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Biomedical subjects

W W Bailey

Publications and source records attributed to W W Bailey.

29 records · Page 2Linked to original sources
PubMed1986

The effects of methylprednisolone on complement-mediated neutrophil activation during cardiopulmonary bypass.

Complement-mediated neutrophil activation (CMNA) has been implicated as an important pathophysiologic mechanism contributing to acute microvascular lung injury in the adult respiratory distress syndrome (ARDS). Using cardiopulmonary bypass (CPB) as a clinical model for complement-mediated microvascular injury, we studied the effects of methylprednisolone (MPSS) pretreatment on manifestations of CMNA in 28 pediatric patients undergoing CPB. Six patients not receiving MPSS served as controls. Results demonstrated that MPSS did not prevent complement activation as noted by 4.5- and 7.7-fold increases in plasma C3a des Arg levels during and immediately after CPB, respectively. However, detectable in vivo and in vitro manifestations of CMNA were altered. Neutropenia during CPB was attenuated to 65% of prebypass values compared with 47% in the control group. Neutrophil selective chemotactic desensitization toward C5a/C5a des Arg during the on bypass and postbypass periods was evident in the control group (0.41 and 0.76 cm specific migration, respectively) and prevented in the MPSS group (1.55 and 2.00 cm specific migration, respectively). We conclude that CMNA during CPB is ameliorated and/or prevented by MPSS pretreatment. These findings suggest that MPSS pretreatment may ameliorate complement-mediated microvascular (lung) injury in CPB and ARDS.

Anaphylatoxins↗
PubMed1984

Pulsed Doppler echocardiographic evaluation of ventricular septal defect patches.

Doppler echocardiography has been shown to have high sensitivity and specificity for noninvasive detection of the flow disturbance of ventricular septal defect. After surgery for ventricular septal defect, one might expect loss of the ventricular septal defect flow disturbance. We used two-dimensional and pulsed Doppler echocardiography to evaluate 30 children undergoing surgery for ventricular septal defect to determine postoperative Doppler findings and the effect of ventricular septal defect patch material on those findings. Twenty-one patients had Dacron patches and nine pericardial patches. Doppler examinations were performed immediately after surgery and at intervals thereafter. The patches were imaged on two-dimensional echocardiograms and the Doppler method was used to evaluate flow at the patches. Doppler echocardiography was also used to estimate volume flow in the aorta and pulmonary artery to estimate postoperative ratio of pulmonary to systemic flow (Qp/Qs). Immediately after surgery 93% of patients had a flow disturbance detected by Doppler echocardiography in the region of the surgically placed patch. On postoperative day 1, 62% of Dacron-patched defects and 66% of pericardial patched defects showed evidence of residual shunting on Doppler examination. By the third postoperative day, this prevalence fell to 23% and 44%, respectively. By 2 weeks after surgery there was evidence of residual shunting in only two patients. In 26 of 30 early postoperative Qp/Qs estimates were under 1.6/1; all but two of these lost the Doppler-detected flow disturbance by 2 weeks after surgery. In three of 30 Qp/Qs estimates exceeded 1.9/1; two of these three required reoperation.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Volume Determination↗
PubMed1983

Noninvasive evaluation of Blalock-Taussig shunts: determination of patency and differentiation from patent ductus arteriosus by doppler echocardiography.

Pulsed Doppler echocardiography has been used to detect continuous turbulent flow in the right pulmonary artery after Blalock-Taussig shunts. Since continuous turbulent flow could also arise from patent ductus arteriosus (frequently present in the neonate), continuous turbulent flow in the right pulmonary artery is not specific for Blalock-Taussig shunt function. We evaluated 35 Blalock-Taussig shunts from suprasternal or high parasternal approach for flow in the right pulmonary artery, and in the Blalock-Taussig shunts themselves. From precordial approach, Doppler evaluations of the main pulmonary artery were also made in search of flow characteristic of patent ductus arteriosus. Doppler detection of flow within the Blalock-Taussig shunts indicated shunt patency, and indicated that continuous turbulent flow in the right pulmonary artery was not due to only patent ductus arteriosus. Shunts were proven patent in 31 patients, occluded in four. Twelve patients also had patent ductus arteriosus. By Doppler, the right pulmonary artery had continuous turbulent flow in 30 of 31 patients in whom the right pulmonary artery was found. From the suprasternal or high parasternal approach, the right Blalock-Taussig shunts were detected by marked continuous turbulent flow directed away from the transducer, between the aortic and superior vena caval flow signals. Left Blalock-Taussig shunts had similar directional continuous turbulent flow. Prosthetic shunts were identified by the dense shunt material. Twenty-four of 31 functional shunts were identified, and all contained continuous turbulent flow. Three left-sided shunts were missed. All four occluded shunts were identified by Doppler, and had no lumen flow within.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗
PubMed1983

Postinfarction angina: results of early revascularization.

To assess the efficacy of surgical revascularization for postinfarction angina within 30 days of acute infarction, the clinical course of 103 patients treated surgically from January 1979 to July 1982 was reviewed. There were 84 men (82%) and 19 women (18%) with a mean age of 58 years (range 34 to 80). Group A (11 patients) underwent surgery within 24 hours of infarction, Group B (21 patients) within 7 days and Group C (71 patients) within 30 days. Eighty-four patients (82%) had subendocardial infarctions and 19 patients (18%) had transmural infarction. Transmural infarction was more common in patients in Group A (36%) than in those in either Group B (19%) or Group C (15%). There were two deaths, both in Group C (1.9%), within 30 days of surgery. The use of intraaortic balloon or inotropic support and the occurrence of major arrhythmias or perioperative infarction was noted in 30 patients (29%) (64% in Group A, 33% in Group B and 18% in Group C). The average time in the intensive care unit was 3.2 days, with an average total hospital stay after surgery of 8.3 days. Late follow-up (mean 15.4 months, range 1 to 39) is complete for 97 patients (97%). There were no late myocardial infarctions and 93 patients (96%) were essentially free of angina. The only late death (1.0%) was caused by septicemia from delayed sternal wound infection. This study suggests that myocardial revascularization within the first 30 days after myocardial infarction can be accomplished with an acceptable operative mortality in selected patients with postinfarction angina refractory to medical management.

Adult↗
PubMed1983

Influence of propranolol on supraventricular tachycardia early after coronary artery revascularization. A randomized trial.

A total of 116 patients undergoing coronary revascularization were randomized preoperatively in a double-blind manner to receive 80 mg daily of propranolol or placebo in the postoperative period. Preoperatively, all patients had been receiving at least 80 mg of propranolol a day to the time of the operation. In addition, all patients had a left ventricular ejection fraction of 0.4 or more, no history of supraventricular tachyarrhythmia (SVT), and no need of digitalis preparations or other antiarrhythmic drugs. All patients were monitored for 5 days and propranolol or placebo was started 24 hours postoperatively. SVT was documented with biatrial electrograms in all cases. Study groups were similar in postoperative creatine kinase MB levels and postoperative weight gain, but the placebo group tended to be older and have more grafts per patient. Seven patients randomized were dropped from the study, two with perioperative infarction, four with persistent ventricular arrhythmias necessitating quinidine or procainamide, and one with persistent postoperative hypotension (placebo). There were no significant differences in the incidence of postoperative SVT in these two groups: 13.2% in the propranolol group and 16.1% in the placebo group. We conclude that 80 mg daily of propranolol given postoperatively to patients undergoing coronary revascularization does not effectively reduce the incidence of SVT.

Clinical Trials as Topic↗
PubMed1982

Dacron patch closure of aortic annulus mycotic aneurysms.

Six patients with large mycotic aortic annular aneurysms were successfully operated on over a 3-year period. Aortic valve replacement was facilitated in all six patients by closing the orifice of the abscess with a Dacron patch and then seating the prosthetic valve at the level of the aortic annulus. In each case, a portion of the prosthetic valve ring was sutured directly to the patch. No patient has clinical evidence of a perivalvular leak 18-48 months after operation. One patient required reoperation to close a ventricular septal defect caused by partial patch dehiscence. Dacron patch closure has been highly effective in our experience and is simpler than many other options.

Adult↗
PubMed1981

The practice of coronary artery bypass surgery in 1980.

We obtained information from 677 cardiac surgeons in the United States on the type of practice, case load, and techniques currently used for coronary bypass operations. These surgeons collectively performed 93,000 bypass operations in 1979. Less than 25% of these procedures were done in university or federal hospitals; the majority were performed in the private sector by surgeons engaged in a single specialty group practice. The mean case load in 1979 was 137 operations per surgeon, and only 46 (6.8%) did fewer than 25 bypass operations during that year. These surgeons devote a relatively small percentage of their professional activity to other areas in thoracic surgery--the majority do not perform congenital heart surgery and two thirds devote less than 10% of their professional activity to general thoracic surgery. Compared with our previous national survey done in 1975, techniques used for bypass grafting have changed considerably over the past 5 years. An increasing number of surgeons conduct cardiopulmonary bypass with an arterial input line introduced into the ascending aorta and with a single cannula for venous drainage and do not routinely vent the left ventricle. Cold chemical cardioplegia has become the technique of choice (by 91% of surgeons) for myocardial protection, sequential bypass grafts are now widely employed, and 83.2% of surgeons perform all distal anastomoses during a single period of cardioplegic arrest.

Cardiac Surgical Procedures↗
PubMed1981

Carotid arterial disease in patients undergoing coronary artery bypass operations.

The occurrence of stroke associated with coronary artery bypass operations is approximately 2%. In an attempt to reduce this incidence some centers have proposed carotid thromboendarterectomy for symptomatic and asymptomatic carotid arterial disease in patients undergoing a coronary artery bypass operation. To obtain a better understanding of the incidence of carotid occlusive disease in candidates for the coronary bypass operation and to evaluate the practical use of a noninvasive method to screen patients preoperatively, we evaluated 102 patients preoperatively with an ultrasonic Duplex scanner; 24 studies were requested on the basis of either previous neurologic problems or the presence of a bruit and 78 patients were evaluated as part of a study protocol. In the unrequested group 6% (5/78) of the patients had a stenosis of 50% diameter reduction or more. In the requested group 54% (13/24) had a stenosis of 50% diameter reduction or more. In the postoperative phase one stroke and one transient ischemic attack were noted among the unrequested group and none in those suspected of having carotid disease on clinical grounds. Neither affected patient had a high-grade stenosis. There is little evidence to support the contention that noninvasive screening of patients free of symptoms or signs of carotid disease prior to coronary artery bypass operation is a valuable method of screening for patients who will sustain a focal neurologic event.

Carotid Artery Diseases↗
PubMed1977

Late results with synthetic valved external conduits from venous ventricle to pulmonary arteries.

Eighty-five patients operated on before January 1976 have survived at least 30 days after insertion of a valved external conduit by the venous ventricle (usually the right) and the pulmonary arteries as a part of the repair of their congenital heart disease. Follow-up information is available on 83 patients, and mean follow-up time has been 27.7 months. Seven patients have required reoperation because of obstructive complications. Actuarial analysis indicates that the proportion of patients requiring reoperation is 4.0 +/- 2.8% at 2 years, 12.9 +/- 5.5% at 3 1/2 years, and 30.4 +/- 12.1% at 5 years. In five patients compression of the conduit between the sternum and heart was the primary cause of the obstruction. The proportion requiring reoperation for conduit compression is 2.0 +/- 2.0% at 2 years, 8.6 +/- 4.9% at 3 1/2 years, and 27 +/- 12.4% at 5 years. Age at operation is not related to the proportion of patients requiring reoperation, nor is the type of conduit. No patients have yet required reoperation for conduit compression whose operation has been done since we began systematically to position the conduit well away from the sternum. By actuarial analysis the proportion of patients surviving 5 years is 76.7%. Of those alive at follow-up examination, 78% were without limitation of activity.

Adolescent↗