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Biomedical subjects

G C Morris

Publications and source records attributed to G C Morris.

At least 37 records · Page 2Linked to original sources
PubMed1982

Clinical results of coronary bypass in 500 patients at least 10 years after operation.

We determined the outcome of coronary artery bypass surgery in 500 consecutive patients followed for at least 10 years after operation. There were 446 males (89.2%). Angina pectoris was the major indication for operation. Four hundred six patients (81%) had multivessel coronary artery disease and 348 (69.9%) had good left ventricular function. At 10 years of follow-up, 48% of patients were asymptomatic and 41% were improved. Propranolol was being used by 36% of patients and nitrates by 49%. Of the 355 patients younger than 65 years of age at the time of follow-up, 57% were employed full time and 24% were working part-time. Reoperation was performed in 9% of patients. Analysis of survival by Kaplan-Meier curves indicated that overall 10-year survival rates were 78% for one-vessel disease, 69% for two-vessel disease, 48% for three-vessel disease and 67% for left main coronary artery disease. For patients with good left ventricular function, the 10-year survival rates were 83% for one-vessel disease, 73% for two-vessel disease, 53% for three-vessel disease and 73% for left main disease. For patients with poor left ventricular function, the rates were 56%, 59%, 40% and 54%, respectively. Cox multivariate analysis indicated that preoperative diuretic use, history of heart failure, the number of diseased vessels, and infarct on the preoperative ECG were all good predictors of survival. This study shows that the outcome of coronary artery bypass surgery 10 years operation is highly favorable.

Angina Pectoris↗
PubMed1981

Unusual presentation of bronchogenic carcinoma: case report and review of the literature.

Although blood spread of pulmonary malignancy presumably occurs through microembolization, frank embolization of tumor fragments is uncommon. The first reported case of bronchogenic carcinoma appearing as a peripheral arterial embolus is described. The patient, a 64-year-old female, had acute ischemia of the left leg secondary to tumor embolism to the left profunda femoris and popliteal arteries. Shortly after embolectomy, she suffered atelectasis of the whole left lung from an epitheloid carcinoma in the left main bronchus. Twenty-eight cases of frank tumor embolism to the arterial tree occurring during the course of a noncardiac malignancy have been reported. None, however, occurred as an initial event. Pulmonary metastasis in patients with advanced malignancy was the source of the arterial emboli in 45% (13/29) of reported cases, but bronchogenic carcinoma was the original cell type in 38% (11/29) of cases. In general, arterial tumor embolism is a complication of advanced malignancy usually originating from one of multiple pulmonary metastases. This first case report of tumor embolism to a lower extremity occurring as the initial event in the clinical course of a bronchogenic carcinoma serves to emphasize the protein manifestations of malignant disease.

Angiography↗
PubMed1981

Late repair of coarctation of the descending thoracic aorta in 190 patients. Results up to 30 years after operation.

Over a 30-year period, 190 consecutive patients had repair of coarctation of the descending thoracic aorta at a mean age of 25 years (range, 1 to 60 years); 130 were male. Median preoperative blood pressure (BP) was as follows: systolic, 160 mm Hg (range, 94 to 300 mm Hg) and diastolic, 90 mm Hg (range, 50 to 160 mm Hg). Dacron grafts were used in 64.7% of patients. Follow-up was obtained at a mean interval of 84.9 months, range, one to 360 months. Survival status was established for 86.1% (163/190) of patients. Postoperatively, the median BP was 133 mm Hg systolic (range, 90 to 195 mm Hg) and 80 mm Hg diastolic (range, 50 to 120 mm Hg). Overall, 80% of patients were either normotensive or had mild hypertension after operation. The best BP response and late survival were in patients operated on under 13 years of age. This study further confirms that early operation (below 5 years of age) is desirable. However, contrary to some previous reports, patients operated on as adolescents, despite some mild residual hypertension, had an excellent long-term prognosis. Patients over 21 years of age at operation had a high rate of persistent hypertension and experienced other serious cardiovascular complications.

Adolescent↗
PubMed1981

Acute and chronic stimulation thresholds of intramyocardial screw-in pacemaker electrodes.

Two screw-in intramyocardial electrodes were inserted in the left ventricle of each of 6 mongrel dogs, and the electrical characteristics were studied over a six-month period. The unipolar lead configuration had consistently better threshold and sensing values than the bipolar configuration during this period. Peaking between implantation and 3 weeks later, mean lead thresholds increased significantly (unipolar, 0.4 to 8.2 mu J; bipolar, 0.6 to 10.2 mu J) while R wave amplitude decreased (unipolar, 16.6 to 8.5 mv; bipolar, 10.6 to 5.8 mv). Mean chronic values for stimulation thresholds were as follows: unipolar, 2.6 mu J, and bipolar, 3.1 mu J. Mean values for the R wave amplitude were as follows: unipolar, 10.6 mv, and bipolar, 7.2 mv. Analysis of the results indicated that with certain exceptions, the optimum system has 2 intramyocardial electrodes, 1 in unipolar configuration and 1 "reserve." In general, adequate values at implantation are a stimulation threshold of 1.4 mu J (e.g., 1.1 v at 500 ohms and 0.6 msec pulse width) and an R wave amplitude of 5 mv.

Animals↗
PubMed1981

Perforation of the pulmonary artery with Swan-Ganz catheters: diagnosis and surgical management.

Swan-Ganz catheters have become a very valuable and frequently used method of monitoring hemodynamics in sick patients. Although the incidence of complications is very low, more reports are beginning to appear. One of the more serious complications is the rupture of the pulmonary artery. This report concerns three patients who had a rupture of the pulmonary artery who survived, including one of almost fatal exanguination. A literature review of all cases of pulmonary artery rupture is presented. Fifty-three per cent (8/15) were fatal. Emphasis is placed on the prevention of this by using the guidelines. Discussion also covers possible contributing causes and treatment. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained cardiac or respiratory changes.

Adult↗
PubMed1981

Resection of abdominal aortic aneurysm in the presence of horseshoe kidney.

We report four cases of abdominal aortic aneurysm associated with horseshoe kidney. These cases illustrate the factors that determine the ease of resection in this situation: whether the isthmus of the kidney is parenchymatous or thin and fibrous; the presence or absence of anomalous renal arteries; and the origin of the arterial supply of the renal isthmus. Although the technical challenges involved in aneurysm resection in the presence of horseshoe kidney are significant, these cases illustrate that standard resection and replacement of the aneurysm with a prosthetic graft usually should be possible.

Aged↗
PubMed1980

Surgical treatment of renovascular hypertension. Long-term follow-up of 216 patients up to 20 years.

During a period of 20 years, 216 patients between the ages of 19 and 76 years underwent renal artery reconstruction for correction of renovascular hypertension. Reconstruction was bilateral in 18% of the patients. A transperitoneal approach was used in all cases. The most commonly used reconstructions were aortoneal bypass in 43% of the patients, thromboendarterectomy with primary closure or patch in 26%, and nephrectomy in 11%. There were 13 late nephrectomies. There was no operative mortality. Postoperatively, blood pressure was normal in 85% of the patients, improved in 11% and unchanged in 2%. Follow-up was one to 20 years. Actuarial survival at five years was 93%, at ten years 80%, and at 20 years 70%. Normal blood pressure was present at five years in 81% of the survivors, at ten years in 77%, and at 15 years in 74%. The results indicate the excellent long-term results of renovascular reconstruction for renovascular hypertension in appropriate patients.

Adult↗
PubMed1980

Clinical experience with the Smeloff-Cutter prosthesis: 1- to 12-year follow-up.

To determine the long-term results of aortic valve replacement with the Smeloff-Cutter prosthesis, the fate of 358 of 459 (78%) consecutive patients was determined 1 to 12 years postoperatively. There were 319 male patients (70%). Mean age at operation was 57 years (range, 15 to 84 years). Aortic stenosis was the dominant lesion in 267 patients (58%) and aortic regurgitation in 133 patients (29%). Fifty-nine patients (13%) had both aortic stenosis and regurgitation. In addition to aortic valve replacement, 93 patients (20%) had coronary artery bypass, 30 (6.5%) had mitral commissurotomy, 23 (5%) had mitral valve replacement, and 41 (9%) had other procedures. Preoperative status by New York Heart Association Functional Class was: Class I, 3 (1%); Class II, 39 (8%); Class III, 148 (32%); and Class IV, 269 (59%). Operative (30-day) mortality was 8.5% (39 out of 459). Functional improvement was obtained in all postoperative survivors: 345 (82%), Class I; 63 (15%), Class II; and 12 (3%), Class III. A perivalvular leak developed in 6 patients (1%) and subacute bacterial endocarditis in five (1%). Actuarial long-term survival was 80% at 5 years and 71% at 8 years. Thromboembolism occurred in 34 patients (9.5%). The incidence of thromboembolism per 100 patient-years for patients receiving no anticoagulants was 5.4; antiplatelet agents, 2.9; and Coumadin (sodium warfarin), 2.6. Major thromboembolism was uncommon in patients on a regimen of sodium warfarin but major morbidity from bleeding was significant.

Adolescent↗
PubMed1980

Late results of reconstructive surgery for renovascular disease.

In order to determine the late results of reconstructive surgery for renovascular disease, a review was made of a series of 505 consecutive patients who underwent operation over a 20-year period. There were 257 males (50.9%) with an age range of 3-80 years. Renal artery bypass grafts were used in 75.4% (471/625) and thromboendarterectomy and/or patch angioplasty in 15.0% (94/625) of reconstructions. Associated vascular procedures were performed in 38.0% (186/489) of patients. Operative mortality (30-day) was 1.8% (9/489) overall, and 4.8% (9/186) with associated procedures but there was no operative mortality in 303 consecutive isolated renal artery reconstructions. The blood pressure was normal or improved in 65% of patients at a mean follow-up interval of 49.3 months, range 1-240 months. The best response rate was obtained in younger patients with isolated renal lesions. Linear regression analysis showed age at operation to be the most important determinant of blood pressure response (p < 0.003) with the presence or absence of diffuse atherosclerosis as another but less powerful determinant of responsiveness (p < 0.07). Crude 15-year survival was 70% (340/489). The overall five- and ten-year actuarial survival probabilities were 80 and 62% respectively. The most common causes of death were myocardial infarction, stroke, and cancer. Cox regression analysis for variables influencing survival indicated that age at operation (p < 0.001), sex (p < 0.01) and the presence or absence of fibromuscular disease (p < 0.002) were the major determinants of late survival with persistent severe hypertension exerting an important but lesser influence. The results of this study indicate that about two-thirds of patients will experience long-term relief of hypertension after operation and that the best long-term survival and blood pressure relief will be obtained in patients less than 50 years of age. Because hypertension in females is better tolerated, younger, male patients appear to have the most to gain from successful renovascular reconstruction.

Adolescent↗
PubMed1980

Long-term results of treatment of the totally occluded renal artery in forty patients with renovascular hypertension.

A study of 40 patients with renovascular hypertension and a totally occluded renal artery was made to determine the optimal management of such lesions. There were 20 men and 20 women, ranging in age from 9 to 73 years (mean age, 51.4 years). Associated contralateral renal artery stenosis was present in 31 patients. Twenty-one patients underwent reconstruction of the occluded renal artery; 15 of the 21 experienced long-term success (up to 223 months) and six experienced failure. Sixteen patients underwent follow-up arteriography. The 14 patients who were treated by primary nephrectomy and reconstruction of a contralateral stenotic kidney had excellent results. In five patients, only a contralateral reconstruction was performed. Factors that were analyzed to determine the best predictors of success included age, sex, total renal function, contralateral reconstruction, associated vascular procedure, surgical technique, nephrogram or excretion of dye on intravenous pyelography, visualization of the distal renal artery on aortography, length of the kidney, and weight and pathology of the nephrectomy specimens. Only the size and weight of the kidney were consistent predictors of outcome. The preoperative demonstration of function in the kidney supplied by a totally occluded renal artery was unimportant. As a result of this study, we recommend reconstruction only for kidneys > 9.5 cm in length and nephrectomy or no treatment for smaller kidneys supplied by totally occluded renal arteries except when preservation of renal tissue is important. In such cases, revascularization of a small kidney can be accomplished but is associated with a significant risk of subsequent nephrectomy.

Adolescent↗
PubMed1979

Suture material as a factor in the occurrence of anastomotic false aneurysms. An analysis of 26 cases.

False aneurysm formation is a well-recognized late complication of prosthetic graft insertion. Despite the fact that other etiologic factors may be involved, the behavior of the suture material remains of central importance. In a retrospective review of 1,330 peripheral vascular cases, we found 26 cases involving a total of 39 false aneurysms, or an incidence of 2% (26/1,330). Twenty-four of these were directly attributable to failure of the monofilament plastic suture or silk suture material. Braided Dacron suture was used in the original anastomosis in another seven cases, and in these instances the false aneurysms were not related to suture failure but were association with such factors as previous endarterectomy, failure of arterial wall, and chronic hypertension. None of the 39 aneurysms was secondary to infection or trauma. These results emphasize the importance of using a braided, nonabsorbable suture material to ensure the continued integrity of an anastomosis involving prosthetic grafts.

Aged↗
PubMed1979

Renal artery aneurysm. Long-term relief of renovascular hypertension by in situ operative correction.

Renal artery aneurysm is an uncommon cause of renovascular hypertension. Nephrectomy or, more recently ex vivo arterial reconstruction have been recommended as the treatment of choice. In contrast, we advocate in situ repair of the aneurysm and any associated lesions. Twenty-five hypertensive patients with 30 renal artery aneurysms were treated by tangential aneurysmectomy with primary arteriorrhaphy, saphenous vein patch angioplasty, or bypass graft. Nephrectomy was performed in two patients, one for a ruptured aneurysm. There was no operative mortality. Follow-up was obtained on all patients six months to 19 years after operation. Hypertension was relieved immediately and in the long-term in the majority of survivors. We believe these results indicate that despite the presence of severe renovascular disease, the affected kidney can be preserved and hypertension successfully relieved by a direct surgical approach without recourse to either nephrectomy or ex vivo reconstruction.

Adolescent↗