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Biomedical subjects

F C Wells

Publications and source records attributed to F C Wells.

87 records · Page 5Linked to original sources
PubMed1984

Use of prostacyclin and ultrafiltration in adult respiratory distress syndrome.

A primigravida with severe kyphoscoliosis developed cardio-respiratory failure in pregnancy. Cardiac arrest occurred 10 days after Caesarean section; gastric acid was aspirated then and was followed by the development of adult respiratory distress syndrome. Initial recovery, with clearing of peripheral oedema, was followed by a recurrence of respiratory distress associated with infection. Profound hypoxaemia and oliguria unresponsive to diuretics were relieved by the infusion of prostacyclin combined with fluid removal by ultrafiltration. This treatment may be of value in the management of respiratory distress syndrome when pulmonary oedema is the dominant feature.

Adult↗
PubMed1983

Wound infection in cardiothoracic surgery.

The incidence of wound inflammation and infection for ten days after routine cardiothoracic operations was monitored in 454 patients having routine open-heart surgery (179), thoracotomy (100), or coronary artery bypass surgery (175). The percentage incidence of inflammation/infection for intracardiac operations was 12/2.3, for thoracotomies 12/1, and for coronary artery surgery including leg wounds 39/12 (sternal infection rate 7.5%). The incidence of staphylococcal infection was similar in the three groups. The excess of sternal wound infections in patients having coronary artery surgery was related to gram-negative bacteria (enterobacteria or acinetobacter) and similar bacteria were found in leg wounds. The findings suggest that bacteria from the leg or perineum are transmitted to the sternal wound at operation. A preoperative bath with chlorhexidine did not alter the incidence of infection but did seem to reduce the incidence of inflammation in leg wounds.

Cardiopulmonary Bypass↗
PubMed1983

Duration of circulatory arrest does influence the psychological development of children after cardiac operation in early life.

Published works on intelligence quotient (IQ) and development following the use of profound hypothermia and circulatory arrest (TCA) to repair congenital heart defects in infants and young children suggest that little or no psychomotor impairment results. IQ scores derived from cognitive, memory, perceptual, quantitative, and verbal tests (McCarthy scale of the children's abilities, mean score 100, SD 16) were measured in 31 patients 5 years following operations performed with TCA between 1972 and 1976. These patients were compared with three control groups: (1) 19 patients with similar defects but operated upon using moderate hypothermia and continuous cardiopulmonary bypass (CPB); (2) 16 children who were the siblings of the TCA patients; and (3) 14 children who were the siblings of the CPB patients. The hypothermic temperatures reached were closely clustered around 15 degrees C in the TCA group and 28 degrees C in the CPB group. TCA time ranged from 22 to 71 minutes. Statistical analysis, which included, t test, chi square test of association, and Wilcoxon test, showed that the only baseline characteristic which differed between the two patient groups in respect to age at operation, age at testing, and preoperative physiological variables (level of cyanosis, weight, oxygen saturation, and hemoglobin concentration) was weight (p = 0.03). The mean score of the TCA group (91 +/- 4.0, SE) was significantly lower (p = 0.002) than that of their siblings (106 +/- 4.1, SE). The score for the CPB patients (102 +/- 5.2, SE) was not demonstrably different from that of their siblings (96 +/- 5.9, SE). The sibling and patient (TCA) IQ differences were associated with duration of arrest in verbal (p = 0.06), quantitative (p = 0.07), and general cognitive (p = 0.003) scores. A decrease of 0.53 point per minute of arrest time was estimated for the entire group of 31 patients; that is, in the 19 patients with siblings, for each minute increase in circulatory arrest time, the patients dropped 0.69 IQ point below their siblings. These results and analysis of other published data do not support the generally accepted view that TCA can be used entirely without penalty. We question the accepted "safe" limit of circulatory arrest of 60 minutes.

Cardiopulmonary Bypass↗
PubMed1982

Emergency open-heart surgery. Experience with 100 consecutive cases.

One thousand two hundred and three open-heart operations were performed at Papworth Hospital between January 1973 and December 1978 with an early (30 day) operative mortality of 5.3%. One hundred patients were treated on an emergency basis. This is defined as an operation necessarily performed within 24 hours of referral to a surgeon. The early mortality in this group was 24 (24 per cent) and accounted for one third of the early deaths during the period under review. The main clinical conditions requiring emergency surgery included ischaemic heart disease (36 patients, early mortality 22.2%); critical valve disease (24 patients, 12.5%); bacterial endocarditis (14 patients, 28.5%); acute aortic dissection (11 patients, 36%) and complications associated with valve substitutes (11 patients, 36%). Almost all the deaths in the ischaemic heart disease group occurred in those undergoing operation for the complications of infarction. Many factors contribute to the higher risk of emergency open-heart surgery. Of these, dysfunction of other organ systems secondary to low cardiac output and the state of the left ventricle are the most important. Earlier referral for operation of patients with critical valve disease should help to reduce mortality.

Adult↗
PubMedDate not supplied

Radiological evaluation of the ascending aorta following repair of type A dissection.

A patient with persistent chronic dissection proximal to an aortic interposition graft for repair of a type A dissection prompted us to review the computed tomographic (CT) findings in 14 other such patients 5-47 months after surgery. No other case of proximal aortic dissection was identified although dilatation of the aortic root proximal to the graft was present in 8 patients (57%). Persistent dissection distal to the graft in 11 patients (79%) was in keeping with that reported by other workers. Chronic dissection proximal to the surgical repair of a dissection seems a rare although important complication.

Aortic Dissection↗
PubMedDate not supplied

Airway stenoses after lung transplantation: management with expanding metal stents.

Success in lung transplantation has been hindered by airway complications, usually as a result of anastomotic ischemia and stenosis. We report our experience with expanding metal stents in managing airway stenoses after lung transplantation. From April 1984 through November 1993, 46 single lung, 5 double lung, and 154 heart-lung transplantations were performed at Papworth Hospital. All patients received immunosuppression with azathioprine, cyclosporine, methylprednisolone, and induction antithymocyte globulin. Fourteen patients (nine single lung, two double lung, and three heart-lung) had an airway stenosis requiring a stent. The most common features were shortness of breath, wheezing or stridor, and a fall in pulmonary function tests (11 patients). Three patients had pneumonia. Airway stenosis was diagnosed on bronchoscopy an average of 61 days after transplantation (range 3 to 245 days). Stent placement occurred an average of 18 days after the diagnosis (range 2 to 84 days). One heart-lung transplant recipient received a silicone rubber stent. All other patients received expanding metal stents. Six patients required multiple stent placements. After stent placement the average increase in the forced expiratory volume in 1 second was 117%. Infection complicated the stenoses in 12 patients. Pseudomonas aeruginosa and Aspergillus fumigatus were the most common pathogens, each occurring in six cases. Multiple pathogens were isolated in seven cases. Three patients died as a direct consequence of their airway problems. Two died of pneumonia despite stenting, and a third died of acute occlusion of the silicone rubber stent. Expanding metal stents are an effective treatment of airway stenoses in lung transplant recipients. Patients with suspected airway problems should be referred for early bronchoscopy with the potential for stent placement.

Adult↗
PubMedDate not supplied

Domino heart transplantation: the Papworth experience.

The use of donor hearts from heart-lung recipients, the so-called domino procedure, began at Papworth Hospital in November 1988. Between then and September 1992, 198 heart transplantations and 86 heart-lung transplantations were performed. Fifty-three heart-lung recipients donated their hearts for use in the domino procedure. Thirty-two domino hearts were transplanted at Papworth and 21 were exported to other centers. Institution of the domino procedure allowed us to perform 19% more heart transplantations (166 to 198) than would have been done had the procedure not been used. The ischemic time was significantly shorter for the domino hearts compared with organs from brain dead donors (134 minutes versus 191 minutes; p < 0.001). No difference was found in the 3-month (84% versus 83%) or 1-year (74% versus 76%) survival between domino and nondomino recipients. Other potential advantages of the domino procedure include detailed pretransplantation evaluation of the heart in live donors and the potential for human leukocyte antigen matching. Additionally many heart-lung recipients have elevated pulmonary artery pressures and a "conditioned", hypertrophied right ventricle. The use of such hearts for heart transplantation has theoretic appeal for patients with elevated pulmonary vascular resistance.

Actuarial Analysis↗
PubMedDate not supplied

Heart-lung transplantation for end-stage respiratory disease in patients with cystic fibrosis at Papworth Hospital.

Between October 1985 and July 1992 we performed heart-lung transplantation in 42 patients with end-stage respiratory disease caused by cystic fibrosis. Twenty-eight of these patients are alive at 3 months to 7 years after heart-lung transplantation. Actuarial survival at 1 year and 3 years after transplantation was 78% and 65%, respectively, in this group, which compares favorably with 77% and 60%, respectively, in patients without cystic fibrosis undergoing heart-lung transplantation. Similarly no significant difference was found in the incidence of postoperative infections between patients with cystic fibrosis and patients without cystic fibrosis undergoing heart-lung transplantation. Quality of life indexes analyzed by the Nottingham Health Profile reveal significant improvements for patients surviving longer than 3 months from surgery. Long-term survival is determined by the development of obliterative bronchiolitis, which has occurred in 11 patients, six of whom have died. Early postoperative survival appears to be compromised by poor preoperative nutritional status. The study provides evidence that patients with end-stage respiratory disease caused by cystic fibrosis gain a survival advantage and improvement in quality of life after heart-lung transplantation when compared with patients who do not receive this form of therapy.

Actuarial Analysis↗
PubMedDate not supplied

Audit of referral and explant diagnoses in lung transplantation: a pathologic study of lungs removed for parenchymal disease.

BACKGROUND: Lung transplantation is performed for an increasing range of pulmonary conditions in which the diagnosis is often clinical or based on limited biopsy material. Diagnosis may be made late in the course of the disease where specific features are no longer present. Posttransplantation complications and disease recurrence may relate to the primary disease, and accurate diagnosis is therefore essential. METHODS AND RESULTS: A pathologic review of 183 explanted lungs over a 10-year period (heart-lung = 109, single lung = 65, double lung = 9) showed 29 significant discrepancies or additional features likely to effect outcome. The final pathologic diagnosis was cystic fibrosis (n = 66), emphysema (59), bronchiectasis (17), pulmonary fibrosis (19), sarcoidosis (10), Langerhans cell histiocytosis (3), pulmonary veno-occlusive disease (3), posttransplantation obliterative bronchiolitis (2), primary hemosiderosis (1), rheumatoid obliterative bronchiolitis (1), extrinsic allergic alveolitis (1), pneumoconiosis (1). Unsuspected diagnoses included tuberculosis (8) (four cases of which were active and in single lung recipients requiring antituberculous chemotherapy), sarcoidosis (9), (of which, six were unsuspected primary diagnoses and three were additional diagnoses), veno-occlusive disease (3), carcinoma (1), pneumoconiosis (1), and pulmonary fibrosis (2). Aspergillus infection (2) and bronchocentric granulomatosis (3) were found in patients with cystic fibrosis. One active tuberculosis case also showed an aspergilloma. Unsuspected infections requiring therapy in immunosuppressed patients and previously unsuspected sarcoidosis, which is known to recur in the graft, were the major novel diagnoses. Discrepancy rate was 12 of 65 in single lungs (19%) and 17 of 109 in heart-lungs (16%). CONCLUSIONS: These results emphasize the need for accurate preoperative diagnosis especially when the similarly diseased native lung remains in situ.

Adult↗
PubMedDate not supplied

Bullous emphysema: the role of the surgeon.

Emphysema is the permanent dilatation of the distal respiratory passages. Although the mainstay of treatment of emphysema is medical, there are certain groups of patients who obtain both symptomatic and prognostic benefits from certain surgical treatments, both old and new. This article discusses the indications for treatment and the different treatment options.

Humans↗