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Biomedical subjects

I J Reece

Publications and source records attributed to I J Reece.

At least 37 records · Page 2Linked to original sources
PubMed1986

Non-invasive assessment by Doppler ultrasound of 155 patients with bioprosthetic valves: a comparison of the Wessex porcine, low profile Ionescu-Shiley, and Hancock pericardial bioprostheses.

One hundred and fifty five patients with 167 bioprosthetic valves (68 Wessex porcine, 54 Hancock pericardial, and 45 low profile Ionescu-Shiley pericardial valves) were studied by Doppler ultrasound. Valve gradients were calculated from the mitral and aortic flow velocities by the modified Bernoulli equation. Mean mitral gradients were significantly smaller across the Ionescu-Shiley valves than across the Wessex porcine or Hancock pericardial valves. Mitral pressure half time was, however, significantly longer in the Hancock pericardial than in the Wessex porcine or Ionescu-Shiley valves. No significant differences were seen among the groups of aortic bioprostheses, though the comparable size of Wessex porcine valves showed significantly higher gradients. Bioprosthetic regurgitation was detected in 13 of 103 mitral and 11 of 59 aortic valves, though it was suspected clinically in only 12 mitral and six aortic bioprostheses. Doppler ultrasound is a repeatable non-invasive method of acquiring haemodynamic information in vivo from a variety of bioprostheses and it can detect bioprosthetic regurgitation at an early stage.

Adult↗
PubMed1985

Surgical treatment of mitral systolic click syndrome: results in 37 patients.

From 1974 to 1983, 37 symptomatic patients with mitral systolic click (Barlow's syndrome) underwent mitral valve repair. In 11 patients (30%), the click syndrome was associated with minor mitral regurgitation. Thirty-two patients (86%) had chest pain, 20 had arrhythmia (54%), and 20 had dyspnea as a major complaint. In 5 patients, the arrhythmia was serious, and in 2 of them, it was potentially life threatening. Mitral annuloplasty using a collar prosthesis was performed in 33 patients with posterior leaflet plication in 2, shortening of the chordae in 1, and commissural plication in 2. In 4 patients, commissural plication was performed. One of these patients also required cusp plication and shortening of the chordae, and another required repair of ruptured chordae. There were no operative or late cardiac-related deaths at a mean follow-up of 4.7 years (range, 1 to 10 years). Sixty-two percent of patients with prolapse alone and 91% of those with associated regurgitation were improved by at least one New York Heart Association Functional Class, with 60% of patients obtaining relief of one or more symptoms. In the presence of major symptoms, mitral annuloplasty offers symptomatic relief for some patients with mitral systolic click syndrome without valve incompetence, but it gives substantially better results in patients with mitral regurgitation.

Adult↗
PubMed1985

Intra-aortic balloon pumping: seven years' experience.

The indications for intra-aortic balloon pumping vary widely from country to country and from one cardiac surgical unit to another. Its use in Glasgow from 1976 to 1983 in 63 patients has been reviewed. Six of the patients (9.5%) had the intra-aortic balloon inserted before cardiac surgery, 43 (68.2%) at the time of surgery, and 14 (22.2%) in the postoperative period. Of the 63 patients, 11 could not be weaned from cardiopulmonary bypass despite intra-aortic balloon pumping, and died in the operating room. A further 35 patients had intra-aortic balloon pumping but died in the immediate postoperative period. Seventeen patients (27%) survived from six weeks to 3.3 years after receiving the support of intra-aortic balloon pumping. There was major morbidity in 11 patients (17%), all of whom developed degrees of ischaemia due to ileofemoral arterial obstruction in the leg in which the balloon was inserted. The conservative use of the method in this centre is reflected in the high mortality of these patients.

Adult↗
PubMed1985

Cardiac transplantation: indications, procurement, operation, and management.

Between July 1982 and April 1984, 22 patients underwent cardiac transplantations at the Texas Heart Institute with a cumulative follow-up of 188 patient-months (mean of 8.6 months and a range of 0.5 to 21). The actuarial survival rate at 20 months was 72%. Strict selection criteria for potential recipients and donors, optimal perioperative management, which includes endomyocardial biopsy, and most important the introduction of cyclosporine are the major factors that led to these increasing survival rates. The high incidence of cyclosporine-related complications, especially hypertension and myocardial fibrosis, will require long-term evaluation to adequately assess the therapeutic effectiveness of this new immunosuppressive agent.

Central Nervous System Diseases↗
PubMed1984

Empyema following intra-abdominal sepsis.

Over the past 9 years, ten patients have presented to the Thoracic Unit, Glasgow Royal Infirmary, with 12 empyemas secondary to intra-abdominal sepsis. In eight patients, the presenting signs and symptoms were wrongly attributed to primary intra-thoracic pathology. All were subsequently found to have intra-abdominal sepsis. The presence of empyema after recent abdominal surgery or abdominal pain strongly suggests a diagnosis of ipsilateral subphrenic abscess. Adequate surgical drainage is essential. In our experience, limited thoracotomy with subdiaphragmatic extension offers the best access to both pleural and subphrenic spaces and provides the greatest chance of eradicating infection on both sides of the diaphragm.

Abdomen↗
PubMed1984

The surgical management of extravalvular aortic root infection.

Fifteen patients with extravalvular aortic root infection and associated infective endocarditis underwent urgent operation for this condition at Glasgow Royal Infirmary between 1977 and 1983. Four patients (26.7%) subsequently died between 1 and 68 months after operation. All patients underwent aortic valve replacement, with debridement or suture closure of abscess cavities as indicated. Three patients also required insertion of permanent pacing systems for complete heart block. Three other patients required further surgical intervention. Aortic valve rereplacement was done on two occasions in 1 patient and repair of a periprosthetic leak in the second patient; the third required one additional procedure to close an aorto-right atrial fistula postoperatively. Ten out of 11 survivors are in New York Heart Association Class I, and the remaining patient is in Class II. Aggressive surgical therapy without the need for complicated reconstructive procedures of the aortic root is effective in the management of extravalvular aortic root infections.

Abscess↗
PubMed1984

Early results of cardiac transplantation at the Texas Heart Institute.

From July 1982 to November 1983 18 patients (one female) underwent orthotopic cardiac transplantation at the Texas Heart Institute. Prednisone and cyclosporin were used for maintenance immunosuppression in all patients. Cumulative follow up has now been for 90 patient months (0.75-20 months). Rejection occurred in 10 recipients (56%) and was fatal in three, giving an incidence of rejection of 0.6 episodes per recipient and a mortality rate of 30% per episode. At one year 39% of recipients were free of infection and 73% free of fatal rejection. Infection episodes occurred on 32 occasions in 14 patients and 24 episodes required treatment. There were no infection related deaths, although the first year actuarial freedom from infection rate was only 24%. With 14 of the 18 patients surviving (78%), an actuarial one year survival of 74%, and freedom from major complications in the short term, the efficacy of cyclosporin immunosuppression for cardiac transplantation is confirmed.

Adult↗
PubMed1984

Infection after cardiac transplantation: treatment and prognosis.

Since July 1982, 18 patients have undergone orthotopic cardiac transplantation at the Texas Heart Institute with steroid and cyclosporine immunosuppression. There have been no deaths from infection despite 15 bacterial, 8 viral, 6 fungal and 1 protozoal infection episodes. With a total follow-up of 90 patient months (mean follow-up, 5.0 months; range 0.1 to 18 months), the incidence of infection is 33 episodes per 100 patient months (1.7 episodes per patient). Only 23 episodes (77%) required drug treatment. Compared to conventional immunosuppressive regimes, cyclosporine treatment is associated with a substantial reduction in the incidence and severity of infection in cardiac allograft recipients.

Journal Article↗
PubMed1984

Evolution of the Texas Heart Institute Distant Organ Procurement Program.

Between August and December 1983, the Texas Heart Institute Transplantation Service performed 10 cardiac transplants. All hearts were removed at outside hospitals and transported to the Heart Institute. Adequate return of cardiac function occurred in all groups after ischemic times of 58.5 minutes for hearts procured within Houston (range, 56-62 minutes) and 152 minutes for those procured in other cities (range, 130-179 minutes). Eight of the transplant patients are alive and well following operation. Distal procurement has more than doubled the number of suitable organs, and offers considerable potential for expansion of the transplant program.

Journal Article↗
PubMed1984

Cardiac tumors. Clinical spectrum and prognosis of lesions other than classical benign myxoma in 20 patients.

Between 1961 and 1983, 20 patients underwent operation at the Texas Heart Institute for primary tumors other than classical benign myxoma. Total follow-up was 70.7 patient years (mean 3.5 years). There were 10 adults and 10 children under 12 years of age. There were two operative deaths and four late deaths. All of the pediatric patients had benign lesions (five fibromas, five rhabdomyomas), and only one patient in this group died (during the operation). All operative survivors are alive between 0.9 and 18 years postoperatively, although in three cases excision was incomplete. Of the 10 adult patients, five had benign lesions; all were completely excised. In the other five adult patients, unresectable malignant tumors were found, and all four operative survivors died of metastatic disease within 8 months. Benign cardiac tumors in childhood have an excellent prognosis when completely excised and appear to have a good short-term prognosis even when excision is incomplete. Although prognosis for benign tumors in adults is good, malignant tumors are associated with very poor survival.

Adolescent↗