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Biomedical subjects

J E Codd

Publications and source records attributed to J E Codd.

At least 73 records · Page 4Linked to original sources
PubMed1977

Renal transplantation in Lindau-von Hippel Disease.

Renal cell carcinoma may develop in up to 25% of patients with Lindau-von Hippel disease who survive the earlier manifestations of this disease, and this neoplasm may frequently be bilateral. With early detection of such lesions, operative cure of renal cell carcinoma is more likely in these patients. However, some patients may need to undergo bilateral nephrectomy for cure. Such a patient may benefit from cadaver renal transplant in spite of the increased risk of cancer in immunosuppressed patients. We present such a case in a patient with Lindau-von Hippel disease.

Adenocarcinoma↗
PubMed1977

Nonsyphilitic coronary ostial stenosis.

From October 1970 to June 1977, a total of 15 patients (12 women) were seen with atherosclerotic coronary ostial stenosis (14 left, one right). All patients had angina and two had aortic valve disease. Additional coronary arterial disease was present in nine. One patient declined surgery and died four months later after myocardial infarction. All patients had coronary bypass grafts and two had aortic valve replacement. One patient with valve replacement and one with preoperative cardiogenic shock died postoperatively. Angina recurred nine months postoperatively in one patient; the others (11) are free of angina. Postoperative catheterization from two weeks to 4.5 years in ten of 12 showed 11 of 13 vein grafts and eight of nine internal mammary artery grafts to be patent. In three patients, only a single left-sided coronary bypass was placed to the left anterior descending artery, because the circumflex branches were too small. Ideally, two left-sided bypass grafts should be placed for left ostial disease.

Adult↗
PubMed1977

Local blood flow characteristics of arteriovenous fistulas in the forearm for dialysis.

Local flow characteristics were studied in 21 patients with end-to-side cephalic vein to radial artery fistulas, constructed in the wrist for chronic hemodialysis. Intraoperative electromagnetic flow studies indicated a mean fistula flow of 242+/-72 milliliters per minute. Approximately two-thirds of the total fistula flow was derived from antegrade flow in the proximal part of the radial artery and one-third from retrograde flow in the distal part of the radial artery. Temporary occlusion of the distal part of the radial artery caused a 36% decrease in total fistula flow. Ten patients had an initial spasm of the radial artery which abated after 20 minutes. Calculations of a cross sectional area indicate that the size of the radial artery is more important than the size of the cephalic vein or the anastomosis in limiting total fistula flow. End of vein to side of artery anastomoses are preferred to end-to-end anastomoses because immediate retrograde flow in the distal part of the radial artery contributes significantly to total fistula flow.

Arm↗
PubMed1977

Blood flow measurements in arteriovenous dialysis fistulas.

Blood flows were measured in 75 arteriovenous dialysis fistulas (AVF) at the time of fistula construction. End cephalic vein to side of radial artery AVF had a mean flow of 242 +/- 89 ml. per minute which was similar to bovine heterograft AVF that also originated from the radial artery (291 +/- 67 ml. per minute). AVF originating from the brachial artery had flow rates twice those originating from the radial artery (599 +/- 163 vs. 251 +/- 89 ml. per minute), respectively). Flow rates were similar for straight arm (641 +/- 111 ml. per minute), curved forearm (561 +/- 187 ml. per minute), and curved thigh (592 +/- 134 ml. per minute) bovine AVF. Initial blood flow through arteriovenous dialysis fistulas is too low to cause heart failure, except in patients with previously compromised cardiac function. In such patients AVF from the radial artery theoretically would be preferred over brachial or femoral artery AVF.

Adolescent↗
PubMed1977

Myocardial injury following myocardial revascularization. Detection by isoenzyme analysis.

To clarify the value of isoenzymes in the detection of acute myocardial injury (AMI) associated with coronary artery bypass grafting, 350 consecutive patients (804 grafts) were evaluated with serial electrocardiograms (ECG) and serum levels of serum glutamic oxaloacetic transaminase (SGOT), total creatinine phosphokinase (CPK), and lactic dehydrogenase (LDH) on Days 0, 1,2,3,4,5, and 7. Graft patency 1 to 6 months postoperatively was 92%. Sixty patients (18%) had ECG evidence of AMI. Four patients died (1.1%) Of the 185 patients with serial LDH isoenzyme analysis, 46 had elevated cardiac fraction (LDH-1). Only 35 of these had AMI by ECG. The others had nonspecific ECG changes, but associated enzymatic andhemodynamic evidence of AMI. The CPK-MB band was elevated in all patients in the immediate postoperative period, but did not correlate with ECG, hemodynamic, or enzymatic evidence of AMI. The diagnosis of AMI following coronary artery bypass could not be substantiated by evaluation of total LDH, CPK, or CPK-MB. LDH-1 is specific in detecting AMI after a coronary artery bypass graft.

Adult↗
PubMed1976

Left ventricular aneurysmectomy.

Comparison of preoperative and postoperative studies in 81 patients undergoing left ventricular aneurysmectomy failed to show consistent hemodynamic trends. The most reliable prognostic indicator for survival (84% early, 71% late) was the function of the basilar ventricular segments. In 62 of the 81 patients, there was concomitant aortocoronary bypass grafting. Eighty-eight percent of the surviving patients are essentially free of symptoms. These findings support the continued surgical treatment of ventricular aneurysm in symptomatic patients, and suggest nonoperative treatment for patients who are asymptomatic.

Coronary Artery Bypass↗
PubMed1976

Evaluation of choledochoduodenostomy in the treatment of malignant obstruction of the biliary tree.

The results of direct decompression of the common duct for malignant obstruction of the distal biliary tree by side-to-side choledochoduodenostomy are presented. Thirty-three patients were treated with twenty-four (73 per cent) having carcinoma of the pancreas. Seventy-two per cent of the patients had had previous cholecystectomy or cholelithiasis whereas the common duct was utilized in preference to cholecystojejunostomy in six patients. The operative mortality was 12 per cent and six patients had complications. No deaths could be attributed to the choledochoduodenostomy, and complications did not significantly affect palliation. Mean postoperative survival was 10 +/- 0.9 months. Two patients had obstruction of the anastomosis as a terminal event. This study suggests that appropriately applied choledochoduodenostomy is a simple, effective means to decompress the common duct obstructed by tumor.

Aged↗
PubMed1976

Aggressive management of genitourinary complications of renal transplantation.

In the course of 184 renal transplantations performed in St. Louis since 1963, twenty-six minor and twenty-three major complications have occurred. As a result of these complications four kidneys have been lost and 1 patient has died. Aggressive therapy has been utilized in the management of all but two of the major complications and is associated with one death and the loss of two kidneys. On the basis of these results intensive therapy for genitourinary complications is encouraged, and the principles of therapy are discussed.

Adult↗
PubMed1976

Intraaortic balloon assistance.

Intraaortic balloon (IAB) assistance in 64 patients over 2 1/2 years has resulted in a survival rate of 11% (1 patient) when used alone but 47% when utilized in patients treated surgically (long-term survival, 38% [21 patients]). Patients undergoing coronary artery bypass grafting or aortic valve replacement have a long-term survival of 50% (8 and 9 patients, respectively). The required duration of IAB support has a bearing on the clinical result. Complications have been minimal. Though it was originally developed to assist in the nonoperative management of complications of ischemic heart disease, IAB assistance offers significant promise as an adjuvant to operative therapy for both ischemic and valvular heart disease.

Aortic Valve↗
PubMed1976

Operative flow measurements and coronary bypass graft patency.

Early (one week) and late (one year) postoperative angiography was performed in 142 patients having 310 grafts (117 right coronary artery [RCA], 134 left anterior descending [LAD], and 59 circumflex coronary artery [CCA]) to assess the factors responsible for failure of aorta-coronary artery saphenous vein grafts. Early catheterization revealed an 85.5 per cent patency rate with similar rates for each artery (RCA 88 per cent, LAD 85 per cent, and CCA 81 per cent). At one year 238 grafts remained patent, for a cumulative patency rate of 76.8 per cent with a similar distribution for each vessel (RCA 75 per cent, LAD 78 per cent, and CCA 76 per cent). Intraoperative flow measurements were correlated with early and late patency. Grafts with a basal flow less than 20 ml. per minute have a 42 per cent early closure rate and a 21 per cent late closure rate (cumulative 63 per cent). A basal flow of less than 40 ml. per minute was associated with a 25 per cent early failure and an 11 per cent late failure rate (cumulative 36 per cent). Basal flow at levels greater than 40 ml. per minute was not associated with an increased probability of graft closure. Absence of reactive hyperemia (30 second graft occlusion) was associated with a 19 per cent probability of early closure and a 31 per cent probability of cumulative thrombosis. A papaverine-induced flow increase (15 mg. given into the graft) of less than 100 per cent over basal flow gave a 20 per cent probability of early failure and 30 per cent probability of cumulative closure. Thus intraoperative basal flow measurements are of predictive value in determining the fate of aorta-coronary artery vein bypass grafts, and vasodilatory maneuvers provide little additional information.

Coronary Artery Bypass↗
PubMed1976

Serum lactic dehydrogenase and irreversible renal allograft rejection.

The relationship between serum lactic dehydrogenase (SLDH) values and renal allograft rejection was examined in the dog and in man. Nine dogs with renal allografts and four with autografts had similar maximal elevations of SLDH during the first five postoperative days (mean, 420 +/- 213 and 433 +/- 80 I.U. per liter, respectively). During rejection of the allografts between days 7 and 14 the maximum SLDH was 810 +/- 285 I.U. per liter, and in autografts the peak SLDH was 233 +/- 22 I.U. per liter (p less than 0.01). The isoenzyme pattern of maximum SLDH during rejection was prominent in LDH5 and corresponded with renal tissue LDH isoenzyme composition. In 93 episodes of initial acute human renal allograft rejection reactions, the SLDH peaked above 500 I.U. per liter in 23 cases and remained below 500 I.U. per liter in 70 cases. SLDH levels above 500 I.U. per liter were associated with complete rejection of the kidney in 91 percent of patients and SLDH levels persistently below 500 I.U. per liter corresponded with reversal of rejection reaction in 99 percent of patients (p less than 0.01). Marked SLDH elevation is associated with severe, usually complete renal allograft rejection and may be useful in identifying patients with irreversible rejection reactions.

Animals↗