Primary prevention of falls.
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Accidental Falls↗
Biomedical subjects
H Sloan
Publications and source records attributed to H Sloan.
Adjuvant treatment using transfer factor for bronchogenic carcinoma: long-term follow-up.
Transfer factor, a dialyzable lymphocyte extract that may act as an immune stimulator by transferring antigen-specific immunity between genetically dissimilar individuals, was administered in a prospective, randomized study to patients with non-small cell bronchogenic carcinoma. Between 1976 and 1982, 63 patients who underwent pulmonary resection, mediastinal lymph node dissection, and, when indicated by the presence of mediastinal lymph node involvement, mediastinal irradiation were randomized into two groups. Group 1 (n = 28) received 1 mL of pooled transfer factor at 3-month intervals after operation; group 2 (n = 35 ) served as controls and received saline solution. There were no statistically significant differences between the two groups with respect to age, sex, tumor histology, stage of disease, or extent of resection. One patient was lost to follow-up at 96 months; follow-up was complete in all others through July 1990. In patients receiving transfer factor, the 2-, 5-, and 10-year survival rates were 82%, 64%, and 43% respectively, whereas in controls they were 63%, 43%, and 23%. Survival in patients receiving transfer factor was consistently better than in those receiving placebo. Furthermore, survival in patients receiving transfer factor was greater at all stages of disease for both adenocarcinoma and squamous cell carcinoma. Although these long-term results were not statistically significant using survival analysis with covariates (p = 0.08), they confirm our previously reported short-term findings suggesting that administration of transfer factor, either through nonspecific immune stimulation, enhancement of cell-mediated immunity, or an as yet undefined mechanism, can improve survival in patients with bronchogenic carcinoma.
Adenocarcinoma↗
Longitudinal psychological assessment in tetralogy of Fallot.
To determine whether preoperative psychological testing in children with cyanotic heart disease could provide an accurate estimate of adult performance, we studied 21 subjects (mean age, 30.3 +/- 4.8 years) who had undergone surgical repair for tetralogy of Fallot between 1958 and 1966 (mean age, 8.7 +/- 3.9 years); 17 received childhood preoperative testing (mean age, 8.9 +/- 4.2) and four had early postoperative testing. Follow-up psychological tests administered in 1983 included Wechsler Adult Intelligence Scale Revised, Jackson Personality Research Form E, Rosenberg Self-Esteem Scale, and a questionnaire-interview on educational, occupational, and psychosocial status. Adult IQ (x = 93.4 +/- 15.6) and child IQ (x = 97.5 +/- 14.6) scores were highly correlated (r = 0.87, p less than 0.01), revealing considerable stability across 22.3 +/- 2.2 years. On 17 of 22 Jackson personality scales, the subjects (S) were within the normal range. Scoring below the 16th percentile were 11/21 S on intellectual curiosity, 9/21 S on adaptability to change, and 8/21 S on leadership skills. Scoring above the 84th percentile were 8/21 S on harm avoidance and 8/21 S on giving nurturance to others. Univariate one-way ANOVAs indicated that those subjects with the higher IQ scores had the higher incomes, job levels, and educational attainments. We conclude that the results of perioperative psychological testing in children with tetralogy of Fallot are congruent with postoperative adult intellectual and psychosocial status.
Adult↗
Effect of smokeless tobacco on plasma lipoproteins in adolescents.
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Adolescent↗
Influence of saccharide length on polysaccharide appetite in the rat.
The appetite of female rats for saccharides of different chain lengths was assessed in brief (5-min) one-bottle acceptance and two-bottle preference tests. The saccharides (and their lengths in glucose units) included glucose (1), maltose (2), maltotriose (3), maltooligosaccharide (4-8), maltopolysaccharide (average length 43), and Polycose (1 to 30+); 0.0125 and 0.025 molar solutions of these saccharides were tested. The results revealed that the rats' order of preference for these saccharides was as follows: maltooligosaccharide greater than maltotriose = maltose greater than glucose; and maltooligosaccharide greater than Polycose = maltopolysaccharide greater than maltose. Thus, as saccharide chain length increased from 1 to 4-8 glucose units palatability increased, but with further increases in chain length palatability declined somewhat. Previous findings have suggested that rats have a "polysaccharide" taste receptor and the present results indicate that the receptor is maximally (or near-maximally) stimulated by saccharides of 4-8 glucose units in length.
Animals↗
Long-term prognosis after repair of double-chamber right ventricle with ventricular septal defect.
To determine long-term postoperative results in patients with double-chamber right ventricle and ventricular septal defect, 20 patients who had survived complete repair between 1959 and 1966 were recalled and studied. An interview, physical examination, electrocardiogram and chest x-ray were performed in all 20 patients, a treadmill exercise test in 16, 24-hour Holter monitor recording in 7 and postoperative cardiac catheterization in 8. Mean age at repair was 14 years and at follow-up evaluation 33 years. There were no late deaths. At a mean follow-up of 19 years, 17 patients were in New York Heart Association functional class I, 1 patient was in class II and 2 patients were in class III. Reoperation was performed in 2 patients (10%), and at present only 1 patient (5%) is considered to have hemodynamically significant cardiac compromise. Aortic regurgitation, not present in any patient preoperatively, developed in 5 patients (25%). Mild residual right ventricular outflow obstruction was present in 2 (10%) and the murmur of a hemodynamically insignificant residual ventricular septal defect or tricuspid regurgitation was present in 5 patients (25%). One patient (5%) had cardiomegaly (cardiothoracic ratio greater than 0.55). The frequency of infective endocarditis in the postoperative follow-up period was 1 per 388 patient-years. Thus, 20 years after repair of double-chamber right ventricle, mild residua and sequelae are common, but serious cardiac compromise is infrequent.
Adolescent↗
Long-term prognosis (15 to 26 years) after repair of tetralogy of Fallot: I. Survival and symptomatic status.
One hundred eighty-two patients with tetralogy of Fallot repaired before or during 1967 were studied by interview, physical examination, and noninvasive testing. Twenty were excluded from the final analysis because review of cineangiograms and operative reports disclosed that they had had double-chambered right ventricle rather than tetralogy of Fallot. On follow-up ranging from 15 to 26 years (mean, 20.2 years), there were 86 patients in New York Heart Association Functional Class I, 53 in Class II, 5 in Class III, and none in Class IV. There were 9 late deaths. Functional classification was not ascertained in the remaining 9 patients. Cumulative survival at 25 years postoperatively was 94.4%. There was no significant relationship between survival and year of operation, age at operation, sex, or presence of a prior shunt. The 9 late deaths occurred between 6 and 23 years after operation and were due to late-onset complete heart block in 2 patients, congestive failure in 4, suicide in 1, accident in 1, and an unknown cause in 1. We conclude that long-term survival after repair of tetralogy of Fallot is excellent and not influenced by prior shunt.
Adolescent↗
Repair of truncus arteriosus in neonates with the use of a valveless conduit.
Each of seven infants 1 to 9 days old and weighing 2.1 to 3.3 kg with truncus arteriosus underwent repair of their defects with a right ventricular-to-pulmonary artery valveless conduit. Congestive heart failure and cyanosis were present before surgery in each. Five patients survived surgery and one of these subsequently died. Comparison between preoperative hemodynamics of the survivors and nonsurvivors disclosed similar peak systolic pulmonary arterial and aortic pressures, and pulmonary (Rp) or systemic resistance (Rs) in the groups. However, the mean Rp/Rs ratio in survivors (0.15) was significantly less than in nonsurvivors (0.63) (p = .001). The four remaining survivors are asymptomatic 7 months to 5.5 years after operation. Postoperative cardiac catheterization in three patients disclosed proximal conduit obstruction of 10 to 20 mm Hg in each, distal conduit obstruction of 35 mm Hg in two, and mild truncal valve stenosis and moderate truncal regurgitation in one each. We recommend the use of a valveless conduit for the symptomatic neonate with truncus arteriosus and a low Rp/Rs ratio (less than or equal to 0.03).
Blood Vessel Prosthesis↗
Mediastinal metastases in bronchogenic carcinoma: influence of postoperative irradiation, cell type, and location.
A 17-year experience with 136 patients with bronchogenic carcinoma and mediastinal metastases is reported. Six died postoperatively. Postoperative mediastinal irradiation was given to 110 patients surviving curative resection who had evidence of tumor spreading to the mediastinal lymph nodes. The remaining 20 patients did not receive radiation therapy. Of the 136 patients, 29 (21.3%) lived 5 years free from disease and 9 survived 10 or more years. Of the 110 patients who survived operation and underwent irradiation, 29 (26.4%) survived 5 years. None of the 20 patients not receiving radiation therapy lived 5 years. Of the patients who underwent irradiation, 18 of the 50 patients with squamous cell carcinoma survived 5 years, while only 7 of 55 with adenocarcinoma survived 5 years. We do not believe that the discovery of mediastinal lymph node involvement in bronchogenic carcinoma is a contraindication to pulmonary resection. As in our previous reports, histological cell type has proved to be an important indicator of absolute survival. Patients with squamous cell carcinoma had an absolute-5-year survival of 33.9%, while the patients with adenocarcinoma had an absolute survival of 12.3%. The level of lymph node metastasis has an influence on prognosis as well. Patients with subcarinal lymph node metastases had a lower survival than patients with superior mediastinal involvement.
Adenocarcinoma↗
Carcinoma of the lung in women.
The 5-year survival of 293 men and of 78 women undergoing pulmonary resection and mediastinal lymph node dissection is compared. These patients were broken into two age groups: Group 1, 40 through 49 years of age, and Group 2, 50 years of age and older. They were subdivided further according to clinical stage, cell type, and sex. Of the 25 men in Group 1, 15 (60%) survived 5 years, while 98 (37%) of the 268 men in Group 2 survived 5 years. Among the 31 women in Group 1, 5 (16%) survived for 5 years, while 15 (32%) of the 47 women in Group 2 survived for that length of time. The survival among women in the younger age group was significantly lower than for both groups of women in the older age group (p = 0.0335) and men in the younger age group (p = 0.0033). This is believed to be due to the higher incidence of both Stage III disease and adenocarcinoma in the younger women. Twenty-two of the younger women (71%) were classified Stage III compared with 14 (30%) of the older women. Fourteen younger men (56%) had reached Stage III, and 101 older men (38%) were classified as Stage III. These data suggest that sex is an important factor in determining survival because there appears to be a relationship between it and the stage of the disease, and cell type. Overall, women had a poorer 5-year survival than men. Younger women have a strikingly lower survival than any other group, which is explained by their higher incidence of both Stage III classification and adenocarcinoma.
Adenocarcinoma↗
The Beijing Cardiothoracic Symposium.
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Cardiac Surgical Procedures↗
Ventricular pacing in children.
Ventricular pacing was performed in forty-one children ranging from one day to twenty years of age (median age = 10). Weight of the recipient at implant ranged from 2 kg. to 86 kg. Indications included presyncope, syncope, dyspnea on exertion, congestive heart failure, postoperative infra-Hisian heart block, and inadequate cardiac rate during pharmacotherapy. Four patients died during follow-up, but no deaths were attributable to pacemaker management. In contrast, 66% of the patients required more than one pacemaker related-operative procedure, and 43% of leads implanted failed by 48 hours. Indications for permanent cardiac pacing in this population at this time are symptomatic congenital AV block, symptomatic sinus node disease, and AV block in the postoperative period. Technological developments which might reduce complications seen in this population and electrophysiologic techniques which may better define indications for pacing in children are also reviewed.
Adolescent↗
Correction of truncus arteriosus in the neonate using a nonvalved conduit.
Successful correction of truncus arteriosus in two neonates, both 4 days of age, is described. Nonvalved polytetrafluoroethylene (PTFE) conduits were used because of the small size of the infants. Both recovered from operation with no signs right ventricular failure and remain well. Catheterization data on one patient show satisfactory hemodynamics 1 year after operation with only residual branch pulmonary artery stenosis. These data suggest that a conduit valve is not essential in the correction of truncus arteriosus even in the neonate.
Blood Vessel Prosthesis↗
Bronchogenic carcinoma and postoperative empyema: is survival really enhanced?
From 1959 to 1974, 542 patients underwent curative resection for bronchogenic carcinoma. Postoperative empyema occurred in 17 of these patients. The overall 5-year survival of these 17 patients was only 18%, compared with 27% in the 525 patients without empyema. We were unable to demonstrate by our study or by a review of the literature that postoperative empyema favorably influences survival in patients who have had pulmonary resection for bronchogenic carcinoma.
Aged↗
J. Maxwell Chamberlain, 1906-1968.
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History, 20th Century↗
Intraoperative esophageal manometry: is it valid?
Forty-five patients undergoing a Collis-Nissen antireflux operation had preoperative, several intraoperative, and postoperative distal esophageal high-pressure-zone (HPZ) measurements. In 11 patients (24%), intraoperative manipulation of the esophagus alone, prior to beginning the repair, had a major effect upon the HPZ. The final mean intraoperative HPZ pressure (21.2 mm Hg) differed significantly (p less than 0.01) from that obtained postoperatively at 1 to 3 weeks (15.2 mm Hg), 6 months (11.2 mm Hg), and 12 mm Hg), and 12 months, (12.1 mm Hg). However, there was no significant statistical correlation between the final intraoperative HPZ pressures and those obtained after 6 and 12 months. Irrespective of the final intraoperative HPZ value, no patient undergoing acid reflux testing at 6 to 12 months after operation had any gastroesophageal reflux. It is concluded that esophageal manipulation (mobilization or dilation) results in variable intraoperative Hpz values that are not reliable predictors of HPZ values obtained late postoperatively. The rationale for altering the technique of an operation simply to obtain an "ideal" intraoperative HPZ value must be seriously questioned.
Female↗
Technique of mitral valve replacement.
A technique for mitral valve replacement is described that provides adequate exposure for excision of the valve and secure suturing of the annulus, even in patients with a small left atrium. The technique has been used in more than 100 patients and has resulted in only a minimal amount of perivalvular leak.
Aortic Valve Stenosis↗