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Biomedical subjects

J W Hurst

Publications and source records attributed to J W Hurst.

At least 91 records · Page 5Linked to original sources
PubMed1985

Ruptured papillary muscle, a complication of myocardial infarction: clinical presentation, diagnosis, and treatment.

Ruptured papillary muscle due to myocardial infarction was encountered in 14 patients during the period 1975-1983. Five of the 14 patients had a history of angina pectoris and two had a history of prior myocardial infarction. Eleven patients with myocardial infarction developed additional pain due to myocardial ischemia and/or a murmur of mitral regurgitation and pulmonary edema within a week, 3 others had a prolonged course with intermittent pain due to myocardial ischemia and breathlessness for longer periods and then deteriorated. Thirteen of our 14 patients developed a murmur and all but one had pulmonary edema on the chest x-ray. Five patients had infarction patterns on the electrocardiogram, the remainder of the patients had only ST- and T-wave changes. Echocardiograms showed fine flutter and notching of the anterior mitral leaflets and vigorous contractions of the left ventricle. Only one patient was demonstrated to have a papillary muscle tip prolapsing into the left atrium on two-dimensional echocardiography. Twelve patients underwent surgery and 8 survived. Seven patients had single-vessel coronary disease, 4 involving the circumflex system and 3 involving the right coronary system. Four of the 7 patients with single-vessel coronary disease survived surgery. Five patients went to surgery with the intra-aortic balloon pump in place and only 3 survived. Three others had the pump inserted intraoperatively and 2 of these survived. Six of 9 patients who had mitral valve replacement and coronary bypass survived. Ejection fraction ranged from 40 to 79%. Surgical survival did seem to be related to the extent of papillary muscle rupture, with the best results occurring in the group with a small portion of the tip ruptured. Seven patients had a stormy clinical course and required surgery within 10 days of rupture. Four of these 7 survived. It seems reasonable to believe that these patients who often have small infarction and limited coronary disease have good potential for survival. Our approach has been to move toward surgery once the diagnosis is made to avoid the sudden deterioration that frequently occurs. The surgical mortality in this group remains in the 30 to 40% range.

Aged↗
PubMed1984

Massive prostatic infarction following aortocoronary bypass surgery: a report of two cases.

We present two patients who had massive prostatic infarctions following coronary bypass surgery. Whereas small areas of prostatic infarction are commonly seen in urologic practice, massive infarction is rarely seen. Massive prostatic infarction has been observed under conditions similar to those occurring with bypass surgery, so no claim is made that the condition occurs uniquely in patients who have recently undergone bypass surgery. Since coronary bypass surgery is commonly performed and since the procedure is often done on men with prostatic hyperplasia, we can reasonably expect to see this condition more commonly that we have in the past. It is our hope that others will be alerted to this condition and look for it in patients with prostatism who undergo coronary bypass surgery, other types of cardiac surgery, and any condition where prostatism and hypotension are present and pressor agents are used in treatment.

Aged↗
PubMed1984

Neutrophil dysfunction in sepsis. III. Degranulation as a mechanism for nonspecific deactivation.

Prominent and global abnormalities in chemotactic, oxidative, and microbicidal activity have been identified in neutrophils from patients with severe sepsis. To evaluate the possible contribution of degranulation as the basis for the observed abnormalities, 12 patients with intrabdominal infection were serially studied and neutrophil chemotaxis, enzyme content, and receptors for FMLP were evaluated. There was a significant correlation between chemotactic response to both activated serum and FMLP with the granular enzymes beta-glucuronidase and lysozyme. For FMLP-directed migration, r = 0.73, P less than 0.001 for lysozyme, and r = 0.59, P less than 0.001 for beta-glucuronidase. There was a similarly significant correlation between loss of lysozyme and an increase in FMLP receptors, previously shown to be a marker for degranulation. These data support the concept that in vivo degranulation, possibly due to effects of circulating chemoattractants on adherent neutrophils, is responsible for the enzymatic and chemotactic loss seen in cells from septic patients. This hypothesis also provides a mechanism to explain the respiratory distress syndrome if degranulation were to occur in the pulmonary capillary bed.

Bacterial Infections↗
PubMed1984

Seasonal persistence of resting cyst toxicity in the dinoflagellate Gonyaulax tamarensis var. excavata.

Resting cysts collected in the autumn from bottom sediments were stored in the laboratory, in the dark at 4 degrees C, through the winter. Over a six month period, toxicity of the stored resting cysts was compared with toxicity of cysts from freshly-collected sediments. Resting cysts retained toxin over the winter months. Toxin levels show an apparent rise. Toxicity measurements of cysts from sediment samples kept in the laboratory reflect in situ levels.

Animals↗
PubMed1984

Osler as visiting professor: house pupils plus six skills.

After working with the house officers in a modern hospital for several days, Osler explains the six skills they should emphasize in their training: clinical, procedural, mental, teaching, judgmental, and managerial skills. Humaneness, he says, is expected of them and must be highly developed, especially in the modern era of high technology.

Clinical Competence↗
PubMed1982

Clinical factors influencing survival and adequacy of revascularization after coronary bypass operation.

We retrospectively analyzed the clinical data on 3479 consecutive patients having coronary bypass surgery. Patients with triple vessel and left main coronary disease had a greater frequency of inotropic requirements than did patients with single or double vessel disease (7.9% and 8.6% versus 3.8% and 4.2%; P less than 0.001). Presence of previous myocardial infarction, heart failure, or left ventricular contraction abnormalities significantly decreased the ability to achieve complete revascularization with bypass grafting. Hospital mortality since 1976 has been 0.8% (25/3040). Hospital mortality was significantly increased by history of myocardial infarction (P less than 0.001), hypertension (P less than 0.05), heart failure (P less than 0.01), extent of anatomic disease (P less than 0.005), presence of preoperative ST-T wave changes (P less than 0.001), and severe abnormalities of left ventricular function (P less than 0.001). Anginal pattern, history of hypertension, previous myocardial infarction, preoperative heart failure but not perioperative myocardial infarction significantly affected long-term survival. Patients with normal left ventricular function had excellent 42-month survival regardless of vessel disease. Inability to achieve complete revascularization did not adversely affect hospital mortality, but did significantly reduce late survival. Although bypass grafting improves survival in patients with multivessel disease and left ventricular dysfunction, the benefits appear to be significantly reduced when left ventricular damage has occurred.

Aged↗
PubMed1981

Influence of left ventricular aneurysm on survival following the coronary bypass operation.

Patients having coronary bypass and aneurysm resection (N = 40) or aneurysm plication (N = 32) were compared with patients having coronary bypass without aneurysm (N = 2782). Unlike other series, the primary indication for surgery in the aneurysm patients was angina pectoris, with heart failure playing a secondary role. Multivessel disease was present in 83% of the patients with aneurysm. Total occlusion of the anterior descending coronary artery was more prevalent in the group of patients who had aneurysmectomy (75%) than in rhe group of patients who had plication (38%), and more grafts/patient could be performed in the plication group (2.6 vs 2.0). Location of the aneurysm was most often anteroapical (N = 55) and infrequently inferior (N = 6). Septal wall motion was akinetic or aneurysmal in 47% of the aneurysmectomy group, and 10% of the plication group. Postoperative requirements for inotropes or intra-aortic balloon assist was much higher in the aneurysm group (aneurysmectomy or plication) than in patients without aneurysm having bypass. Hospital mortality for aneurysm patients was 2.7% versus 1.4% in patients without aneurysms having coronary bypass. The actuarial survival rate at 42 months for all aneurysm patients was 90%. Improvement in anginal symptoms after plication and coronary bypass (96%) was more frequent than with aneurysmectomy and coronary bypass (76%) and this was attributed to larger viable muscle mass and greater revascularization. Although two-thirds of patients having surgery for aneurysms had improvement in heart failure symptoms after operation, 30% of those having aneurysmectomies and 35% of those having plications said they were unimproved after surgery. However, this could be explained by the finding that a significant number (35% of the aneurysmectomy and 45% of the plication group) were in heart failure Class I prior to operation. Hospital mortality has been progressively reduced and late survival increased by the surgical treatment of left ventricular aneurysm, primarily through early operation at a time when coronary bypass can be used as an adjunct to aneurysm resection or plication.

Aged↗
PubMed1980

Mitral valve prolapse.

Mitral valve prolapse (MVP) now is a commonly recognized syndrome with an apparent prevalence of approximately 4-6%. It appears to occur more frequently in females and occasionally it is familial. In most instances, the syndrome is idiopathic, although it occurs in association with many other conditions, particularly Marfan's syndrome, rheumatic heart disease, coronary heart disease, congestive cardiomyopathy, ostium secundum atrial septal defect, Ehlers-Danlos syndrome or abnormalities of the thoracic cage. The majority of patients with the syndrome have minimal, if any, symptoms and have a benign course. When symptoms do occur, more frequently they are palpitations, chest pain, dyspnea on exertion or fatigue. Neuropsychiatric symptoms or even transient ischemic episodes may occur rarely. Very rarely, complications such as severe mitral regurgitation, arrhythmias or infective endocarditis may occur. Characteristically, patients have a midsystolic click, occasionally followed by a systolic murmur. The timing of the click and the onset of the murmur usually is variable, depending on the ventricular volume. The electrocardiogram frequently shows ST-T wave changes. The diagnosis usually can be confirmed by echocardiography or left ventricular angiography. Most patients with MVP require no treatment other than reassurance. If a systolic murmur is present, prophylaxis against infective endocarditis during dental work probably is useful. Patients with palpitations or chest pain usually respond well to treatment with propranolol. Patients with progressive severe mitral regurgitation require mitral valve replacement.

Death, Sudden↗