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Biomedical subjects

E W Cameron

Publications and source records attributed to E W Cameron.

At least 55 records · Page 3Linked to original sources
PubMed1989

Percutaneous cricothyroidostomy (minitracheostomy) for bronchial toilet: results of therapeutic and prophylactic use.

In the period 1984 to 1988, 2,448 patients underwent major thoracic operations in our unit. Of these patients, 144 (5.9%) underwent percutaneous cricothyroidostomy (minitracheostomy) using a 20F pediatric silver tracheostomy tube. Minitracheostomies were performed for the treatment of sputum retention in 81 patients, prophylactically in 62 patients, and as a route for high-frequency jet ventilation in 1 patient. Minitracheostomy tubes remained in situ a median of four days. Suction function was satisfactory in 99% of patients, with only 2 patients requiring subsequent suction bronchoscopy and no occurrence of tube blockage. Ninety-four percent of minitracheostomies performed were entirely uneventful. Bleeding was the most common complication (3.5%), and no instances of subglottic stenosis have occurred. During the review period, there was a significant increase in the percentage of patients requiring major operations undergoing prophylactic, but not therapeutic, minitracheostomy (p less than 0.001). This was associated with a significant decrease in the percentage of patients requiring suction bronchoscopy (p less than 0.001). We conclude that prophylactic minitracheostomy with the 20F pediatric silver tracheostomy tube is a safe and effective procedure in the prevention of postoperative sputum retention.

Aged↗
PubMed1989

Comparison of ventricular septal surgery and mitral valve replacement for hypertrophic obstructive cardiomyopathy.

We have reviewed the results of two different forms of surgical management of hypertrophic obstructive cardiomyopathy refractory to medical therapy. Twenty-one patients were treated with 22 procedures between 1963 and 1987. Eleven underwent a ventricular septal procedure by myotomy with or without myectomy, and 11 underwent mitral valve replacement (MVR), 1 of whom had previously undergone a ventricular septal procedure. The groups were comparable with respect to severity and duration of symptoms, age range, electrocardiographic features, and hemodynamic changes. Mitral valve replacement produced a greater and more consistent reduction in the left ventricular outflow tract pressure gradient than a ventricular septal procedure (MVR, 68.3 mm Hg preoperatively and 2.5 mm Hg postoperatively; ventricular septal procedure, 60.1 mm Hg preoperatively and 13.4 mm Hg postoperatively). This was associated with better postoperative ventricular configuration in diastole and more apparent loss of midcavity narrowing in systole. Ejection fraction did not fall after a ventricular septal procedure but decreased significantly from a mean of 79% to a mean of 61% after MVR. Similarly, left ventricular end-diastolic pressure remained unchanged after a ventricular septal procedure but fell from a mean of 26.6 mm Hg to 17 mm Hg after MVR. Although both groups experienced a generally satisfactory symptomatic result, this appeared more reliable with MVR. We suggest that MVR offers a more predictable improvement than a ventricular septal procedure and may be the procedure of choice for units with limited experience with ventricular septal procedures.

Adolescent↗
PubMed1989

Long term survival after pulmonary resection for small cell carcinoma of the lung.

A retrospective review was undertaken of the long term survival of 97 patients with histologically proved small cell carcinoma of the lung resected during the 10 years January 1977-December 1986. Twenty seven patients (28%) had stage I disease, 29 (30%) stage II, and 41 (42%) stage III. Patients with stage I and II tumours were managed by resection alone. Patients with stage III disease received adjuvant chemotherapy (cyclophosphamide, doxorubicin, and vincristine). Pneumonectomy was undertaken in 75 patients, lobectomy in 21, and wedge resection in one patient. Three patients died within 30 days of operation. The cumulative five year survival of all patients, irrespective of tumour stage, was 17%. The cumulative five year survival was 35% for patients with stage I disease, 23% for stage II, and zero for stage III. The median survival for patients with stage III tumours was 17 months. There was no significant difference in cumulative survival between patients with stage I and II disease. Cumulative survival, however, was significantly better for patients with stage I and II disease than for those with stage III disease. The data suggest that for patients with stage I and stage II disease surgery offers the prospect of long term survival.

Adult↗
PubMed1988

Surgical management of left ventricular aneurysm and diffuse coronary artery disease: immediate and long term results in patients receiving three or more grafts.

Because little information is available concerning the outcome of surgery for left ventricular aneurysm when multiple concurrent coronary grafts are required, we have reviewed 35 consecutive patients undergoing aneurysm surgery and multiple (greater than or equal to 3) grafts between December 1973 and April 1984. There were 6 operative deaths (17%). All occurred amongst those (16) undergoing LV plication procedures with no deaths amongst those (19) undergoing aneurysm resection (p less than 0.01). Operative mortality was not influenced by preoperative functional status, left ventricular end diastolic pressure, completeness of revascularisation, endarterectomy (13 patients) or whether cold crystalloid cardioplegia or intermittent aortic cross clamp with ventricular fibrillation was used. Overall 5-year actuarial survival was 70% with survival beyond surgery being 84% to 5 years and independent of the type of aneurysm procedure. Of the survivors, 16 were improved by 1-3 functional classes, 3 were unchanged and one was worse. Surgery in this group of patients offers the prospect of good symptomatic improvement and survival figures which at least equal the results of less complex ventricular aneurysm surgery and exceed those reported for medical management.

Adult↗
PubMed1987

One lung anaesthesia. Cardiovascular and respiratory function compared during conventional ventilation and high frequency jet ventilation.

Ten patients about to undergo left-sided thoracotomy for carcinoma of the lung were entered into a crossover trial to compare cardiovascular and respiratory function during high frequency jet ventilation and conventional mechanical ventilation for one lung anaesthesia. All patients were anaesthetised with a standard technique using double lumen tubes and placed in the lateral position with the left chest open. The results showed no significant differences with regard to ventilation sequence but one lung high frequency jet ventilation gave higher values than one lung conventional ventilation for shunt (p less than 0.01) and positive end expiratory pressure (p less than 0.05) and lower peak inflation pressure values (p less than 0.01). There were no significant differences in cardiac output, pulmonary capillary wedge pressure, arterial carbon dioxide or available oxygen. Surgical conditions were satisfactory during both methods of ventilation and satisfactory gas exchange occurred. It was, however, more difficult to assess adequacy of ventilation during high frequency jet ventilation and the routine use of this method of ventilation is not recommended during one lung anaesthesia.

Anesthesia, Inhalation↗
PubMed1985

Diagnosis and management of spontaneous transmural rupture of the oesophagus (Boerhaave's syndrome).

The presentation, diagnosis and management of 14 cases of spontaneous transmural oesophageal rupture have been reviewed. Analysis suggested that the classical triad of vomiting, chest pain and subcutaneous emphysema was rare (1/14) and therefore misleading. Abdominal pain and tenderness obscured the clinical picture; the temporal relationship of pain to vomiting varied and subcutaneous emphysema was uncommon (4/14). Consequently, only two cases were correctly diagnosed on presentation and diagnosis in the others was markedly delayed (average 4 days). Contrast swallow examination, when eventually performed, was diagnostic. Twelve patients underwent repair: four under 24 h, who all survived and eight over 24 h, amongst whom there were one (12.5 per cent) operative and two (25 per cent) late deaths. Conservative management was successful in the remaining two cases. Oesophageal fistula, empyema and incorrect initial surgery were common and serious complications. Management options are reviewed and their relative merits considered.

Adult↗
PubMed1984

Myocardial infarction related to coronary artery bypass graft surgery.

Fifty consecutive patients undergoing coronary artery bypass grafting for chronic stable angina were assessed by serial electrocardiography, preoperative and postoperative myocardial scanning with technetium-99m pyrophosphate, gated radionuclide ventriculography, and serial measurement of creatine kinase, aspartate aminotransferase, urea stable lactic dehydrogenase, and creatine kinase isoenzyme (MB) to assess the incidence of perioperative myocardial infarction and identify the most appropriate diagnostic techniques. The correlation between myocardial scanning and the measurement of peak enzyme and isoenzyme activity was excellent in the diagnosis of perioperative infarction, although electrocardiography proved less helpful. There appeared to be no advantage in measuring creatine kinase MB rather than the more routinely measured enzymes. There were two deaths and evidence of myocardial infarction in five other patients, an incidence of 14%. Perioperative infarction was associated with a significant reduction in resting ejection fraction in two cases. In those patients without evidence of perioperative infarction the mean increase in ejection fraction of 7.8% was statistically significant.

Adult↗
PubMed1984

Wound prophylaxis in thoracic surgery: a new approach.

A prospective double blind, randomised study was performed in 100 patients undergoing major elective thoracic surgery to assess a new method of prophylaxis of wound infection using one preincisional intraparietal infiltration of cefuroxime sodium along the line of proposed incision as the sole protection against wound infection. A significant (p less than 0.01) reduction in the incidence of wound infection occurred in the antibiotic treated group (2%) compared with the control group (20%), who received by the same route the same volume of saline only. The groups were comparable with respect to age, sex, pathological condition, and operative variables. The use of additional antibiotics was significantly greater in the control group (p less than 0.01), largely owing to a much greater incidence of postoperative pulmonary infection in the control group (60%) than in the antibiotic treated group (40%). No morbidity was associated with this technique. The organisms found in oesophageal and bronchial operative luminal specimens did not correlate with postoperative wound or pulmonary infection or with organisms causing these infections. Reductions in wound and pulmonary infection rates equivalent to those produced by conventional multiple dose parenteral regimens were achieved by this technique.

Aged↗
PubMed1984

Myocardial ischaemia in constrictive pericarditis--a morphometric and electron microscopical study.

Left ventricular biopsies, taken during pericardiectomy, were morphometrically and morphologically examined to determine the pathology of the myocardium in constrictive pericarditis (CP). To serve as a normal control a similar appraisal was made of tissue from the left ventricle of a patient undergoing atrial septal repair. Morphometrically, mean cross-fibre diameters at the position of the nucleus in atrial septal defect (ASD) and CP hearts were within a range previously reported as normal. In hearts from patients with CP, the range of individual myocardial fibre diameters was extended. Ultrastructurally the myocardium in ASD appeared normal. In CP, myofibres could be divided into two groups: (a) small and morphologically normal; and (b) large and oedematous. Oedematous fibres contained abnormal nuclei and sarcoplasmic organelles and myofibrillar dissolution was a prominent feature in many cells. These pathological features are among those previously used to characterize myofibre ischaemia. In CP, prolonged cardiac compression is thought to predispose the heart to atrophy due to its inability to function properly (disuse atrophy). The results of this study suggest that in CP, myocardial ischaemia is a more important factor in the aetiology of myocardial dysfunction than is atrophy which arises from enforced cardiac disuse.

Adolescent↗
PubMed1983

Surgical management of native valve endocarditis.

From 1972 to 1981 40 patients have required urgent valve replacement for left-sided bacterial endocarditis. The aortic valve was replaced in 31 patients, the mitral valve in four, and both in five patients. Twenty-six patients (65.5%) were in functional class IV heart failure according to the New York Heart Association criteria, and 13 patients (32.5%) were in class III heart failure at the time of operation. One patient in class II was operated on urgently for multiple cerebral embolism but died of fatal cerebral haemorrhage. In 22 patients (55%) there were no pre-existing valvular lesions and these patients were found to be more liable to develop severe haemodynamic failure. Premature closure of the mitral valve, documented by M-mode echocardiography, was a useful diagnostic aid and successfully determined the best timing of surgery in 14 out of 20 patients with severe aortic regurgitation. Cardiac arrest before operation appeared to be a significant risk factor (p = 0.0015) unless followed by immediate cardiopulmonary bypass. There were eight operative deaths (20%). Of 26 patients who were in functional class IV heart failure, 19 were operated on within four days of their haemodynamic deterioration and all survived. The operation was delayed in the remaining seven patients and none of them survived (p = 0.000003). There were no operative deaths among the patients in class III heart failure. There was only one episode of reinfection in the 16 patients followed up for at least three years. The duration of postoperative antibiotic treatment (four to six weeks in our patients), rather than any preoperative antibiotic regimen, seems to be important for preventing reinfection. At present there are 28 survivors, of whom 24 are in functional class I and four in class II.

Adolescent↗
PubMed1983

Surgical management of prosthetic valve endocarditis.

Operative mortality in patients with prosthetic valve endocarditis (PVE), who already have severe hemodynamic failure, is extremely high (35% to 84%). Over a period of 10 years, between 1972 and 1981, fourteen consecutive urgent operations were performed for PVE in 12 patients. On thirteen occasions the patients were in severe hemodynamic failure (NYHA Functional Class IV), and five of them had early PVE (within 60 days of previous operation). In all patients at least two of the other recognized risk factors, such as presence of non-streptococcal organisms, detachment of the prosthesis, and myocardial invasion, were present. All of the patients but one were operated upon within 48 hours of their hemodynamic deterioration, and there was one postoperative death (operative mortality 7%). Our results indicate that an acceptable surgical mortality in patients with intractable heart failure due to early and late PVE can be achieved by prompt surgical intervention despite the presence of multiple risk factors.

Endocarditis, Bacterial↗
PubMed1982

Disseminated aspergillosis occurring in patients with respiratory, renal, and hepatic failure.

Respiratory, renal, and hepatic insufficiency developed in five patients who had been admitted to hospital for a variety of reasons. Although in four cases Aspergillus had been isolated from tracheal secretions before death, the significance of this finding was not fully appreciated, and in all five the diagnosis of aspergillosis was made at necropsy. Since treatment has to be started early if it is to be effective, patients with any combination of respiratory, renal, and hepatic failure should have their tracheal secretions examined daily. If Aspergillus is cultured, and hyphae are present in a fresh smear, and the patient has features of a generalised infection without an obvious site of infection, treatment for aspergillosis should be considered.

Acute Kidney Injury↗
PubMed1981

Management of disrupted sternotomy.

Seventeen out of 929 consecutive patients (1.8%) who underwent open-heart surgery during the last three years developed dehiscence of the sternotomy. Infection was the most common cause of dehiscence and occurred more often after reopening of the incision to control bleeding or relieve tamponade. We describe a one stage closure which was used in all 17 cases. A successful result was obtained in 16 cases, discharge from hospital occurring between 21 and 51 days after closure.

Humans↗
PubMed1980

Characteristics and management of chronic destructive pneumonia.

In 12 years 627 patients presented to Wentworth Hospital, Natal with chronic destructive pneumonia (CDP). Common symptoms were haemoptysis, the production of foul-smelling sputum, and chest pain. The disease pursued a chronic course with acute exacerbations which may be lethal. The majority of patients were African men aged between 20 and 50 years who were free from other significant disease apart from dental infection. Radiographically and pathologically CDP had the characteristics of a necrotising pneumonia, and microbiological investigation showed mixed aerobic and anaerobic flora in the lower respiratory tract. Gram-positive aerobic cocci and Bacteroides species were the predominant organisms. In 120 patients treatment regimens were based on chloramphenicol, in 429 cephalosporins, and in 78 on combination therapy with cephalosporins, penicillin, and metronidazole. One hundred and seventy patients also required operative management in an attempt to control progress of the disease. The overall inpatient mortality rate from CDP was 7.8%. In the group of patients treated with combination therapy the mortality rate was 1.3%.

Adult↗
PubMed1979

Ultrastructural artefacts in biopsied normal myocardium and their relevance to myocardial biopsy in man.

Biopsy specimens, as a source of myocardial tissue, are being used increasingly in the appraisal of various myocardial diseases. A study of myocardial tissue, biopsied and processed in various ways, and obtained from normal healthy experimental animals, showed that a variety of artefacts may be found. These artefacts develop in reactive, beating myocardium but not in non-reactive hearts. The artefacts are in many instances similar to, or mimic, changes previously described as pathological in origin. This is most unsatisfactory, and if valid pathological appraisals of myocardial biopsies are to be made, a technique allowing the recovery of tissue, free of biopsy artefact, is required. Such a technique is described.

Animals↗
PubMed1978

Bronchography in children aged 3 years and under. Anaesthetic techniques and results.

Bilateral bronchography was performed on 89 children aged between 3 months and 3 years. The bronchographic technique involves instillation of oily propyliodone into the tracheobronchial tree by positive pressure ventilation, and the procedure is carried out under general anaesthesia. Technically adequate bronchograms were obtained in 84 of the children, and with a solitary exception the complications of bronchography were few and trivial. In bronchiectatic children bronchography is a valuable and accurate investigation, which should in general be restricted to those patients who on clinical grounds are thought to have surgically manageable bronchiectasis.

Anesthesia, Inhalation↗
PubMed1978

Treatment of chronic destructive pneumonia with cephalosporins, penicillin and metronidazole.

Three hundred and ten patients with chronic destructive pneumonia (CDP), a necrotizing pneumonia probably caused by aerobic and anaerobic bacterial synergism, were treated with cephalosporins (80 of these with cephalosporins, penicillin and metronidazole). The reasons for selecting these drugs to treat CDP are given and evidence is presented which suggests that the combination of cephalosporins, penicillin and metronidazole is more effective therapy for CDP than cephalosporins alone. This finding supports the thesis that anaerobes are implicated in the aetiology of CDP.

Administration, Oral↗