Search PubMed⌕ Search

Biomedical subjects

J J Collins

Publications and source records attributed to J J Collins.

At least 289 records · Page 16Linked to original sources
PubMed1978

Changing indications for the surgical treatment of unstable angina.

From 1970 to 1977, 127 patients were operated on for unstable angina. On the basis of response to intensive medical therapy, patients were classified into a medically controlled, semielective surgery group (54 patients) and a medically uncontrolled, emergent/urgent surgical group (73 patients). There were five operative deaths. 1/54 in the medically controlled group (1.8%) and 4/73 (5%) in the medically uncontrolled group; 4/5 operative deaths occured with left main coronary stenosis. There were five late deaths during a follow-up period of 12 to 84 months, 37.5 with an actuarial survival of 83.5%. If patients with unstable angina can be medically controlled, operation can be delayed and the operative long-term survival is similar to that of elective coronary bypass. Patients who cannot be controlled medically, particularly those with left main coronary lesions, should be operated on urgently with selective use of preoperative balloon support.

Adult↗
PubMed1978

Insulin therapy for depressed myocardial contractility after prolonged ischemia.

Insulin was administered to two patients whose diminished myocardial contractility made it difficult to terminate cardiopulmonary bypass. In both instances, bypass was successfully terminated shortly after the insulin injection. These clinical observations led to experiments under the controlled conditions provided by the isolated, working rat heart preparation. The recovery of contractility after 30 minutes of severe ischemia was assessed in all 11 control and 11 insulin-treated hearts. Myocardial performance, as judged by the product of heart rate and peak systolic blood pressure, was significantly greater in the insulin-treated hearts. These clinical observations and experimental findings suggest the need for more extensive study of the potential value of insulin in treating depressed contractility after prolonged myocardial ischemia.

Animals↗
PubMed1978

Late results of operation for acute aortic dissection producing aortic insufficiency.

Since July, 1970, 8 patients with acute dissecting aneurysms of the ascending aorta producing aortic insufficiency have undergone immediate operation employing a technique in which the origin of the dissection is resected, the dissected base of the aorta is lined with nondistensible prosthetic cloth for support, and the native aortic valve is resuspended. Aortic continuity is then reestablished with end-to-end anastomosis or use of a short segment of woven graft (not necessarily circumferential). There were no operative deaths. Mean follow-up has been 60 months (range, 25 to 82 months). One late death has occurred (cerebral hemorrhage at 48 months); of the remaining 7 patients, 2 have faint murmurs of aortic insufficiency, but all are in New York Heart Association Functional Class I. This technique of aortic reconstruction in acute ascending dissections allows preservation of the native aortic valve while preventing late aortic root dilatation or major valve insufficiency.

Adult↗
PubMed1978

Myocardial revascularization in patients with multivessel coronary artery disease and minimal angina pectoris.

Mortality risk in coronary artery disease (CAD) is more closely related to angiographic findings of multiple coronary artery obstructions and left ventricular asynergy than to the severity of angina pectoris, the major symptom of CAD. Since coronary revascularization surgery is most frequently performed to relieve chest pain, there are few reports evaluating the results of coronary artery bypass surgery in patients with minimal or no angina pectoris but with anatomically severe disease. From July, 1970, through December, 1976, 844 patients had coronary artery bypass surgery performed at the Peter Bent Brigham Hospital for chronic or unstable angina pectoris. Twenty patients (2.3%) were operated on because of severe coronary obstruction but who had minimal or no angina. Fourteen patients underwent coronary arteriography because of a positive exercise tolerance test, and six because of a prior myocardial infarction. All but one patient had multivessel CAD, and four patients had significant left main coronary lesions. There was no operative mortality. One late death occurred 5 years postoperatively, for a 5.0% cumulative mortality. Average follow-up has been 34 months (range, 19 to 80 months). Of 12 patients with both pre- and postoperative exercise tests, eight have reverted to normal, and four show a less ischemic response to exercise. Coronary revascularization may have a beneficial effect on the patient with "asymptomatic" but anatomically severe CAD.

Adult↗
PubMed1978

Conservative management of uremic pericardial effusions.

Although there has been a recent trend toward early operative treatment of uremic pericardial effusions unresponsive to intensified dialysis, this approach may be unnecessarily aggressive. Review of 787 patients in our chronic dialysis program since 1969 has shown 54 patients (6.9 percent) to have developed 56 episodes of large pericardial effusion. All were managed by increasing the frequency of dialysis. If the effusion failed to diminish or if life-threatening signs of tamponade developed, pericardiocentesis was performed. In 63 percent (35/56) the effusion resolved with increased dialysis. In 37 percent (21/56), pericardiocentesis was performed, with 57 percent (12/21) requiring only one aspiration. During a mean follow-up of 34 months (2 to 100 months) only 5.5 percent (3/54) have undergone operation: one partial pericardiectomy incidental to pulmonary decortication and two pericardiectomies for late (3 months and 5 months, respectively) constriction. There were five complications of pericardiocentesis: one pneumothorax, one pneumoperitoneum, one costochondritis, and two myocardial punctures without sequelae. The one death related to pericardial effusion in this series occurred in a home-dialysis patient who arrived in the emergency room moribund. Our experience suggests that the great majority of uremic pericardial effusions can be effectively controlled with simple needle aspiration by experienced personnel and that pericardial resection is usually not necessary.

Adolescent↗
PubMed1977

Results of reoperation for recurrent angina pectoris.

Although a coronary bypass operation improves the quality of life and possibly prolongs it, a small percentage of patients do not have satisfactory results and require reoperation. From July, 1970, to March 1975, 358 patients underwent coronary bypass for chronic disabling or preinfarction angina. Angina requiring operation recurred in 24 men and 2 women. Hyperlipoproteinemia was present in 19 of the 26 (73%), and 3 patients had early-onset diabetes mellitus. Only 2 of 14 patients with progression of arteriosclerosis were helped by a second operation. Of 7 patients with occluded grafts, local disease, and no progression, 5 were helped by reoperation. Patients with occluded coronary bypass grafts without progression of arteriosclerosis benefit substantially from a second revascularization procedure. Aguarded prognosis must be held, however, for those with progression of arteriosclerosis with hyperlipoproteinemia or juvenile-onset diabetes who undergo reoperation. Patients with initially diffuse disease and graft occlusion also seem to benefit less from a second operation.

Angina Pectoris↗
PubMed1977

Radiolucent retractor for operative coronary angiography.

A new retractor has been designed for sternal separation during cardiac operations. This retractor has the advantage of radiolucent blades that allow visualization of the entire heart by roentgenographic techniques without compromise of surgical exposure during the course of operation. The retractor also has swivel blades that provide excellent conformity to the sternal edges without pressure points, which tend to produce fractures.

Cardiac Surgical Procedures↗
PubMed1977

Interspecies determinants of Friend leukemia virus antigens involved in cytolysis of virus-pfoducing cells.

The cytolytic reactivity of a complex goat anti-feline leukemia virus (FeLV) antiserum for mouse cells (Eveline) releasing large quantities of Friend leukemia virus (FLV) was analyzed by the sensitive [14C]nicotinamide release microcytotoxicity assay. Whereas this interspecies killing reactivity could be blocked by absorption of the goat anti-FeLV serum with a preparation of disrupted FLV, absorption with purified FLV gp71, the major envelope glycoprotein, had no effect. Subsequent serum absorptions with the individual FLV structural polypeptides revealed that the lysis of the Eveline cells by the goat anti-FeLV serum is mediated by antibodies recognizing the interspecies determinant of p30, the major internal capsid protein. The expression of this internal viral component at the surface of virus-producing cells is discussed further. The results also demonstrated that removal of approximately 70% of the carbohydrate portion of gp71 with a preparation of glycosidases did not affect the integrity of its interspecies determinant; these results are in agreement with an earlier study (Bolgnesi et al., 1975) that examined primarily the group- and type-specific sites.

Animals↗
PubMed1977

Role of carbohydrate in biological functions of Friend murine leukemia virus gp71.

Purified gp71 of Friend murine leukemia virus (FLV) can interfere with virus infection, absorb neutralizing antibody, and in the presence of group-specific anti-gp71 antibody, hemagglutinate sheep erythrocytes. Interference by FLV gp71 with several murine leukemia viruses (MuLV) was tested in the XC and S + L- assay systems. Treatment of gp71 with trypsin or Pronase eliminated its interfering capacity. However, treatment with neuraminidase or a mixture of glycosidase enzymes, which left the major serological properties of gp71 intact, did not reduce the interference potential of gp71 for FLV or AKR MuLV. The capacity of gp71 to absorb type- or group-specific virus-neutralizing antibodies was similarly affected by the various enzyme treatments. In contrast, indirect hemagglutination by gp71 was abolished not only by proteases but also by treatment with glycosidase enzymes, although neuraminidase had no effect. Preliminary data indicate that infectivity of FLV or xenotropic MuLV was not affected by short treatment with glycosidase enzymes.

AKR murine leukemia virus↗
PubMed1977

Mitral regurgitation due to intermittent prosthetic valvular dysfunction.

A second case of malfunction of a Harken disk valve due to undue disk wear is reported. Two and one-half years after aortic and mitral valvular replacement, the patient had paraprosthetic aortic insufficiency and physical findings suggesting intermittent dysfunction of his prosthetic mitral valve. Catheterization showed intermittent hemodynamic abnormalities; fluoroscopic and cineangiographic findings indicated intermittent mitral regurgitation secondary to undue mitral disk wear. At operation, the excised valve showed normal struts and sewing ring but severe disk wear. There was loss of disk substance and rim notching.

Cardiac Catheterization↗