Octreotide acetate in the treatment of hypercalcemia accompanying small cell carcinoma.
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Carcinoma, Small Cell↗
Biomedical subjects
G M Rees
Publications and source records attributed to G M Rees.
High-dose aspirin inhibits shear-induced platelet reaction involving thrombin generation.
BACKGROUND: A unifying concept of explaining all pharmacological actions of aspirin by the irreversible blockage of the enzyme cyclooxygenase and therefore the inhibition of prostaglandin biosynthesis has left many unanswered questions. METHODS AND RESULTS: Two hundred ninety-four patients taking 75 mg/day aspirin were tested 3 months after coronary artery bypass surgery. Platelet thromboxane formation (whole blood aggregation to arachidonate) was completely prevented in 80% of patients. Compared with matched healthy controls (n = 95), a significant platelet hyperreactivity was observed in patients (p less than 0.0001 versus less than 0.002). Ninety patients were advised to increase their daily dose of aspirin from 75 mg to 300 mg. Platelet reactivity retested 1 month after increasing the dose has significantly decreased (p = 0.0008; less than 0.0001), whereas it remained unchanged in those patients (n = 84) who continued with the same dose regimens. In normal subjects, ingestion of a single 600-mg aspirin significantly inhibited shear-induced platelet reaction. CONCLUSIONS: It is concluded that aspirin does affect the platelet response to shear forces, but this requires higher dosage (greater than 300 mg/day), suggesting a mechanism probably different from that of interference with thromboxane formation.
Aspirin↗
Contamination of underwater seal drainage systems in thoracic surgery.
The incidence of bacteriological contamination of drainage fluid (water constituting the underwater seal plus drainage effluent) was studied in 38 patients (50 chest drains), up to 6 days after thoracotomy. No bacteriological contamination was demonstrated in any of the samples taken during this period of time. We conclude that the underwater seal drainage system may be left for up to 6 days postoperatively without change of any of its components and without risk of contamination.
Drainage↗
Quantitative measure of small vessel anastomotic contour using corrosion resin cast models: an aid to surgical training.
A surgeon who had not previously carried out a small vessel anastomosis performed 20 consecutive anastomoses between human long saphenous vein and the left anterior descending artery of a pig's heart. Corrosion resin cast models were made of the anastomoses and subjected to a quantitative analysis of the anastomotic contour. A trend of improvement in contour parameters was found with increasing experience. This model may be useful for surgeons in training.
Animals↗
Preoperative hemostatic activity and excessive bleeding after cardiopulmonary bypass.
The rationale for predicting the risk of excessive postoperative bleeding by assessing the hemostatic status of a patient before cardiopulmonary bypass was investigated. A novel, rapid, overall test (hemostatometry) consisting of a physiologically relevant test of platelet function (shear-induced hemostasis) and coagulation was performed using nonanticoagulated blood and compared with the routine coagulation screen. Two hundred five patients undergoing elective coronary revascularization were studied 3 to 4 days before operation. Forty-nine bled excessively for nonsurgical reasons; none were predicted by the routine coagulation tests. Using a stepwise discriminant analysis, hemostatometry correctly predicted 31 of 49 (63%). Thirty of 156 predicted as bleeders by hemostatometry did not bleed. Thus, preoperative hemostatometry predicted 77% of the true outcome. The false predictions suggest, however, that certain bleeding abnormalities probably acquired during cardiopulmonary bypass cannot be predicted. These findings do not justify the routine use of preoperative tests in assessing the bleeding risk in patients undergoing cardiopulmonary bypass.
Blood Coagulation↗
Modified technique of internal mammary artery harvest.
A simple method of internal mammary artery harvesting is described. Hydrostatic pressure is used as an aid to dissection of the tissues including the internal mammary artery from the chest wall. The technique minimizes trauma to the mammary artery and allows for a rapid harvest.
Dissection↗
The role of surgery in the management of solitary coronary artery aneurysm.
A 55-year-old lady presenting with angina was diagnosed on angiography as having a solitary aneurysm of a lateral circumflex artery. She underwent clipping of the aneurysm and a long saphenous vein bypass graft to the distal vessel. The role of surgery in the management of coronary aneurysms is discussed.
Angina Pectoris↗
Pleurectomy for chylothorax associated with intestinal lymphangiectasia.
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Adult↗
Future of Bart's preclinical school.
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Academic Medical Centers↗
Measles vaccine not just for children anymore.
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Adult↗
Pulmonary mycotic aneurysms secondary to infective endocarditis in a patient with a persistent ductus arteriosus and partial anomalous pulmonary venous drainage.
Mycotic aneurysms are a rare but recognized complication of infective endocarditis. Aneurysms of the pulmonary artery are usually associated with infected congenital heart lesions and especially with persistent ductus arteriosus. This report deals with a patient with a persistent ductus who developed multiple mycotic aneurysms in the right lung following infective endocarditis, and whose management was complicated by anomalous venous drainage of most of the contralacteral lung. Surgical closure of the ductus to reduce pulmonary blood flow failed to prevent haemoptysis, and further surgery to ligate the feeder arteries to the aneurysms was required.
Adult↗
The behaviour of presternal scars in a fair-skinned population.
The incidence of keloid and hypertrophic change and of scar stretching in the presternal region were studied in a fair-skinned population following open heart surgery through a median sternotomy incision. No patient in this study developed keloid change although scar hypertrophy and stretching were frequent. These changes were unrelated to the material used in subcuticular suture of the skin in a comparison of catgut, prolene and polyglycolic acid. Hitherto, unrecognised differences of scar maturation between different areas of the presternal skin were noted to be statistically significant. Scar hypertrophy is most likely in that part of the scar overlying the body of the sternum and particularly in the female. Scar stretching occurs most frequently in the lower third of the scar overlying the xiphisternum and extending onto the abdomen.
Adolescent↗
Unusual form of bilateral partial anomalous pulmonary venous drainage.
A 23-year-old man with known valvular pulmonary stenosis was found to have a very unusual form of bilateral partial anomalous pulmonary venous drainage. The venous drainage from the upper parts of both lungs was anomalous, draining from the left lung via a persistent left-sided superior vena cava and from the right lung directly into the right atrial/right superior vena caval junction. The venous drainage from the lower parts of both lungs was normal. The embryological pathogenesis of the defect is discussed.
Adult↗
Prevention of nitrous oxide-induced megaloblastic changes in bone marrow using folinic acid.
Prolonged anaesthesia with nitrous oxide inactivates vitamin B12 and impairs DNA synthesis in bone marrow cells. The use of parenteral folinic acid in the prevention of these toxic effects has been studied in 11 patients, ventilated artificially with nitrous oxide in oxygen for 24 h. Bone marrow aspirates were performed before and after exposure to nitrous oxide. They were assessed morphologically and with the deoxyuridine suppression test. Folinic acid 30 mg immediately before anaesthesia and 30 mg 12 h later, prevented the toxic effects of nitrous oxide in four out of five patients, whereas smaller amounts of folinic acid (between 3 and 36 mg in 24 h), were ineffective.
Adolescent↗
The management of insulin dependent diabetes during cardiopulmonary bypass and general surgery.
Two groups of insulin dependent diabetic subjects have been studied: six undergoing general surgical procedures and six undergoing hypothermic cardiopulmonary bypass surgery for coronary artery vein grafting. Intravenous glucose insulin mixtures were infused from the onset of surgery in both groups of patients, supplying 0.4 units of insulin per gram of glucose per hour, and 0.6 units of insulin per gram of glucose per hour in general and cardiac surgical patients respectively. Postoperatively diabetes was controlled carefully with an insulin syringe pump regulated by venous blood glucose monitoring. In cardiac surgical patients far more insulin was required to control diabetes postoperatively than in the general surgery patients (at 1 hour 1.6 units, SEM 0.4 compared to 0.7 SEM 0.1, p less than 0.05; and at 4 hours 2.0 units SEM 0.3 compared to 0.8 units SEM 0.1, p less than 0.02). Five non-diabetic subjects who underwent surgery for coronary artery venous bypass grafting were also studied. They developed significant postoperative hyperglycaemia (5.0, SEM 0.2, mmol/litre pre-operatively, compared with 8.8, SEM 0.7, mmol/litre p less than 0.03 at 1 hour and 10.2, SEM 1.7, mmol/litre, p less than 0.02 at 4 hours after bypass terminated).
Adult↗
Surgical treatment of false aneurysm of the left ventricle after myocardial infarction.
Rupture of the left ventricle after myocardial infarction results either in sudden death from cardiac tamponade or, when pericardial adhesions are present, in bleeding that is confined to a limited space, which gradually expands as the blood flows through a small communicating orifice under high pressure, forming a false aneurysm. In three such patients a false aneurysm of the left ventricle after myocardial infarction was successfully treated by operation. The interval from the initiating event to the time of surgery averaged 10 months. Two of the patients had pericarditis and all presented at some stage of the illness with tachyarrhythmias and cardiac failure. All the patients survived operation and have improved functionally. Because of the propensity of false aneurysms to rupture, early diagnosis and aggressive surgical treatment are recommended.
Female↗
Combined exercise radionuclide and hemodynamic evaluation of left ventricular aneurysmectomy.
Twelve patients were studied by rest and exercise radionuclide ventriculography following left ventricular aneurysmectomy (LVA). Left ventricular filling pressure (LVFP) was also measured. Nine patients had been studied pre-LVA at rest and exercise before and after isosorbide dinitrate (ISDN). Resting ejection fraction (LVEF) improved after LVA (p less than 0.25), but exercise LVEF did not. End-diastolic volume (EDV) and resting LVFP also fell after LVA (p less than 0.25 for EDV, p less than 0.05 for LVFP) and although exercise LVFP fell (p less than 0.02), the values were abnormal in all patients. Ejection fraction of contractile segment (EFCS) from the resting radionuclide study pre-LVA was related to resting LVEF post-LVA (r = 0.71 p less than 0.02), although postoperative LVEF could not be predicted from preoperative EFCS in individual patients. Deterioration in LVEF and LVFP from rest to exercise post-LVA occurred both in patients with single-vessel occlusion and in those with multivessel coronary disease, irrespective of whether or not revascularization had been performed. Thus LVA is effective in improving resting ventricular function; exercise performance may remain abnormal even in patients without residual coronary disease.
Adult↗
Thermography in assessing coronary artery saphenous graft patency and blood flow.
Infrared thermography has been used in 32 patients undergoing coronary artery saphenous bypass graft surgery in our department, in order to visualise graft patency and flow at the time surgery. 16 of these patients also had flow measurements with the use of electromagnetic flow meters to one or more of their grafts, which had already been thermographed in order to establish a correlation between the two methods. This study has confirmed that grafts which show good flow by means of electromagnetic flow meters also have a good pictorial graft patency and flow with infrared thermography.
Coronary Artery Bypass↗