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Biomedical subjects

T Treasure

Publications and source records attributed to T Treasure.

At least 199 records · Page 11Linked to original sources
PubMed1985

Factors relating to the development of hypertension after cardiopulmonary bypass.

Paroxysmal hypertension after cardiac surgery is a phenomenon of physiological and clinical significance. The possible preoperative and intraoperative factors that may predict its occurrence were studied in 81 consecutive patients undergoing coronary artery surgery (n = 58) or valve replacement (n = 27), of whom 45 (56%) developed postoperative hypertension. Hypertension occurred significantly more often in those patients who received beta adrenergic blocking agents preoperatively and who underwent coronary artery surgery. Patients with hypertension had significantly higher mean left ventricular ejection fractions preoperatively (52%) than those without (41%) and required phentolamine significantly more often and isoprenaline significantly less often intraoperatively. It is suggested that the significance of preoperative beta adrenergic blockade, the type of operation, and the intraoperative requirement for phentolamine in patients who developed post-operative hypertension may indicate the role of enhanced sympathetic activity and disturbance of cardiac receptors during surgery. Preoperative myocardial performance and the method of myocardial protection during surgery are likely to influence the occurrence of the hypertensive phenomenon.

Adrenergic beta-Antagonists↗
PubMed1985

Variable anatomy of the right coronary artery supply to the left ventricle.

The right coronary artery is "dominant" (contributing to the supply of the left ventricular muscle) in 90% of people. Although the most common pattern is for the right coronary artery to bifurcate at the crux giving the posterior descending (posterior interventricular) artery, a branch may arise before the crux, either as an aberrant acute marginal artery or as an early posterior descending artery, crossing the diaphragmatic surface of the right ventricle. Recognition of this possibility may be important if surgical revascularisation is to be complete. To establish the frequency of these different patterns of blood supply, 22 hearts were studied in the dissecting room, and 100 consecutive coronary angiograms and 100 consecutive operative drawings were reviewed. A vessel arising before the crux contributed to the supply of the left ventricle in one third of cases.

Coronary Angiography↗
PubMed1984

Correlation of angiographic and surgical findings in distal coronary branches.

In 60 consecutive patients undergoing vein graft surgery the angiographic appearances of the coronary vessels were compared with those of the vessels at operation. On the basis of lumen diameter at the potential sites for grafting it was possible to predict with reasonable accuracy from examination of the angiogram which vessels were large enough to be grafted. Angiographic predictive accuracy was 82% and was similar both for vessels which filled normally and for those which filled by collaterals. The predictive value of the angiographic assessment was similar for branches thought to be too small (predictive value 74%) and for those considered sufficiently large (predictive value 85%) to receive a vein graft. Disease of the vessel walls was found at surgery (66% of coronary branches examined) more frequently than was predicted from the angiographic appearances (33%). Previous necropsy studies have found a high prevalence of coronary atheroma in the population, yet normal angiographic appearances in the coronary arteries are not uncommon in patients undergoing investigation for suspected coronary disease. The present study showed that atheroma may be present in coronary vessels without encroaching into the vessel lumen, so that it is not evident on the angiogram. Coronary atheroma is thus present more often and is more widely distributed in the coronary tree than is indicated by coronary angiography.

Arteriosclerosis↗
PubMed1983

Diminutive pulmonary artery growth following right ventricular outflow tract enlargement.

We have assessed the clinical results and angiographic pulmonary artery growth following construction of the right ventricular outflow tract in 10 children with tetralogy of Fallot or pulmonary atresia. All cases were associated with diminutive pulmonary arteries and considered unsuitable for total corrective surgery. The mean age of the children was 34 months, mean weight 10 kg and mean body surface area 0.48 m2. The right ventricular outflow tract was constructed by insertion of a patch of dura mater (5 patients), pericardium (2 patients), homograft valved conduit (2 patients) and infundibulectomy (1 patient). The ventricular septal defect was not closed. Study of the patients between 13 and 37 months postoperatively revealed an increase in mean arterial oxygen saturation of 22% (P less than 0.01) and a fall in mean haemoglobin concentration of 1.6 g% (P less than 0.05). Overall change in pulmonary artery diameter compared to that of the trachea was insignificant although in individual cases a 50% increase in diameter was shown. Palliation of symptoms was equivalent to conventional shunting procedures. Closure of the ventricular septal defect was performed successfully in 2 patients at a later date.

Child↗
PubMed1983

Coronary artery bypass surgery.

Coronary artery surgery entirely relieves or very much reduces angina in over 90 per cent of patients and it can now be undertaken with a very low operative risk. Furthermore, it increases life expectancy for many angina sufferers. It has been shown to increase the probability of surviving for 5 years in those who have life-threatening forms of coronary artery disease and as figures have become available for 10-year results they confirm that this improvement in prognosis is sustained in the second 5 years after surgery. The data now available indicate that the prognosis is improved by surgical treatment in all except those with only one vessel involved or with the less hazardous forms of two-vessel disease who have a good outlook however they are managed. At present it is thought appropriate to offer surgery to all those with angina that is severe enough to limit a reasonable life style and that adequate medical treatment has failed to control. At a relatively early stage in the assessment it is desirable to know the result of a formally conducted exercise ECG test and this together with the outcome of a trial of medical management decides whether or not coronary angiography should be performed. With this further information available it is possible to take into account the improvement in prognosis with surgical treatment in patients with the more dangerous forms of coronary artery disease. Depending on the severity of the angiographic appearance, perseverance with medical measures may be appropriate.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

The effect of hypothermic circulatory arrest time on cerebral function, morphology, and biochemistry. An experimental study.

Thirty-two pairs (n = 64) of Mongolian gerbils were surface cooled to 18 degrees C and randomly subjected to 0 to 180 minutes of bilateral carotid occlusion in the neck. They were rewarmed after release of the carotid occlusion. After rewarming, one member of each pair was allowed to survive 7 days and then was put to death for brain histologic study; the other was subjected to brain preservation by quick freezing for subsequent biochemical studies. In the survivors, neurologic function was depressed during the 7 subsequent days, and the depression was in direct relation to the time of carotid occlusion (p = 0.0005). The proportion of normal hippocampal neurons decreased in direct proportion to the length of carotid occlusion (p less than 0.0001). The depression in neurologic function and in the proportion of normal neurons was evident when occlusion time exceeded 45 minutes. The proportion of normal neurons was correlated with neurologic function (r = 0.56, p = 0.0001). Cortical adenosine triphosphate (ATP) concentration after brain reperfusion was reduced in comparison with normal and varied inversely with carotid occlusion time (r = -0.84, p less than 0.0001). Alanine (p less than 0.001), lactate (p = 0.01), and pyruvate (p = 0.001) concentrations were elevated, in direct relation to carotid occlusion time. These observations are consistent with other experimental studies of profoundly hypothermic total circulatory arrest and indicate the damaging effect of this modality, particularly when the circulatory arrest time exceeds 45 minutes.

Animals↗
PubMed1981

Clinical evaluation of an automatic potassium electrode. Use of the Nova 1 ion-selective electrode in a cardiac surgical intensive care unit.

A Nova 1 potassium analyser has been evaluated for the first 3 months of its use in a cardiac surgical intensive care unit. The machine was out of action for 11 out of 104 days. 515 external calibrations were performed with 4.50 mmol/l potassium standards: mean 4.49 mmol/l, standard deviation 0.07. 692 comparisons were made with routine laboratory flame photometer measurements on the same sample: correlation coefficient r = 0.815. It is concluded that Nova 1, if kept in working order, can provide potassium estimations quickly and accurately.

Cardiac Surgical Procedures↗
PubMed1981

Prognosis of peripheral lung tumours related to size of the primary.

Three hundred and fourteen cases of peripheral lung tumours managed surgically over a 15-year period have been analysed to re-examine the effect of tumour size on the probability of survival up to five years after operation. The cases were classified into four groups according to the size of the primary. There was a significant inverse relationship between tumour size and five-year survival over the four groups (p less than 0.05) but this relationship did not hold for the largest tumours. The tumours over 6 cm did no worse than the group one size smaller (4.5-6.0 cm). Analysis of the survival in each group revealed a different pattern of annual loss in the largest tumours which suggested that this group included carcinomas self-selected for less metastatic potential. The peripheral tumours as a whole included more undifferentiated but fewer small cell carcinomas than the overall chest clinic figures. Within the peripheral tumours squamous carcinomas became more common and adenocarcinomas less common with increasing size. No small cell or adenocarcinomas were found among the five-year survivors in the large tumour group. Because 20% of patients with tumours over 6 cm lived for five years in this group of 314 patients we do not believe that they should be excluded from operative treatment on the basis of size alone.

Adenocarcinoma↗
PubMed1978

Isolated complete transection of the common bile duct by blunt abdominal trauma.

Isolated complete transection of the common bile duct due to blunt trauma is rare. Its occurrence and successful treatment in an 8-year-old boy are described. Inital minor peritonism resolved quickly, followed by a deceptive asymptomatic period and insidious development of jaundice, anorexia, vomiting, pain, acholic stools and progressive abdominal distension due to sterile biliary ascites. A preliminary cholecystostomy was followed by construction of a Roux-en-Y cholecystojejunostomy.

Abdominal Injuries↗