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Biomedical subjects

J A Alexander

Publications and source records attributed to J A Alexander.

At least 145 records · Page 8Linked to original sources
PubMed1984

Intraoperative balloon-catheter dilatation: University of Florida experience.

Thirty-four patients with stable angina underwent coronary artery bypass surgery with supplemental intraoperative coronary artery balloon-catheter dilatation. Coronary dilatation was performed on 35 vessels at 50 sites. The balloon catheter could not be passed through one stenotic site. Intimal dissection occurred at two sites, as noted on early postoperative angiographic studies, with resolution on follow-up studies. There was one perioperative myocardial infarction, 100% early relief of angina, and one operative death. Of 25 distal arterial narrowings studied early by angiography (mean, 10 days), 15 (60%) were unchanged, two (8%) were worse, and eight (32%) were improved. Discrete narrowings improved more than diffuse narrowings; in 46% of the former there was an increase in luminal diameter, in comparison to only 17% of the latter. During a maximal 34-month follow-up period, two patients developed recurrent angina and one died of congestive heart failure. Of 13 distal coronary narrowings studied late (mean, 1 year), six (46%) were unchanged, three (23%) were worse, and four (31%) were improved. Postoperative serial catheterization (early and late) of 10 distal narrowings revealed that nine were unchanged and one was worse. Adjunctive intraoperative coronary balloon-catheter dilatation can be performed safely with acceptable clinical results. The procedure may also allow more complete revascularization of the myocardium.

Angina Pectoris↗
PubMed1984

Coronary artery bypass graft surgery: relative efficacy of initial proximal versus distal anastomoses.

Controversy exists concerning the most appropriate sequence of anastomoses in coronary artery bypass grafting (CABG) procedures. While the more commonly employed method of distal coronary anastomoses first has withstood a long clinical experience, a recent study and several cardiac surgical groups have suggested that construction of the proximal anastomoses first offers certain advantages. In 30 patients undergoing CABG, we performed a prospective, randomized trial comparing both techniques. Relative efficacy was assessed by hemodynamic, radionuclide, electrocardiographic, enzymatic, thermographic, and clinical evaluation. The length of cardiopulmonary bypass was longer in the group having the distal anastomoses done first. Myocardial temperature mapping was similar between groups. Hemodynamic changes, including cardiac output, ejection fraction, and regional wall motion, were nearly identical between the groups. The incidence of myocardial damage reflected by levels of myocardial-specific isoenzymes (serum CK-MB) and electrocardiographic changes was also similar. In conclusion, the sequence of anastomoses is not critical in routine CABG operations. However, we speculate that each technique may have certain advantages under different clinical circumstances found on occasion. Ideally, each method should be part of the coronary surgeon's armamentarium.

Angina Pectoris↗
PubMed1984

Hospitals and the provision of care to the aged: a cluster analysis.

As the American population ages, the hospital industry will undergo substantial restructuring to meet the increased demand for geriatric and long-term care services. Understanding this important trend, however, has been inhibited by limited research and the vast range of services that currently exists. This investigation develops empirically a classification schema of hospitals that reflects the mix of geriatric services they provide. The study also identifies the organizational and environmental characteristics of hospitals providing these geriatric service categories. Factor analysis, clustering, and analysis of variance were performed on a sample of 416 hospitals. Seven distinct groupings of hospitals that differed systematically on geriatric service mix and other contextual factors were identified.

Aged↗
PubMed1984

Biochemical and ultrastructural integrity of the saphenous vein conduit during coronary artery bypass grafting. Preliminary results of the effect of papaverine.

Factors associated with early and late graft patency related to aorta-coronary artery bypass grafting with a reversed segment of saphenous vein are clinically important. The present investigation examines the biochemical and electron microscopic integrity of this venous conduit intraoperatively with regard to pharmacologic manipulation with papaverine. Portions of saphenous vein were analyzed in 22 patients undergoing coronary artery bypass operations. Levels of a stable derivative of prostacyclin, 6-keto-PGF1 alpha, were measured by radioimmunoassay. Scanning as well as transmission electron microscopy was also performed. In particular, the efficacy of local vein treatment with papaverine, a phosphodiesterase inhibitor, was evaluated. We found that levels of 6-keto-PGF1 alpha in venous effluent showed a biphasic response with initial elevation followed by a relative depression after papaverine exposure. There were no such changes observed in veins subjected to a balanced electrolyte solution (Plasma-Lyte). In addition, levels of the platelet-inhibitory substance 6-keto-PGF1 alpha in venous tissue were less in papaverine-treated veins than those found in veins treated only with the balanced electrolyte solution (Plasma-Lyte). Furthermore, evidence for ultrastructural damage was also somewhat greater in the papaverine-treated group. An alternative method of dilating the saphenous vein after harvesting, which involves the creation of the proximal aorta-coronary anastomosis first and gentle finger manipulation subsequently, appeared to minimize venous injury. Under present clinical conditions, it appears that some amount of injury is inevitable during harvesting and suturing of the human saphenous vein during coronary bypass grafting.

6-Ketoprostaglandin F1 alpha↗
PubMed1984

Hospital contract management: a descriptive profile.

Despite the dramatic growth in hospital contract management in the last decade, research only recently has begun to provide insights into the structure, operation, and effectiveness of these arrangements. Two descriptive questions regarding hospital contract management are addressed in an effort to increase correspondence between theoretical and evaluative research in this area: (1) how do contract-managed hospitals differ from traditionally managed hospitals? and (2) how do contract-managed hospitals differ from each other? Principal discriminating variables in the analyses are hospital size, control, urban-rural location, region, management organization control, and management organization size. Results of the analysis on a sample of 406 contract-managed hospitals and 401 unaffiliated hospitals reveal important differences between contract-managed and traditionally managed hospitals as well as among contract management organizations. These findings are discussed in terms of their implications for future research and performance evaluations on contract management arrangements.

Contract Services↗
PubMed1983

Relative efficacy of left ventricular venting and venous drainage techniques commonly used during coronary artery bypass graft surgery.

Sixty patients with symptomatic coronary artery disease undergoing coronary artery bypass graft operation were prospectively randomized into one of six equal groups based on the intraoperative method of left ventricular venting and venous drainage. Group 1 had bicaval venous drainage without snaring and left ventricular venting through the superior pulmonary vein; Group 2, two-stage venous drainage and venting as in Group 1; Group 3, bicaval venous drainage without snaring and no left ventricular vent; Group 4, two-stage venous drainage and no left ventricular vent; Group 5, bicaval venous drainage without snaring and with ascending aortic venting through a catheter; and Group 6, two-stage venous drainage and venting as in Group 5. Left ventricular performance was determined by radionuclide ventriculography from which global ejection fraction and regional wall motion were determined. Cardiac output was obtained by the thermodilution technique. Myocardial temperature was assessed by a needle thermistor during aortic cross-clamping. Serial electrocardiograms and levels of myocardial-specific isoenzymes (serum CPK-MB) were also analyzed. Each of the techniques tested was equally effective as determined by an analysis of intraoperative myocardial cooling and postoperative hemodynamic profiles, radionuclide ventriculography, and ECG or enzymatic evidence of myocardial damage. However, we maintain that this conclusion is valid only if adequate ventricular decompression is provided intraoperatively.

Cardiac Catheterization↗
PubMed1983

Comparison of early and long-term results with intraoperative transluminal balloon catheter dilatation and coronary artery bypass grafting.

Twenty-six patients with chronic stable angina underwent intraoperative coronary artery balloon catheter dilatation and concomitant coronary artery bypass grafting (CABG). In one patient (3.8%) the catheter could not be passed through the arterial narrowing, and in two patients (8%) early angiographic evidence for arterial damage was detected. Postoperative angiographic data were available in 85% of patients early (mean 10 days) and in 50% of patients late (mean 12 months). Early results showed one perioperative myocardial infarction, 100% relief of angina, and no operative mortality. Compared to preoperative studies, of 23 angiographically visualized distal narrowings dilated in an antegrade fashion, 12 (52%) were unchanged, two (9%) were worse, and nine (39%) were improved. Those arterial segments with discrete distal narrowings (n = 13) had better angiographic results than those with diffuse distal narrowings (n = 9). In 49% of the former and in 22% of the latter arterial narrowings, improvement (increased luminal diameter) was documented postoperatively. In addition, there were four proximal narrowings which were dilated in a retrograde fashion; three were unchanged and one was improved compared to preoperative studies. Only one of 27 dilated segments (3%) was totally occluded postoperatively. Late results showed two patients (8%) developed recurrent chest pain and one patient (4%) died related to congestive heart failure. The two patients who had angiographically documented coronary arterial intimal injury showed evidence of resolution at late study. In 13 distal narrowings, six (46%) were unchanged, three (23%) were worse, and four (31%) were improved compared to the preoperative appearance. In 10 distal narrowings visualized both early and late postoperatively, nine were unchanged and one was worse. In summary, coronary artery balloon catheter dilatation during CABG is relatively safe and is associated with acceptable clinical results. Angiographic evidence for improvement is less than symptomatic relief postoperatively. Therefore, objective evaluation may be necessary for accurate determination of operative results. The need for a national registry related to intraoperative angioplasty is probably warranted.

Angina Pectoris↗
PubMed1983

Biological and biochemical effects of N-(2-chloroethyl)-N'-(trans-4-methylcyclohexyl)-N-nitrosourea on two transplantable murine colon tumors.

Other investigators have reported that transplantable murine colon Tumor 26 is more sensitive than transplantable colon Tumor 38 to treatment with N-(2-chloroethyl)-N'-(trans-4-methylcyclohexyl)-N-nitrosourea. The present report presents the results of several kinds of in vivo and in vitro experiments that were performed to compare the effects of this agent upon these two tumors or upon cultured cells derived from them. In the in vivo experiments, data were also obtained for the spleens, colons, and marrow of the host animals. In the in vivo experiments, it was observed that: (a) approximately equal quantities of 14C from the 2-chloroethyl-14C-labeled agent were fixed to the DNA of the two tumors and the three host tissues following a single i.p. injection of the radioactive agent; (b) in all of the tissues examined at 24 hr after treatment, the drug caused greater inhibition of the synthesis of DNA than of the synthesis of RNA or protein, and the extents of inhibition of DNA synthesis were greater at 24 hr after treatment than at 6 hr after treatment; (c) the inhibition of DNA synthesis was slightly greater for Tumor 26 than for Tumor 38; (d) although the extents of inhibition of synthesis of DNA by Tumor 26 and by the colonic mucosa were similar at 24 hr after treatment of the animal, colonic mucosa much more quickly recovered the ability to synthesize DNA; and (e) the agent had no significant effect upon the sizes of the pools of purine and pyrimidine ribonucleoside phosphates. Cultured cells derived from the two tumors retained their tumorigenicity upon reimplantation into mice and their differential sensitivities to the agent, although approximately equal quantities of the 14C of the radioactive agent were fixed to the nuclei of the cells. In the in vitro experiments, the main effect of the agent upon the synthesis of macromolecules was the delayed inhibition of synthesis of DNA by Tumor 26 cells. Several experimental methods yielded evidence that the agent caused strand scission of the DNA of both kinds of cells, and there was more evidence of cross-linking of the DNA of Tumor 26 cells than of Tumor 38 cells. These results are consistent with the possibility that the differences in sensitivity of the two tumors to the agent are due to differences in the extents of cross-linking of the DNA. This explanation would be in agreement with the proposal suggested by other investigators who worked with other experimental systems.

Animals↗
PubMed1982

Preliminary experience with intraoperative transluminal balloon-catheter dilation and coronary artery bypass grafting for the treatment of symptomatic diffuse coronary artery disease.

Transluminal balloon-catheter dilation of coronary artery lesions has become increasingly common in the cardiac catheterization laboratory. We describe a method of intraoperative dilation that may improve surgical results when used in combination with coronary artery bypass graft (CABG) operations in patients with diffusely diseased coronary arteries. In 16 patients, long-segment intraoperative dilations were performed to enlarge luminal narrowings in 21 different regions. All of these patients had postoperative coronary angiography and left ventriculography so that we could objectively evaluate the coronary dilatations. There were no operative deaths or perioperative myocardial infarctions, and angina was relieved in all patients. Of the 21 dilated segments, 12 (57%) were unchanged, 2 (10%) became worse, and 7 (33%) were improved postoperatively. In addition, two new areas of intimal damage were detected in patients with unchanged postoperative liminal diameters. We conclude that further experience and longer follow-up are necessary before the efficacy of intraoperative coronary artery balloon-catheter dilation can be accurately determined.

Angioplasty, Balloon↗
PubMed1982

The effects of profound cryotherapy upon the pulmonary parenchyma.

Cryotherapy, the application of supercool temperatures to living tissue, has proved successful in the treatment of many superficial neoplasms. Recent clinical studies have suggested the efficacy of an aggressive surgical excision of multiple pulmonary metastatic nodules. The current experiments were designed to study the effects of profound cryotherapy upon the pulmonary parenchyma as a preliminary to the use of this modality clinically in patients in whom further pulmonary resection is impossible. Six dogs were subjected to temperatures of -120 degrees C on the visceral pleural surface of the lingula for three successive freeze/thaw cycles. Serial roentgenograms were obtained on all animals and surviving animals were killed between 4 and 28 days following cryotherapy. Radiographically, an infiltrate developed in the region of cryotherapy within 3 to 5 days, clearing completely by 28 days. There was no instance of delayed pneumothorax developing. Histologically, a subpleural hemorrhagic infarct developed in the region of cryotherapy with mesothelial proliferation on the overlying pleural surface. Within 28 days the infarct had resolved to a subpleural fibrous scar with normal surrounding pulmonary parenchyma. These studies demonstrate the safety of profound pulmonary cryotherapy and suggest cautions clinical trials.

Animals↗