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Biomedical subjects

R McKay

Publications and source records attributed to R McKay.

At least 127 records · Page 7Linked to original sources
PubMed1982

Septation of the univentricular heart with left anterior subaortic outlet chamber.

Surgical repair by ventricular septation was accomplished in 16 patients with univentricular heart of the left ventricular type, two atrioventricular (AV) valves, and a left anterior subaortic outlet chamber. There were seven hospital deaths (44%; CL 29% to 60%), six from low cardiac output, including each of five patients with outlet foramen obstruction (100%; LC 68% to 100%), In the subset of 11 patients with unobstructed outlet foramen, there were only two deaths (18%; CL 6% to 38%), both in patients with small ventricular size. Multivariate analysis in the group of 16 patients indicates that small ventricular size and again the presence of outlet foramen obstruction are incremental risk factors for hospital death. No late deaths occurred among nine survivors followed between 2 months and 4 years (median = 1.5 years). Only one patient was taking cardiac medication and each was in New York Heart Association Functional Class I. Late postoperative exercise testing in seven showed good exercise tolerance, although values were below normal for children of similar age. Planned initial palliation, appropriate timing to repair, appropriate patient selection, and improving surgical methods should reduce hospital mortality further. The late functional results are encouraging and support continuation of this surgical procedure in patients with suitable anatomy.

Blood Pressure↗
PubMed1981

Binding of an SV40 T antigen-related protein to the DNA of SV40 regulatory mutants.

When simian virus 40 (SV40) infects host cells, the viral genes are expressed in two phases. Early in infection, the virus genome is transcribed and translated to yield two related proteins, 'large T' and 'small t' antigens. Later the rate of synthesis of the early messenger RNA falls and the viral genes coding for the coat proteins are transcribed and translated. Early gene transcription is inhibited only when an active large T antigen is present in the cell (for review see ref. 1). These and other observations have led to the hypothesis that T antigen acts as a negative feedback repressor of its own RNA transcript. The properties of SV40 tsA mutants, which produce temperature-sensitive T antigen, provide evidence for another role of T antigen--in the initiation of viral DNA replication. Mutations around the origin of DNA replication in SV40 lead to a cis-acting defect in DNA replication. These mutations fall outside the region of the A gene which codes for T antigen but within the region known to bind T antigen and the closely related and more easily prepared D2T protein which is synthesized by an adeno-SV40 hybrid virus Ad2D2 and seems to differ from SV40 T antigen only in its amino-terminal segment. Revertants of origin-defective mutants have been isolated with second site mutations within the DNA A gene coding sequence. These data support the view that T antigen modulates transcription and replication of SV40 DNA by binding to one or more sites in and around the viral origin of replication. We present here evidence to show that mutants of SV40 carrying constructed mutations in the regulatory region show reduced binding of D2T protein in vitro. This is the first demonstration in a eukaryote that a mutation in a regulatory DNA sequence alters the binding of a controlling protein in vitro.

Antigens, Neoplasm↗
PubMed1981

Monoclonal antibodies distinguish identifiable neurones in the leech.

Monoclonal antibodies were isolated by screening 475 hybridomas obtained from mice immunized with whole leech nerve cords. The majority (about 300) reacted with leech nervous tissue, but only about 40 made antibodies that identified single kinds or small sets of cells. Twenty of the antibodies which react with specific neurones were studied in greater detail and are described here. They include antibodies against identified sensory neurones and motor neurones as well as against numerous unidentified cells.

Animals↗
PubMed1981

Intracardiac surgery in infants under age 3 months: predictors of postoperative in-hospital cardiac death.

Data are reported on 142 infants less than 3 months old who left the operating room alive after an open intracardiac operation during the 13 years from January 1967 to July 1980. The probability of postoperative in-hospital cardiac death for acute postoperative heart failure (the most common mode of death in these infants) was found by multivariate logistic analysis to be significantly related only to the strength of pedal pulses, the pedal skin temperature and the cardiac index in the first 5 postoperative hours. When cardiac index was not analyzed and cold cardioplegic myocardial preservation methods used, only pedal pulses and pedal skin temperature were significant predictors of hospital death. Blood pressure and heart rate were not related to this mode of hospital death. Oliguria occurred in 23 percent of patients; it was related primarily to inadequate cardiac performance and increased the probability of hospital death. Treatment protocols are derived based on these facts.

Cardiac Output↗
PubMed1981

Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts.

Between April, 1975, and December, 1979, 99 modified Blalock-Taussig shunts (MBTSs) were carried out at The Hospital for Sick Children, Great Ormond Street. The operation consists of interposing between the subclavian artery and the pulmonary artery a prosthesis of greater diameter than that of the subclavian artery. The first 13 operations were performed with a prosthesis of woven Dacron. Conduits of expanded polytetrafluorethylene (PTFE) were used for 86 MBTSs, and these form the basis of this report. Forty-four (51.1%) shunts were performed in infancy, 25 in patients under the age of 1 month (29.0%). Prostheses of 4 mm were used in 34 cases, 5 mm in 14, and 6 mm in 38. There were five shunt failures (5.8%) documented at postmortem or angiocardiographic investigation. Including two late deaths for which postmortem examinations were not obtained, the overall failure rate was 8.1% (seven patients). All these patients were operated upon in infancy, four of them in the neonatal period. Although a longer follow-up is necessary to assess the validity of these shunts, the early results are encouraging. We believe we can now recommend MBTS as an alternative when the classical Blalock-Taussig shunt is considered unsuitable.

Blood Vessel Prosthesis↗
PubMed1981

Surgical treatment of mitral regurgitation caused by floppy valves: repair versus replacement.

Between October 1969 and April 1980, 132 patients underwent operation for floppy mitral valve. The 46 patients in group A underwent valve replacement using an inverted, fresh, unstented, antibiotic-sterilized aortic homograft and the 86 patients in group B underwent valve repair. The onset of symptoms was sudden. More than 80% of the patients in both groups were in New York Association functional class III or IV. The dominant lesion in both groups was ruptured chordae to the posterior cusp (72% in group A and 58% in group B). There were five early deaths (11%) and 15 late deaths (32%) in group A and four early deaths (5%) and five late deaths (7%) in group B. The actuarial survival rate at 5 years was 62% in group A and 90% in group B. In group A, five patients (11%) had valve failure, which led to late death in two. Four patients (8%) in group A required reoperation. Two patients in group B developed a loud mitral systolic murmur soon after operation and required reoperation. Two patients in group B had thromboembolism before routine anticoagulation. Sixteen patients (61%) in group A and 56 (76%) in group B were functional class I after operation.

Anticoagulants↗
PubMed1980

Movable genes.

Explore the source record for details and available documents.

Animals↗
PubMed1980

Postoperative angiographic assessment of modified Blalock-Taussig shunts using expanded polytetrafluoroethylene (Gore-Tex).

Thirty-six of 87 modified Blalock-Taussig shunts done with expanded polytetrafluoroethylene (Gore-Tex) were restudied angiocardiographically. In 7 patients the study was carried out within 1 month of the shunt operation because the patients failed to make satisfactory clinical progress. Two shunts were occluded and 1 ws stenosed; all 3 were in neonates. The remaining 29 patients were reinvestigated electively between 5 and 29 months postoperatively and had a 97% shunt patency rate. Because of the rather high incidence of irregular or stenosed shunts among neonates with 4 mm conduits, we now prefer to use a larger conduit even in this age group.

Arteriovenous Shunt, Surgical↗
PubMed1980

Development of a multihospital pharmacy quality assurance program.

Seven community hospitals have worked cooperatively for 18 months to develop an initial hospital pharmacy quality assurance program. Auditing criteria were developed for nine service areas corresponding to the model program developed by the American Society of Hospital Pharmacists. Current plans are to implement and modify this program as required at each participating hospital. Follow-up programs will also be essential to a functional, ongoing program, and these will be developed in the future.

Interinstitutional Relations↗
PubMed1979

Consumer protection... the realities of medical audit.

The concept of medical audit is an extension of consumer philosophy, writes Ron McKay, but if you are paying for someone else's treatment how do you ensure your money has been spent correctly? In the United States the answer was auditing treatment and medical competence. In the light of the Royal Commission's recommendation for a greater degree of urgency in implementing medical audit here he asks how much can be learned from the US?

Delivery of Health Care↗
PubMed1979

Ageing Britain: private lives . . .

Author looks at the increased use of private residential accomodation by local authorities and focuses on the inadequacy of statutory controls on private homes.

Aged↗