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Biomedical subjects

M J Barry

Publications and source records attributed to M J Barry.

At least 145 records · Page 8Linked to original sources
PubMed1986

Heat-denatured albumin-coated Dacron vascular grafts: physical characteristics and in vivo performance.

Dacron fabrics with a wide range of porosities were autoclaved for 3 minutes after being soaked in serum, 5% albumin, or 25% albumin. Porosity of compound Dacron grafts made with 25% albumin was less than 1 ml/min/cm2 regardless of the fabric base, whereas porosity of grafts made with serum or 5% albumin was proportional to the porosity of the base fabric. Porosity of the compound grafts remained stable for more than 48 hours and to pressure greater than 450 mm Hg, if the grafts were kept moist. Tubes of Marlex mesh coated with heat-denatured albumin, implanted as infrarenal aortic replacements in dogs, showed complete albumin absorption by 3 weeks. However, perigraft tissue reaction and graft incorporation were minimal and extensive false aneurysm formation resulted. Knitted filamentous Dacron 6 mm tubes coated with heat-denatured albumin were implanted as iliofemoral bypass grafts in 12 dogs, with blood-preclotted knitted filamentous Dacron grafts implanted as contralateral control grafts. Comparison of the albumin-coated grafts with the blood-preclotted control grafts showed no differences in healing or patency at 4 to 6 months. Heat-denatured 25% albumin forms a strong and hemostatic coating regardless of fabric base. Albumin-Dacron compound grafts are easily and rapidly made in the operating room, handle well, and are suitable for large and medium-sized arterial replacements without changes in healing or patency. Because of slow tissue incorporation, however, albumin-coated knitted Dacron grafts should be avoided in patients who require long-term anticoagulation therapy.

Albumins↗
PubMed1985

The value of computed tomography in staging bronchogenic carcinoma: a changing role for mediastinoscopy.

Forty-one patients underwent operative staging for bronchogenic carcinoma following computed tomography of the mediastinum between August, 1982, and March, 1984. Twenty-seven patients were classified as Stage I preoperatively; in 2 of them, positive mediastinal nodes were found at thoracotomy. For the 14 patients in whom positive nodes had been identified by computed tomographic (CT) scanning, staging was unchanged as a result of the findings at mediastinoscopy or thoracotomy or both. In this series, computed tomography had a sensitivity of 89%, a specificity of 100%, and an overall accuracy rate of 95%. We conclude that mediastinoscopy is not needed in patients without evidence of mediastinal nodal enlargement by CT scan; when performed, it should be guided toward those nodes identified as positive.

Carcinoma, Bronchogenic↗
PubMed1985

Transseptal control of the difficult aortic annulus.

Successful control of the aortic root in extensive erosive endocarditis, with or without mycotic ventricular septal defect, frequently depends on secure prosthetic fixation to the interventricular septum. We describe transseptal suture fixation of aortic root prostheses through a pulmonary infundibular approach and recommend its early use to avoid difficult, often injurious, attempts at septal suture from within the left ventricular outflow tract.

Aorta↗
PubMed1985

Decision analysis for the practicing gastroenterologist. 2. Insights into the efficacy of diagnostic strategies using decision analysis.

Decision analysis is a valuable tool for studying diagnostic strategies in gastroenterology. Multiple comprehensive patient management strategies can be compared in hypothetical populations of patients with varying characteristics reflecting real clinical situations which could not be readily empirically studied. Measures of clinical outcome can be compared and cost effectiveness ratios calculated. Analyses of the diagnostic approaches to suspected obstructive jaundice and pancreatic cancer presenting as abdominal pain are discussed as examples. A useful decision analysis combines the best data available in a clinically relevant fashion. Although decision analysis cannot replace empiric research, it helps clarify reasons for the uncertainty so common in clinical practice and provides insight into the diagnostic process that might otherwise be elusive.

Biopsy, Needle↗
PubMed1984

Treatment of cardiac compression after cardiopulmonary bypass.

A diversity of techniques for delayed closure of the sternum have been advocated for management of hypotension due to cardiac compression after cardiopulmonary bypass. A simple technique utilizing materials readily available in any operating room has been described. It provides for expansion of the cardiac space and sterile coverage of the mediastinum when the skin cannot be approximated.

Cardiopulmonary Bypass↗
PubMed1975

Positive therapeutic response to lithium in hypomania secondary to organic brain syndrome.

A 57-year-old man with no personal or family history of manic-depressive disease developed symptoms of hypomania after a cerebrovascular accident and surgical trauma to the brain. The patient responded well to lithium carbonate treatment over a 2-year period. Although this therapy is contraindicated in cases of organic brain syndrome, the authors suggest that it should be considered in the management of hypomanic behavior following organic brain dysfunction.

Brain Injuries↗
PubMedDate not supplied

Natural history of clinically localized prostate cancer.

The natural history of clinically localized prostate cancer is controversial. However, the data that is available suggests outcomes are good for men with well and moderately differentiated disease, but relatively poor for men with poorly differentiated cancer. For example, in one synthesis of individual-patient level data from six series, ten-year prostate cancer-specific mortality for men with well, moderate, and poorly differentiated disease was estimated at 13%, 13%, and 66%, respectively. Tumor grade is the dominant predictor of prognosis. Few studies report on risks of morbidity due to local cancer progression; the data available suggest this risk is relatively low. Cancer-specific mortality figures overestimate the impact of disease among older men with competing causes of mortality. Given the available data on prognosis of men with localized prostate cancer not treated for cure, clinical trials designed to measure the effectiveness of aggressive therapy will need to be large.

Aged↗
PubMedDate not supplied

The impact of different therapies on symptoms of benign prostatic hyperplasia: a prospective study.

We conducted an observational study to evaluate prospectively the effectiveness of four modes of treatment for benign prostatic hyperplasia (BPH)-watchful waiting, alpha-blocker therapy, finasteride therapy, and surgery (transurethral prostatectomy). A total of 1459 men aged 48 to 84 years, who were diagnosed for the first time by physicians as having BPH in 1994 and who had not received treatment, participated in the study. During 1 year of follow-up, 1064 (72.9%) men remained on no treatment (watchful waiting), 156 (10.7%) were treated with finasteride, 198 (13.6%) were treated with an alpha-blocker, and 41 (2.8%) underwent prostatectomy. The American Urological Association (AUA) Symptom Index was administered to the cohort before the initiation of treatment in 1994, as well as 1 year later. Improvements in lower urinary tract symptoms, as measured by the AUA Symptom Index, were assessed using linear and logistic regression, adjusting for age and baseline. Men who underwent prostatectomy reported the biggest improvements in lower urinary tract symptoms, whether assessed by mean changes in symptom scores relative to no treatment (-5.44; 95% confidence interval [CI]-6.91 to -3.97) or by the odds of improving by 5 or more points on the AUA Symptom Index (odds ratio, 12.66; 95% CI, 5.93 to 27.0). Irrespective of the initial degree of symptom severity, prostate surgery resulted in larger improvements than those reported for either finasteride or alpha-blocker therapy. In this prospective, observational study, prostatic surgery was associated with statistically and clinically significant improvements in BPH symptoms.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

A rare complication of aortic valve endocarditis: diagnosis with transesophageal echocardiography.

Rupture of the membranous interventricular septum resulting in a left ventricular to right atrial shunt is a rare complication of endocarditis. Early recognition of this complication is essential because these patients require early surgical intervention. We report a case of a left ventricular-right atrial shunt complicating aortic valve endocarditis in which transesophageal echocardiography was used to accurately diagnose the lesion before surgery. We will discuss the role of transesophageal echocardiography in the diagnosis of this lesion and will review the existing literature pertaining to this rare complication.

Adult↗