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Biomedical subjects

G F Murray

Publications and source records attributed to G F Murray.

At least 37 records · Page 2Linked to original sources
PubMed1993

Effects of insufflation on hemodynamics during thoracoscopy.

Thoracic procedures once requiring open thoracotomy are now being performed with video-assisted thoracoscopy. To visualize adequately the intrathoracic structures, creation of an artificial pneumothorax by carbon dioxide insufflation under positive pressures has been advocated. We hypothesized that positive-pressure insufflation during thorascopy would cause significant hemodynamic compromise. Eight healthy female pigs underwent general endotracheal anesthesia and placement of monitoring lines. After placement of a thorascope, baseline hemodynamic measurements were obtained at 0 mm Hg (atmospheric pressure). Measurements were taken randomly at 5, 10, and 15 mm Hg using carbon dioxide insufflation after stabilization at each pressure. Data were analyzed using Page's test for noparametric variables. Insufflation pressures of 5 mm Hg or greater resulted in significant decreases in cardiac index, mean arterial pressure, stroke volume, and left ventricular stroke work index, whereas central venous pressure increased (p < 0.001). Changes in heart rate were not significant. We do not recommend routine positive-pressure insufflation during thorascopy because of the significant hemodynamic compromise in our experimental model.

Animals↗
PubMed1993

Current management of esophageal impactions.

We analyzed our experience at a university medical center from 1977 to 1990 to assess our success in using esophagoscopy and related treatments for removing esophageal impactions. There were 157 episodes of impaction in 150 patients, consisting of 39 pediatric and 111 adult patients. In the pediatric cases, foreign bodies were most often the cause of impaction, while adult cases were usually caused by food or bones. Esophagoscopy was performed successfully in 32 of 34 pediatric patients in which it was attempted; there was only one complication. Other forms of therapy that were infrequently tried met with variable results. Esophagoscopy was successful in removing the impaction in 104 of 109 attempts in adults. Two perforations occurred, with one resulting in death. Various other methods achieved success in the remaining patients. The data suggest that esophageal impaction can be treated successfully by endoscopy with very low morbidity and mortality.

Adolescent↗
PubMed1991

Are sutures better than staples for closing bronchi and pulmonary vessels?

Little is known about the strength of suture lines and stapled closures of the bronchus, pulmonary arteries, and pulmonary veins. This experiment tested and compared the hydrostatic leakage point of each of these structures when closed by either sutures or staples. Fourteen fresh mature porcine cadavers and 8 human cadavers of age greater than 50 years were studied to determine whether the pig could be used as an appropriate model for future in vivo studies. Cadavers were selected so that closures depended only on the material used and not on any clot reinforcing the closure lines. The results of the study suggest that staple closure of the pulmonary artery and the main bronchus is as secure as suture closure. Pulmonary veins leak at a lower pressure when closed with staples; however, this pressure far exceeds physiological pressures in the left atrium. The data also suggest that the pig is an appropriate model for approximating conditions found in patients and is a good model for chronic studies comparing suture and staple closures.

Bronchi↗
PubMed1991

Immediate muscle flap coverage for repair of cardiac rupture associated with mediastinitis.

Sternal wound infection with mediastinitis is a dreaded complication of cardiac surgery. Even more devastating is perforation of the heart or great vessels secondary to advanced mediastinitis. The exsanguinating hemorrhage and presence of extensive infection usually lead to a poor salvage rate in these patients. Citations in the English literature of successful management of cardiac rupture associated with mediastinitis are, as expected, scare. Recently, the capability for immediate muscle flap coverage in the repair of associated rupture of the heart secondary to active mediastinal infection has been discussed in two reports. This article presents another report, in which bilateral pectoralis major muscle flaps were used successfully in salvage of a patient who sustained rupture of the right ventricle after debridement of an extensively purulent sternal wound and mediastinum.

Aged↗
PubMed1990

Role of lung decortication in symptomatic empyemas in children.

Despite appropriate antibiotics and pleural drainage, the condition of some children with empyema fails to improve. In a 5-year period, 10 children ranging in age from 2 to 16 years underwent lung decortication for a refractory, symptomatic empyema, which had developed 3 to 5 weeks after an initial pneumonic infiltrate. Responsible organisms included beta-hemolytic streptococci, Haemophilus influenzae, or Streptococcus pneumoniae in 6 children. Negative cultures were found in 4 children. The initial computed tomographic scan of the chest in 4 of 8 patients showed more than 75% limitation of lung expansion by the contents of the empyema cavity. In 4 other patients, an extensive pleural peel was seen on initial computed tomographic scan of the chest. Several studies also showed cystic lesions in the collapsed lung. Multiple computed tomographic scans in 3 patients confirmed the lack of clinical and chest roentgenographic improvement with conservative therapy. At decortication in each, the visceral and parietal pleural peel was completely removed, freeing the trapped lung. Two patients also had a concomitant lobectomy for a necrotic right upper lobe (1 patient) and left lower lobe (1). Clinical improvement was marked, with return of temperature, white blood cell count, and appetite to normal. Postoperative morbidity was minimal. Analysis of these patients in whom traditional conservative therapy failed suggested that the initial management during the early exudative phase was often delayed and was not aggressive enough from the standpoint of pleural drainage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Revascularization of a symptomatic pseudoaneurysm of the anterior tibial artery.

Traumatic pseudoaneurysms of the peripheral arterial vasculature occur infrequently. The majority of the experience with these lesions is from this century's wartime experience. Pseudoaneurysms of the tibial vessels comprise only three to seven per cent of all pseudoaneurysms and only seven cases of anterior tibial artery pseudoaneurysms have been reported in the American and British literature since World War II. A high index of suspicion must be maintained for prompt detection of these lesions. Formerly, injuries of the tibial vessels were managed by nonoperative measures or exploration and arterial ligation. These approaches were met with varying results. The evolution of current vascular surgical techniques allows successful reconstruction of these vessels. We wish to report a successful method of repair of symptomatic pseudoaneurysm of the anterior tibial artery using a saphenous vein interposition graft. This technique restored arterial continuity and allowed maximal opportunity for limb salvage. Additional management techniques are discussed and compared in order to improve rapid diagnosis and provide efficient treatment.

Accidents, Occupational↗
PubMed1990

Left atrial to femoral arterial bypass using the biomedicus pump for operations of the thoracic aorta.

Left atrial to left femoral arterial bypass is an approach to operations of the thoracic aorta dating back to the late 1950s. Since that time, various modifications of the basic bypass circuit have evolved. In addition, temporary bypass shunts have also been described in a variety of positions. The goals of bypass of the thoracic aorta regardless of the technique include prevention of distal hypoperfusion, which can lead to paraplegia, limb loss, multiple organ failure, and sometimes death. Recently, there have been reports of the use of the biomedicus centrifugal pump in bypass circuits of the thoracic aorta. Our series, as well as the success of others, using this variation of a traditional bypass circuit of the thoracic aorta, establishes the biopump's capability of minimizing inherent complications in the bypass circuit.

Adolescent↗
PubMed1990

Wolff-Parkinson-White syndrome.

This article discusses a patient with Wolff-Parkinson-White syndrome who recently underwent surgical ablation of her accessory pathway at West Virginia University Health Sciences Center. Surgical cure of this arrhythmia is possible in a high percentage of cases and should be strongly considered for those with life-threatening arrhythmias or poorly controlled symptoms.

Adult↗
PubMed1989

Intralobar sequestration. A missed diagnosis.

Intralobar pulmonary sequestration is an uncommon but distinct clinical entity that may be the unrecognized cause of recurrent pulmonary infections. Between 1967 and 1987, 10 patients, ranging in age from 5 to 39 years, were found to have an intralobar sequestration. Nine patients (90%) had a history of recurrent pulmonary infections, chronic cough, and intermittent fevers. One patient was asymptomatic. Many patients had been treated with antibiotics on numerous occasions. The delay in diagnosis varied between 3 months and 7 years (mean delay, 1.5 years). The chest roentgenogram was abnormal in all patients. The intralobar sequestration was present in the left lower lobe in 7 patients and the right lower lobe in 3 patients. Bronchography was abnormal in 4 patients in whom it was done. Bronchoscopy was performed in 7 patients, but it was only helpful in excluding other diagnoses. Preoperative thoracic arteriography in 9 patients visualized the systemic arterial supply from the thoracic or abdominal aorta to the intralobar sequestration and helped prevent any catastrophic surgical bleeding. A lobectomy was performed in 9 patients and a segmentectomy in 1 patient without morbidity or mortality. In patients with recurrent infections in the same lower lobe, a high index of suspicion for an intralobar sequestration should prompt early diagnostic arteriography and, if confirmed, early operative intervention.

Adult↗
PubMed1989

Stage I palliation of hypoplastic left heart syndrome: the importance of neoaorta construction.

After Norwood's initial report of successful first-stage palliation of hypoplastic left heart syndrome in neonates, the occurrence of distal aortic obstructions, shunt problems, and late deaths have led to modifications in the surgical technique. Between January 1986 and December 1987, 12 neonates from three to 16 days old underwent stage I palliation with the same objectives. An open atrial septectomy was always performed. The pulmonary artery bifurcation was transected from the main pulmonary artery and closed with an aortic homograft patch. The aortotomy was begun 2 cm below the patent ductus arteriosus insertion and extended across the transverse arch and down the ascending aorta. The neoaorta was constructed using the hypoplastic ascending aorta-transverse aortic arch, the main pulmonary artery, and an aortic homograft augmentation patch. The homograft is hemostatic and pliable, and molds well in forming the neoaorta. A 4-mm shunt was inserted between the right innominate artery and the right pulmonary artery in 5 patients and the neoaorta and the pulmonary artery bifurcation patch in 7 patients. The early systemic oxygen saturation was optimized at 75% to 80% with hyperventilation, high concentration of inspired oxygen, sodium bicarbonate, and the frequent use of vasopressors to maintain an arterial blood pressure of 65 to 75 mm Hg. Two patients (17%) died early after operation; 1 had severe right ventricular dysfunction and both had severe tricuspid regurgitation. There were 2 late deaths at 7 and 13 months, of sepsis and hypoxia. The 8 survivors (67%) continue to do well over follow-up. The preoperative tricuspid regurgitation has remained stable in 3 survivors and disappeared in 2 survivors.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta↗
PubMed1989

Sex differences in cocaine use and experiences: a double standard revived?

Women's use of prescription medication exceeds that of men's and yet is not viewed with the alarm and disapproval that accompanies women's lower levels of use of alcohol and illicit drugs. Reports in the media, based on anecdotal accounts, have identified women as a group at particular risk for cocaine addiction and have suggested that their problems with cocaine are greater than men's. After reviewing the scientific literature and analyzing the results of an original research study, this paper argues that there is no evidence that women's cocaine use exceeds that of men's, that women's rates of use are growing faster than men's, or that female cocaine users experience more problems than male cocaine users. Since the deviant image of the female cocaine user is a social construction lacking a factual basis, we conclude that a different standard is being applied to women who use cocaine than to men who use cocaine.

Adult↗
PubMed1989

Sudden cardiac death.

This article reviews the epidemiology of sudden cardiac death, and outlines suggested management of patients who are successfully resuscitated from cardiac arrest. Emphasis is placed on the favorable impact of newer means of therapy on the very high recurrence rate using empiric antiarrhythmic treatment.

Death, Sudden↗
PubMed1989

Partial anomalous pulmonary venous connection to the right side of the heart.

Partial anomalous pulmonary venous connection to the right side of the heart often complicates surgery for atrial septal defects. Between 1964 and 1987, 39 patients, ranging from 2 to 52 years old, underwent repair of partial anomalous pulmonary venous connection. At least one anomalous pulmonary vein arose from the right upper lobe in 38 patients and right middle lobe in 30 patients and connected to the superior vena cava in 28 patients and the right atrium only in 11 patients. An atrial septal defect was present in 32 patients (82%). Patients who had partial anomalous pulmonary venous connection to the superior vena cava-right atrium junction, the right atrium or both were treated by septal translocation (two patients) or patch redirection of the anomalous pulmonary venous flow to the left atrium through a native atrial septal defect (eight patients) or a surgically created atrial septal defect in two patients with intact atrial septum. For partial anomalous pulmonary venous connection to the high superior vena cava (27 patients), the superior vena cava was transected and oversewn above the anomalous veins. The anomalous pulmonary venous flow was redirected through the proximal superior vena cava into the left atrium across a sinus venous atrial septum defect (22 patients) or a surgically created atrial septal defect in five patients with intact atrial septum. The atrial septal defect was coapted to the intracardiac orifice of the superior vena cava, and the distal superior vena cava was anastomosed to the right atrial appendage. One 31-year-old woman with severe pulmonary hypertension died early and was the only death in the series. A technical error early in the series resulted in one symptomatic superior vena cava obstruction. Only one patient remains in sick sinus syndrome late. All patients remain well over long follow-up (1 to 24 years). Postoperative catheterization or echocardiography has revealed no intracardiac defects, pulmonary venous obstruction, or superior vena cava obstruction (except the one technical error). Correction of partial anomalous pulmonary venous connection should be individualized according to the site of connection of the anomalous pulmonary veins and the location of the atrial defect to minimize undesirable postoperative sequelae often associated with other methods of repair.

Adolescent↗
PubMed1988

Early primary repair of tetralogy of Fallot.

Young age, low weight, and the requirement for transannular patch reconstruction of the right ventricular outflow tract (RVOT) are thought to adversely affect intracardiac repair of tetralogy of Fallot. Forty patients underwent complete repair between January, 1984, and January, 1987. Only infants with pulmonary atresia, complete atrioventricular canal, or coronary artery anomalies were shunted initially. The malalignment ventricular septal defect was closed with a Dacron patch. Infundibular resection was minimized. All atrial communications were left open. Thirty-four patients (85%) had a transannular RVOT patch, and 2 patients (5%) had a nontransannular patch. All 10 infants weighing 3.4 to 9.6 kg had a transannular RVOT patch at 7 weeks to 12 months of age. An RVOT patch was used in 26 of 30 children operated on between 1 and 6 years of age (median age, 24 months). No patient undergoing intracardiac repair died. Postoperative RVOT pullback gradients were between 0 and 35 mm Hg (mean, 18.5 mm Hg). Postoperative pulmonary artery saturation (mean, 73%) did not reveal any residual ventricular septal defect. The right ventricular/arterial pressure ratio was always less than 0.6 (mean, 0.4). All children are doing well at follow-up from two to 37 months. Serial echocardiograms reveal no residual ventricular septal defect and only 1 moderate RVOT gradient. Follow-up cardiac catheterization in 15 patients revealed no residual ventricular septal defect and RVOT gradients between 5 and 35 mm Hg. The right ventricular/left ventricular pressure ratio was always less than 0.6 (mean, 0.48). The early and late results justify continued primary repair of tetralogy of Fallot in symptomatic children, regardless of age or weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗