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Biomedical subjects

J Fisher

Publications and source records attributed to J Fisher.

At least 451 records · Page 25Linked to original sources
PubMed1984

Vascularized muscular and musculocutaneous flaps for management of osteomyelitis.

Thirty-three cases of recalcitrant osteomyelitis treated by free tissue transfer are reviewed. The immediate success rate was 76 per cent; however, on follow-up for at least 1 year, there was a 12 per cent rate of recurrent drainage. The authors conclude that this is a good operation for this problem but that it is not a panacea because if followed long enough, a significant number of patients will develop recurrent drainage.

Adult↗
PubMed1983

Function of the hypertrophied left ventricle at rest and during exercise. Hypertension and aortic stenosis.

Assessment of left ventricular function may be of value in patients with pressure-loaded, hypertrophied left ventricles for the purpose of characterizing such patients as to prognostic risk. To determine whether left ventricular function is in part independent of loading stresses in such patients, and to assess the effects of removal of loading factors, we have reviewed preliminary data in 60 patients with essential hypertension and in 26 patients with aortic stenosis who were studied with radionuclide cineangiography. Patients with hypertension manifested a poor but statistically significant direct relationship between systolic arterial pressure and left ventricular ejection fraction at rest, and a poor but significant inverse relationship between systolic pressure and the magnitude of change in ejection fraction from rest to exercise. However, a strong correlation existed between echocardiographic systolic fractional shortening and end-systolic wall stress at rest. Nonetheless, many patients with normal fractional shortening-end-systolic wall stress relationships had subnormal ejection fraction responses during exercise; the two patients with subnormal fractional shortening-end-systolic wall stress relationships at rest also had subnormal fractional shortening-end-systolic wall stress relationships during exercise. Arterial pressure alone was not predictive of these functional responses. These data suggest that hypertensive patients can be categorized on the basis of left ventricular function at rest and during exercise, independent of arterial pressure. Among patients with aortic stenosis, ejection fraction at rest averaged 67 percent before valve replacement (normal = 57 percent, p less than 0.01), and changed little after operation (71 percent, not significant). However, potential functional benefits of afterload reduction in the patient with the chronically pressure-loaded, hypertrophied left ventricle was suggested by results during exercise: before surgery the ejection fraction during exercise averaged 56 percent (normal = 71 percent, p less than 0.01), but after valve replacement it rose to 72 percent (not significant versus normal). Thus, our data in patients with aortic stenosis supplement our data in patients with hypertension, indicating that myocardial functional improvement can be achieved by unloading therapy in patients with long-standing left ventricular pressure-loading and hypertrophy.

Adult↗
PubMed1983

Stereoselectivity of chloroperoxidase-dependent halogenation.

The stereoselectivity of chloroperoxidase halogenation of four substrates has been examined. Chloroperoxidase catalyzes the bromination, but not chlorination, of racemic 2-exo-methylbicyclo[2.2.1]hept-5-ene-2-endo-carboxylic acid (to the delta-lactone) and racemic bicyclo-[3.2.0]hept-2-en-6-one (to the 2-exo-bromo-3-endo-hydroxy-bromohydrin). These products are obtained in near quantitative yield and are racemic. The circumstances of the bromination strongly suggest that halogenation does not occur at the active site but rather by chloroperoxidase-catalyzed formation of Br2 and its release into solution. The inability of chloroperoxidase to halogenate these two alkenes at its active site most probably derives from a steric exclusion from the active site. The stereoselectivity of two additional substrates that undergo active site chlorination was determined. Methionine is quantitatively converted to a 50:50 ratio of the two methionine sulfoxide diastereomers. 2-Methyl-4-propylcyclopentane-1,3-dione is quantitatively chlorinated to 2-chloro-2-methyl-4-propylcyclopentane-1,3-dione. On the basis of optical rotation and proton nuclear magnetic resonance, this product is present as a 40:60 ratio of the racemic diastereomers. It is concluded that active site chlorination by chloroperoxidase proceeds without appreciable stereoselectivity.

Bromine↗
PubMed1983

Transpulmonary artery correction of anomalous origin of the left coronary artery by saphenous vein graft.

A transpulmonary saphenous vein graft was used to repair an anomalous origin of the Left coronary artery from the pulmonary artery (ALCAPA). Postoperative cardiac catheterization revealed correction of the previous systemic arterial to venous shunt and a patent intrapulmonary artery conduit. The patient has experienced substantial symptomatic and functional improvement from the operation operation despite development of mild pulmonary outflow obstruction. Saphenous vein transpulmonary artery correction for ALCAPA offers an alternative surgical approach and may be the procedure of choice when anatomy or prior surgery preclude the more standard modes of revascularization.

Adult↗
PubMed1983

Latissimus dorsi myocutaneous free flap vascularised by an extra-anatomic graft in the lower limb following traumatic disruption of the popliteal artery.

A case is presented in which the thoracodorsal artery of a latissimus dorsi free flap was anastomosed to an autogenous reverse saphenous bypass graft. The bypass graft was used to revascularise a leg with traumatic disruption of the popliteal artery and an open comminuted fracture of the distal tibia and fibula with extensive soft tissue loss. At 2-year follow up, isotope scans showed patency of the extra-anatomic graft and a good flow into the thoracodorsal artery.

Adult↗
PubMed1983

Contextual correlates of the duration of drinking: confirmation of ethnographic findings with a self-report instrument.

The present study examined the relationship between the number of drinking companions and duration of drinking events with a representative sample of adult current drinkers. The findings indicated that number of companions is significantly related to duration in both public and private settings. Drinking events are of longer duration when two or more persons are present. Age was found to interact with number of companions. Small group size tends to limit duration with young drinkers while larger groups increase duration among the oldest drinkers. These findings support and extend the results of earlier ethnographic studies.

Adolescent↗
PubMed1983

Digital subtraction intravenous left ventricular angiography: comparison with conventional intraventricular angiography.

Standard contrast left ventriculography with catheter placement into the left ventricle entails risks and inconvenience. Computer-based digital subtraction techniques now permit high contrast left ventriculography after intravenous administration of contrast medium. To compare the accuracy of intravenous digital subtraction left ventriculography with film-based, standard contrast ventriculography, we assessed left ventricular function by both methods in 32 patients (8 with valvular disease, 22 with coronary disease and 2 with atypical pain). Studies in 31 of 32 patients were considered. Left ventricular ejection fraction by standard contrast ventriculography ranged from 24 to 88%. Digital subtraction angiography was performed with bolus injection of radiopaque contrast material (30 cc at 20 cc/s) into the inferior vena cava. The two methods correlated closely in end-diastolic volume (correlation coefficient [r] = 0.96, probability [p] less than 0.001), end-systolic volume (r = 0.97, p less than 0.001) and ejection fraction (r = 0.98, p less than 0.001). Segmental function was assessed visually; precise agreement existed between the two techniques in 123 (79%) of the 155 segments (p less than 0.001). It is concluded that intravenous digital angiography provides left ventricular images of sufficiently good quality to allow accurate quantitative assessment of global left ventricular function and volumes as well as determination of regional function.

Adult↗
PubMed1983

Exercise left ventriculography utilizing intravenous digital angiography.

Exercise left ventriculography has been shown to be a sensitive and specific tool for the detection of coronary artery disease. At the present time, such studies require radionuclide-base methods. Computer-based techniques recently have been shown to provide high resolution images of the left ventricle when the levophase of an intravenous injection of radiopaque contrast medium is imaged with fluoroscopy. To evaluate the possible efficacy of using "intravenous digital subtraction left ventriculograms" in exercise ventriculography, such ventriculograms were performed at rest and during maximal supine bicycle exercise in 31 patients. Studies that could be analyzed were obtained in 29 patients. In 21 patients with coronary artery disease, ejection fraction was 58% at rest and 45% with exercise (p less than 0.001 vs. rest). In contrast, in seven patients with no coronary artery disease, ejection fraction was 65% at rest and 69% with exercise (difference not significant). In a subgroup of 8 patients with "severe" coronary obstruction, the change in ejection fraction from rest to exercise was -18%, while in the remaining 13 patients with less severe disease, it was -9% (p less than 0.001). All patients with coronary artery disease manifested new or worsening segmental wall abnormality with exercise, compared with two of seven patients without coronary disease (p less than 0.01). Sixteen patients underwent rest and exercise radionuclide cineangiography in addition to digital subtraction angiography. There was a strong correlation between the two techniques for ejection fraction at rest (r = 0.78, p less than 0.001), ejection fraction and with exercise (r = 0.83, p less than 0.001) and change in ejection fraction from rest to exercise (r = 0.88, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

The gluteus maximus musculocutaneous V-Y advancement flap for large sacral defects.

Sacral soft tissue defects from 10 to 18 cm in diameter were closed with gluteus maximus musculocutaneous V-Y advancement flaps in 17 patients. Defects were secondary to pressure, radiation injury, or tumor resection and occurred in both ambulatory and nonambulatory patients. Technique varied according to the size of the ulcer and the ambulatory status. This musculocutaneous unit advanced in a V-Y fashion provides well-vascularized tissue for coverage of large sacral defects. It allows for restoration of normal contour, with primary closure of the donor site. Ambulatory patients noticed little or no functional deficit.

Adult↗
PubMed1983

Designing the latissimus dorsi free flap for knee coverage.

Several techniques have been described for coverage of the exposed knee joint using local soft tissue and muscle. Occasionally, because of multiple previous procedures or the extent of the defect, local tissue is inadequate. In these situations the latissimus dorsi free flap is useful. The most acceptable recipient vessels comprise the superficial femoral system, but they are at a significant distance from the knee. This distance is bridged by designing the flap as a paddle with a narrow strip of proximal muscle in continuity with the thoracodorsal vessels. Placing the skin island eccentrically allows the muscle to be folded on itself and packed into the bony defect.

Adult↗