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Biomedical subjects

J J Collins

Publications and source records attributed to J J Collins.

At least 325 records · Page 18Linked to original sources
PubMed1975

Improved long-term survival after aortocoronary bypass for advanced coronary artery disease.

Three hundred thirty patients undergoing coronary bypass grafts for disabling angina, "preinfarction" angina, or coronary occlusion without cardiogenic shock have undergone coronary revascularization from July 1970 to March 1974. The operative mortality was 1.2 per cent and the long-term mortality, 4 per cent. Patients were subjected to life table analysis, and the figures suggest that in patients with two- and three-vessel coronary artery disease who received complete revascularization, there was a significant prolongation of life when compared with data from a large series of medically treated patients with angiographically documented coronary artery disease. Longer follow-up data will be important in definitively ascertaining the favorable effect of coronary revascularization on longevity.

Adult↗
PubMed1975

Cardiac surgery in patients undergoing renal dialysis or transplantation.

The coexistence of organic cardiac disease and chronic renal failure presents a therapeutic dilemma. Cardiac operations have been performed on patients who were undergoing hemodialysis or who had had successful renal transplantation. There are several aspects of management of these patients which differ from those of the routine cardiac surgical patient. Guidelines for management are outlined and discussed.

Adult↗
PubMed1975

Local cardiac hypothermia for myocardial protection during correction of congenital heart disease.

Eighty-eight operations for correction of intracardiac congenital heart defects were performed using local cardiac hypothermia for protection of the ischemic myocardium. Twenty-six patients underwent repair of tetralogy of Fallot, 23 had patch closure of ventricular septal defect, 24 had correction of various types of congenital aortic stenosis, and 15 were operated upon for other complex lesions. The overall operative mortality was 5.6%. Ischemia times ranged from 9 to 119 minutes (mean, 48 minutes). Ischemic arrest protected by local cardiac hypothermia provides an optimal operative field, permitting repair of uncomplicated intracardiac defects in a precise, unhurried manner. No hemodynamic abnormalities attributable to the technique were encountered.

Adolescent↗
PubMed1975

Role of carbohydrate in determining the immunochemical properties of the major glycoprotein (gp71) of Friend murine leukemia virus.

Treatment of Friend leukemia virus gp71 with protease-free glycosidase enzymes results in removal of the major portion of the carbohydrate without affecting the amount of protein present. The digested material migrates as protein of about 60,000 to 65,000 molecular weight on sodium dodecyl sulfatepolyacrylamide gel electrophoresis. Analyses of the serological properties of gp71 after enzyme treatment indicated that the type, group, and interspecies determinants were not destroyed. In contrast, treatment with proteolytic enzymes led to the complete destruction of the gp71 molecule, including the total elimination of its serological reactivity as measured by direct and competition radioimmunoassay and by a serum cytotoxicity assay. We conclude that the carbohydrate portion of gp71 is not of major significance in defining the antigenic determinants of this viral glycoprotein.

Carbohydrates↗
PubMed1975

Relation between contractile reserve and prognosis in patients with coronary artery disease and a depressed ejection fraction.

Postextrasystolic potentiation (PESP) and 1-epinephrine infusion have previously been shown by the ventriculographic technique to augment left ventricular wall motion in patients with coronary artery disease. The present study relates the magnitude of this augmentation to short-term prognosis in 56 patients with coronary artery disease and a factor already identified with reduced life expectancy, i.e., an abnormal ejection fraction (EF less than .50). Forty-two patients received PESP and 14 1-epinephrine infusion. Based on severity of symptoms and technical suitability, 37 were treated surgically and 19 medically. Mean follwo-up times were 11.7 and 14.3 months, respectively. The mean increase in EF induced by PESP or 1-epinephrine infusion was significantly greater in patients who subsequently had good results from either surgical or medical therapy than in those who died or had progressive cardiac deterioration. In addition, those patients with an increase in EF of .10 or greater had a statistically greater chance of doing well than patients with less augmentation. Evaluation of change in ejection fraction after inotropic stimulation in patients with depressed ejection fractions is helpful in identifying those patients with greatest contractile reserve and hence better short-term prognosis with eigher medical or surgical therapy. Because of its ease of performance and greater enhancement of contractility, PESP is preferred to 1-epinephrine infusion as the inotropic stimulus of choice.

Cardiac Catheterization↗
PubMed1975

Ventricular function before and after direct revascularization surgery. A proposal for an index of vascularization to correlate angiographic and ventriculographic findings.

In order to determine the effect of direct bypass surgery on the total coronary arterial supply to the heart, a numerical construct was devised to incorporate the development of new obstructive lesions and the presence of patent or nonpatent grafts. This construct, termed a vascularization index (VI), was used to evaluate left ventricular function and anginal symptoms after coronary artery bypass surgery in 56 patients. Patients with an increase in local or total arterial blood supply (positive delts VI) often had similar directional changes in segmental wall motion and ventricular ejection fraction. Patients with a decrease in local or total arterial blood supply (negative delta VI), due to either nonpatent grafts or progression of atherosclerotic disease, also usually had similar directional changes in segmental wall motion and ventricular ejection fraction. (Although nearly all patients reported a decrease in anginal symptoms after surgery, delta VI could not identify degree of improvement.) Use of an integrated approach in describing pre and postoperative myocardial blood supply appears to be the most reliable method of explaining changes in left ventricular function.

Angiocardiography↗
PubMed1975

Cardiac valve replacement with the stabilized glutaraldehyde porcine aortic valve: indications, operative results, and followup.

Porcine aortic valve xenografts stabilized with glutaraldehyde have been implanted in 91 patients with acquired and congenital valvular heart disease. The indications for use of this valve have included age, previous sensitivity to anticoagulants, or a concomitant condition contraindicating anticoagulant therapy. There were two operative deaths and three late deaths in 44 mitral, 25 aortic, 16 aortic-mitral, 5 mitral-tricuspid, and one aortic-mitral-tricuspid replacements. There were no valve failures from cusp rupture, although one valve was replaced because of annular disproportion. There was one inhospital stroke but no late emboli in a 3 to 33 month followup period, 16.5; 72 patients are functional class 1, 10 class 2, and one patient is class 3. In appropriate patients this biologic tissue valve relieves the hemodynamic abnormalities of valvular heart disease, is associated with a low embolization rate without anticoagulant therapy and, to date, has been durable.

Adolescent↗
PubMed1975

The effects of phlebotomy, hemodilution and autologous transfusion on systemic oxygenation and whole blood utilization in open heart surgery.

Blood utilization in 400 consecutive adult patients undergoing a wide variety of cardiovascular operations requiring cardiopulmonary bypass was documented following institution of: 1) complete oxygenator hemodilution; 2) intraoperative phlebotomy and autologous transfusion; 3) infusion of residual oxygenator red cells; and 4) use of reconstituted frozen cells in patients whose blood type was uncommon. These techniques have resulted in an average utilization of 4.8 units of blood per adult patient. Fourteen patients required no blood at all and a total of 259 patients required less than 5 units of blood during their entire hospital course. Physiologic effects of this blood program and hemodilution were evaluated in ten patients and the results indicate that marked reduction of red cell mass by hemodilution with hypothermia and low flow perfusion is not detrimental to satisfactory whole blood oxygenation during open heart surgery.

Adolescent↗
PubMed1975

Determinants of survival following cardiac operations in elderly patients.

Ninety-four cardiac operations were performed on 92 patients 65 years of age and over at the Peter Bent Brigham Hospital, Boston, from July 1970 to July 1974. There were 39 aortic valve replacements, 11 mitral valve replacements, 14 double valve operations, 16 coronary revascularizations, five repairs of aortic dissections, and one atrial septal defect closure. The operative mortality was 11 percent in elective cases and 40 percent in the emergency cases, an overall mortality of 17 percent. There were no hospital deaths following elective double valve operations or coronary bypass procedures. Combined hospital and late mortality of ventricular aneurysmectomy approached 100 percent. Myocardial infarction accounted for eight of the 16 hospital deaths. The overall late mortality has been 7.5 percent. Ninety-seven percent of surviving patients are functional class 1 or 2 with a follow-up of 4 to 48 months. These data suggest that any necessary cardiac surgery, excepting ventricular aneurysmectomies, may be performed electively with low risk and a high likelihood of satisfactory rehabilitation in the elderly age group. The major determinants of mortality are the urgency of the intervention and associated coronary artery disease.

Aged↗
PubMed1975

Revascularization of the right coronary artery by retrograde perfusion of the mammary artery. An experimental study.

Although the internal mammary artery bypass seems an ideal coronary bypass vessel, it has not usually been possible to use this vessel to bypass distal lesions in the right coronary circulation. In this experiment, the right internal mammary artery was utilized in retrograde fashion to evaluate this anatomically more suitable vessel as a bypass graft to the occluded right coronary artery in the dog. Reversal of acute myocardial ischemia was demonstrated by mapping epicardial ST-segment elevation and measuring surface pH. Preliminary long-term experiments have also demonstrated patency and perfusion of the distal right coronary artery by this method.

Angiocardiography↗