Biomedical subjects
Publications and source records attributed to D G Ellertson.
A technique is described for covering the anterior surface of the heart and bypass grafts with autologous pericardium after myocardial revascularization. A trapezoidal flap is created that incorporates bilateral relaxing incisions to avoid distortion of grafts or increased risk of pericardial tamponade.
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Two patients who sustained cardiac rupture complicating recent myocardial infarction were salvaged by expeditious diagnosis and surgical treatment. The cases of 9 other similar patients have been reported in the English-language literature. The cases of these 11 patients were reviewed in an attempt to find common clinical, pathological, and therapeutic features that might have been instrumental in the successful outcome of this usually fatal complication.
Since April, 1977, a total of eight patients have undergone sequential bypass grafting of the internal mammary artery (IMA) to the coronary arteries at our institution. The indication for this newly described procedure was either insufficient supply of adequate veins (four patients) or the presence of a diseased aortic wall (two patients). Operative procedures included left IMA bypass to the left anterior descending (LAD) artery and its major diagonal branch in six patients; to the obtuse marginal branch and distal circumflex artery in one patient; and to two consecutive sites on the LAD in one patient. All patients became angina-free after operation for a follow-up period lasting up to 6 years. Recatheterization studies were performed in four patients, in all of whom the IMA sequential grafts were found patent. We believe that IMA sequential grafting is an important option available to the cardiac surgeon in managing some patients with coronary artery disease.
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Patients with empyema and impaired immune response often remain in a toxic condition after tube thoracostomy because the infection is not localized and walled off satisfactorily. Consequently, the reported mortality rate is extremely high. Despite the expectation of a high mortality rate from thoracotomy and débridement in this category of critically ill patients, we were forced to perform pleural decortication in eight patients after lesser procedures had failed. They were immunodeficient because of (1) high-dose steroids (HDS) for sagittal sinus thrombosis, (2) HDS for systemic lupus erythematosus, (3) HDS for chronic myelogenous leukemia and myelofibrosis, (4) HDS for multiple myeloma, (5) hemolytic anemia with pulmonary infiltrates, (6) chemotherapy for Hodgkin's disease, (7) diabetes mellitus with Kimmelstiel-Wilson disease, and (8) diabetes mellitus with chronic glomerulonephritis. Six of the eight patients survived and were discharged with completely healed incisions 3 to 6 weeks after operation. This compares well with the survival rates reported by others. Although risky, the over-all survival rate may be better with thoracotomy and decortication than with prolonged tube drainage and open drainage in immunodeficient patients with empyema, and the period of morbidity is shortened considerably.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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