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Biomedical subjects

S M Scott

Publications and source records attributed to S M Scott.

At least 127 records · Page 7Linked to original sources
PubMed1979

Iatrogenic coronary artery stenosis following aortic valve replacement.

Until recnetly, coronary arterial perfusion was one of the best methods to protect myocardium during aortic valve replacement. However, the insertion of perfusion cannulas may produce immediate traumatic lesions and late stenosis of the coronary arteries, with grave consequences. Two patients with normal coronary arteries prior to operation developed obstruction of the maximal left main coronary artery following aortic replacement. One of these patients represents the first case of iatrogenic coronary arterial stenosis in which the aortic valve was replaced with a porcine bioprosthesis. Accelerating angina pectoris and ventricular arrhythmias were the presenting clinical manifestations. Aorta-coronary bypass grafting to the left anterior descending and circumflex coronary arteries was successfully performed in one patient, while the other patient died before investigative procedures could be undertaken. Any patient whose aortic valve has been replaced and who develops angina pectoris a few months after operation should be suspected of having developed stenosis of the proximal coronary artery. Coronary angiography should be perfomed promptly. Once the lesion is recognized, the operaiton should be performed posthaste because these lesions are life threatening owing to their proximal location and rapid evolution.

Aortic Valve↗
PubMed1978

Insidious strut fractures in a DeBakey-Surgitool aortic valve prosthesis.

Recent reports of cage wear occurring in DeBakey-Surgitool aortic valve prostheses prompted us to examine with image intensification all our patients who have had this type of prosthesis implanted. One patient, who was asymptomatic, was discovered to have a prosthesis with two fractured struts. This patient's prosthetic valve was replaced successfully with a stented porcine heterograft prosthesis. Including the valve removed from this patient, 8 DeBakey-Surgitool aortic valves with structural defects have been reported to the manufacturer. In the absence of a catastrophic event, patients with valves having fractured or worn struts may be totally asymptomatic, and routine periodic roentgenographic examination may be the only way of detecting strut wear or fracture.

Adolescent↗
PubMed1978

Heroin addiction as a family phenomenon: a new conceptual model.

The chronic relapsing nature of heroin addiction can be explained from a family systems viewpoint. The addiction cycle is part of a family pattern involving a complex homeostatic system of interlocking feedback mechanisms. These serve to maintain the addiction and consequently the overall family stability. Drug-taking usually starts at adolescence. It is related to an intense fear of separation experienced by the family in response to the addict's attempts at individuation. The family becomes stuck at a particular developmental stage. Heroin provides a solution at several levels to the dilemma of whether or not to allow him independence. Paradoxically, it permits him to simultaneously be both close and distant, "in" and "out", competent and incompetent, relative to his family of origin. This is pseudoindividuation. An understanding of these concepts, and their integration into a homeostatic model, can provide the basis for effective treatment.

Adolescent↗
PubMed1977

The value of multiple-plane angiography in the assessment of aortoiliac disease.

Aortography, regarded as a definite diagnostic study in evaluating pateints with peripheral vascular occlusive disease, is usually done in the anteroposterior projection only. Occasionally, a significantly diseased area may not be identified on this projection, and an oblique view of the aortoiliac region may clarify the presence and severity of arteriosclerosis. At present, our indications for obtaining oblique views of the aortoiliac region are (1) when symptoms correlate poorly with the arteriographic findings in the anteroposterior projection, or (2) when the severity of the lesion is in doubt. These projections also are used to evaluate patients who have had previous aortoiliac bypass grafts and in whom ischemic symptoms recur. Patients with unilateral limb ischemia who are being considered for femorofemoral bypass graft procedures or iliac endarterectomy are also appropriate candidates, especially when radiopaque material overlies the vessels. Arteriograms in oblique projections also are recommended for more precise evaluation of the origin of the profunda femoris artery.

Angiography↗
PubMed1976

Experience with the DeBakey-surgitool aortic prosthetic valve.

The DeBakey-Surgitool aortic valve differs from popular cloth-covered prostheses by having a bare metal cage and a pyrolytic carbon ball. This valve was implanted in 37 patients. There were 7 operative deaths (19%), none of which was related to the valve design. Thirty survivors have been followed up to five years with 12 late deaths. The single thromboembolic event resulted in the only valve-related death. One patient developed a periprosthetic leak and another has hemolytic anemia. The incidence of thromboembolism in small series (3%) is comparable to that with the cloth-covered valves. This and the absence of complications related to cloth wear are important considerations when selecting a prosthesis.

Adult↗
PubMed1976

The sutureless aortic valve prosthesis: experience with and technical considerations for replacement of the early model.

Reoperation was performed in seven (16%) of 43 patients with early models of Magovern sutureless aortic valve prostheses, because of thromboembolism and ball variance. All patients survived reoperation with no major complications. Removal of the sutureless prosthesis was not difficult when an insertion tool of proper size was used. A scarred annulus remained which was favorable for the suturing of a new prosthesis. The incidence of disabling thromboembolism (42%) and poppet failure (21%) is high with these early models. When these complications occur, replacement of the prosthesis is recommended to prevent death or recurrent embolic episodes.

Adult↗
PubMed1976

Renovascular hypertension and acute aortic dissection in a patient with renal transplant.

The late results of renal transplantation are very encouraging. Apart from the more common complications, such as the rejection phenomenon and recurrent infections, occasionally renovascular hypertension may occur as a late complication. This is, to our knowledge, the first reported case of acute dissecting aortic aneurysm in a young man who had received a renal transplant six years earlier and later developed renovascular hypertension. All patients with renal transplant who develop severe hypertension which is refractory to medical management should be considered for renal arteriogaphy and correction of stenosis, if it is present.

Adult↗
PubMed1976

Subclavian artery laceration due to migration of a Hagie pin.

Injuries to subclavian artery are infrequent and usually occur due to gunshot or stab wounds and occasionally by blunt trauma to the chest. An early diagnosis and control of hemorrhage is essential to prevent death which may occur due to exsanguinating hemorrhage. A case of injury to the subclavian artery due to migration of a Hagie pin, which was used to treat the acromioclavicular separation, is reported. The subclavian artery was ligated initially, which produced an ischemic and functionless upper extremity. Revascularization of the arm was successfully accomplished by an axilloaxillary bypass grafting procedure. This simple procedure is advocated in situations requiring ligation of the subclavian artery following trauma, when direct reconstruction is not feasible.

Acromioclavicular Joint↗
PubMed1975

Opportunistic endocarditis following open-heart surgery.

The incidence of endocarditis following open-heart operations is declining, but the relative incidence of endocarditis by the opportunistic organisms, both bacterial and fungal, has increased. These "opportunists" require careful identification and sensitivity testing so that appropriate therapy can be planned. In cases of candida endocarditis, a positive precipitin test and elevated candida antibody titer may provide an earlier means of diagnosis than blood cultures. These patients should be treated promptly with adequate dosages of specific antimicrobial or antifungal agents. Reoperation should be considered early if there is evidence of valve dehiscence or embolic phenomena or if drug therapy fails to control the infection.

Adult↗
PubMed1975

False aneurysm of the abdominal aorta due to blunt trauma.

Nonpenetrating trauma to the abdominal aorta is uncommon and the development of a traumatic abdominal aortic aneurysm is even more rare. The victims of blunt trauma to the abdomen should be examined for diminution or absence of femoral pulses, especially if numbness, diminished sensations, or motor weakness appear following trauma. If pulse abnormalities are present, aortography should be performed promptly to exclude aortic disruption or dissection. Immediate surgery should be performed once the diagnosis of aortic disruption is made. To our knowledge, this is the second reported case of successful surgical treatment of a false aneurysm of the abdominal aorta following nonpenetrating trauma.

Aorta, Abdominal↗
PubMed1975

Extrathoracic bypass for stenosis of innominate artery.

Stenosis of the innominate artery usually occurs in older patients in whom the risks of conventional, corrective procedures such as transthoracic endarterectomy or aorto-innominate arterial bypass grafting are quite high. An axillo-axillary bypass procedure was performed in a high-risk patient with innominate arterial stenosis who had repeated episodes of transient cerebral ischemia due to decreased blood flow through the right carotid artery and reversal of blood flow through the right vertebral artery. Postoperatively, he has had dramatic improvement in his symptoms. Because of its simplicity, avoidance of major thoracotomy, avoidance of temporary occlusion of the carotid artery, and excellent late results, axillo-axillary bypass grafting is being proposed as the procedure of choice for stenosis of the innominate artery.

Age Factors↗
PubMed1975

Multiple-plane angiography for more precise evaluation of aortoiliac disease.

In 14 patients an oblique view of the aotoiliac region was obtained in addition to the conventional anteroposterior view. Angiograms in oblique projections are indicated in the following situations: (1) where the symptoms cannot be explained by the findings on the conventional anteroposterior view (2) where the patient has had previous anoroiliac grafts and has redeveloped ischmic symptoms, and (3) where patients with unilateral limb ischemia due to unilateral aotoiliac occlusive disease are being considered for a femororfemoral bypass graft procedure. In six patients appreciation of the true significance of the suspected occlusive lesion was of great value in planning the proper surgical procedure. In the remaining eight, angiographic corroboraion of the absence of significant occlusive disease was equally helpful in managing the patient's condition. Examples of each group are presented.

Angiography↗
PubMed1975

Femorofemoral grafts for unilateral occlusion of aortic bifurcation grafts.

Femorofemoral bypass grafts were performed in 10 patients who developed thrombosis of one of the limbs of previously placed aortoiliac or aortofemoral bifurcation grafts. There were no operative deaths or significant postoperative morbidity, and no amputations had to be performed following the bypass. Nine of the 10 patients have patent grafts from 5 to 70 months (average 33 months) following operation. Of these nine, eight are asymptomatic and one has mild claudication on the side of the unoccluded limb. Because of its simplicity, low operative risk, and encouraging late success rate, we feel that femorofemoral bypass grafting for late unilateral occlusion of a prosthetic bifurcation graft is the procedure of choice.

Aortic Diseases↗
PubMed1975

Femorofemoral bypass graft: choice or compromise?

Thirty-one femorofemoral crossover graft procedures were performed in 27 patients who had unilateral limb ischemia either due to unilateral aortoiliac occlusive disease of due to thrombosis of one of the limbs of a previously placed aortic bifurcation graft. There was no operative mortality, and only two patients required late amputation. There have been two late deaths. Thrombosis of the femorofemoral graft occurred in five patients. Four patients had a second femorofemoral graft, three of whom have long-term patency. Grafts are patent in 23 of 25 surviving patients. The femorofemoral graft procedure is relatively simple and is associated with a low operative mortality and morbidity. Its late patency rates are comparable with those following conventional aortic bifurcation graft procedures. Therefore, we believe the indications for femorofemoral graft should be broadened to include all patients with unilateral aortoiliac occlusive disease where anatomic conditions are favorable and there is unilateral occlusion of an aortic bifurcation graft.

Adult↗