A simple method of decreasing the morbidity of split-thickness skin graft donor sites.
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Bandages↗
Biomedical subjects
R J Morris
Publications and source records attributed to R J Morris.
Coronary artery bypass surgery in nonagenarians.
As the number of nonagenarians increases yearly in the United States, surgeons will be asked more often to evaluate the possibility of intervention for coronary artery disease in this age group. The purpose of this study is to document experience with patients 90 years of age or older in order to determine whether coronary artery bypass grafting surgery is justified. Eleven patients aged 90 years or more underwent cardiac surgery for symptomatic coronary artery disease refractory to medical management between January 1, 1987, and December 31, 1996. All patients were in NYHA Class IV preoperatively. In-hospital death occurred in two patients (18%). In-hospital morbidity occurred in all patients (100%) including seven cardiac, four respiratory, two neurologic, and one infectious. All survivors left the hospital symptomatically improved. The mean length of stay was 28 days. Four patients died at a mean of 2 years and 2 months postoperatively. Five patients remain alive at a mean of 1 year and 7 months. Coronary artery bypass grafting in nonagenarians can be performed successfully in selected cases. However, increased mortality and morbidity rates and length of stay are associated with this age group. For survivors, the quality of life is improved and the projected life expectancy restored.
Aged↗
Surgical treatment of interventional coronary angiographic accidents.
Newer methodologies have increased the incidence of coronary interventions. At the authors' institution, 5,614 coronary interventional procedures (28% of all catheterizations) were performed over a 3-year period, from 1995 to 1997. Eighty-one patients (1.4%) suffered angiographic accidents, including coronary artery dissection, free rupture, tamponade, foreign body embolism, and wire entrapment, and were retrospectively reviewed. All patients were taken for emergency surgery in less than 4 hours. The mean age was 61.2 years, 44 (54%) were men, and 37 (46%) were in cardiogenic shock at the time of surgery. Fifty-seven patients (70%) had intraaortic balloon counterpulsation. The number of previous cardiac interventions ranged from one to four with a mean of 1.9. One to five bypass grafts (mean, 2.2) were performed, and three patients required temporary ventricular assist devices. There were six deaths for a 30-day mortality rate of 7.4%. Thirty-two patients (39.5%) suffered significant morbidity, including cerebrovascular accidents, and renal and respiratory failure. Perioperative myocardial infarctions were diagnosed in 39 (48%) patients. Average length of stay was 12.1 days. One-year survival was satisfactory at 90% (73/81), with 56 survivors (77%) regaining normal everyday activity. Early surgical intervention, rapid revascularization, and temporary mechanical support are keys to low mortality in this high-risk group. Identification of high-risk interventions and significant comorbid conditions, with concomitant surgical consultation, need to be pursued to reduce the high morbidity rate.
Activities of Daily Living↗
Comparison of tests of beta-cell function across a range of glucose tolerance from normal to diabetes.
Adequate comparisons of the relative performance of different tests of beta-cell function are not available. We compared discrimination of commonly used in vivo tests of beta-cell function across a range of glucose tolerance in seven subjects with normal glucose tolerance (NGT), eight subjects with impaired glucose tolerance (IGT), and nine subjects with type 2 diabetes. In random order, each subject underwent two of each of the following tests: 1) frequently sampled 0.3-g/kg intravenous glucose tolerance test (FSIVGTT) with MinMod analysis; 2) homeostasis model assessment (HOMA) from three samples at 5-min intervals with a model incorporating immunoreactive or specific insulin measurements; and 3) continuous infusion of 180 mg x min(-1) x m(-2) glucose with model assessment (CIGMA) of three samples at 50, 55, and 60 min (1-h CIGMA) and at 110, 115, and 120 min (2-h CIGMA). The discrimination of each test was assessed by the ratio of the within-subject SD to the underlying between-subject SD, the discriminant ratio (DR). The degree to which tests measured the same physiological variable was assessed using Pearson's correlation coefficient adjusted for attenuation due to test imprecision. An unbiased line of equivalence, taking into account the imprecision of both tests, was used to compare results. Beta-cell function assessed from HOMA and beta-cell function assessed from CIGMA (CIGMA%beta) (using immunoreactive insulin) had higher DRs than first-phase intravenous glucose tolerance test-derived incremental insulin peak, area, insulin-to-glucose index, and acute insulin response to glucose from FSIVGTT-MinMod. CIGMA%beta (immunoreactive insulin) had the highest DR. FSIVGTT-derived first-phase insulin response tests correlated only moderately with HOMA and CIGMA. Using specific rather than immunoreactive insulin for HOMA and CIGMA did not improve discriminatory power. Simple tests such as HOMA and CIGMA, using immunoreactive insulin, offer better beta-cell function discrimination across subjects with NGT, IGT, and type 2 diabetes than measurements derived from FSIVGTT first-phase insulin response.
Analysis of Variance↗
Within- and between-subject variation in commonly measured anthropometric and biochemical variables.
BACKGROUND: The biological variation of some commonly assessed metabolic variables in healthy subjects has not been studied extensively. The aim of the study was to assess, in 12 healthy subjects (6 male and 6 female; mean (SD) age; 22.7 (1.5) years) following an overnight fast, the day-to-day variation of body fat (impedance method), triglycerides, nonesterified fatty acid (NEFAs), glycerol, 3-hydroxybutyrate (3-OHB), lactate, glucose, insulin (RIA), C-peptide, and glucagon on 12 consecutive days. METHODS: Between- and within-subject coefficients of variation (CVG and CVW) were estimated using a random effects analysis of variance, and assay variation was subtracted to give the coefficient of within-subject biological variation (CVI). Individuality indices were calculated as CVW/CVG. RESULTS: The overall means, CVI, and individuality indices were as follows: for body fat, 24.2%, 10%, and 0.3; for triglycerides, 0.61 mmol/L, 21%, and 1.1; for NEFAs, 376 micromol/L, 45%, and 1.4; for glycerol, 48 micromol/L, 36%, and 0.8; for 3-OHB, 43 micromol/L, 61%, and 1.5; for lactate, 0.88 mmol/L, 31%, and 1.1; for glucose, 4.9 mmol/L, 4.8%, and 0.7; for insulin, 52 pmol/L, 26%, and 1.0; for C-peptide, 0.39 nmol/L, 24%, and 0.9; and for glucagon, 53 ng/L, 19%, and 0.8. CONCLUSIONS: The data presented here are necessary for the evaluation of several important metabolic variables in individual and group studies. The biological variation of some metabolites makes it difficult to characterize the status of healthy subjects with a single measurement.
3-Hydroxybutyric Acid↗
Soft tissue giant cell tumor of low malignant potential: a proposal for the reclassification of malignant giant cell tumor of soft parts.
Although "giant cell tumor of soft parts" has traditionally been considered a single entity as reflected in the original term "malignant giant cell tumor of soft parts (MGCT)" and later by the term "malignant fibrous histiocytoma, giant cell type" the degree of atypia and mitotic activity varies in this group, suggesting biologic heterogeneity. The clinicopathologic features of 31 tumors meeting the traditional criteria of MGCT but having only mild to moderate nuclear atypia are presented. Patients with these tumors (19 females; 12 males) ranged in age from 14 to 84 years (mean, 40 years) and presented with masses of involving either superficial (n = 16) or deep (n = 13) soft tissue. Most occurred on the arm or hand (n = 16) and ranged in size from 0.7 to 6.5 cm (mean, 2.1 cm). The tumors consisted of sheets and nodules of rounded mononuclear cells that blended with spindled cells and benign osteoclastic giant cells. Pleomorphic giant cells were absent. Osteoid was noted in 10 cases, but features typically associated with tenosynovial giant cell tumors (such as dense stromal hyaline, siderophages, and xanthoma cells) were nearly always absent. Mitotic figures ranged from 1-10/10 HPF (mean, 2-3/10 high-powered field), and angiolymphatic invasion was present in 10 cases. Necrosis was absent, however. The mononuclear cells expressed CD68, tartrate-resistant acid phosphatase, and smooth muscle actin, but lacked CD45, S100 protein, desmin, and lysozyme, an immunophenotypic profile identical to that of giant cell tumor of bone. Follow-up information in 19 patients (mean, 3 yrs; median, 1-7 yrs) indicated recurrences in four patients, but none developed metastasis. This behavior contrasts significantly with the high-grade behavior traditionally associated with MGCT of soft parts. These giant cell tumors can be consistently recognized by the lack of cytologic atypia even in the face of mitotic activity and vascular invasion. Although their long term metastatic risk is not fully defined, we propose they be termed "giant cell tumors of low malignant potential" and regarded as the soft tissue analogue of giant cell tumor of bone. The term "malignant giant cell tumor of soft parts" or giant cell malignant fibrous histiocytoma should be restricted to histologically high-grade lesions.
Acid Phosphatase↗
A composite CMV-IE enhancer/beta-actin promoter is ubiquitously expressed in mouse cutaneous epithelium.
In most existing transgenic mouse models developed for the study of specific genes in the skin, the goal has been to target transgene expression to defined populations of cells in the cutaneous epithelium. Keratin promoters have been especially useful for this purpose. In some instances, however, it may be desirable to express a transgene in all the cells of the cutaneous epithelium. Since no ubiquitously expressed promoter sequences had previously been identified, we used lacZ reporter transgenes to test two enhancer/promoter sequences for ubiquitous expression in the skin of adult transgenic mice. We find that a CMV enhancer/CMV promoter is not active in most cell types in the skin, whereas a CMV enhancer/modified beta-actin promoter sequence is active in the suprabasal and basal cells of the epidermis as well as in the epithelial cells of the hair follicles, sebaceous glands, and the dermal papillae.
Actins↗
Enhanced bursts of IPSCs in dentate granule cells in mice with regionally inhibited long-term potentiation.
Until recently, most studies on the synaptic-cellular basis of learning and memory concentrated on the activity-dependent changes occurring in principal cells such as hippocampal pyramidal cells and dentate granule cells. However, the ability of the inhibitory interneurons to regulate synaptic plasticity remains less understood. This study tested the hypothesis that the gamma-aminobutyric-acid (GABA)-mediated inhibitory neurotransmission is enhanced in mice that show no detectable long-term potentiation in the dentate gyrus in the absence of the GABAA receptor antagonist bicuculline. Patch clamp recordings were made from dentate granule cells in brain slices from wild-type and Thy-1 knockout (KO) mice. The frequency, amplitude and kinetics of miniature inhibitory postsynaptic currents (mIPSCs, generated by the action potential-independent release of GABA) was not different between animals. However, bursts of spontaneous IPSCs (sIPSCs, generated by both action potential-independent and -dependent GABA release) in KO mice were associated with larger synaptic charge transfers and increased durations. When pairs of IPSCs were evoked at varying intervals, the amplitude of the second response with respect to the first was significantly larger in KO animals. These results further support the concept that enhancement of interneuronal functions in cortical structures can have profound effects on the activity-dependent synaptic plasticity observed in principal cells.
Animals↗
Diagnosis and management of traumatic aorto-right ventricular fistulas.
BACKGROUND: Traumatic aorto-right ventricular (Ao-RV) fistulas are rare lesions that result in congestive heart failure if left untreated. Early diagnosis and prompt surgical intervention are required to avoid the natural outcome of cardiac decompensation. METHODS: All cases of traumatic Ao-RV fistula described in the English literature since 1958 were reviewed. The clinical presentation, methods of diagnosis, and treatment strategies were assessed to determine the pathophysiology, natural history, and outcome of surgical intervention. RESULTS: Forty cases of traumatic Ao-RV fistulas were described in the English literature. There were 39 men and 1 woman, with a mean age of 28.3 years (range, 15 to 50 years). Twenty-two (55%) patients had isolated Ao-RV fistulas. Fourteen (35%) had Ao-RV fistulas with aortic insufficiency. Definitive surgical repair was performed in 38 patients. The associated aortic valve injuries were managed with repair techniques or replacement with prosthetic devices. The surgical outcomes in all patients were satisfactory. CONCLUSIONS: The pathophysiology and natural history of Ao-RV fistulas involves the development of congestive heart failure. Traumatic aortic insufficiency frequently is associated with this disorder. Early diagnosis and prompt treatment are necessary to avoid the natural outcome of cardiac decompensation. Definitive repair should be performed with the aid of cardiopulmonary bypass during the same hospitalization.
Adolescent↗
Total simultaneous repair of coarctation and intracardiac pathology in adult patients.
BACKGROUND: Thoracic aortic coarctation accompanied by a second surgically reparable lesion is a rare combination in the adult patient. The simultaneous operative management of both lesions is desirable because of the higher morbidity and mortality that would occur with staged procedures. METHODS: We describe the simultaneous operative management in three adult patients with coarctation and a second cardiac lesion. All 3 patients had intrapericardial ascending aorta-descending aorta bypass and concomitant repair of a cardiac lesion. The attendant repairs in the 3 patients, respectively, were aortic valve replacement, orthotopic heart transplantation, and coronary artery bypass grafting. RESULTS: Double arterial cannulation, retrograde cardioplegia, large-bore aorto-aortic bypass grafts, and early use of alpha-agonists to stabilize systemic pressure were all key to ensuring safe conduct of the operation. Each patient had an essentially uneventful postoperative course. CONCLUSIONS: Thoracic coarctation and concomitant cardiac pathology can be safely and readily managed with a single-stage approach involving cardiac repair and extraanatomic ascending aorta-descending aorta bypass grafting. A review of the English-language literature of patients managed similarly is included.
Adrenergic alpha-Agonists↗
Minimally invasive saphenous vein harvesting.
BACKGROUND: Minimally invasive techniques to harvest the saphenous vein for coronary artery bypass grafting continue to improve and evolve. Smaller cutaneous incisions have been shown to decrease postoperative discomfort and improve healing. We describe a technique involving carbon dioxide insufflation and endoscopic dissection to allow easier and atraumatic dissection. METHODS: The VasoView endoscope system (Origin Medsystems, Inc) was used to harvest the saphenous vein for coronary artery bypass grafting in 27 patients. This group was compared with 24 patients having traditional saphenous vein harvesting. Wounds were examined for complications daily. Pain and postoperative mobility were quantified independently by physical therapists. RESULTS: Comparison of patients in the two groups revealed greater edema in the legs with traditional harvesting. Patients with endoscopic removal also had less pain and increased mobility postoperatively. On average, minimally invasive harvesting allowed patients to ambulate to a predischarge goal of 300 ft 2 days earlier. CONCLUSIONS: Minimally invasive harvesting of the saphenous vein by insufflation techniques is safe, effective, and atraumatic to the conduit. Discomfort is minimized, promoting earlier and improved ambulation.
Aged↗
Reliability of single sample experimental designs: comfortable effort level.
This study was designed to ascertain the intrasubject variability across multiple recording sessions-most often disregarded in reporting group mean data or unavailable because of single sample experimental designs. Intrasubject variability was assessed within and across several experimental sessions from measures of speaking fundamental frequency, vocal intensity, and reading rate. Three age groups of men and women--young, middle-aged, and elderly--repeated the vowel /a/, read a standard passage, and spoke extemporaneously during each experimental session. Statistical analyses were performed to assess each speaker's variability from his or her own mean, and that which consistently varied for any one speaking sample type, both within or across days. Results indicated that intrasubject variability was minimal, with approximately 4% of the data exhibiting significant variation across experimental sessions.
Adult↗
Errors in intraocular lens power calculation after photorefractive keratectomy.
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Aged↗
Temporary epicardial atrial pacing electrodes: duration of effectiveness based on position.
BACKGROUND: To investigate the duration of effectiveness in the postoperative period of temporary epicardial atrial pacing electrodes on the right atrium, based on position. METHODS: The function of temporary epicardial atrial pacing electrodes were examined in 55 patients undergoing coronary artery bypass grafting from March 20, 1996, to July 31, 1996, at Allegheny University Hospitals, Hahnemann Division, Philadelphia, PA. There were 41 male and 14 female patients. The mean age was 71 years (range 35 to 86 years). Two atrial and two ventricular temporary epicardial pacing electrodes were placed at the termination of cardiopulmonary bypass. One atrial electrode was placed on the body of the right atrium at the junction of the superior vena cava (body electrode); the other was passed through the pursestring of the atrial cannulation site (appendage electrode). RESULTS: The mean thresholds for the atrial body electrodes on the operative day and postoperative days 1 and 2 were 4.96, 6.67, and 6.80 mA, respectively. The mean thresholds for the atrial appendage electrodes were 5.98, 7.50, and 8.59 mA, respectively. CONCLUSIONS: Temporary epicardial atrial pacing electrodes are more effective when the wires are placed in the atrial body of the right atrium than if they are wrapped within the pursestring of the right atrial appendage. As a result of these findings, the common practice of placing the pacing wire through pursestring tissue should be abandoned.
Adult↗
Amiodarone-associated hemoptysis.
Amiodarone is a benzofuran derivative with a chemical structure similar to thyroxine. Originally introduced to treat angina pectoris, amiodarone was found to have antiarrhythmic properties, and in 1985, was approved in the United States for treatment of life-threatening ventricular arrhythmias. It is now used for various ventricular and supraventricular arrhythmias refractory to conventional first-line medications, and as a result, side effects have been observed with increased frequency. The most severe and potentially life-threatening of these side effects is the development of pulmonary toxicity. Typically, amiodarone pulmonary toxicity (APT) is manifested by acute pneumonitis and chronic fibrosis. Amiodarone-associated hemoptysis (AAH) is a rare occurrence. The authors describe a case of AAH successfully treated with cessation of drug and steroid therapy.
Amiodarone↗
Horner's syndrome in infancy.
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Eye Color↗
Coronary artery bypass grafting in patients with COPD.
OBJECTIVE: To more fully define the influence of COPD in patients undergoing coronary artery bypass grafting (CABG). METHODS: One hundred ninety-one patients with COPD underwent CABG from March 1, 1995, to June 21, 1996. There were 129 male and 62 female patients. The mean age was 69 years (45 to 86 years). Patients with COPD were defined according to the Summit Database definition: requires therapy for the treatment of chronic pulmonary compromise or has an FEV1 <75% of predicted value. RESULTS: Hospital mortality was 7%. Hospital morbidity was 50%. Statistically significant (p<0.05) morbidity included general pulmonary complications (12%) and atrial fibrillation (27%). Hospital mortality for COPD patients with postoperative pneumonia was 11%. Hospital mortality for patients with COPD receiving steroids was 19%. The hospital mortality for patients > or = 75 years of age was 17%. The combined mortality for patients with COPD who are > or = 75 years of age and receiving steroid therapy was 50%. The mean length of stay was 12 days. Late mortality was 1% at a mean of 1.5 years. CONCLUSIONS: Hospital mortality in most patients with mild-to-moderate COPD undergoing CABG is similar to those without COPD. In the minority of patients with severe COPD who are receiving steroids and > 75 years, the hospital mortality is exceptionally high. These findings support CABG in patients with mild-to-moderate COPD. Nonsurgical therapy should be considered for elderly COPD patients with severe disease taking steroids.
Aged↗
Cell-specific ecdysone-inducible expression of FLP recombinase in mammalian cells.
The ability of site-specific recombinases, like FLP and Cre, to catalyze alterations in genomic DNA is well established, whereas their application to genetic engineering strategies has been restricted because of the inability to temporally regulate their expression and subsequent recombination events in specific populations of cells. We describe a regulatory system for ecdysone-controlled expression of FLP recombinase. Furthermore, we demonstrate that ecdysone-induced, FLP-mediated site-specific recombination events can be targeted to specific cells. This system can be applied to cell-lineage studies as well as to the design of gene-therapy strategies, particularly in stem cells.
3T3 Cells↗