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Biomedical subjects

R C Elkins

Publications and source records attributed to R C Elkins.

At least 91 records · Page 5Linked to original sources
PubMed1979

KMA-Greenfield filter placement for chronic pulmonary hypertension.

Over a period of four years, 23 patients had the diagnosis of chronic pulmonary hypertension made on the basis of elevated resting pulmonary arterial pressures above 30 mmHg mean. Clinical features included dyspnea (100%), previous thromboembolism (43%), congestive failure (39%), venous thrombosis (35%), syncope (30%), lung disease (22%), recent trauma (22%), hemoptysis (17%) and precordial pain (17%). Pulmonary angiograms showed embolic occlusion in all but four patients, who were considered to have primary pulmonary hypertension. KimRay-Greenfield((R)) vena caval filters were inserted in 18 patients. Three of them were in refractory shock at the time, and only the one who had successful intraluminal catheter embolectomy survived. These patients have been followed an average of 23 months with two embolic deaths, one from the right atrium and one bypassing a filter misplaced in the right iliac vein (overall mortality 22%). There has been no other known recurrent embolism, but one patient developed hematuria from the filter. The five patients who did not receive a filter have all died after intervals up to 18 months. Recurrent thromboembolism was documented in three and suspected in one patient with known embolic disease who died suddenly. Regardless of etiologic factors, pulmonary hypertension with cor pulmonale is associated with a high incidence of fatal thromboembolism. In our experience, maximal protection is afforded by long-term anticoagulation therapy and the placement of a venacaval filter.

Adolescent↗
PubMed1978

Isolation and characterization of glycoproteins from canine tracheal mucus.

Three homogeneous glycoproteins were isolated from reduced and S-carboxy-methylated canine tracheal pouch mucus by gel filtration and ion-exchange chromatography. Initial fractionation was carried out on Sephadex G-200; chromatography of the excluded Sephadex G-200 fraction on Bio-Gel A-15 m yielded two high molecular weight glycoprotein fractions. Following rechromatography on the same column, the main fraction behaved as an electrophoretically homogeneous high molecular weight (581 600) glycoprotein, with a high carbohydrate content (80%) and a single amino-terminal amino acid (arginine). Ion-exchange chromatography (DEAE-cellulose) of the included Sephadex G-200 fraction yielded two electrophoretically homogeneous glycoproteins of lower molecular weight (20 800 and 24 600, respectively). A single amino-terminal amino acid, glycine and alanine, respectively, was detected for each glycoprotein. Chemical analysis of these three glycoproteins revealed the presence of fucose, galactose, N-acetylgalactosamine, N-acetylglucosamine, N-acetylneuraminic acid and sulfate monoester. The high molecular weight glycoprotein had a higher hexose, sialic acid and sulfate content, per mg of protein, than the low molecular weight glycoproteins. The results of the alkaline borohydride treatment indicated that the majority of the carbohydrate chains of these glycoproteins are linked to the protein core through O-glycosidic bonds involving N-acetylgalactosamine and serine or threonine.

Amino Acids↗
PubMed1978

Discussion and management of late failures in reconstructive procedures involving the abdominal aorta.

Review of fifty-eight late failures of 326 procedures performed for revascularization of the abdominal aorta over the past six years showed a low overall operative mortality of 9 per cent. Secondary vascular procedures directed at the aorta itself or at its graft substitute proved more effective in relieving symptoms and restoring flow than did secondary procedures directed at more distal problems in the lower extremities. The aortofemoral graft in conjunction with profundaplasty proved to be the most effective means of restoring flow to the lower extermity after graft occlusion in a previous aortoiliac or aortofemoral graft.

Adult↗
PubMed1978

Relationship of necrosis and tumor border to lymph node metastases and 10-year survival in carcinoma of the breast.

The pathologic findings of 330 patients with invasive carcinoma of the breast who were followed for 10 years after radical mastectomy was reviewed. The presence or absence of necrosis and the character of the border of the tumor were two factors which were observable in all cases. Necrosis in the carcinoma was associated with a higher mortality rate, a higher incidence of axillary node metastases, and a higher mortality rate in patients with axillary node metastases than were primary carcinomas without necrosis. Tumors with necrosis and a root border showed significantly more aggressive behavior than did those tumors with a rounded border and no necrosis.

Breast Neoplasms↗
PubMed1978

Entrapment of sized emboli by the KMA-Greenfield intracaval filter.

Clinical studies demonstrating the effectiveness of the Kim-Ray Greenfield vena caval filter in the management of pulmonary emboli have stimulated efforts to accurately define this filter's capability to entrap sized emboli and maintain caval patency. Twenty-three dogs had filters inserted and positioned distal to the renal veins. Radiopaque emboli measuring 2 to 5 mm were introduced via the femoral vein. Cineradiography allowed direct observation of emboli capture and filter flow dynamics. Probability of entrapment was found to be related to (1) emboli size, (2) depth of filling of the conical-shaped filter by prior entrapment of emboli, and (3) absence of distal venous hypertension. The geometric design of the filter, which allows progressive vertical filling while maintaining circumferential blood flow, is thought to be responsible for entrapment of emboli and avoidance of venous thrombosis and hypertension.

Animals↗
PubMed1977

Comparison of Nissen fundoplication and Belsey Mark IV in the management of gastroesophageal reflux.

Our experience for the past four years with antireflux surgery has been reviewed. The Nissen fundoplication resulted in symptomatic improvement in 87.5 per cent of cases as compared with 64 per cent who were improved after the Belsey Mark IV procedure. Objective evaluation as measured by the standard acid reflux test (SART) revealed recurrent reflux in 9 per cent of those who underwent fundoplication and in 47 per cent of those treated with the Belsey repair. Mortality rates were similar. These results indicate that Nissen fundoplication is superior to the Belsey Mark IV procedure in the management of gastroesophageal reflux.

Abscess↗
PubMed1977

The asymptomatic bruit.

A review of 144 carotid endarterectomies performed in 108 patients at the Oklahoma Health Science Center over the past six years showed an acceptable operative morbidity and mortality in group of patients with an asymptomatic midcervical bruit who underwent prophylactic carotid endarterectomy prior to anticipated elective surgery. Long-term follow-up showed these patients to be free of neurologic symptoms of fatalities in 100 per cent of long-term survivors and suggests that carefully selected patients with an asymptomatic bruit may undergo carotid endarterectomy to prevent future neurologic complication.

Aged↗
PubMed1977

Clinical experience with the Kim-Ray Greenfield vena caval filter.

Over a four year period in two institutions, 85 Kim-Ray Greenfield vena caval filters were inserted in 76 patients who have been followed for a minimum of 6 to 53 months. The most frequent indication for placement was pulmonary embolism during anticoagulant therapy. Both femoral and jugular routes were used for transvenous insertion, and fewer complications were associated with the jugular approach. Surgical mortality within two weeks of operation occurred in three patients (4%), none from recurrent embolism. Late complications included recurrent thrombophlebitis in 7% and persistent extremity edema in 12% of patients. Two patients developed recurrent embolism (2.6%) which also was seen in 2 patients after clips were placed on the vena cava above the filter after misplacement. Venacavagrams in 31 patients an average of 11 months postoperative showed patency in 30 (97%) and lysis of trapped thrombi in four patients. No episodes of migration have occurred and the filter offers the advantages of sustained patency and effective filtration without vena caval occlusion.

Adolescent↗
PubMed1977

Echocardiographic, angiocardiographic, and surgical correlations in right ventricular myxoma simulating valvar pulmonic stenosis.

The echocardiographic, angiographic and surgical correlations in a patients with a right ventricular myxoma simulating valvar pulmonic stenosis are presented. A dense mass of echoes was seen in the body of the right ventricle in diastole; in the right ventricular outflow tract throughout the cardiac cycle; and within the pulmonic valve in systole. These echocardiographic findings suggested the presence of a mass high in the right ventricle, which moved throught the pulmonic valve in systole. This impression was confirmed by angiography and surgery. A 53 mmHg gradient across the pulmonic valve was noted at cardiac catheterization. At operation a myxoma which originated above the crista supraventricularis was found. The tumor moved into the main pulmonary artery in systole. Surgical removal of the tumor resulted in the disappearance of the abnormal echoes.

Adolescent↗
PubMed1976

Hemodynamic and respiratory responses of conscious swine to E. coli endotoxin.

The injection of a sublethal bolus of E. coli into conscious swine produces an early increase in PAP and a decrease in LAP. This hemodynamic effect may be secondary to the pulmonary venous constriction seen in other species, or may relate to demonstrated multiple pulmonary microemboli. Hypoxemia developed in only four of 17 animals although all endotoxin-treated swine showed interstitial edema and elevated wet/dry weight ratios with normal pulmonary surfactant. In addition, endotoxin-treated swine developed signs of disseminated intravascular coagulation, with renal cortical infarcts in 44%, and coronary arterial thrombi in 28% including one transmural myocardial infarction. This effect was observed in the absence of prolonged hypotension in swine and should provide a useful model for further study of the relationship of endotoxin to disseminated intravascular coagulation.

Animals↗
PubMed1976

The effects of coronary vasodilatation on cardiac performance during endotoxin shock.

Results of studies have suggested that endotoxin and lowered coronary arterial perfusion pressures are detrimental to cardiac performance and lead to failure. Prevention of cardiac failure in the isolated canine heart preparation confronted with endotoxin and decreased coronary perfusion pressure was possible by perfusing these hearts with sodium nitroprusside. Prevention of failure was manifested by a lowered left ventricular endiastolic pressure and was associated with increased coronary flow and decreased coronary resistance with increased oxygen delivery and decreased oxygen extraction. Possible explanations for improved performance by dilator perfusion include increased delivery of oxygen and nutrients to myocardial tissue as well as a reduction of ventricular wall tension by dilating the coronary vascular skeleton. Prevention of extravasation of interstitial fluid into myocardial tissue by reducing overperfusion of potentially damaged coronary vessels could serve to maintain myocardial integrity and ventricular compliance. The potential use of such therapy warrants further study, with emphasis on evaluating the hemodynamics of the intact animal.

Animals↗
PubMed1975

Hypoglycemic effects of endotoxin in eviscerated dogs.

Terminal stage, endotoxin shock in the dog is associated with profound hypoglycemia. The response of eviscerated dogs with absent pancreatic and hepatic function is compatible with insulin independent peripheral tissue catabolism of glucose, and an increased lactate-pyruvate ratio suggests anaerobic metabolism. Increased survival in dogs administered exogenous glucose indicates reversible, fuel dependent changes of peripheral tissue metabolism. Since hyperglycemia has been a predominant finding in clinical endotoxin shock, species differences are emphasized, but perhaps closer scrutiny of the terminal stages of clinical endotoxin shock would be more compatible with this experimental model. In any event, an explanation of the metabolic changes in this model may prove valuable in understanding the physiopathology of endotoxin shock.

Animals↗