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Biomedical subjects

W A Gay

Publications and source records attributed to W A Gay.

At least 73 records · Page 4Linked to original sources
PubMed1981

Complications of percutaneous intraaortic balloon pumping.

Eight-nine consecutive patients who were considered candidates for counterpulsation were reviewed for complications of the percutaneous intraaortic balloon pump (PIABP). Indications for counterpulsation were cardiogenic shock in 37 patients, refractory ischemia in 35, postcardiotomy shock in nine, acute infarction with threatened extension in four, septic shock in three and elective preoperative use in one patient. In 67 patients (75.3%), successful passage of the balloon was accomplished in a single attempt; the opposite-side attempt was successful in 10 patients (11.2%) and neither attempt was successful in 12 (13.5%). Seventy-seven patients who underwent PIABP had major complications, including limb ischemia in 12, bleeding at the puncture site in three, permanent foot drop in three, aortic dissection in three, renal embolism in one and false aneurysm at the puncture site in one. Fourteen patients had minor complications: asymptomatic loss of pedal pulses in eight, transient bacteremia in two, parasthesias in two and wound hematoma in two. No patient had free perforation, balloon rupture or wound infection. The rate and severity of complications of PIABP are similar to those with conventional IABP insertion. Ease of insertion alone should not be grounds for using PIABP in patients who can be managed without counterpulsation.

Aortic Rupture↗
PubMed1981

Postpericardiotomy syndrome in adults: incidence, autoimmunity and virology.

While continuing a study of immunologic and virologic aspects of the postpericardiotomy syndrome (PPS) in infants and children, we undertook a companion study in adults. Whereas the incidence in 119 children was 27.8%, as is usual for our hospital, the incidence in 142 adults was 17.6%. Most of the operations (95 of 142) were performed on patients who were 50-69 years old. Incidence decreased as age increased: 28.5% for ages less than 40 years, 19.7% for ages 40--59 years, 14.2% for ages 60--69 years, and 10% for ages 70 years and older. Heart-reactive antibody in high titer was found in all patients with PPS; a rise in antiviral antibody to one or more of a battery of eight common viruses (adenovirus, cytomegalovirus, and coxsackie-virus B 1 to 6) was identified in 68% of these with PPS but in only 5% of those without clinical manifestations. We conclude that in adults, as in children, PPS may be an autoimmune phenomenon triggered by viral illness.

Adult↗
PubMed1980

Tumors of the chest wall.

Primary tumors of the chest wall are uncommon but should be considered in the evaluation of patients with persistent chest wall pain or the presence of a chest wall mass, especially when this is near the costal cartilages. Special radiographic techniques may help to define the diagnostic possibilities and the extent of local involvement. Since at least half of the primary rib tumors and virtually all of the sternal tumors are malignant, these problems demand prompt investigation, accurate tissue diagnosis, and, usually, generous surgical excision. With appropriate attention to skin, soft tissue, and skeletal involvement, resection of major chest wall tumors can be done safely, and there are a variety of reconstructive techniques available to deal with the resulting defects. Radiotherapy has little role in the treatment of chest wall tumors except for the myeloproliferative disorders and possibly some cases of Ewing's sarcoma. Chemotherapy has similarly been ineffective for the cartilaginous tumors but shows some promise in the multidisciplinary approach to osteogenic sarcoma. Surgical resection, however, remains the mainstay for the treatment of most tumors of the chest wall. Even in instances of recurrent disease there are many whose long-term survival has been achieved by multiple operative procedures.

Chondroma↗
PubMed1980

Viral illness and the postpericardiotomy syndrome. A prospective study in children.

Postoperative fever and pericardial-pleural reaction, designated postpericardiotomy syndrome (PPS), is a common complication of cardiac surgery involving entry into the pericardium. To determine whether the etiology of PPS is viral or immunologic, we undertook a prospective, triple-blind study of consecutive long-term survivors of intrapericardial surgery in the pediatric age group. We evaluated clinical evidence of syndrome and concurrent appearance of antiheart antibody (AHA) by indirect immunofluorescence and antiviral antibody (AVA) by complement fixation in sera preoperatively and serially postoperatively. Incidence of PPS was 27% overall in 400 subjects, but only 3.5% in infants younger than 2 years of age. AHA in high titer appeared in all patients with PPS. A fourfold or greater rise in titer to AVA was found in 70% of these but in only 5% of those with negative AHA and no PPS. AVA rise, tested in 280 consecutive patients, was to no single one of the eight viruses studied (adenovirus, cytomegalovirus, and coxsackievirus B 1-6). Instead, the rise and fall, consistent with antiviral response to a recent infection, was exhibited usually to one but occasionally to two or more viruses, and the viral prevalence changed from year to year, as did that in the community. The study suggests that concurrent fresh or reactivated viral illness plays a role in triggering the immunologic response that characterizes the PPS.

Aging↗
PubMed1980

Advantages of hypothermic potassium cardioplegia and superiority of continuous versus intermittent aortic cross-clamping.

The relative effectivenss of hypothermic potassium (K) cardioplegia in conjunction with either continuous or intermittent aortic cross-clamping was evaluated in 20 mongrel dogs. Isovolumetric left ventricular (LV) contractions and myocardial biopsies were obtained before and after a total of 90 minutes of aortic cross-clamping. The dogs were randomly divided into four groups of five dogs each as follows: Group I, continuous 90 minute cross-clamping and multidose K at 4 degrees C (40 mEq/L); Group II, intermittent cross-clamping consisting of six 15 minute periods of cross-clamping separated by 5 minute reperfusion periods and K cardioplegia at 4 degrees C given at the start of each cross-clamping period; Group III, continuous 90 minute cross-clamping and multidose buffered saline at 4 degrees C; Group IV, intermittent cross-clamping, consisting of six 15 minute periods of cross-clamping separated by 5 minute reperfusion periods and buffered saline at 4 degrees C given at the initiation of each cross-clamp period. Group I dogs had the best myocardial performance, with no difference between control values of peak LV pressure and dP/dtmax and those recordings obtained 60 minutes after release of the aortic cross-clamp. Significant depression of LV function was noted in all other groups. Examination of force-velocity and length-tension relationships confirmed better myocardial performance in Groups I and II (multidose K at 4 degrees C) than in Groups III and IV (buffered saline at 4 degrees C). Groups I and III (continuous cross-clamping) had no de-rease in diastolic LV compliance after cross-clamping, whereas compliance was decreased in both Groups II and IV (intermittent cross-clamping) at higher preloads (p less than 0.05 and p less than 0.025, respectively). The wet weight/dry weight myocardial ratios were lower in Groups I and III (continuous cross-clamping) than in Groups II and IV (intermittent cross-clamping). Although creatine phosphate (CP) concentrations were rapidly restored by reperfusion in all groups, adenosine triphosphate (ATP) and glycogen myocardial stores were better preserved at the end of cross-clamping in Groups I and II (multidose K at 4 degrees C). Although LV diastolic compliance was decreased and myocardial water content was increased in Groups II and IV (intermittent cross-clamping), no differences in the minimal extent of subendocardial hemorrhage, edema, and contraction-band necrosis were observed among any of the groups examined electron microscopically. The present study identifies continuous aortic cross-clamping with multidose K at 4 degrees C as a superior method of myocardial protection.

Animals↗
PubMed1979

Adverse hemodynamic and ultrastructural changes in dog hearts subjected to protein-calorie malnutrition.

In the absence of thiamine deficiency, the specific effects of protein-calorie malnutrition on left ventricular (L.V.) function are unknown. Mature beagle dogs of both sexes were subjected to a hypocaloric, nitrogen-poor diet which resulted in a weight loss of approximately 40% after seven weeks. Following preparation of this nutritional model, myocardial contractility was assessed acutely by obtaining isovolumetric L.V. contractions on cardiopulmonary bypass at constant heart rate, mean aortic pressure, and at a wide range of end-diastolic volumes. These changes were compared to a matched group of animals which were normally fed. There were consistent decreases in L.V. compliance in malnourished animals compared with normals; indices of ventricular contractility per se (L.V. dp/dt, force-velocity relations, peak developed L.V. pressure) were also diminished in the experimental animals. Myocardial concentration of glycogen was diminished in malnourished compared to control animals. Light and electron microscopic examination confirmed the presence of myofibrillar atrophy in the presence of interstitial edema. These results suggest that protein-calorie malnutrition seriously interferes with normal L.V. function in the experimental animal by reducing compliance as a result of "starvation edema," and by reducing myocardial contractility associated with atrophy of the myofibers.

Animal Nutritional Physiological Phenomena↗
PubMed1979

Perioperative myocardial infarction associated with coronary artery bypass graft surgery: improved sensitivity in the diagnosis within 6 hours after operation with 99mTc-glucoheptonate myocardial imaging and myocardial-specific isoenzymes.

The present study was performed to evaluate scintigraphic imaging with technetium 99m-labeled glucoheptonate and serum enzyme levels of creatine phosphokinase isoenzyme (MB-CPK) in the early diagnosis of perioperative acute myocardial infarction associated with saphenous vein bypass graft operations. Myocardial imaging was done in 27 patients (50% of whom were considered high-risk) before operation and again 5 hours after operation. Four of these patients (15%) had both electrocardiographic and serum MB-CPK evidence of acute myocardial infarction, and all 4 had developed positive postoperative scintigrams. Four other patients had only elevated serum MB-CPK, and scintigrams became positive after operation in 3 of them. In addition, serum MB-CPK 6 hours after operation was 83 +/- 21 mIU/ml (mean +/- standard error of the mean) in patients with positive postoperative scans compared with 24 +/- 5 mIU/ml in those patients with negative postoperative scintigrams (p less than 0.001). Myocardial imaging with 99mTc-glucoheptonate in the perioperative period is rapid, safe, and atraumatic. Furthermore, our results suggest that it is a sensitive method for the early diagnosis of perioperative acute myocardial infarction, and, when imaging is combined with serum MB-CPK isoenzyme analysis, the reliability of the diagnosis of acute myocardial infarction is enhanced even further. Only 1 of the patients who showed perioperative myocardial damage had acute hemodynamic compromise or obvious impairment of recovery in the immediate postoperative period, and the 30-day mortality of the total group was 4% (1 of 27).

Acute Disease↗
PubMed1978

Role of delayed intraaortic balloon pumping in treatment of experimental myocardial infarction.

Intraaortic balloon pumping improves coronary blood flow characteristics while simultaneously reducing myocardial oxygen demands by reducing aortic systolic pressure. Clinical application of intraaortic balloon pumping has largely been in the "high risk" patient (cardiogenic shock, postinfarction angina, left main coronary artery disease and unstable angina) for support during diagnostic studies or cardiac surgery, or both. In addition, there is some evidence that balloon pumping immediately after coronary occlusion reduces the size of experimentally induced myocardial infarcts. In this study, myocardial infarcts were produced by ligation of the left anterior descending coronary artery in 12 dogs, 6 of which were treated with balloon counterpulsation beginning 3 hours after coronary occlusion. All dogs were killed 8 hours after coronary ligation. Intraaortic balloon pumping resulted in the expected hemodynamic changes (decreased aortic systolic pressure, left ventricular end-diastolic pressure and heart rate and increased aortic peak diastolic pressure). In addition, there was a significant reduction in infarct size in the group with balloon pumping as determined with epicardial S-T segment mapping, myocardial imaging with technetium-99m-glucoheptonate and histochemical staining with nitroblue tetrazolium. These results suggest that even when instituted as long as 3 hours after coronary occlusion, intraaortic balloon pumping results in significant reduction in infarct size and, it might be speculated, the mortality and morbidity associated with acute myocardial infarction may also be decreased.

Angina Pectoris↗