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Biomedical subjects

R O Russell

Publications and source records attributed to R O Russell.

At least 109 records · Page 6Linked to original sources
PubMed1978

Pulmonary consolidation associated with infusion of a glucose-insulin-potassium solution in acute myocardial infarction.

From 1972 to 1975, we have observed seven patients with localized pulmonary consolidation distal to the tip of a Swan-Ganz catheter. These seven instances occurred in a population of over 300 patients receiving a hypertonic solution of glucose, insulin, and potassium for acute myocardial infarction. In four patients the glucose-insulin-potassium solution was instilled directly into the right pulmonary artery from the tip of the Swan-Ganz catheter. In the subsequent three patients the solution was administered via the right atrial port and thus perfused the entire pulmonary vascular bed. The roentgenographic appearance of this localized pulmonary consolidation is indistinguishable from infarction caused by pulmonary thromboembolus or wedging of the catheter.

Adult↗
PubMed1978

Deep venous thrombosis of the upper extremity associated with use of the Swan-Ganz catheter.

Two patients who developed unilateral neck vein distention following insertion of a Swan-Ganz catheter are described. One patient developed unilateral swelling of the arm used for catheter insertion. Following removal of the Swan-Ganz catheter in this patient, venograms of both upper extremities revealed internal jugular vein thrombosis and subclavian vein thrombosis of the involved extremity. The other patient had thrombosis of the internal jugular veins and subclavian veins bilaterally, as well as superior vena cava thrombosis.

Catheterization↗
PubMed1978

Changes in left ventricular segmental wall motion following randomization to medicine or surgery in patients with unstable angina.

Twenty-six patients with unstable angina pectoris had biplane left ventricular (LV) angiograms and coronary arteriograms (CAGs) initially and at a median of 1 year following randomization to medical (15 patients) or surgical 11 patients) therapy. Left ventricular segmental wall motion was analyzed by a digital computer yielding segmental ejection fraction for 10 zones along the LV perimeter. Baseline and follow-up CAGs were analyzed simultaneously by one observer, and changes in LV segmental coronary perfusion were estimated. Left ventricular angiograms were analyzed separately from CAGs and independently of knowledge of changes in estimated segmental coronary perfusion. Left ventricular segmental wall motion was more frequently improved in surgical patients than in medical patients. Furthermore, in surgical patients there was a significant correlation between changes in LV segmental wall motion and perfusion to LV segments supplied by the left anterior descending coronary artery, whereas no such correlation for any segment was found in the medical group. Thus, this prospective randomized study suggests that, in patients with unstable angina, coronary revascularization may significantly improve LV segmental wall motion compared to medically treated patients. In the surgical group, improvement in LV wall motion relates to improvement in coronary perfusion to the segments supplied by the left anterior descending artery.

Adult↗
PubMed1978

Long-term patency of saphenous veins for coronary bypass grafting.

The patency of 871 aortocoronary saphenous vein grafts in 438 patients was evaluated for a mean (+/- SEM) of 12.1 +/- 0.3 months after operation. Second studies were performed in 62 patients (134 grafts) at a mean of 42 +/- 1.3 months postoperatively (range, 13 to 61 months). The 1-year patency rate was 79.4% and increased from 76% for 546 grafts placed in 1970-1973 (Period I) to 85% for 325 grafts in 1974-1976 (period II) (P = 0.001). Overall patency was highest (82%) for grafts to the anterior descending system and lowest (76%) for the right system. These patency rates also increased between periods I and II from 79 to 88% (P < 0.05) for the anterior descending and 72 to 83% (P < 0.05) for the right system. For 47 right coronary arteries having associated distal manual endarterectomy, the graft patency rate was 62% vs 78% for those not endarterectomized (P < 0.05). Of 116 grafts patent at the initial study, five were occluded at the second study, a late failure rate of 3.7% and a mean annual attrition rate of 1.7% between 12 and 42 months after operation. High-grade (> 50%) stenoses were present in three of the five grafts at initial study. Development of late stenosis was observed in two grafts (1.7%). These data document improved 1-year patency rates for grafts in period II and a low incidence of late failure and development of late stenosis for up to 61 months following operation. Continued use of saphenous vein grafts to all three coronary arterial systems appears justified.

Adult↗
PubMed1977

Modern approach to the patient with acute myocardial infarction.

This presentation has described the modern approach to the patient presenting with chest pain suspected as acute myocardial infarction. Noninvasive and invasive methods have been applied to estimate the extent of the myocardial damage and to monitor the electrical, hemodynamic and metabolic changes during the acute phase. In addition to the use of standard analgesics and antiarrhythmics, measurement of the determinants of left ventricular function by noninvasive and invasive techniques provides a physiologic basis for administration of available pharmacologic agents that can alter the afterload, contractile state, preload, heart rate, metabolic state and infarct size. Information from the Swan-Ganz catheter can describe hemodynamic categories that can be optimally managed by regulation of the left ventricular filling pressure. Patients managed in this manner can be identified for early hospital discharge at 7-10 days. Other patients less than 50 years of age or those experiencing recurrent arrhythmias, ischemic pain or evidence of left ventricular dysfunction may be candidates for coronary arteriography and left ventricular angiography before hospital discharge.

Blood Pressure↗
PubMed1977

Quantitative assessment of ventricular performance in unstable ischemic heart disease by dextran function curves.

The ability to quantitate the amount of permanent left ventricular dysfunction in patients with unstable ischemic heart disease would have important clinical value. Left ventricular function curves were constructed in sixteen patients with acute myocardial infarctions and five patients with unstable angina pectoris syndrome at an average of 56 hours (+/- 8) after the onset of symptoms. Fifty ml increments of low molecular weight dextran were rapidly infused into the right antrium during constant monitoring of the pulmonary artery end-diastolic pressure (PAEDP) via a Swan-Ganz thermodilution catheter. An average of 400 ml (range 200-800) was infused to produce a significant change in the PAEDP (range 3-13 mm Hg). The cardiac index was measured before and after the dextran infusion. The slope of the left ventricular function curve was calculated by dividing the change in the cardiac index by the change in the PAEDP. The sixteen patients with acute myocardial infarction underwent left heart catheterization and left ventricular biplane angiography an average of six months later. The five patients with unstable angina pectoris were studied within one month. The slope value of the left ventricular function curve was compared angiographic ejection fraction by linear regression analysis and the correlation coefficient was 0.80. These data demonstrate 1) the slope of the left ventricular function curve in patients with acute myocardial infarction or unstable angina correlates well with the angiographically calculated ejection fraction; 2) as early as two days post myocardial infarction, the residual impairment of left ventricular function can be estimated.

Acute Disease↗
PubMed1977

Improved outcome for prehospital cardiopulmonary collapse with resuscitation by bystanders.

Despite the development of trained mobile rescue squads, cardiopulmonary collapse outside the hospital continues to carry a poor prognosis. We examined retrospectively the clinical courses of 19 consecutive coronary unit patients who had experienced prehospital cardiopulmonary resuscitation. Seven patients received basic life support from bystanders within five minutes. Cardiopulmonary resuscitation in the other 12 patients was delayed beyond five minutes pending the arrival of rescue personnel. Six of seven early-resuscitated patients survived compared with six of 12 late-resuscitated patients (P less than 0.01). The early-resuscitated patients were more alert on admission and had lower pulmonary pressures and higher cardiac outputs compared to the late-resuscitated patients. The early-resuscitated patients also had less residual central nervous system and myocardial damage on discharge than the late-resuscitated patients. On follow-up, three early-resuscitated patients had returned to full-time work compared with none in the late group. Training laymen to initiate early basic life support can benefit the cardiopulmonary collapse victim.

Angina Pectoris↗
PubMed1977

Long-term results of the medical treatment of coronary artery disease.

The natural history of patients with ischemic heart disease varies widely depending upon the anatomic lesion and extent of left ventricular dysfunction. Several clinical variables may also be used to help determine the likelihood of long-term survival. Individuals with high-grade isolated disease of the left anterior descending coronary artery, without significant impairment of ventricular function, have little morbidity and mortality for the 2-year period after arteriography. At the other end of the spectrum, medically treated patients with stenosis of the left main coronary artery or three-vessel disease without such involvement have a reduced life expectancy compared with patients treated surgically. Global judgments on long-term results of the medical treatment of coronary artery disease are meaningless. Efforts should be made to delineate optimal treatment for various subgroups of patients under the broad rubric of ischemic heart disease.

Adult↗
PubMed1977

A multipurpose catheter for electrophysiologic and hemodynamic monitoring plus atrial pacing.

A new multipurpose flow-directed pulmonary arterial catheter has been developed and evaluated in 30 patients with acute cardiopulmonary dysfunction. The catheter permits monitoring of the bipolar atrial electrogram, pulmonary arterial or wedge pressure, central venous pressure, and cardiac output, plus atrial pacing. The standard Swan-Ganz thermistor-equipped catheter was modified to incorporate two ring electrodes on the shaft at 25 and 26 cm from the tip. With the pair of electrodes positioned in the right atrium at the junction with the superior vena cava, stable electrograms of high quality were recorded in all 30 subjects, some for as long as six days. These high-fidelity atrial electrograms permitted rapid and accurate diagnosis of many complex dysrhythmias in these unstable patients. Because of the limited noise in the signal of the electrogram, continuous quantitative measurements of intervals by a computerized system was feasible. Furthermore, the stable intracavitary position of electrodes provided a reliable site for atrial pacing, with pacing thresholds (2 to 12 ma; average, 5 ma) that remained stable for up to four days. Atrial pacing was used to treat sinus bradycardia, atrial tachyarrhythmias, digitalis intoxication, and ventricular dysrhythmias.

Arrhythmias, Cardiac↗
PubMed1976

Surgical versus medical treatment in disease of the left main coronary artery.

Data from 179 patients with a significant lesion of the left main coronary artery were reviewed to compare survival with and without bypass graft surgery. 149 patients were treated with bypass grafting. Of 38 patients treated medically, 24 were suitable for surgery but either had been evaluated before the widespread use of bypass grafting procedures or preferred medical treatment. Major prognostic factors in this group were comparable to the surgical patients. The survival-rate was consistently higher for the surgically treated group and differed significantly (P less than 0-02) for the total duration of follow-up. At twelve months, 89% of the surgical group were alive, but only 73% of the comparable medical group; at twenty-four months, survival-rates were 86% and 65% respectively. These findings, corroborated by other data, suggest that surgery prolongs life for these patients.

Aged↗