been developed that kept the heart, lungs, and kidney functioning for a mean time of 24 hours. Nine adult dogs were anesthetized and artifically ventilated. The heart and lungs were removed en bloc while being perfused by the heart. One kidney was connected to the descending aorta and inferior vena cava. No anticoagulant was used. Another group of six dogs without functioning kidneys was used as the control group. In the experimental group, urine output ranged from 26 to 48 ml/hr, aortic systolic pressures were 80-107 mm Hg, heart rate was 85-100 beats/min, serum potassium content was 3.25-4.40 mmol/l, and serum sodium content was 155-163 mmol/l. In the experimental group, blood creatinine levels decreased from 0.95 to 0.47 mg/dl during preservation; in the control group, blood creatinine levels decreased from 0.96 to 0.79 mg/dl. Lung biopsies in the preparation with the longest survival showed good preservation for as long as 24 hours, and no thrombi were present. This preparation has the advantage of no ischemic time, no foreign material in the circulation, and the ability to automatically maintain acid-base balance and blood electrolytes. The simplicity of this autoperfusion preparation may allow greater transport distance in organ procurement for subsequent transplantation.

Animals↗
PubMed1988

A simple technique for multiorgan preservation.

A simple technique for multiorgan preservation with no ischemic time was developed. In five mongrel dogs, the heart and lungs were separated and removed with the liver, pancreas, kidneys, and a small portion of intestine en bloc while they were being self-perfused. A respirator was used for oxygenation. Arterial and venous blood pressures were measured by indwelling catheters. Fresh blood, glucose, electrolytes, mannitol, prednisolone, and a fat emulsion (Soyacal) were infused through the portal vein. The organs were experimentally perfused for 12 hours. Aortic systolic pressure ranged from 75 to 125 mm Hg, central venous pressure from 0 to 5 mm Hg, portal venous pressure from 0 to 3 mm Hg, bile output from 5 to 20 ml/hr, urine output from 10 to 70 ml/hr, and hematocrit value from 35% to 55%. The heart and lungs were normal and physiologically functional during the preservation time. The pancreas and small intestine appeared normal. Three of the livers showed some congestion. The kidney in one organ block appeared to have some edematous swelling after 16 hours. The technique for multiorgan preservation presented here is simple and effective. The preliminary data are encouraging and suggest further evaluation.

Animals↗
PubMed1987

Down's syndrome.

We discuss the ethical, psychosocial, economic, and medical dimensions of the treatment and management of a child with Down's syndrome and a congenital heart defect.

Down Syndrome↗
PubMed1985

Upper rib fractures following median sternotomy.

First and second rib fractures occurred in 11 (16%) of 69 patients undergoing median sternotomy. Although 6 patients had no symptoms related to the rib fractures, 5 patients had postoperative chest, shoulder, and arm pain suggestive of angina pectoris or postpericardiotomy syndrome. The correct diagnosis of pain related to postoperative upper rib fracture may be made by direct visualization of the fracture on supine anteroposterior radiographs, elicitation of pain by palpation of the rib or motion of the upper extremity, lack of response to nitroglycerin, and negative electrocardiogram and cardiac enzyme levels. Upper rib fractures following median sternotomy are usually radiographically detectable within the first three postoperative days. Placement of the Ankeney sternal retractor with the upper blade in a lower position (fourth intercostal space) may reduce the incidence of this postoperative complication.

Adult↗
PubMed1985

Anomalous left coronary artery from the pulmonary artery: significance of associated intracardiac defects.

Two patients with anomalous origin of the left main coronary artery from the pulmonary artery had an associated defect (one, critical pulmonary stenosis; the other, ventricular septal defect). They presented with signs and symptoms of the associated defect and the coronary anomaly was unrecognized. Both cases at autopsy lacked the usual large right coronary artery seen with this anomaly. The pathophysiologic features of the combined defects are described, their differences from the isolated anomaly are noted and their relation to surgery is discussed.

Abnormalities, Multiple↗
PubMed1985

Acute aortic dissection.

Disease processes affecting the aorta are gaining increasing attention as average longevity of the population in this country increases and as awareness of conditions such as hypertension and atherosclerotic cardiovascular disease improves. Aortic dissection is commonly seen as a manifestation of these processes in the aging population and is the most common catastrophic illness affecting the aorta. Familiarity with its pathogenesis, diagnosis, and therapy is mandatory to prevent almost certain death if left untreated.

Acute Disease↗
PubMed1985

Supravalvular aortic stenosis. Clinical and pathologic observations in six patients.

Supravalvular aortic stenosis with a mean pressure gradient of 101 mm Hg was encountered in six patients aged 1 1/2 to 12 years. Three patients had Williams syndrome. In two other patients the stenosis was familial. The angiographic/anatomic subtype of deformity was hourglass in four patients, diffuse in one, and membranous in one. Four patients are alive following successful surgical repair; the other two died without surgery. Microscopically, disorganized medial elements with fibrotic intima sometimes containing lacunae were observed in five cases; the one other had valvelike tissue only. Ultrastructurally, thick irregular elastic fibers, abundant swirling collagen, hypertrophied smooth-muscle cells, and scant ground substance characterized the medial tissue defect. Although hemodynamics during intrauterine development may predispose to localization of the stenosis to the supra-aortic valvar region, the cause for the mural dysplasia remains uncertain.

Adult↗
PubMed1984

Treatment of ventricular tachycardia using an automatic scanning extrastimulus pacemaker.

A patient with recurrent sustained ventricular tachycardia that was resistant to both conventional and experimental antiarrhythmic agents was treated with a programmable automatic scanning extrastimulus pacemaker. The antitachycardia pacemaker was implanted only after many episodes of spontaneous and laboratory-induced ventricular tachycardia were reliably and reproducibly terminated with programmed ventricular extrastimuli. In the 6 months since implantation of the automatic scanning pacemaker, all episodes of ventricular tachycardia have been terminated successfully by the pacemaker. Acceleration of rate of ventricular tachycardia or induction of ventricular fibrillation did not occur at any time during attempted termination of ventricular tachycardia by the pacemaker. The advantages of the automatic scanning extrastimulus pacemaker over other antitachycardia pacemakers are discussed.

Electrocardiography↗
PubMed1984

Right atrial rupture due to blunt chest trauma.

Violent injury currently accounts for the majority of deaths among young people. Cardiac trauma is responsible for 15% of deaths from thoracic injury, and the incidence of cardiac injury in blunt chest trauma is as high as 76% in some clinical series. Many of these cardiac injuries consist of myocardial contusions. Recently, however, there has been increasing recognition of chamber disruption caused by blunt chest trauma. Cardiac injury is usually the result of direct compression of the heart between the sternum and the dorsal spine. These patients are frequently in extremis, with signs of pericardial tamponade, hypotension, and/or massive hemothorax. Successful management is dependent upon prompt diagnosis and surgical repair. To date there have been only 28 survivors (including the three patients in this report) of this catastrophic and frequently unrecognized injury.

Accidents, Traffic↗
PubMed1983

Thrombotic catastrophe in the patient with multiple Björk-Shiley prostheses.

Thrombosis of the Björk-Shiley prosthesis has been a recognized problem for many years. Review of 172 patients at the University of Kentucky Medical Center who had one or more Björk-Shiley valves inserted between January, 1975, and July, 1980, revealed special problems in those patients with multiple prostheses. Diagnosis and therapy prove more difficult, and the cumulative incidence of thrombosis in the patients with multiple prostheses is 26.8% at six years. Projected long-term use of multiple Björk-Shiley prostheses is discouraged.

Aortic Valve↗
PubMed1982

Management of ascending aortic aneurysm complicating coarctation of the aorta.

Four patients with coarctation of the aorta complicated by an aneurysm of the ascending aorta are described. One patient, treated only medically, died suddenly. For the 3 patients who underwent operation, management was similar. Pharmacological control of blood pressure and repair of the aortic coarctation to achieve anatomical reduction in afterload (stage I) were followed after an interval of one to five weeks by surgical repair of the ascending aortic aneurysm (stage II). Initial repair of the coarctation relieves proximal hypertension, thereby decreasing the chance of progressive dissection or rupture of the aneurysm. It also permits safe arterial cannulation for perfusion during correction of the aneurysm in the second stage. In patients not requiring valve replacement in stage II, continued long-term follow-up for progression of aortic valvular disease appears to be necessary.

Adolescent↗
PubMed1982

Cervical osteomyelitis after esophageal perforation.

A patient with diabetes mellitus who sustained an iatrogenic perforation of the cervical esophagus subsequently had osteomyelitis of the cervical spine involving the bodies of C-6 and C-7. This occurred despite early and aggressive surgical treatment of the perforation. Roentgenograms of the cervical spine should be included in the follow-up of selected patients treated for perforation of the esophagus.

Cervical Vertebrae↗
PubMed1982

Pulmonary atresia with intact ventricular septum and ventriculocoronary communications: surgical significance.

The first stage of a repair of pulmonary atresia with intact ventricular septum (type I) was attempted in a 2-day-old infant. At surgery, decompression of the hypertensive small right ventricle was followed by a sudden loss of myocardial contractility and death. Postmortem examination revealed a fistula with a large orifice in the right ventricular infundibulum that communicated directly with the left main coronary artery. Severe hypertensive changes indicative of abnormally high perfusion pressure were noted in the distal left coronary artery branches. The clinical course suggests that the effect of relieving right ventricular outflow obstruction was a reduction of left main coronary artery blood flow, resulting in fatal intraoperative myocardial ischemia. This unusual case draws attention to the anomalous ventriculocoronary communications often present in pulmonary atresia and their potential for limiting a successful surgical repair.

Coronary Vessel Anomalies↗