Biomedical subjects
C D Campbell
Publications and source records attributed to C D Campbell.
Comparison of the vasoconstrictive and anesthetic effects of intranasally applied cocaine vs. xylometazoline/lidocaine solution.
Cocaine solution has traditionally been the agent of choice for vasoconstriction and anesthesia when applied topically to the nasal mucosa during nasal operative procedures. Because of the relative scarcity and resulting expense of cocaine, there has arisen an impetus for an alternative intranasal solution for mucosal anesthesia and vasoconstriction. As a logical alternative, we have used a mixed solution of xylometazoline and lidocaine with reasonable results. No clinical studies comparing the efficacy of the two solutions exist, however, and there is presently no such solution commercially available. A double-blind, randomized, placebo-controlled study was undertaken to assess the relative efficacy of the preparations. Both solutions resulted in a marked and roughly equivalent degree of mucosal vasoconstriction (as evidenced by comparable increases in nasal airway cross-sectional area). Subjective pain ratings of mucosal pin-prick decreased a surprisingly small degree after application of both solutions. It appears that xylometazoline/lidocaine solution is comparable to cocaine solution for purposes of vasoconstriction and anesthesia during intranasal operative procedures.
Detecting life-threatening arrhythmias.
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Experimental aortocoronary artery bypass grafting using a CO2 laser on the dog: acute experiment.
This study was designed to evaluate the feasibility of using laser tissue welding in aortocoronary bypass operation. Simulated aortocoronary bypass operations were performed on 10 dog hearts supported by extracorporeal circulation. Distal anastomoses between internal mammary artery and coronary artery were achieved using the laser technique, which includes four stay sutures of 7-0 polypropylene and tissue welding between the stays by the laser at a power level of 65 mW. Short-term luminal patency was 100% without stenosis by angiography. Microscopy and histology showed that CO2 laser caused medial change resulting in fusion with preservation of normal intimal morphology. The aortocoronary bypass operation using a CO2 laser is technically feasible, and this technique may open up a new method for patients with small peripheral coronary artery obstruction and for pediatric patients with certain conditions (eg, Kawasaki disease).
Surgery for mitral regurgitation associated with ischemic heart disease. Results and strategies.
Analysis of published reports indicates that ischemic mitral insufficiency is associated with higher operative mortality (10-30%) than is nonischemic mitral valve procedures. Probable incremental risk factors include emergency operation, acute myocardial infarction, hemodynamic instability, poor left ventricular function, pulmonary hypertension, advanced age, and renal failure. Early valve repair or replacement with myocardial revascularization improves survival in patients with circulatory insufficiency due to acute postinfarction mitral regurgitation. Although the technique of repair of nonacute ischemic mitral insufficiency is not standardized, repair with revascularization is preferred. Preliminary data suggest that long-term results are primarily related to the severity of left ventricular dysfunction.
End-to-side and end-to-end vascular anastomoses with a carbon dioxide laser.
This study was designed to compare anastomoses performed with a carbon dioxide laser and conventional anastomoses performed with 7-0 polypropylene suture. In each of 80 rabbits, the divided left carotid artery was anastomosed by a continuous suture technique and the right carotid was anastomosed with a carbon dioxide laser. In each of 40 additional rabbits, both end-to-end and end-to-side laser anastomoses were performed on the same carotid artery. The laser technique involved the placement of three stay sutures (end-to-end technique) or four stay sutures (end-to-side technique) of 7-0 polypropylene and an everting laser seal at a power level of 65 mW. The 1-year overall patency rate was 98% (78/80) in laser anastomoses, 79% (63/80) in suture anastomoses, and 95% (38/40) in combined end-to-end and end-to-side laser anastomoses. Microscopic findings in laser anastomoses demonstrated degeneration of collagen and protein in the adventitia and media, but much less intimal injury than in suture anastomoses, with reendothelialization beginning earlier (within 7 days after anastomosis as compared with 2 to 4 weeks). The tissue tensile strength at 1 hour was less in laser anastomoses than in suture anastomoses, but the laser anastomoses still withstood an intraluminal pressure load of 380 mm Hg. Laser anastomosis improved the microscopic and histologic appearance of the intimal layer, allowing for rapid early reendothelialization and resulting in excellent patency rates.
Mechanical support for postcardiotomy heart failure.
Cardiac failure remains a life-threatening complication for certain patients undergoing intracardiac repair. Despite improvements in surgical techniques, methods of myocardial protection, and postoperative care, patients are frequently at risk to develop postoperative low output syndrome. Approximately 1% of cardiac surgical patients cannot be weaned from extracorporeal circulation in spite of adequate volume loading, the use of inotropic support, and initiation of intraaortic balloon pumping. In these cases, ventricular assist devices (VAD) can mechanically aid the failing heart and reverse the low output state. The concept of mechanical support for the failing left ventricle was first proposed by Clauss et al. in 1961. By 1968, Kantrowitz and associates had developed and refined the first intraaortic balloon pump (IABP). Through the efforts of Moulopolous and others, this device evolved into the present-day intraaortic balloon pump (IABP). Clinical evidence for the efficacy of left ventricular assist devices (LVAD) remained questionable until 1980, when the National Heart, Blood and Lung Institute evaluated short-term LVADs by comparing various types of mechanical aids. This report focused attention primarily on the failing left ventricle (LV). As the use of inotropic support, intraaortic balloon pumping, and LVADs improved, a small group of patients emerged who could not be separated from extracorporeal circulation due to a failing right ventricle. The failing right ventricle emerged as a unique clinical entity similar to postcardiotomy left ventricular failure that also benefited from mechanical cardiac assistance. Current therapy at major centers incorporating mechanical assist devices is based on the premise that the low output state will allow the failing heart to recover from a reversible injury. The frequent occurrence of postcardiotomy ischemia may be due to several factors such as poor myocardial protection, overdistension of the LV, emboli, coronary spasm or technical problems. Whatever the etiology, the end product of cardiac failure is a demand for oxygen consumption that cannot be met, thus leading to cardiac demise.
Combined application of heterologous collagen and fibrin sealant for liver injuries.
Hemostasis in complex liver injuries remains a problem despite improvements in operative techniques including debridement, suturing or packing. To evaluate fibrin sealant (FS), a new biodegradable hemostatic agent in combination with porcine collagen for sealing of liver injuries, three series of experiments were performed in 132 rats. In series I, 18 rats had a 10-mm in diameter and 2-mm in depth punch defect to the left lateral lobe. In the FS group (n = 9), bleeding was treated by insertion of an FS-soaked piece of collagen of equal size which was firmly attached to a plastic disk with wire anchor. In the control group (n = 9), collagen alone was inserted. Fifteen minutes after the insertion the lobe was excised and pull-off experiments were performed with simultaneous script chart recording. There was a highly significant difference in the adhesion to the liver surface (85.6 +/- 7.1 in the FS group versus 24.8 +/- 2.6 g/cm2 in the control group, P less than 0.001). In series II, 42 anticoagulated rats (Coumadin, PT 27.5% +/- 1.3) with lobectomy or liver rupture were placed in three groups (n = 14). Group I was treated with FS, group II with FS and collagen, and group III with catgut sutures which served as controls. Fourteen days later 12 rats of group I, 13 of group II, and 7 of group III were alive yielding 85.7, 92.8, and 50% overall survival rates, P less than 0.05 groups I and II versus group III. In series III, 72 non-anticoagulated rats were treated identically to series II and examined morphologically at 1, 7, 28, and 56 days.(ABSTRACT TRUNCATED AT 250 WORDS)
Use of fibrin sealant for reinforcing arterial anastomoses.
Despite improvements in needles, sutures, and technique, hemorrhage remains a problem in cardiovascular surgery. In this study conventional vascular suture lines and suture lines reinforced with fibrin sealant are compared for blood loss and burst strength. Bilateral femoral arteries in 20 dogs were divided at 50% of their circumference and repaired with six 6-0 polypropylene sutures. Ten animals were systemically heparinized (3 mg/kg), and 10 were not on anticoagulants. The right femoral artery anastomosis was treated with fibrin sealant in all animals, and the left suture line served as the control. Three minutes after initiation of the sealing procedure, blood flow was reinstituted in both femoral arteries. After 3 minutes a significant difference in blood loss between the conventional suture technique and fibrin-reinforced anastomoses was noted in both heparinized (12.1 +/- 2.79 vs. 0.13 +/- 0.06 ml/min; p less than 0.01) and nonheparinized dogs (8.45 +/- 1.37 vs. 0.20 +/- 0.08 ml/min; p less than 0.001). After 30 minutes volume inflow and pressure catheters were inserted into snared compartments encompassing the femoral artery anastomosis. Continuous pressure recordings during volume loading with normal saline solution demonstrated increased bursting pressures of the fibrin-sealed suture lines in both the heparinized (317.5 +/- 13.18 vs. 135 +/- 23.17 mm Hg; p less than 0.001) and nonheparinized animals (474.5 +/- 26.82 vs. 311 +/- 29.31 mm Hg; p less than 0.001). Histologic examination revealed no fibrosis or foreign body reaction and complete resorption of the fibrin sealant within 3 weeks. Fibrin sealant, a powerful hemostatic agent produced from human donors not suffering from hepatitis, decreases blood loss and strengthens suture lines.(ABSTRACT TRUNCATED AT 250 WORDS)
Benefit of fibrin sealing in great vessel surgery.
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Traumatic avulsion of the innominate and left carotid arteries: successful repair.
Traumatic rupture of the aorta or the arch vessels is a rare and frequently fatal injury. This lesion should be considered in all cases of severe chest trauma. Early aortography is essential for accurate diagnosis. Nineteen cases of avulsion of the innominate artery have been previously reported. In only two of them a second aortic arch branch had an associated injury. The case presented here is the first successful repair of a combined avulsion of both the innominate and the carotid arteries from the aortic arch. Cerebral circulation was maintained during the operation with a heparin-coated shunt from the ascending aorta to the right common carotid artery. Reconstruction was accomplished by inserting a bifurcated Dacron prosthesis from the aorta to the innominate and left carotid arteries. The use of a heparin-bonded shunt maintained cerebral perfusion, and greatly simplified the operation and avoided the risk of extracorporeal circulation and systemic anticoagulation in a patient with multiple trauma.
Critical analysis of intra-aortic balloon counterpulsation and transapical left ventricular bypass in the sufficient and insufficient circulation.
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Preservation of ischemic myocardium with TALVB using complete left ventricular decompression.
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Expanded microporous polytetrafluoroethylene as a vascular substitute: a two year follow-up.
Since 1974, 131 femoropopliteal, distal popliteal, and tibial bypasses have been performed using expanded microporous polytetrafluoroethylene (PTFE). Forty patients were operated on for limb salvage, and 21 had had previous bypass procedures. The overall patency rate was 82%. Early occlusions possibly were related to technical error, but most probably were due to severity of disease and poor runoff. Late occlusions were related to progressive atherosclerosis in the proximal or distal arterial tree. A 75.7% cumulative patency rate was noted at 28 months. In man the PTFE prosthesis demonstrates a smooth intimal lining with fibroblastic ingrowth into the interstices of the graft. These results are considered to be excellent in this high-risk patient population. The patency rates achieved with PTFE are better than those accomplished with alternative conduits and approach the patency rates reported with autogenous saphenous vein. Expanded microporous polytetrafluoroethylene with its high patency, pliability, and tissue incorporation is an excellent arterial substitute. Only with continued use of this material and a more uniform patient selection can more equitable comparisons be made between expanded PTFE and the autogenous vein.
Extra-anatomic bypass with expanded polytetrafluoroethylene.
Expanded polytetrafluoroethylene has been used successfully for femoropopliteal bypass, aortopulmonary bypass and as a venous substitute. Thirteen patients with impending limb loss had extra-anatomic bypasses with expanded polytetrafluoroethylene. Five patients with unilateral iliac disease had femorofemoral bypass for impending limb loss, and five debilitated patients underwent axillofemoral and bifemoral bypass for limb salvage. Nine of ten patients had salvage of the extremities. Three patients had extended profundoplasty, two combined with polytetrafluoroethylene femoropopliteal bypass to isolated popliteal artery segments. Two of these patients had limb salvage. The patency rate is 92 per cent, and the limb salvage rate is 85 per cent in this difficult group of patients. The follow-up period extends to 28 months, and 12 patients are beyond one year. In six patients, polytetrafluoroethylene carotid subclavian bypass was performed for the subclavian steal syndrome; all patients had relief of the symptoms. One patient underwent axillary-axillary bypass with excellent results. Expanded microporous polytetrafluoroethylene with its high patency, shortened operating time, biocompatibility and excellent tissue incorporation is an excellent arterial substitute. The pliability and no requirement for preclotting make polytetrafluoroethylene ideally suited for patch angioplasty and suturing in areas difficult to expose.
Selected therapy for ascending aortic aneurysms.
Since 1971, ten patients, 26 to 62 years of age, have undergone repair of ascending aortic aneurysms with concomitant aortic insufficiency. Three patients had Marfan's syndrome, five patients had cystic medial necrosis, one had leutic aortitis, and one had atherosclerotic involvement of the aorta. There was one operative death. Follow-up exceeds seven years. Because of the tendency for progressive annular and sinus dilation in Marfan's syndrome, composite graft and valve conduits with reimplantation of the coronary arteries is the procedure of choice. In selected patients with annulaortic ectasia, good valve tissue and no sinus dilation, bicuspidization of the valve, and replacement of the ascending aorta is indicated. The operation is generally less formidable than composite graft replacement, maintains normal coronary anatomy, and alleviates the long-term risks of anticoagulation.
The effect of growth temperature on the fatty acid composition of Thamnidium elegans Link.
The fatty acid composition of a slightly psychrophilic fungus, Thamnidium elegans, has been determined and compared with other mucoraceous fungi. The growth temperature strongly influences the degree of unsaturation of lipids, as reported for other organisms, but in T. elegans both the quantitative and qualitative profiles of the fatty acids are affected. At low temperature, T. elegans contains both alpha- and gamma-isomers of linolenic acid. The alpha-isomer is reported here for the first time in a mucoraceous fungus. Besides the biosynthesis of alpha-linolenic acid at the low temperature, T. elegans shows an increase in synthesis of a relatively unknown fatty acid in fungi, i.e. octadecatetraenoic acid (18:4delta 6,9,12,15). The significance of the occurrence of both the isomers of linolenic acid as a response to temperature and in relation to fungal phylogeny is discussed.
The behavior of infected arterial prostheses of expanded polytetrafluoroethylene (Gore-Tex).
In 11 dogs the bacteriologic and morphologic reaction of arterial prostheses made of expanded polytetrafluoroethylene (Gore-Tex) to an induced Staphylococcus aureus septicemia at time of graft implantation was evaluated and compared to that observed with Dacron grafts in 10 dogs. Graft infection developed in all dogs, manifested by positive blood and graft cultures. Grafts, however, could be clearly classified as either histologically infected or uninfected with a marked difference in the pattern of positive blood cultures. Histologically uninfected grafts in general demonstrated the tissue ingrowth and neointima formation which characterize Gore-Tex despite positive graft culture. The appearance of overt histologic infection was correlated with failure of a neointima to develop. Gore-Tex did not loose its structural integrity despite frank injection. The use of the Gore-Tex in the face of overt infection cannot be supported.