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Biomedical subjects

G A Guinn

Publications and source records attributed to G A Guinn.

At least 37 records · Page 2Linked to original sources
PubMed1977

Median sternotomy closure with running wire: a simplified method.

A method of median sternotomy closure which utilizes running wire is described here. We believe this method shortens the surgical time involved in closing the chest and also that it is a safe method which provides significant saving of wire material so that it can be accomplished generally with one No. 20 stainless steel wire.

Humans↗
PubMed1977

Rational use of operation in pericardial constriction.

The most appropriate operation for constricting pericardial disease must be selected to provide optimum chance for permanent recovery of myocardial function with minimal morbidity. Our 18 patients demonstrate the changing cause of pericardial constrictive disease and the application of newer surgical treatments. Good results were obtained in 16 patients.

Follow-Up Studies↗
PubMed1976

Clamp for wire closure of sternum.

A modification of the Kocher clamp used for wire closure of the sternum is described. With the clamp applied securely to the individual strands, the wire can be readily twisted; the shorter length of the clamp allows the surgeon a much firmer grip on the wire and saves considerable time during closure.

Cardiac Surgical Procedures↗
PubMed1976

Surgical versus medical treatment for stable angina pectoris: prospective randomized study with 1- to 4-year follow-up.

A prospective randomized study to evaluate aortocoronary bypass was done on 116 patients (56 surgical, 60 medical) who had documented coronary artery disease (70% luminal obstruction in a major artery). The two groups were similar in age and risk factors. All patients have been followed for a mean of 34 months, and recatheterization has been done in 106 of the survivors. Important results show that although most patients in both groups are improved, more surgical patients are asymptomatic (68 vs 8%). Exercise tolerance was better in the surgical group (+94% vs +43%). There was significantly greater evidence of preinfarction angina in the medical group (p less than 0.02), but survival was similar.

Angina Pectoris↗
PubMed1975

Surgical treatment for stable angina pectoris. Prospective randomized study.

To evaluate the role of coronary bypass treatment of stable angina, 72 patients were randomly divided into surgical and medical groups. They were followed with treadmill tests and repeat catheterization. Anginal symptoms decreased or disappeared in 89 per cent of those operated on and 65 per cent of those not operated on, but more of the former than of the latter became asymptomatic: 69 vs. 11 per cent respectively (p smaller than 0.01). Exercise tolerance time improved significantly (p smaller than 0.001) in both groups, but more in the group operated on, plus 78 per cent vs. plus 48 per cent, p smaller than 0.05. During a 28-month follow-up period, fewer cardiac complications occurred in the patients operated on--14 vs. 34 (p smaller than 0.02). Mortality was 9 per cent in the patients operated on and 14 per cent in those not operated on; this difference is not significant. The results indicate that improvement, though demonstrable in both groups, is greater with surgery, and quality of life during the first 28 months is better in patients who are operated on.

Angina Pectoris↗
PubMed1975

Maximal revascularization (reperfusion) in intact conscious dogs after 2 to 5 hours of coronary occlusion.

Acute infarction was produced in intact conscious dogs by inflating a previously implanted balloon cuff around the left anterior descending coronary artery was occluded in 26 control dogs and reperfused by deflating the balloon cuff after 2 hours of occlusion in 19 dogs (group II) and after 5 hours in 11 dogs (group III). Serial studies were performed and repeated after 48 hours and 7 days. All three groups revealed hemodynamic and metabolic deterioration with coronary occlusion and infarct production. Immediately after reperfusion, arrhythmias developed in groups II and III and persistent ventricular tachycardia was present 2 to 3 hours after reperfusion in 74 percent of animals in group II and 82 percent of those in group III compared with 6 percent and 13 percent incidence rates at corresponding times in control dogs. Q waves developed in 83 percent of animals in group II and 100 percent of those in group III but in only 12 and 27 percent of control animals at corresponding times. Hemodynamic deterioration was accelerated in the postreperfusion period in both groups II and III. Angiographic assessment revealed improvement in 42 percent of dogs in group II, but in none of those in group III after reperfusion. Myocardial oxygen extraction diminished to subnormal levels after reperfusion, indicating either reactive hyperemia or shunting effect. Mortality was not significantly influenced by reperfusion. Infarct size was more than 15 percent of ventricular mass in 92 percent of control dogs and in 100 percent of dogs in group III, but in only 50 percent of those in group II. The data indicate that reperfusion in conscious dogs representing early, noninvasive maximal revascularization under ideal circumstances fails to prevent deterioration or death; instead it hastens the development of arrhythmias and myocardial injury. Reperfusion, although deleterious in the first hours, can reduce infarct size if performed after 2 hours, but not after 5 hours, of occlusion.

Animals↗
PubMed1975

Use of the activated coagulation time in intraoperative heparin reversal for cardiopulmonary operations.

Activated clotting time (ACT) was used in 300 consecutive patients undergoing cardiac operations to determine the adequacy of heparin reversal. Mean ACT prior to protamine sulfate administration was 9 minutes 40 seconds. A return to normal value (less than 2 min 10 sec) occurred in three-fourths of our patients following administration of 1.5 mg of protamine sulfate for each 100 units of heparin. Additional protamine sulfate was administered in 50 mg doses to those having abnormal ACT until normal clotting was obtained. Normal values for ACT usually coincided with clotting in the operative field. ACT proved to be a reliable guide to protamine sulfate administration.

Aortic Aneurysm↗
PubMed1975

Surgical treatment of leukemic involvement of the mitral valve.

A patient with severe mitral insufficiency due to infiltration of the valve and myocardium by leukemic lymphocytes is presented. Treatment was replacement of the valve with a prosthesis. The significance of this patient lies in the rarity of the clinical state and the novelty of treatment.

Heart Valve Diseases↗
PubMed1975

Immediate operative treatment for massive hemoptysis.

A series of 15 patients with life threatening, massive hemoptysis is reported. Thirteen of these patients underwent immediate operative treatment with only three deaths. One died after bronchoscopic identification of the bleeding site while awaiting elective thoracotomy. The other patient left the hospital against medical advice. Immediate identification of the site of bleeding by bronchoscopy followed by thoracotomy with resection of the bleeding source, is the preferred method of managing such patients, except when there are specific contraindications to resection.

Adult↗
PubMed1975

Prospective randomized study of coronary bypass surgery in stable angina. The first 100 patients.

In a prospective study to evaluate surgery for angina pectoris, 50 patients randomized to surgery and 50 treated medically have completed 8 to 34 months' follow-up (median, 24 months). Anginal symptoms improved in both groups (88%, 72%), but more operated patients are currently asymptomatic (70%, 8%) and using fewer medications (nitrates, 18%, 96%; propranolol, 8%, 72% of patients). Exercise tests with treadmill revealed increased exercise tolerance time in both groups, more so in the operated group (+ 89%, + 42%), and angina could not be provoked in 70% and 20% of patients, respectively. During the follow-up, fewer cardiac complications developed in the operated group (19 vs. 44; P = less than 0.02); there was no difference in mortality. Repeat catheterization in 83 of 84 survivors at 1 year did not reveal any significant differences in the progression of disease. Atrial pacing studies revealed improvement in anginal threshold in 70% of operated and 48% of nonoperated patients. The study suggests that although subjective and objective improvement occurs with surgical as well as nonsurgical treatment, the frequency and magnitude are higher with surgery. The quality of life appears to be better in the operated patients during the first 24 months. Further follow-up is necessary to determine the duration of such improvement and to assess the influence of surgery on the natural life history of this disease.

Angina Pectoris↗