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Biomedical subjects

S J Phillips

Publications and source records attributed to S J Phillips.

At least 109 records · Page 6Linked to original sources
PubMed1983

The case for early direct myocardial reperfusion.

The treatment of choice, in Des Moines, Iowa for evolving myocardial infarction, is emergency reperfusion by medical or surgical means that are appropriate to the individual patient. If the patient exhibits clinical evidence of continuing evolution at any time distance from the onset of chest pain, cardiac catheterization is done immediately. With single vessel disease, streptokinase lysis is attempted and augmented when necessary by percutaneous transluminal coronary angioplasty. If multiple vessel disease is present, surgical intervention is carried out immediately. As mentioned above, time is not a predictor as to the final outcome whereas the endocardial ventricular architecture correlates well with wall motion recovery. This therapeutic protocol has resulted in an overall mortality rate of 3.5% in patients with evolving myocardial infarction. As mentioned above, all deaths occurred in the patients who were in cardiogenic shock before therapy, and all other 303 patients with evolving myocardial infarction recovered. We certainly do not discourage controlled clinical trials, utilizing these and other techniques, but do encourage you to adopt reperfusion as the primary therapy for evolving myocardial infarction for your patients.

Angioplasty, Balloon↗
PubMed1983

Percutaneous initiation of cardiopulmonary bypass.

Improved technology has allowed us to develop support pumps that can be applied rapidly and safely. A system utilizing thin-walled (4 mm inner diameter) percutaneously inserted sheaths has been designed for rapid bedside arterial and central venous cannulation to establish femoral arterial and venous cardiopulmonary bypass. The system utilizes two 30-cm-long large-bore, thin-walled (end and side holes) venous cannulas and a single 15-cm-long (end hole) arterial reperfusion cannula, which is connected to a pediatric oxygenator and a vortex pump head. Five patients with refractory cardiac arrest who could not be resuscitated by conventional means were revived with this system. Application time was approximately five minutes. This system appears to be an easily applied and reliable short-term mechanical support device.

Cardiopulmonary Bypass↗
PubMed1983

Emergency coronary artery reperfusion: a choice therapy for evolving myocardial infarction. Results in 339 patients.

Between 1975 and 1982, 339 patients underwent emergency coronary artery reperfusion for treatment of evolving myocardial infarction (MI). Group I (112 patients) had reperfusion with intracoronary streptokinase. Group II (46 patients) had reperfusion with a combination of intracoronary streptokinase and percutaneous transluminal coronary angioplasty (PTCA). Group III (181 patients) had saphenous vein bypass grafting. Twenty Group I patients and one Group II patient had emergency bypass grafting as streptokinase and PTCA were unsuccessful and significant myocardium remained at risk due to residual stenosis in the MI artery. Seventy-nine percent of Group III patients had successful thrombectomy of the infarcted artery, 33% of Group I had significant residual lesions after clot lysis, and 16% of Group I and 17% of Group III patients had no observable lesion on restudy. There were 10 early and two late deaths in the surgical patients. There were two deaths in Group I and no deaths in Group II. All deaths occurred in patients who were in cardiogenic shock before reperfusion (Group IV). Late follow-up (220 patients to 78 months) revealed three late MIs, four cerebral vascular accidents, two late cardiac and three noncardiac late deaths, and 31 patients with residual symptoms. Patients with an emerging MI should be treated via reperfusion of the MI vessel by one of these techniques. With single-vessel involvement, streptokinase lysis of the intercoronary thrombosis should be attempted. If this is successful and there is a significant residual stenotic lesion, the vessel should undergo balloon angioplasty at that time. If PTCA is unsuccessful, then bypass grafting should be done. When significant multiple-vessel disease exists in conjunction with an acute MI, the patient should have emergency saphenous vein bypass grafting as the treatment of choice.

Adult↗
PubMed1983

Intravenous balloon pumping for acute right ventricular failure.

A patient with acute right ventricular failure and severe hemodynamic instability following coronary artery revascularization was treated with intra-aortic and intravenous balloon pumping. The intravenous balloon was timed to inflate during diastole and deflate during systole as did the intra-aortic balloon; in fact, the two were connected to the same system through a Y-connector. The intravenous balloon acted as an artificial atrium, which allowed approximately 20% improvement in the cardiac output when this intravenous balloon was functioning. Hemodynamic stability was achieved with this system. Intravenous balloon pumping should be considered for patients with unstable hemodynamics secondary to acute right ventricular failure.

Aged↗
PubMed1983

Spline solution to terminal zero acceleration problems in biomechanical data.

An augmented cubic spline function was evaluated as an alternative solution to the end-point problem which frequently arises in the smoothing and differentiation of biomechanical position-time data. The usual procedures of natural cubic spline functions and digital filtering have the undesirable effect of forcing the accelerations to zero at the ends of the data set. The proposed augmented cubic spline procedure does not have this characteristic but rather requires the curve to pass through a single extra point at each end of the data set. Using two different criteria with large acceleration magnitudes near the end of the data set, we have compared the effectiveness of all three methods in terms of the total curve (root mean square error) and in terms of the last few points (percent and algebraic error). In both experiments the augumented cubic spline procedure was found to be superior to both digital filtering and natural cubic spline functions. It was concluded that this technique could be used for smoothing and differentiating biomechanical data in instances where the underlying function is unknown and the accelerations at the end points of the data set are suspected of being non-zero.

Biomechanical Phenomena↗
PubMed1982

Surgery for evolving myocardial infarction.

One hundred fifty-six patients underwent emergency coronary revascularization during the early phases of evolving myocardial infarction (MI). There were six hospital deaths (3.8%) and two later deaths (1.3%). Thrombectomy of the MI artery was achieved in 79% of the patients, and 17% of the patients showed no observable lesion in the MI vessel on restudy. Graft patency was 99%. Late follow-up to 62 months disclosed 17 patients with residual limitations. Analysis of the data established criteria for recognizing patients with early MI who would benefit from surgical therapy. The criteria are derived by comparing preoperative and postoperative ventricular anatomy, creatine phosphokinase levels, and hemodynamics.

Clinical Enzyme Tests↗
PubMed1982

Coronary artery spasm following coronary artery revascularization.

Coronary artery spasm is a well-documented phenomenon in patients undergoing medial treatment. We describe coronary artery spasm occurring in the immediate postoperative period following coronary artery bypass operation. The spasm occurred in a vessel that was not operated on and that had no apparent lesion. The diagnosis of spasm was made by coronary angiography immediately after operation. Complications associated with this spasm are discussed. Emphasis is placed on early postoperative angiography for patients whose condition is inexplicably unstable after operation.

Amyl Nitrite↗
PubMed1981

Surgical therapy for evolving myocardial infarction: Results in 138 patients.

One hundred thirty-eight selected patients underwent emergency coronary artery revascularization as the treatment for early evolving myocardial infarction. Low early and late (3.6 and 2.9%) mortality and morbidity up to 54 months, with favorable post surgical hemodynamic improvement demonstrates the operability with beneficial results in selected patients with early evolving myocardial infarction.

Adult↗
PubMed1980

DNA sequence organization of the beta-globin complex in the BALB/c mouse.

Clones containing five non-adult beta-globin genes were isolated from a library of BALB/c DNA. Together, the newly cloned regions comprise a contiguous block of 32 kb of the mouse genome. Restriction mapping of genomic DNA established the physical linkage of these non-adult genes to the two adult beta-globin genes as well as the two adult genes to each other. Thus this entire BALB/c beta-globin complex consists of seven linked genes, all with the same transcriptional orientation, arrayed over 70 kb of DNA. The order of these genes is: 5'-epsilon y3-beta h0-beta h1-beta h2-beta h3-beta major-beta minor-3' Portions of each of the five newly identified genes have been sequenced. Only one, epsilon y3, encodes a previously described globin. beta h0 and beta h1, which are closely related, differ significantly from both adult and embryonic globins. The beta h2 sequence is more closely related to the adult genes than to the other non-adult genes. However, it is the sequence least homologous to both of these classes. The 5' half of the beta h3 gene (preceding codon 75) has an aberrant structure. The rest of this sequence is intact, resembling an adult beta-globin gene except for an inserted base at cocon 90, resulting in a frameshift. Consequently, the beta h3 sequence cannot be translated to produce a normal beta-globin.

Animals↗
PubMed1980

Clinical trial with a percutaneously inserted intra-aortic balloon pump: a wider spectrum of patient application.

The intra-aortic balloon pump has been proven to be an effective form of therapy in a variety of situations involving actual or potential ventricular power failure. An experience with 12 newly-designed percutaneous PERCOR-TM intra-aortic balloon pumps is discussed. Emphasis is made on the ease of insertion and removal, and on the fact that a trained surgical team in an operating room setting is not necessary. Effectiveness of the balloon in comparison to the traditional intra-aortic balloon pump is also discussed.

Adult↗