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Biomedical subjects

M Goormastic

Publications and source records attributed to M Goormastic.

At least 73 records · Page 4Linked to original sources
PubMed1986

Predictors of reoperation after myocardial revascularization.

The first 1,000 patients undergoing primary isolated myocardial revascularization each year from 1971 to 1978 were analyzed to define the incidence of reoperation and to elucidate the determinants of reoperation and reoperation-free survival. Six hundred sixty-six patients (9.7%) underwent reoperation in a mean of 6.9 +/- 3.2 years. Cumulative percent reoperation was 2.7% at 5 years, 11.4% at 10 years, and 17.3% at 12 years. The annual incidence of reoperation was 1.1% at 5 years and increased to 3.9% at 12 years. Twenty-five patient descriptors were analyzed for predictors of reoperation. Young age was found to be the most important predictor of potential for reoperation. Other risk factors in descending order of significance were absence of an internal mammary artery graft, incomplete revascularization, New York Heart Association Functional Class III/IV, and single or double vessel disease. Absence of an internal mammary artery graft was an important predictor for all age groups. In the multivariate analyses for risk factors for reoperation-free survival, absence of an internal mammary artery graft was the most important predictor. Other factors of major significance were smoking, incomplete revascularization, and moderate/severe left ventricular impairment. Internal mammary artery grafting neutralizes hypertension, serum cholesterol level higher than 300 mg/dl, and smoking as risk factors for reoperation-free survival.

Adult↗
PubMed1985

Combined cardiac catheterization and carotid cineangiography: an analysis of complications.

Two hundred fifty-three patients underwent cardiac catheterization with selective cineangiography of the carotid arteries. Diagnostic angiograms of both the right and left carotid arteries were obtained in 240 patients (95%). Of these, 217 patients (90%) were studied without complication, 18 (8%) had minor complications, and five (2%) had major complications. Four of the five major complications occurred in patients with bilateral carotid atherosclerosis obliterans. Variations of catheterization technique used in an effort to reduce risk are discussed.

Adult↗
PubMed1985

Recurrence after surgery in Crohn's disease. Relationship to location of disease (clinical pattern) and surgical indication.

Among 615 patients with Crohn's disease originally diagnosed at the Cleveland Clinic Foundation from 1966 to 1969, 592 have been followed (96%) for a mean of 13 yr. Of these, 438 had undergone operation. The purpose of this study was to determine how many of these patients had developed recurrences requiring another operation and to relate recurrences to the original anatomic location of disease (the clinical pattern) and surgical indication. Those patients with ileocolic disease had the highest recurrence: 53% compared with 45% for colonic and 44% for small intestinal patterns. Second recurrences were ileocolic pattern 35%, colon 34%, small intestine 38%. The estimated median time of recurrence was similar among these three groups. The presence of internal fistula or perianal disease as an indicator for surgery were associated with a higher likelihood of recurrence and a shortened estimated median time to recurrence. This study supports the concept of conservatism with regard to the management of these two complications for patients with Crohn's disease.

Adult↗
PubMed1985

Renal transplantation in the older recipient.

From 1976 to 1983, 13 living related and 54 cadaver renal transplants were done in 62 patients more than 50 years old. Patients with no coronary or myocardial disease upon coronary angiography were selected preferentially for transplantation. Over-all 1-year patient and graft survival rates were 88 and 70 per cent, respectively. Among cadaver recipients graft survival was improved (p less than 0.001) when prophylactic antilymphoblast globulin was used. There were fewer steroid-related complications (p less than 0.001) in recipients managed with a low dose rather than a high dose maintenance prednisone regimen. With careful patient selection and a steroid-sparing immunosuppressive regimen, renal transplantation can be done safely in older recipients with no increased risk of death or graft loss.

Age Factors↗
PubMed1985

Determinants of 10-year survival after primary myocardial revascularization.

The first 1000 patients undergoing primary isolated myocardial revascularization each year from 1971 to 1978 were analyzed to elucidate the determinants of long-term survival. Five-year survival was 93.2%, and 10-year survival was 79.3%. Five-year survivals were 96.1%, 94.2%, 92.1%, and 90.8%, respectively, for single, double, triple, and left main disease. Ten-year survivals for the same subsets were 88.6%, 83.0%, 74.9%, and 70.9%. Five-year survivals were 95.3%, 92.4%, 88.0%, and 81.3% for patients with normal, mild, moderate, and severe impairment of the left ventricle. Ten-year survivals for the same subsets were 84.1%, 76.5%, 65.8% and 53.6%. Patients receiving internal mammary artery grafts had 95.6% and 85.8% 5- and 10-year survivals that were superior to 92.0% and 76.2% in patients with only vein grafts. Patients completely revascularized had 95.0% and 82.5% 5- and 10-year survivals, while incompletely revascularized patients had lower (90.5% and 75.2%) 5- and 10-year survivals. Advancing age was the most important factor influencing late survival. Other risk factors in descending order of significance were impaired left ventricular function, no mammary artery graft, smoking, abnormal EKG, three vessel or left main disease, left ventricular end diastolic pressure (LVEDP) greater than 24, hypertension, 1971 to 1974 surgical era, cholesterol greater than 300, incomplete revascularization, and two vessel disease.

Adult↗
PubMed1985

Mitral valve replacement combined with myocardial revascularization: early and late results for 300 patients, 1970 to 1983.

Of 300 consecutive patients undergoing primary operation for mitral valve replacement combined with coronary bypass grafting, 22 (7.3%) died in-hospital. Multivariate testing of preoperative and operative descriptors identified radiographic cardiac enlargement, preoperative paced rhythm or atrial fibrillation, 70% or more left main coronary obstruction, and serum bilirubin of more than 2 mg% as factors associated with an increase in in-hospital mortality. Follow-up of the 278 hospital survivors (mean interval 48 months, range 2 to 165 months) documented survival of 85%, 66%, and 31% and an event-free survival of 65%, 46%, and 21% at 2, 5, and 10 postoperative years, respectively. Cox proportional-hazard regression models of late risk implicated in-hospital ventricular arrhythmias, left ventricular dysfunction, and rheumatic or ischemic causes of mitral valve disease in decreasing long-term survival. In addition, patients with bioprostheses without warfarin anticoagulation had better survival and event-free survival than those with bioprostheses taking warfarin and those with mechanical prostheses with or without warfarin.

Aged↗
PubMed1985

Interobserver variability in EEG interpretation.

A random sample of 100 active electroencephalographers in the United States evaluated 10-second samples of 12 selected EEGs. The evaluations consisted of multiple-choice questions related to the age of the patient, EEG finding, artifact, and consciousness of the patient. The rate of reporting the "correct" response was examined in terms of various respondent characteristics such as EEG board certification, age, percent of time in clinical EEG work, and number of recordings interpreted annually. This study indicates that, even today, there is considerable variability in EEG interpretation, and that this variability is influenced by specific reader characteristics.

Action Potentials↗
PubMed1985

Does mammary artery grafting increase surgical risk?

From 1980 through 1982, 7105 patients underwent primary isolated myocardial revascularization. Of these, 49.2% received only vein grafts and 50.2% received at least one internal mammary artery graft. The incidence of mammary artery grafting increased from 33.5% in 1980 to 67.1% in 1982. The operative mortality rate was 1.4% in the vein group and 0.2% in the mammary artery group (p less than .0001). A multivariate analysis identified six incremental risk factors for operative mortality. After adjusting for these risk factors, the use of vein grafts only was found to be an incremental risk factor (p less than .0001). In a subset of patients without major risk factors, there was no difference in the incidence of perioperative infarction, respiratory insufficiency, wound complication, stroke, use of intra-aortic balloon, reoperation for bleeding, or blood requirements. We conclude that internal mammary artery grafting is safe and is not associated with increased surgical morbidity or mortality.

Adult↗
PubMed1984

Improved results of cadaver renal transplantation with azathioprine, prednisone and antilymphoblast globulin.

From 1980 to 1982, 100 consecutive cadaver renal transplants were performed. All but 2 recipients received preoperative transfusion and all received an initial 2-week course of antilymphoblast globulin. A prospective controlled evaluation of high versus low maintenance prednisone, and antilymphoblast globulin versus intravenous methylprednisolone for first rejection therapy was done. Over-all 1-year graft and patient survivals were 77 and 96 per cent, respectively. Graft survival was equal in the high and low steroid groups. Antilymphoblast globulin was as effective as intravenous methylprednisolone in reversing first rejections. Graft survival was improved with better donor-recipient matched grafts. We conclude that excellent results can be obtained in transfused cadaver renal allograft recipients managed with azathioprine, prednisone and antilymphoblast globulin. The regimen of prophylactic antilymphoblast globulin, low maintenance prednisone and antilymphoblast globulin alone for first rejections is immunologically effective and steroid sparing.

Antilymphocyte Serum↗
PubMed1984

Young adults with coronary atherosclerosis: 10 year results of surgical myocardial revascularization.

This study reviews data on 107 patients, aged 35 years or younger, who underwent surgical coronary revascularization from 1971 to 1975. Early clinical events included one operative death and five nonfatal perioperative myocardial infarctions. Late follow-up (mean interval after operation 115 months) demonstrated actuarial survival rates of 94% at 5 years and 85% at 10 years. Fifteen late deaths, 23 nonfatal myocardial infarctions, 13 reoperations and return of severe angina in 10 patients were considered late clinical events. Actuarial survival free of early or late clinical events was 77% at 5 years and 53% at 10 postoperative years. Testing of clinical, angiographic and operative variables for influence on survival and event-free survival showed that survival was decreased by multivessel disease and impaired left ventricular function; event-free survival was decreased by a family history of coronary disease and cigarette smoking. Both survival and event-free survival were decreased by diabetes and elevated serum cholesterol. Postoperative cardiac catheterization (64 patients, mean postoperative interval 47 months) demonstrated that mammary artery graft patency (25 of 27, 93%) exceeded vein graft patency (49 of 88, 56%, p less than 0.01). The atherogenic diatheses of young adults may compromise the operative result, whereas use of internal mammary artery grafts may enhance the palliation of bypass surgery.

Adult↗
PubMed1984

Primary myocardial revascularization. Trends in surgical mortality.

From 1970 to 1982, 24,672 patients underwent primary isolated myocardial revascularization: Group I, 4,517 patients operated upon from 1970 to 1973; Group II, 6,181 patients from 1974 to 1976; Group III, 6,869 patients from 1977 to 1979; and Group IV, 7,105 patients from 1980 to 1982. Operative mortality was 1.2% for the entire experience and 1.2%, 1.4%, 1.6%, and 0.8% for Groups I to IV, respectively. Mortality for Group IV was significantly lower (p less than 0.001). In decreasing order of significance, the risk factors were emergency operation, congestive heart failure, left main disease, female gender, history of congestive heart failure, advancing age, normothermic arrest, number of grafts, poor ventricular function, and incomplete revascularization. The same analysis of Groups I to IV demonstrated that advanced age, emergency operation, female gender, and congestive heart failure persisted as risk factors while incomplete revascularization and abnormal electrocardiogram emerged as new risk factors. Cardiac causes accounted for 203 (66.2%) patient deaths. This gradually decreased from 75.3% in Group II to 58.5% in Group IV. Neurological deficit was the second most frequent cause of death, 29 (9.6%), reaching a high in Group IV (18.9%). We conclude that (1) morbidity and mortality have decreased significantly despite increasing risk factors; (2) congestive heart failure has replaced emergency operation as the principal risk factor; (3) left main disease, number of grafts, and poor ventricular function have been neutralized as risk factors; and (4) cardiac causes of death are decreasing and being replaced by other system failure.

Age Factors↗
PubMed1984

Comparison of two methods of kinetic modeling.

Kinetic modeling has been shown to be beneficial for a number of reasons in the dialysis population. It is useful as a quality control measure of dialysis, with a critical review of individual dialysis conditions; and it provides quantification for evaluation and change of treatment prescriptions allowing cost-saving reduction of treatment times. Kinetic modeling also provides objective patient and staff education with objective nutritional surveillance and improved patient compliance. A comparison of the results from UKM and DDQ for 40 simultaneously modeled patients showed statistically significant differences in pool volume, protein catabolic rate and dialyzer clearance with UKM yielding a higher mean in each case. Pool volumes obtained in DDQ compared more favorably to those obtained by separate calculations based on sex, age, height and weight, indicating greater accuracy in DDQ. This is partly because in DDQ solute removal is measured directly and rigid control of the dialysis process is not required. DDQ is a more accurate, flexible model which provides both an understanding of each individual's dialysis treatment and protein nutriture, thereby improving patient care.

Adolescent↗
PubMed1983

Improved results of cadaver renal transplantation in the diabetic patient.

The results of 54 renal transplants performed on 48 patients with end stage renal disease and insulin-dependent diabetes mellitus are reported. Pre-transplant screening with coronary angiography was done to determine the presence and severity of coronary artery disease and left ventricular dysfunction. There were 12 living related donor (group 1) and 42 cadaver renal transplants. The cadaver transplant recipients were grouped further into those who received additional prophylactic immunosuppression with antilymphoblast globulin (group 2, 18 patients) and those who received standard immunosuppression with azathioprine and prednisone (group 3, 18 patients). The 2-year patient and graft survival rates in groups 1 to 3 were 81 and 67, 88 and 69, and 61 and 32 per cent, respectively. The use of prophylactic antilymphoblast globulin for adjunctive immunosuppression resulted in significantly improved graft survival among cadaver recipients (p less than 0.003). Selection of patients for transplantation on the basis of preliminary screening with coronary angiography was found to have a major impact on patient survival.

Adult↗
PubMed1983

Replacement of aortic valve combined with myocardial revascularization: determinants of early and late risk for 500 patients, 1967-1981.

Five hundred consecutive patients underwent aortic valve replacement and coronary revascularization in the years from 1967 to 1981, with 29 (5.9%) in-hospital deaths. Current operative mortality (1978-1981) is 3.4%. Univariate and multivariate analyses were used to identify determinants of early and late risk. Female sex, aortic insufficiency, and advanced age increased in-hospital mortality, whereas use of cardioplegia decreased it. At follow-up of 471 patients who survived hospitalization for 1 to 135 months (mean 41) after surgery, 96 late deaths were documented. Survival rates were 87%, 80%, and 55%, and event-free survival rates were 80%, 65%, and 39% at 2, 5, and 10 years after surgery, respectively. The late survival rate was unfavorably influenced by the presence of moderately or severely impaired left ventricular function and double-vessel coronary disease; the rate was enhanced for patients in age group from 50 to 59 years old and was not influenced by the method of myocardial protection. The event-free survival rate decreased with the presence of moderately or severely impaired left ventricular function and was enhanced for patients with New York Heart Association class I or II symptoms before surgery. Patients with bioprostheses who did not receive anticoagulants had higher survival and event-free survival rates than did either patients with bioprostheses who received anticoagulants or patients with mechanical valves, whether they received anticoagulants or not.

Age Factors↗
PubMed1982

Effects on labeling index as a predictor of response to chemotherapy in the 13762 adenocarcinoma.

A series of 24 experiments was carried out, in which treatment effect was determined in vivo on rats bearing measurable implants of 13762 adenocarcinoma treated with a variety of chemotherapeutic agents, alone or in combination. In 11 experiments, a reduction in mean tumor area was observed after treatment (response), while 13 showed no such effect (no response). For each experiment, cells from tumor-bearing animals were placed in suspension culture (10 experiments) or in two-layer soft-agar culture (14 experiments) after 24 h of exposure to drug-containing plasma or control plasma. Cells were harvested from cultures at 24-h intervals thereafter for determination of the thymidine labeling index in treated versus control populations. The sum of labeling indices in control plasma divided by that in treated plasma was determined to combine the available data over time (overall ratio). Critical values for this ratio were defined, which demonstrated significant depression of the labeling index. Significant labeling index depression occurred in nine of 11 experiments where response in vivo occurred, and in one of 13 in which no response was seen (P = 0.0004 by Fisher's exact test). When experiments carried out in soft agar culture or in suspension culture were examined separately, the association of labeling index depression in vitro and response in vivo remained statistically significant. In this model system, labeling index depression by drug-containing plasma is highly predictive of response to therapy.

Adenocarcinoma↗
PubMedDate not supplied

Basal levels of plasma epinephrine and norepinephrine in the dog.

Conscious (n = 62) and anesthetized (n = 34) dogs were studied to establish basal levels and ranges for plasma epinephrine (E) and norepinephrine (NE) in this species. Trained conscious dogs were familiarized to recording conditions and personnel for 2 to 3 weeks and acclimatized to the laboratory for at least 15 minutes prior to blood sampling from a chronically implanted catheter. Their basal values were 65 +/- 47 pg/ml for E and 145 +/- 58 pg/ml for NE, which were significantly lower (p less than 0.05) than values in a second group of conscious dogs trained in the same manner but sampled soon after arrival to the laboratory (E = 144 +/- 93 pg/ml; NE = 193 +/- 86 pg/ml). Catecholamine levels in dogs anesthetized with one of three different regimes commonly used in cardiovascular studies were shown to be similar to the basal values found in conscious dogs acclimatized to the laboratory. The weak correlations found between basal plasma catecholamines and hemodynamic variables in all groups of conscious dogs reflect the complexity of factors interacting with the sympathetic nervous system in the maintenance of arterial pressure. These results document the variability that can be expected when using catecholamine levels as an index of sympathetic nervous system activity and the necessity of standardizing conditions for sample collection.

Acclimatization↗