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Biomedical subjects

H E Garrett

Publications and source records attributed to H E Garrett.

At least 19 recordsLinked to original sources
PubMed2003

Acute drought stress and plant age effects on alkamide and phenolic acid content in purple coneflower roots.

The effects of acute periods of drought stress on dry weight, and alkamide and phenolic acid content in purple coneflower [Echinacea purpurea (L.) Moench, Asteraceae] roots are described. Plants subjected to brief drought stress periods for two seasons during the initial flowering stage (D-F2) produced fall-harvested roots with significantly greater cichoric acid concentration (mg/g) than corresponding well-watered controls of the same age (C-2). Total alkamide, including the tetraenoic acid isomers, and chlorogenic acid concentrations from fall-harvested roots were largely unaffected by drought stress, regardless of when the stress occurred developmentally. The alkamide concentration in three-year roots was significantly less than that in two-year roots, with an average decrease of 50.5 %. Conversely, total phenolic acids increased an average of 67.1 % for all treatments from two to three years of age. Root dry weight increased significantly by an average of 70.0 % for all drought-stressed plants from two to three years of age, compared to an increase of 35.2 % for well-watered controls. The results suggest that controlled drought stress can stimulate increased root dry weight and root cichoric acid content, and that root age is the predominant factor determining overall phytochemical content variation.

Alkynes↗
PubMed2001

A human cadaveric circulation model.

Although endovascular techniques have achieved widespread acceptance, a suitable model for device development and physician training has not been available. Plastic models of the arterial tree and live animal models have significant limitations. Arterial-to-arterial flow is established in fresh frozen human cadavers after a simple thrombolytic process to achieve a more realistic model for endovascular device testing and training. Circulation can be established through most of the arterial system, including the cerebral, aortoiliac, and extremity vessels. This model offers antegrade flow in human arterial anatomy and has been used successfully for physician training and device development.

Angioplasty, Balloon↗
PubMed2000

Prosthetic above-knee femoropopliteal bypass grafting: five-year results of a randomized trial.

PURPOSE: This trial was designed to identify factors affecting patency rates of primary prosthetic above-knee femoropopliteal bypass grafts at 5 years. METHODS: A multi-institutional, prospective trial randomized 240 patients to compare patency rates of Gore-tex and Hemashield above-knee femoropopliteal bypass grafts at 5 years. Univariate comparisons of patency between levels of each prognostic variable were made with the Kaplan-Meier method. Variables that had a univariate P value less than.25 or those known to be important were submitted to a Cox regression analysis. RESULTS: The patient survival rate at 5 years was 59.4%. There were no differences in primary or secondary patency rates at 5 years between the two graft materials (primary, 45% vs 43% and secondary, 68% vs 68%). The risk for graft occlusion was significantly increased for patients younger than 65 years (2.1; P =.001) and for grafts with a diameter less than 7 mm (1.65; P =.0219). Variables with no apparent independent effect on patency rates were smoking status, runoff, diabetes mellitus, sex, presenting symptoms, and postoperative treatment with aspirin or Coumadin. Noninvasive test results were not predictive of subsequent graft function. CONCLUSION: Although the type of prosthetic used for above-knee femoropopliteal bypass grafts does not affect 5-year patency rates, age and graft size do influence results. These factors should be considered before a prosthetic bypass grafting procedure. Furthermore, these data should serve as a contemporary standard, with which evolving and conventional procedures can be compared.

Aged↗
PubMed1997

Complete direct mammary harvest for minimally invasive coronary artery bypass.

Minimally invasive coronary artery bypass has primarily involved left internal mammary artery grafting to the left anterior descending coronary artery through a small left anterior thoracotomy incision. Harvesting of the mammary artery has been accomplished completely using a video-assisted thoracoscopic technique or incompletely to the second interspace under direct vision. With a mammary retractor, the mammary artery can be dissected completely under direct vision, thus eliminating any criticism of an incomplete harvest and any increased difficulty or expense associated with the thoracoscopic harvest. In this series, all 17 mammary arteries were successfully harvested completely under direct vision and 16 patients underwent successful minimally invasive coronary bypass.

Adult↗
PubMed1997

Prosthetic above-knee femoropopliteal bypass grafting: results of a multicenter randomized prospective trial. Above-Knee Femoropopliteal Study Group.

PURPOSE: There are excellent arguments in favor of the preferential use of prosthetic grafts above the knee for the treatment of infrainguinal occlusive disease. This approach has been popularized on the basis of the seemingly acceptable results when using polytetrafluoroethylene (PTFE). However, in many centers, knitted Dacron polyester has been used in these patients, and there are several studies that show equivalent and, in some, superior results with Dacron when compared with PTFE. The purpose of this study was to examine these results in a definitive way. METHODS: A randomized prospective trial in eight clinical academic centers in the United States and Canada was initiated in 1991. Two hundred forty-four patients eligible for such a study, by virtue of criteria extant in each institution at the time, were centrally randomized. They underwent placement of either a knitted Dacron polyester graft impregnated with collagen or a thin-wall expanded reenforced PTFE graft to the above-knee popliteal artery, usually from the common femoral artery. They were frequently observed by protocol for as long as 5 years by a physical examination noninvasive hemodynamic study, including duplex scanning in many instances. Continuing patency was noted, as were other potential adverse outcome events. The data were analyzed by the log-rank test for cumulative patency and expressed as Kaplan-Meier curves. Data were further analyzed with a Cox proportional hazards model. RESULTS: There were no differences in graft groups in demographic or comorbid factors. The procedural mortality rate was zero, and the morbidity rate was low (6.5%). The long-term patient survival rate was excellent (77% at 3 years). At the end of these years, no statistical significance in primary or secondary patency rates was observed between the two grafts (primary patency rate, 62% +/- 14.4% for Dacron; 57% +/- 15.5% for PTFE). No unexpected adverse outcomes on limb status were noted. Patency rates in both graft groups were inferior in patients who received small grafts (5 to 6 mm vs 7 to 8 mm; hazards ratio, 4.15) and younger (<65 years) smoking patients. CONCLUSIONS: The fact that these two prosthetic grafts performed in equivalent fashion in a controlled, well-conducted prospective study is not surprising in spite of the previous work that suggested differences. If the preferential use of synthetic bypass grafts above the knee is to be used, it should be restricted to older nonsmokers with favorable anatomy. In that instance, the choice of graft material will depend on handling characteristics and cost. Above-knee prostheses should be only selectively used in younger, smoking patients, and graft size should be carefully considered in patients who undergo this operation.

Arterial Occlusive Diseases↗
PubMed1996

Aortocoronary bypass with saphenous vein graft. Seven-year follow-up. 1973.

A 42-year-old man had extensive occlusive disease of the coronary artery and angina pectoris. An autogenous saphenous vein bypass from the ascending aorta to the anterior descending coronary artery was performed on Nov 23, 1964. The patient suffered an asymptomatic anterior myocardial infarction during operation but made an uncomplicated recovery. Seven years after the operation, the graft functions with normal left ventricular hemodynamics, while the occlusive process has produced obstruction of the left main coronary artery and almost complete occlusion of the right coronary artery. To our knowledge, this is the first successful case of a saphenous vein-coronary artery bypass with the longest follow-up of a functioning coronary vein bypass graft.

Coronary Artery Bypass↗
PubMed1994

Pulmonary capillary hemangiomatosis: a clinicopathologic review.

Pulmonary capillary hemangiomatosis is a locally aggressive benign vascular neoplasm of the lung characterized by the presence of numerous cytologically benign thin-walled capillary-sized blood vessels proliferating diffusely through the pulmonary interstitium, in and around pulmonary vessels and airways. Pulmonary capillary hemangiomatosis is a rare disease characterized by pulmonary hypertension and a slowly progressive clinical course; it is frequently misdiagnosed clinically as primary pulmonary hypertension and veno-occlusive disease. The purpose of this review is to describe the clinical, radiologic, and histologic features of this rare form of pulmonary vascular neoplasm, which may present considerable diagnostic problems to both the clinician and the histopathologist. Fourteen cases of pulmonary capillary hemangiomatosis have been previously reported. In this review we describe the fourth case of pulmonary capillary hemangiomatosis in which the diagnosis was made antemortem, as well as the fourth to undergo lung transplantation.

Adult↗
PubMed1989

Reoperative median sternotomy.

Sternal reentry for reoperative cardiac procedures poses a substantial risk of technical problems. A simple technique for sternal reentry is described that is both expeditious and safe.

Humans↗
PubMed1989

Retroperitoneal lymphocele after abdominal aortic surgery.

Lymphoceles may occur as a result of lymphatic injury during abdominal aortic surgery. These lymphatic collections may occur as a retroperitoneal mass or as groin lymphoceles. Four cases are presented in which persistent retroperitoneal lymphoceles were discovered 2 to 8 years after surgery. Reexploration of the groin and repeated aspirations of lymphatic fluid failed to control the drainage. Reexploration of the retroperitoneum documented lymphatic injury, which was controlled by ligation of the lymphatics with suture. A review of the literature discloses five similar reported cases of retroperitoneal lymphocele and 12 cases of chylous ascites after abdominal aortic surgery. Clearly, avoiding lymphatic injury or immediate repair of any lymphatic injuries will prevent this problem. Once a persistent lymphocele has developed, aspiration will establish the diagnosis. Our experience would suggest that reexploration of the retroperitoneum is required to control the drainage and to prevent possible graft infection.

Aged↗
PubMed1988

Bedside percutaneous tracheostomy: experience with 55 elective procedures.

Over a 24-month period, tracheostomy was performed in 55 patients using a percutaneous, wire-guided, dilatational technique. All such procedures were undertaken at the patient's bedside in the intensive care unit, with the patient under local anesthesia and mechanically ventilated through an oral endotracheal tube. A variety of wire-guides, dilators, and tracheal tubes were used as experience and proficiency were gained with the approach, and eventually, a simple modification of a standard low-pressure cuffed endotracheal tube was found to facilitate the procedure. The percutaneous method was found to be rapid and simple, to leave almost no cosmetic deformity, and to be almost totally free from infectious complications. This technique should be considered for routine use in critically ill, ventilator-dependent patients.

Adolescent↗
PubMed1988

Tibial artery pseudoaneurysms: delayed complication of balloon catheter embolectomy.

Although complications of balloon catheter embolectomy are infrequent, the injury potential of these catheters is well recognized. This article describes a case of multiple tibial artery pseudoaneurysms that appeared 4 years after embolectomy in a 42-year-old man with otherwise normal arteries. The patient was treated by internal aneurysmorrhaphy without sequelae. A literature review of balloon catheter injuries yielded 46 cases categorized as arterial disruption (29), intimal injury (12), or catheter malfunction (5). These resulted in hemorrhage (13 cases), arteriovenous fistula (12), pseudoaneurysm (four), thrombosis (three), dissection (five), accelerated atherosclerosis (four), and catheter fragment embolism (five). Of these complications, only 41% were recognized during the initial operation. Direct observation detected 32% of these, whereas 68% were shown only by completion arteriography. Complications recognized during initial operation were more frequently asymptomatic without further surgery (84%) than those detected postoperatively (30%, p less than 0.001). Completion arteriography detected 87% of balloon catheter complications compared with only 23% of complications recognized intraoperatively without arteriography (p less than 0.001). We conclude that delicate technique, completion arteriography, prompt surgical treatment, and extended follow-up are important components of balloon catheter embolectomy.

Adult↗
PubMed1986

Surgical intervention in histoplasmosis.

Histoplasmosis is a ubiquitous disease in endemic areas that has a generally subclinical course. Excessive inflammatory response may bring some patients to the attention of a thoracic surgeon to exclude malignancy of a noncalcified pulmonary or mediastinal mass or to relieve compression of specific structures. Mediastinal granuloma or fibrosing mediastinitis may involve the superior vena cava, pulmonary vessels, heart and pericardium, tracheobronchial tree, or esophagus. The cases of 94 recently treated patients are presented as well as a review of the American surgical literature. The current use of computed tomography, the time and extent of operative intervention, and the role of antifungal therapy are important to an overall understanding of the surgical treatment of the manifestations of histoplasmosis.

Bronchial Diseases↗
PubMed1985

Operative technique for repair of tracheoinnominate artery fistula.

Tracheoinnominate artery fistula is a relatively rare but highly lethal complication for long-term tracheostomy patients that occurs with an estimated incidence of 1 out of every 150 tracheostomies performed. Appropriate operative technique during tracheostomy and meticulous postoperative care usually prevent this devastating lesion. When tracheoinnominate fistula is suspected, immediate evaluation under general anesthesia in the operating suite, followed by prompt thoracotomy and repair, is essential for the survival of these patients.

Brachiocephalic Trunk↗
PubMed1984

In vitro observations of greater saphenous vein valves during pulsatile and nonpulsatile flow and following lysis.

A significant number of saphenous vein femoral-popliteal bypass graft failures have been attributed to flow abnormalities caused by venous valves. Seventy-seven greater saphenous vein valves were observed and photographed through a 0-degree choledochoscope during pulsatile and nonpulsatile flow. No valve was seen to lie flat against the vein wall. With pulsatile flow the valves were noted to close during diastole. Stasis was noted within the valve cusps. Twenty-three valves produced photographs of sufficient quality to allow measurement of the luminal obstruction caused by the valves. This valvular obstruction represented 61% +/- 12% of the total vein lumen. Fifty venous valves were lysed by five different techniques: the microscissors, the Connolly vein stripper, the Mills valvulotome, the venotomy valvulectomy of Hall, and eversion valvulectomy. The first three methods created valvular incompetence, but flaps of valve cusps were observed to disturb flow and place potentially thrombogenic surfaces within the vein lumen. Valvulectomy, whether by venotomy or eversion, removed the valve cusps satisfactorily.

Blood Vessel Prosthesis↗
PubMed1983

Coronary artery bypass grafts. Success after selective intracoronary thrombolysis in acute myocardial infarction.

Thirteen of 19 patients undergoing streptokinase infusion within five hours after acute myocardial infarction were deemed satisfactory candidates for bypass surgery. In all cases, operation was performed within less than a week, with no demonstrable ill effects from the enzyme. There was only one pulmonary-related death and only two patients in whom the results have been less than satisfactory. Eleven patients have markedly benefited from the combination of procedures, demonstrating excellent functional myocardial preservation. Radioisotope myocardial scan, exercise ECG, and repeat cardiac catheterizations have been used to assess myocardial status.

Adult↗
PubMed1983

Arteriographic measurement of the abdominal aorta, iliac, and femoral arteries in women with atherosclerotic occlusive disease.

Arteriographic measurements were made in 73 consecutive women undergoing arterial reconstruction for aorto-iliac occlusive disease. The anatomical distribution of atherosclerosis was unaffected by arterial size. Women with isolated aorto-iliac atherosclerosis had the same size arteries as those with concomitant outflow disease. Aortic, iliac, and femoral artery diameters were distributed as a single group, with no distinct subgroup of "small arteries." However, women whose aorta was less than 1 S.D. below the mean were younger and had less cardiovascular disease even when the effects of age and body size on arterial diameter were excluded. Women with this statistical definition of "small aorta" were clinically analogous to those previously identified anecdotally. The authors propose that a "small aorta" in a women with aorto-iliac atherosclerosis be defined as less than 19 mm in diameter above and less than 13 mm below the renal arteries and less than 10 mm at the bifurcation.

Adult↗