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Biomedical subjects

G A Guinn

Publications and source records attributed to G A Guinn.

At least 19 recordsLinked to original sources
PubMed1993

Cardiopulmonary bypass in patients with previously completed stroke.

It has been assumed that patients with neurological residua after a completed stroke are at increased risk of neurological complications associated with cardiac operations requiring cardiopulmonary bypass. To evaluate these assumptions, we reviewed retrospectively 1,163 consecutive patients undergoing cardiac operations with cardiopulmonary bypass. Among these 1,163 patients were 43 patients having a previously completed stroke with neurological residua, but without clinically significant extracranial carotid artery disease. Forty-one underwent coronary artery bypass grafting; of these, 1 required concomitant aortic valve replacement, 1 had mitral valve replacement, and 1 had aortic valve replacement. There was one death in this group of 43 patients, due to massive pulmonary embolism. Only 1 of these 43 patients experienced new neurological symptoms after operation, which would appear to indicate that patients with a previous, completed stroke may not be at increased risk of neurological complications from cardiac operations requiring cardiopulmonary bypass.

Aged↗
PubMed1985

Ulnar nerve injury with open-heart surgery.

The effects of different arm positions during open-heart surgery on the incidence of ulnar nerve injury were studied prospectively in 35 patients. It was concluded that ulnar nerve damage was common and was due to nerve compression at the elbow. A significant reduction in the incidence of nerve injury can be effected by placing the forearms above the head rather than at the patient's side.

Cardiac Surgical Procedures↗
PubMed1984

Herpesviridae in the endothelial and smooth muscle cells of the proximal aorta in arteriosclerotic patients.

Punch-biopsy specimens were obtained from uninvolved areas of the proximal aorta of each of 60 patients with atherosclerosis undergoing cardiovascular surgery. Electron microscopic study of the smooth muscle and endothelial cells of the aortas showed cellular hyperplasia, nuclear and nucleolar atypia. Virions of the Herpesviridae family were observed in ten of the patients. They were detected in occasional smooth muscle and rare endothelial cells. Specimens were taken from three separate sites of each aorta and distributed into five blocks for each patient. In only a single block from each of the ten positive patients could virus be identified. Nine of the ten virus-positive patients also exhibited intracytoplasmic microtubular inclusions. In four patients only the microtubular inclusions were seen. Microcapillaries were observed in the midportion of the media, which we consider to be an attempt of a repair process.

Adult↗
PubMed1981

Thomas G. Orr Memorial Lecture. Cardiovascular surgery in Saudi Arabia.

A program in cardiovascular surgery from Baylor College of Medicine was transplanted halfway around the world to the Kingdom of Saudi Arabia, providing services with results similar to those obtained in more medically advanced areas of the world. In order to do this, however, numerous support services must be in place and functioning efficiently, and there must be a cooperative spirit on the part of all concerned. In this manner it has been possible not only to provide cardiovascular service to the Kingdom, but also to establish a bidirectional training program. It is intended that eventually this program of cardiovascular surgery will be conducted by Saudi nationals.

Adolescent↗
PubMed1981

Operative techniques in infective endocarditis.

Twenty-six of 163 patients with infective endocarditis treated between 1969 and 1979 required operation. The consequences of infection in these 26 patients included leaflet destruction, annular "ring" abscess, fistula formation with ventricular and atrial septal perforation, and myocardial abscess with heart block. Surgical principles used to repair these abnormalities successfully were excision of necrotic tissue, valve replacement, repair of annular defects, and closure of perforations. Temporary and permanent cardiac pacing were used also. The operative mortality was 13%.

Abscess↗
PubMed1979

Aryl hydrocarbon hydroxylase inducibility in lung cancer patients undergoing radiotherapy.

Aryl hydrocarbon hydroxylase (AHH) inducibility was studied in cultured lymphocytes from 21 healthy control subjects and from 15 lung cancer patients selected for radiation therapy. AHH inducibility of the patients was measured prior to, during and at the end of radiation therapy. Four of 15 patients had values comparable to the healthy controls. Cellular DNA and protein measurements of cultured lymphocytes were the same for patients and healthy controls. There was no significant difference in the percentage of lymphoblast formation and percentage of cell survival between the two groups. Radiation therapy reduces the number of lymphocytes in vivo and the amount of lymphoblast formation in vitro. AHH inducibulity is signifcantly lowered by radiation in the patients who had very high inducibility at pre-treatment level. DNA and protein contents of cultured lymphocytes did not change during radiation therapy.

Aged↗
PubMed1979

Surgery in active infective endocarditis.

Controversy persists concerning the role of early surgical intervention in severe infective endocarditis (IE). We therefore reviewed 163 episodes of well-documented IE in which 32 cardiac operations were performed during the active phase of IE. Congestive heart failure (CHF) was the principal indication for surgery in 88% (28/32); systemic emboli, 1/32; and persisting sepsis, 3/32. Staphylococcus and enterococcus were the most common infecting organisms in the operative group (44% and 16% respectively). Surgical mortality (11/32,37%) did not differ (p greater than 0.05) from medical mortality (26/131,20%). All 11 operative deaths occurred in patients moribund prior to surgery, including three with preoperative cardiac arrest. Surgical patients undergoing preoperative cardiac catheterization demonstrated marked CHF: a mean left ventricular end-diastolic pressure of 25.3 mm Hg. The mean cardiac index in 8/11 surgical deaths was lower (p less than 0.05) vs surgical survivors: 2.21/min/m2 vs. 3.21/min/m2. Postoperative complications were rare in the 21 surgical survivors. There were no episodes of continued infection, prosthetic dehiscence, or advanced heart block; only one paravalvular leak; and one systemic embolus. These findings emphasize the high medical and surgical mortality in patients with IE, suggest that delayed operative intervention may be a major causative factor resulting in a high surgical mortality, and justify an aggressive surgical approach in patients with valve dysfunction and heart failure. These data indicate that survivors of surgical intervention during active IE have eradication of infection and few postoperative complications.

Adult↗
PubMed1978

Percutaneous drainage of lung abscess.

The availability of effective antimicrobial agents has greatly decreased the need for surgical intervention in patients who have a pyogenic lung abscess. We describe 3 patients with lung abscesses caused by gram-negative bacteria who failed to respond to medical treatment and who were believed to be unable to withstand lobectomy. Percutaneous insertion of a drainage tube directly into the abscess brought about a dramatic clinical response, with prompt closure of the cavity. This procedure provides an alternative to thoracotomy and lobectomy in treating lung abscesses that fail to respond to medical therapy.

Drainage↗
PubMed1978

The electrical dose for direct ventricular defibrillation in man.

The threshold electrical energy for direct ventricular defibrillation was measured in 100 patients whose hypothermic hearts were fibrillated for cardiac operations. In 93 cases 10 joules or less was sufficient, and in 48 of these cases 5 joules or less defibrillated the ventricles. Because a shock of 10 joules defibrillated the heart of most of our patients, we recommend an initial shock of 5 to 10 joules rather than the 20 joules used more commonly. Until the safety margin between defibrillation threshold and damage threshold is established for direct defibrillation, use of shocks with adequate but not excessive strength may avoid unnecessary damage to the myocardium. When hearts refibrillate after defibrillation, it is unnecessary to use higher energy settings for subsequent defibrillation attempts. Instead, an antiarrhythmic drug should be administered and another shock of the same intensity that defibrillated the first time should be applied.

Adult↗
PubMed1977

Median sternotomy closure with running wire: a simplified method.

A method of median sternotomy closure which utilizes running wire is described here. We believe this method shortens the surgical time involved in closing the chest and also that it is a safe method which provides significant saving of wire material so that it can be accomplished generally with one No. 20 stainless steel wire.

Humans↗