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Biomedical subjects

D L Bricker

Publications and source records attributed to D L Bricker.

At least 19 recordsLinked to original sources
PubMed1996

Aprotinin for primary coronary artery bypass grafting: a multicenter trial of three dose regimens.

BACKGROUND: High-dose aprotinin reduces transfusion requirements in patients undergoing coronary artery bypass grafting, but the safety and effectiveness of smaller doses is unclear. Furthermore, patient selection criteria for optimal use of the drug are not well defined. METHODS: Seven hundred and four first-time coronary artery bypass grafting patients were randomized to receive one of three doses of aprotinin (high, low, and pump-prime-only) or placebo. The patients were stratified as to risk of excessive bleeding. RESULTS: All three aprotinin doses were highly effective in reducing bleeding and transfusion requirements. Consistent efficacy was not, however, demonstrated in the subgroup of patients at low risk for bleeding. There were no differences in mortality or the incidences of renal failure, strokes, or definite myocardial infarctions between the groups, although the pump-prime-only dose was associated with a small increase in definite, probable, or possible myocardial infarctions (p = 0.045). CONCLUSIONS: Low-dose and pump-prime-only aprotinin regimens provide reductions in bleeding and transfusion requirements that are similar to those of high-dose regimens. Although safe, aprotinin is not routinely indicated for the first-time coronary artery bypass grafting patient who is at low risk for postoperative bleeding. The pump-prime-only dose is not currently recommended because of a possible association with more frequent myocardial infarctions.

Aged↗
PubMed1979

Cardiopulmonary bypass in anesthetic management of resection. Its use for severe tracheal stenosis.

On initial evaluation, two patients were found to be in severe respiratory distress from tracheal obstruction. One patient had late obstruction after a crushing injury to the chest, whereas the other had subtotal tracheal obstruction from a carcinoid adenoma. In each case, the state of the patient seemed to preclude safe anesthetic induction with an endotracheal tube as the sole means of oxygenating the patient. Partial cardiopulmonary bypass provided an adjunct to ensure adequate oxygenation for tracheal resection. Consideration for the use of this technique is recommended in similar circumstances.

Adenoma↗
PubMed1979

Late results of myocardial revascularization.

Data are presented on 1,400 consecutive patients who had myocardial revascularization at our institution. The patients ranged in age from 33 to 80 years. Coronary bypass was done with an associated noncardiac procedure in 70 patients and with an associated cardiac procedure in 73 patients. The hospital mortality was 2.0%. Left ventricular function was a primary determinant of hospital mortality. With a 98% follow-up, survival was 93.1% at a mean of three years (range, six months to seven years). Ventricular function was the prime determinant of the overall long-term survival. These data indicate that myocardial revascularization, either alone or with an associated cardiac or noncardiac procedure, can be done with a low operative mortality. Because of the excellent five-year survival in our group of patients followed up for this length of time, we believe these data support the hypothesis that myocardial revascularization extends the life expectancy of patients with coronary artery disease.

Adult↗
PubMed1978

Concomitant coronary artery bypass and major noncardiac surgery.

Concomitant cardiac procedures performed in conjunction with coronary bypass have become commonplace, but not concomitant noncardiac procedures. Bernhard and associates were the first to report concomitant coronary bypass and carotid endarterectomy. This series, begun in 1971, consists of 71 noncardiac procedures performed concomitantly with coronary bypass on 68 patients. Thirty-seven procedures were performed for associated vascular disease, including carotid endarterectomy (25 patients) and resection of abdominal aortic aneurysm (three patients). Other concomitant problems included are thymoma, bronchogenic carcinoma, and hiatal hernia. The operative mortality rate of 2.9 percent compares very favorably with that of 1.7 percent in our group of patients having isolated coronary artery bypass. A plea is made for consideration of concomitant surgery in patients with operable coronary heart disease who have an additional serious noncardiac surgical disease.

Coronary Artery Bypass↗
PubMed1977

Renal artery aneurysm presenting as a chest mass.

An enlarging mass in the right chest in a 25-year-old woman was found at operation to be a false aneurysm of the renal artery. Preoperative diagnosis was not made despite an extensive workup including arteriography. Successful resection was carried out via a posterolateral thoracotomy. Although vascular reconstruction was not feasible. The danger of rupture of such an aneurysm from an incisional biopsy is emphasized.

Adult↗