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Biomedical subjects

G F Murray

Publications and source records attributed to G F Murray.

At least 73 records · Page 4Linked to original sources
PubMed1983

The cervical approach to esophageal leiomyomas.

Intramural leiomyoma is the most common benign esophageal tumor. The treatment of choice is enucleation without mucosal encroachment. Esophageal resection with reconstruction is rarely necessary, obviating the need for wide exposure. This report demonstrates the technical simplicity of the cervical approach to leiomyomata of the proximal thoracic esophagus. The operative technique avoids the morbidity of the commonly employed thoracotomy incision and deserves consideration in the treatment of accessible lesions.

Adult↗
PubMed1983

Clinical experience with the Hall pivoting disk valve.

One hundred seventy-two patients have had Medtronic-Hall pivoting disk valves implanted at the University of North Carolina since April, 1978 as a primary procedure or in combination with other cardiac surgery. One hundred twenty-three patients (31 combined) had aortic valves implanted, 32 patients (3 combined) had mitral valves implanted, and 17 patients (7 combined) had aortic and mitral valves implanted. The actuarial survival at 4 1/2 years, excluding the operative mortality, is 100% for all patients with mitral valve replacement and 91% for all patients with aortic valve replacement. The actuarial survival at 2 1/2 years for all patients with aortic and mitral valves replaced is 88%. None of the patients had clinical evidence of hemolysis. The average LDH value was 531 +/- 240 IU/L. Eighty percent of the surviving patients were totally asymptomatic, 19% were symptomatic with moderate exertion, and only 1% were unchanged or worse. Four cerebrovascular accidents occurred in this group of patients for a 1.1/100 patient years incidence of cerebrovascular accidents in the aortic group and a 3.8/100 patient years incidence in the mitral group. Two of the mitral valves were replaced because of thrombosis and one aortic valve was found to be thrombosed at autopsy in a late death for an incidence of 0.6/100 patient years in the aortic group and 3.8/100 patient years in the mitral group. Hemodynamic measurements performed intraoperatively showed that only the smallest valve size, #21, was somewhat stenotic, with the average valve area being 1.3 cm2 for that size. There were no structural valve failures observed in this group of patients.

Aortic Valve↗
PubMed1983

Effects of pneumonectomy on pulmonary input impedance.

The long-term effects of pneumonectomy on the pulmonary circulation quantifiable through pulmonary input impedance analysis were studied. Excision of the left lung was performed in purebred beagle dogs aged 6 to 10 weeks (n = 6 group I) or 1 year (n = 8 group II). Unoperated beagles served as controls (n = 8 group III). When the dogs were 5 years of age, pulmonary pressure and flow were measured and the impedance spectra calculated. Characteristic impedance (Zo) (indicative of changes in proximal vessel physical properties) and pulmonary vascular resistance (PVR) (indicative of the distal response) were estimated. In group III the cardiac output (CO) was 1.7 +/- 0.4 L/min, mean pressure 16 +/- 5 mm Hg, PVR 605 +/- 448 dyne-sec/cm, and Zo 204 +/- 76 dyne-sec/cm. Group I results exhibited bimodal distributions that were not statistically different from results of groups II or III; four dogs had spectra comparable to those of group III, while two dogs had developed moderate hypertension and high PVR and Zo. Group II results were more normally distributed, and comparison with group III indicated statistically significant differences (P less than 0.05) in CO (1.1 +/- 2 L/min), PVR (1396 +/- 573 dynes-sec/cm), and Zo (543 +/- 273 dynes-sec/cm). Doubling of PVR and Zo in group II indicated that proximal vessel compliance and peripheral perfusion radius had not increased following pneumonectomy in adult beagles. Group I results indicate that marked facilitory adaptation can occur when pneumonectomy is performed in puppies; however, the adaptation may not be based on true lung growth and, therefore, may not be sustained indefinitely.

Adaptation, Physiological↗
PubMed1982

Bronchial carcinoma and the lymphatic sump: the importance of bronchoscopic findings.

The lymphatic sump of Borrie is an important area of regional node metastasis in each lung. The sump area is of increased importance on the right side, since bilobectomy has been recommended to ensure complete removal of lymphatic disease in patients with lower or middle lobe carcinoma. The role of bronchoscopy in assessing lymphatic metastasis of bronchial carcinoma was investigated in 42 patients at the North Carolina Memorial Hospital. Because of the high incidence of associated lymphatic metastases, bilobectomy is indicated for right lower or middle lobe lesions observed at bronchoscopy. Simple lobectomy may be utilized when bronchoscopic findings are negative and when there is no involvement of the lymph nodes of the sump of Borrie at the time of operation. If there is gross nodal involvement of the lymphatic sump, pneumonectomy will be required.

Bronchoscopy↗
PubMed1982

Structural changes in the canine lung and pulmonary arteries after pneumonectomy.

The study set out to describe the structural changes in the remaining lung of beagle dogs after left-sided pneumonectomy, performed at 6-10 wk or 1 yr of age. After a 5-yr postoperative recovery, lung volume and weight had increased in the operated groups, though only the latter was significant in comparison with 5-yr-old controls. In both operated groups, total alveolar number in the right lung was normal. The total volume of alveolar ducts, mean linear intercept, and (in the young operated group) mean alveolar volume were increased, indicating a compensatory enlargement of distal air spaces. Lobar differences reinforced these conclusions. In the 1-yr operated group, medial hypertrophy was present in preacinar arteries, with a similar trend in intra-acinar arteries where peripheral extension of medial smooth muscle was also present. Despite the lack of structural change in their pulmonary arterial system, the young operated group had right ventricular hypertrophy. Previously reported evidence of alveolar proliferation shortly after pneumonectomy probably represents a speeding up of normal developmental patterns, but after prolonged recovery the final alveolar number is no greater than normal.

Animals↗
PubMed1981

Clinical and experimental evaluation of left ventriculoiliac shunt bypass during repair of lesions of the descending thoracic aorta.

Temporary ventriculoiliac bypass with a tridodecylmethylammonium chloride-coated shunt has been used routinely at the University of North Carolina for the past seven years for repair of lesions of the descending thoracic aorta. Although the technic appears to be safe and reliable, the hemodynamic effects of prolonged nonvalved apical diversion on left ventricular function are not defined. To evaluate left ventricular performance during ventriculoiliac shunt bypass, the procedure was investigated in adult sheep. Systolic flow through the shunt was pulsatile and accounted for approximately 35% of the total cardiac output. Reversed flow was minimal. No significant change occurred in cardiac output, left ventricular end-diastolic pressure, or left atrial pressure. Perfusion of the abdominal viscera through the shunt was sufficient to prevent intestinal and renal ischemia. Our results indicate that the shunt provides left ventricular decompression without evidence of deterioration in left ventricular performance for up to three hours of apical bypass and aortic occlusion. It is included that bypass with a left ventriculoiliac shunt provides safe and effective diversion during repair of lesions of the descending thoracic aorta and offers and excellent alternative to methods involving greater technical hazard or requiring systemic anticoagulation.

Aortic Dissection↗
PubMed1981

Forced oscillatory resistance and compliance parameters following pneumonectomy in beagle dogs.

Forced oscillatory resistance (RFO) and compliance (CFO) were measured in 3 groups of adult beagle dogs. Group I (n = 12) had undergone a left pneumonectomy at 6-10 weeks of age; group II (n = 11) underwent a similar procedure at 1 year of age; and group III (n = 8) served as unoperated controls. The mean value of RFO for group II was significantly higher than corresponding values for groups I and III. Similarly, the mean value of CFO was significantly lower for group II. Mean values for RFO and CFO between groups I and III were not statistically different. When RFO and CFO were normalized by functional residual capacity, mean values for all three groups were similar. However, when RFO and CFO were normalized by body weight, mean values for groups I and II were significantly different from those of group III. These findings cannot be explained directly by postoperative hyperinflation of the remaining lung. They suggest that there is an adaptive change in the mechanical characteristics of the remaining lung following pneumonectomy and that the degree of adaptation varies with the age of the animal undergoing resection.

Adaptation, Physiological↗
PubMed1981

A review of trends in alcohol and cannabis use among young people.

This review identifies recent trend studies in alcohol and cannabis use among young people in an attempt to define increases over time, demographic subgroups where changes have taken place, possible future trends and areas where there is a lack of current information. Trend studies on alcohol use are described for eight countries: Australia, Canada, Denmark, Finland, Mexico, Norway, Sweden and the United States of America. Only four countries: Australia, Canada, Norway and the United States of America had trend studies of cannabis use. Rates of alcohol use are reported to have reached a peak and per capita alcohol consumption to have stabilized or decreased in many Western countries since 1975-1976. Rates of cannabis use are reported to have increased remarkably from the late 1960s to the late 1970s although the hazards of cannabis use are becoming more widely recognized.

Adolescent↗
PubMed1980

Right ventricular myxoma. Case report and review of phonocardiographic and auscultatory manifestations.

Tumors in the right ventricle are extremely rare. This report concerns the pathogenesis of physical signs resulting from a right ventricular myxoma. In systole a loud midsystolic murmur representing outflow obstruction was present. In diastole a prominent vibration was heard and recorded. By echophonocardiography this noise could be ascribed to sudden halting of the retrograde excursion of the mass into the right ventricle--a mechanism analogus to the tumor "plop" associated with the halting of antegrade movement of a left atrial myxoma in the left ventricle in early diastole.

Adolescent↗
PubMed1980

Surgical management of left ventricular-aortic discontinuity complicating bacterial endocarditis.

Successful hemodynamic repair of left ventricular-aortic discontinuity complicating bacterial endocarditis in 2 patients was achieved using a composite valve-woven Dacron tube graft. The prosthetic valve was sutured without tension into the remaining aortic annulus, ventricular muscle, and base of the aortic leaflet of the mitral valve. Use of the composite graft allows adequate debridement of the abscess, restores ventricular-aortic continuity, excludes the abscess wall from systemic pressure, and does not require saphenous vein coronary bypass. Total exclusion of the aortic root, as described, is a lifesaving alternative repair in the care of desperately ill patients with this condition.

Abscess↗
PubMed1980

Operation for motor dysfunction of the esophagus.

Modern operative treatment of motor dysfunction of the esophagus began in 1949 with the recognition that anastomotic procedures that bypass or destroy the distal esophageal sphincter are associated with the development of reflux esophagitis and stricture. Thirty years later, reflux esophagitis related to esophagomyotomy or intrinsic esophageal disease remains the dominant concern and challenge. This review examines the current status of operative procedures for the management of three important primary disorders of esophageal motility: achalasia, diffuse esophageal spasm, and scleroderma. Relief of esophageal obstruction by esophagomyotomy or reconstruction is the common surgical goal. The addition of a fundoplication procedure to discourage esophageal reflux remains controversial in each disorder. Esophageal resection may become necessary when stricture persists or esophagomyotomy fails to provide lasting relief of dysphagia.

Esophageal Diseases↗
PubMed1979

The effects of early pneumonectomy on the remaining pulmonary parenchyma.

To determine the age-related response of the remaining pulmonary parenchyma to lung resection, a matched set of 24 purebred beagle dogs underwent pneumonectomy at 6 to 10 weeks of age (group I) or at 1 year of age (group II). Eight unoperated adult beagles served as controls (group III). One year after pneumonectomy, pulmonary hemodynamics in group I were the same as those in older animals shortly after pneumonectomy and in normal control animals. Functional residual capacity, total lung capacity, single breath diffusing capacity for carbon monoxide, and static lung compliance were measured in all three groups while anesthetized and intubated. Lung volumes and diffusion capacity for carbon monoxide in group I did not differ significantly from those of control animals. Group I animals did have a lower lung compliance than the control group, but significantly greater than the group II adult pneumonectomy dogs. The adult pneumonectomy dogs (group II) had significantly lower values for lung volumes, diffusion capacity, and compliance when compared to the control group. Arterial blood gases were not significantly different among the groups. It is concluded that beagles undergoing early pneumonectomy have an increase of alveoli beyond the normal complement in the remaining lung with concomitant remodeling of the pulmonary capillary bed resulting in normal lung volumes, diffusing capacity, and gas exchange.

Age Factors↗
PubMed1978

Valve placement in the ventricular apex for complicated left ventricular outflow obstruction.

Successful correction of severe valvular calcific aortic stenosis is described in which a stented porcine aortic heterograft was placed in the ventricular apex. Creation of a double outlet is a valid alternative approach to relieve left ventricular hypertension, and indication for such a procedure may be encountered unexpectedly. Intramyocardial placement of a durable tissue valve provides a simple and effective option for the cardiac surgeon.

Aged↗
PubMed1977

Tricuspid atresia: corrective operation without a bioprosthetic valve.

A case of successful correction of type IB tricuspid atresia is described in which the patient's own normal pulmonary valve was used in its natural location. Morphological features of tricuspid atresia suggest that use of the in situ pulmonary valve is possible in most patients with normally related great arteries. Elimination of the requirement for valved conduits and bioprosthetic valves may eventually permit corrective operation in the very young child.

Child↗
PubMed1977

The assessment of operability of esophageal carcinoma.

The extremely poor outlook for patients with esophageal cancer necessitates careful definition of the extent of disease prior to the selection of treatment. Evaluation of regional lymph node involvement may avoid excessive morbidity and identify favorable candidates for aggressive excisional therapy. The role of combined mediastinoscopy and celiotomy in assessing the operability of epidermoid carcinoma of the thoracic esophagus was examined in 30 consecutive candidates for esophageal resection at the North Carolina Memorial Hospital. The prognostic value of combined mediastinoscopy and celiotomy in assessing the operability of epidermoid value in assessing mediastinal extension of carcinoma of the upper thoracic and midthoracic esophagus.

Abdominal Neoplasms↗
PubMed1977

The role of transbronchial lung biopsy in diffuse pulmonary disease.

Forty consecutive patients underwent flexible fiberoptic transbronchial lung biopsy for diagnosis of diffuse nodular or infiltrative lung disease. Biplane fluoroscopic examination with image intensification greatly facilitated accurate placement of the biopsy forceps near the pleura; Specimens of lung parenchyma were obtained for culture and histological study in every case. A pathological diagnosis was correctly established in 34 of 40 patients. Transbronchial biopsy was helpful in the clinical management of an additional 4 patients. Biopsy results were not accurate in 2 patients. No significant morbidity was associated with the procedure. Fiberoptic transbronchial lung biopsy is a safe and useful adjunct to the diagnosis of parenchymal lung disease.

Adolescent↗
PubMed1977

The long-term outlook for valve replacement in active endocarditis.

This study follows the clinical course of 22 patients in the active phase of infective endocarditis who inderwent valve replacement at North Carolina Memorial Hospital between March, 1966, and March, 1976. At the time of operation, there was gross valve tissue destruction in 16 patients, verrucae in nine, ruptured chordae tendineae in five, and myocardial or annular abscess formation in five. Four patients survived less than 6 months after the initial operation. One survived almost 3 years before dying of recurrent carcinoma of the lung. The remaining 17 patients have been followed an average of 4.6 years. Major postoperative complications were as follows: paravalvular problem, five patients; congestive heart failure, seven patients; complete heart block, three patients; systemic arterial emboli, four patients. These complications often were associated with the preoperative presence of annular or myocardial abscess. Thus it appears that postoperative complications often result from annular structural deficiencies rather than being directly related to active infection.

Adolescent↗