Biomedical subjects
D E Harken
Publications and source records attributed to D E Harken.
Anti-antivivisection. Have we waited too long?
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Heart valves: ten commandments and still counting.
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The emergence of cardiac surgery. I. Personal recollections of the 1940s and 1950s.
"Personal recollections" is given temporal torture back to the pessimism of Aristotle, Bilroth, and Paget. The delightful triumph of the "doers" in Rehn's suture of a stab wound and Souttar's intracardiac mitral valve manipulations is saluted. The brave but disappointing adventures of Doyan, Duval, Tuffier, Carrel, Graham, Beck, and Cutler are noted. The unique role of heart surgery in the change from extirpative to physiologic surgery is illustrated by the spectrum ranging from Blalock and Taussig to intracardiac surgery to pacemakers. The question of "why not?" have cardiac surgery before World War II led to experimental designs for extirpation of bacterial endocarditic vegetations. These studies became obsolete because of the merciful correction by penicillin. They were reapplied to the removal of shell fragments in World War II. This was the first consistently successful intracardiac surgery and led to the closed correction of mitral stenosis and other conditions. Heart surgery now stands as the model for physiologic surgery and the actuarial forms of follow-up to tell all medical and surgical successors more about the basic "what and when" for better health care delivery.
Warfarin-induced alopecia.
Earlier reports of the association between oral anticoagulation and alopecia describe a high incidence of this complication (42 to 78 percent). However, judged by its extreme rarity in a survey of eight experienced, busy academic dermatologists in Boston, this association is not common, nor is the assumption that the alopecia tends to occur soon after the administration of warfarin necessarily true. Nevertheless, alopecia persists in the face of continued warfarin administration; the time required for hair to regrow after discontinuation of the drug may be too long to be practical if continued anticoagulation is necessary; the effect of oral substitutes for warfarin is unknown; and alopecia may recur if the patient is rechallenged with warfarin.
Trade in human tissue needs regulation. Introductory perspective.
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Perceived adequacy of patient education and fears and adjustments after cardiac surgery.
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Correlates of angina pectoris among men awaiting coronary by-pass surgery.
Biomedical, behavioral, and psychological correlates of angina pectoris were identified in 204 men awaiting coronary artery by-pass graft surgery. Angina was rated by use of a precoded series of interview questions. Four circumstances of anginal symptoms were investigated: exertional, emotional, post-prandial, and while resting or sleeping. These were uncorrelated with one another, except for exertional and post-prandial. Two-thirds of these patients experienced angina less often than daily in the most recent unrestricted month. Severity of coronary artery obstruction was not positively associated with frequency or severity of any type of angina, and were primarily behavioral and psychological. Disturbances of sleep, physical inactivity, history of cigarette smoking, distressed response to life crises, life dissatisfactions, hostility, use of propranolol, duration of cardiac illness, and age were among the predictors in the multiple regression equations. These results from selected by-pass candidates may apply more directly to such persons than to unselected community residents reporting angina symptoms. The findings suggest the need for greater focus on sources of variability in myocardial oxygen supply and demand in understanding the dynamics of angina episodes.
Malnutrition: a poorly understood surgical risk factor in aged cardiac patients.
This feasibility report is based on the fact that malnutrition has been recognized but too little understood in connection with surgical risk. Patients with cardiac cachexia are remarkably similar to many patients with cachexia of the aged. Cachectic patients generally go through an operation well, but their condition often deteriorates slowly and they die a few days later; they behave as if they are running out of energy reserves. Malnourished people can be divided into three categories: kwashiorkorlike, marasmic, and marasmic-kwashiorkorlike. Recognition and classification of protein/calorie malnutrition into these categories directs treatment. Recognition is based on the usual physical and laboratory tests, plus triceps skinfold/arm circumference observations; leukocyte counts, with absolute and relative lymphocyte counts; serial transferrin, globulin, and albumin assessments; and, particularly, Candida and mumps skin testing to identify the anergic state. Intravenous and oral hyperalimentation can bring about conspicuous improvement in the appearance, attitude, and ability to withstand stress--including major heart surgery--of malnourished patients. However, astute clinical balance is essential, since either oral or intravenous hyperalimentation may cause renal nitrogen overload; moreover, if intravenous delivery is too rapid, congestive heart failure may be precipitated.
Nutritional support in cardiac cachexia.
A nutritional survey of 350 hospital patients reveals 50 with cardiac disease who had clinically significant protein-calorie malnutrition. Assessment criteria of malnutrition (per cent normal) included triceps skin fold (52 per cent), arm muscle circumference (88 per cent), and impaired delayed hypersensitivity skin testing (i.e., deficiency in cell-mediated immunity), the latter frequently observed in patients with concurrent weight loss. The functional category of cardiac status was not precise in predictin the morbidity and mortality of 14 patients undergoing cardiac valvuloplasty. By contrast, a nutritional/metabolic profile using weight loss, triceps skin fold (35 per cent), arm muscle circumference (27 per cent), and cell-mediated immunity (29 per cent) did identify high-risk patients who could be expected to benefit by concurrent nutritional support (4/4). Further studies are indicated to determine if nutritional support for cardiac cachexia can reduce the levels of morbidity and mortality during mitral and tricuspid valve surgery.
Pre- and postoperative hyperalimentation in the treatment of cardiac cachexia.
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Fifteen-to twenty-year study of one thousand patients undergoing closed mitral valvuloplasty.
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Coronary artery disease--what can be done by whom?
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Standards and the flood of medical devices.
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Valvular heart disease: undiagnosed valvular involvement, concomitant coronary artery disease and systemic embolization.
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