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Biomedical subjects

B B Roe

Publications and source records attributed to B B Roe.

At least 19 recordsLinked to original sources
PubMed1987

Air embolism prevention.

Although fortunately rare, the serious and potentially fatal complication of air embolism continues to occur following open-heart surgery. Its reliable prevention is dependent on the avoidance of specific procedural hazards and the exercise of various maneuvers to evacuate residual air from the heart before it is allowed to eject. Specifically, the beating heart should not be opened without ventricular fibrillation, cardioplegia, or aortic cross-clamping unless special precautions are exercised.

Cardiac Surgical Procedures↗
PubMed1985

Rational remuneration.

Physicians face the end of a phase of unrealistic and unprecedented prosperity fostered by unrestrained third-party remuneration policies. The cost of that phase, along with inflation and the use of expensive technology, has created an economic crisis. I urge my colleagues to take the initiative to address this crisis with other affected groups in the private sector by working to develop guidelines to restrain abuses, promote cost effectiveness, simplify administration, and increase fairness in the remuneration system. Remuneration scales should reflect variations among specialties in terms of skill, stress, and time involved, but should avoid unmeasurable and unverifiable differences within each category of service. Slowness and ineptitude should no longer be rewarded under the guise of "complexity." In the long run, standardized fees will be fair and will simplify the payment process greatly. Reasonable remuneration for agency-subsidized services can be derived in several ways, and once the median remuneration for various services has been established in each specialty, existing relative-value scales can be applied for other cases in that specialty. These measures would effect substantial savings in health care costs without incurring bureaucratic interference or impairing the quality of service. Moreover, they would allow distribution deficiencies to be remedied by permitting a response to market forces--i.e., higher payments would be made in underserved areas.

Economic Competition↗
PubMed1978

Cardiac valve replacement in patients over 65 during a 10-year period.

From 1967 through 1976, 754 adult patients were subjected to open heart procedures for acquired valvular disease at the University of California, San Francisco, 104 of whom were 66 years of age or over (mean = 70 years). The operative mortality of 15.0% in the elderly group did not differ significantly from that of 14.3% in the entire adult series for the 10-year period. Mortality was consistently higher in combined procedures (multiple valve replacement and valve replacement with coronary grafting). Since the introduction, in 1973, of hypothermic hyperkalemic coronary washout for intraoperative protection of the ischemic myocardium, the hospital mortality rate has decreased to 8.1% overall, 6.0% for isolated aortic valve replacement and 0% for isolated mitral valve replacement in patients over 65. Moreover, the long-term survival following aortic and mitral valve replacement in this series appears to approximate the survival curve of the normal population of the same age. This experience suggests that cardiac surgery has become safer for all patients during the past 10 years and that operative mortality is related primarily to the type and severity of disease rather than to age.

Age Factors↗
PubMed1977

The application of radionuclide infarct scintigraphy to diagnose perioperative myocardial infarction following revascularization.

To evaluate the application of radionuclide infarct scintigraphy to diagnose myocardial infarction after revascularization, we obtained postoperative technetium 99m pyrophosphate myocardial scintigrams, serial electrocardiograms and CPK-MB isoenzymes in ten control and 51 revascularized patients. All control patients had negative electrocardiograms and scintigrams, but eight had positive isoenzymes. Eight revascularized patients had positive electrocardiograms, images and enzymes and two had positive scintigrams and enzymes with negative electrocardiograms. Thirty-four patients with negative electorcardiograms and scintigrams had positive isoenzymes; in only seven patients were all tests negative. Our data suggest radionuclide infarct scintigraphy is a useful adjunct to the electrocardiogram in diagnosing perioperative infarction. The frequent presence of CPK-MB in postoperative patients without other evidence of infarction suggests that further studies are required to identify all factors responsible for its release.

Adult↗
PubMed1977

Myocardial protection with cold, ischemic, potassium-induced cardioplegia.

A total of 204 patients, ages 3 months to 84 years, underwent open-heart surgery with the aid of cardiopulmonary bypass with moderate hypothermia. For protection of the myocardium, cardioplegia was induced by washing out the coronary arteries with an iced, buffered, isoosmolar, potassium-based infusate. After aortic cross-clamping, the aortic root or individual coronary arteries were perfused with 500 to 2,000 c.c. of an aqueous solution (at zero to 4 degrees C.) containing 20 mEq. of potassium. Periods of ischemic arrest as long as 208 minutes have been well tolerated, with only two of the eleven hospital deaths considered heart related. Defibrillation occurred spontaneously in 41 per cent and after one shock in 47 per cent of patient, without apparent correlation between duration of ischemia and restoration of effective rhythm.

Cardiac Surgical Procedures↗