Biomedical subjects

H H Harris

Publications and source records attributed to H H Harris.

At least 19 recordsLinked to original sources

PubMed1991

Use of the inferior epigastric artery as a free graft for myocardial revascularization.

From March 1990 through January 1991, 47 patients undergoing myocardial revascularization had one (37) or both (10) inferior epigastric arteries (IEA) used as a conduit for bypass with 62 distal anastomoses. The internal thoracic artery (ITA) was used bilaterally in 41 patients and unilaterally in 6 with 100 distal anastomoses. Five patients had a single saphenous vein graft. In total, 167 anastomoses (3.55 per patient) were performed. Single IEA grafts were harvested through a paramedian incision and bilateral grafts, a midline incision. Harvest time was 36.5 minutes for IEA grafts and 29.6 minutes for ITA grafts (p less than 0.0001). Graft length was 11.9 cm for IEA grafts and 16.5 cm for ITA grafts (p less than 0.0001). Distal graft diameter was 2.0 mm for IEA grafts and 2.1 mm for ITA grafts (p less than 0.01). Graft flow was 49.7 mL/min for IEA grafts and 48.7 mL/min for ITA grafts. Microscopic assessment of segments of both the IEA and ITA from 14 patients revealed similar internal elastic laminae and an equal number of fenestrations. Combined intimal and medial thickness was comparable in both conduits. Medial elastic tissue was more prominent in ITA grafts and lacking in eight of the 14 IEA grafts. Gross plaque formation was noted in the proximal 1 to 3 cm of 50% of IEA grafts, but the lumen was not compromised and microscopic thickening was minimal. An unexpected finding was medial calcifications (Mönckeberg's disease) in two of the 14 IEAs without associated atherosclerosis. There was one hospital death, one abdominal wound infection, and one instance of fat necrosis superficial to the sternum.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdominal Muscles↗

PubMed1990

Reoperation in the intensive care unit.

From July 1, 1984, through June 30, 1989, after 1,259 open heart operations, 110 patients (8.7%) underwent 162 early reoperations either in the intensive care unit (144 procedures) or in the operating room (26 procedures). Reexploration for bleeding (49 procedures) (3.9%) and intraaortic balloon removal (50 procedures) (4.0%) were the two most common procedures. Ninety percent and 96% of these procedures, respectively, were performed in the intensive care unit. Mediastinal infections occurred in 4 (6.1%) of 66 patients undergoing repeat mediastinal operations for all indications. No infection occurred after reexploration for bleeding nor did mediastinal infection occur after reoperation in the intensive care unit. Postoperative death in these 110 patients was not related to reoperation except possibly in the case of 1 patient (0.9%). Average transit time to and from the operating room for patients returned there for reoperation was 89.7 minutes. Charges for procedures performed in the operating room were at least twice as great as for those performed in the intensive care unit. This experience supports expanded use of reoperation in the intensive care unit, as it is safe, effective, economical, and convenient.

Adult↗

PubMed1990

Aortic valve decalcification.

Ultrasonic decalcification of the aortic valve was performed in 22 elderly patients with critical aortic stenosis (aortic valve areas less than 0.8 cm2) as an alternative to prosthetic valve replacement. All of the patients had symptoms. The mean New York Heart Association class was 3.3 +/- 0.9. Adequate decalcification with restoration of leaflet mobility was achieved in all patients, including seven with bicuspid aortic valves. Leaflet perforation occurred and was successfully repaired in five patients. Ten patients underwent concomitant myocardial revascularization. There were two operative deaths (9%) and three late deaths. Echocardiograms were obtained preoperatively, postoperatively, and at 6 months. The mean aortic valve area increased significantly from 0.72 +/- 0.17 to 1.42 +/- 0.31 cm2 (p less than 0.001) and the peak gradient decreased from 74 +/- 34 to 25 +/- 13 mm Hg (p less than 0.001). At 6 months the aortic valve area (1.29 +/- 0.48 cm2) and peak gradient (31 +/- 12 mm Hg) continued to be significantly better than the preoperative measurements (p less than 0.001), but the 6-month aortic valve area was slightly decreased and the gradient increased when compared with the immediate postoperative values (p less than 0.02). The prevalence of mild to moderate aortic insufficiency increased from 50% of the patients preoperatively to 87% at 6 months (p less than 0.05). Two patients subsequently required aortic valve replacement for restenosis and aortic insufficiency. Ultrasonic decalcification is effective in relieving aortic stenosis, but subsequent restenosis and insufficiency may limit its application.

Aged↗

PubMed1989

Coronary artery bypass grafting for unstable angina pectoris: risk analysis.

Unstable angina pectoris is a broad, nonspecific diagnosis encompassing a wide variety of clinical syndromes. The intravenous administration of nitroglycerin preoperatively is indicative of a more acute clinical situation, and allows for selection and analysis of a more homogeneous patient population. We reviewed the results of coronary artery bypass grafting for unstable angina defined as angina necessitating intravenous administration of nitroglycerin preoperatively. There were 129 patients (83 men and 46 women) with a mean age of 63.2 years (range, 36 to 86 years). Complications included operative death in 6.2%, postoperative low cardiac output in 11%, and perioperative myocardial infarction in 9%. Twenty perioperative variables were analyzed to identify risk factors for these end points. For operative death, age (p less than 0.05), cross-clamp time (p less than 0.05), and cardiopulmonary bypass time (p less than 0.001) were significant in the univariate analysis, but only age (p less than 0.05, F = 4.6) was an independent predictor using multivariate analysis (stepwise linear regression). For low cardiac output, univariate analysis demonstrated that cross-clamp time (p less than 0.01), preoperative use of an intraaortic balloon for angina (p less than 0.05), left ventricular score (p less than 0.05), number of diseased coronary vessels (p less than 0.05), and cardiopulmonary bypass time (p less than 0.001) were significant variables. However, only use of an intraaortic balloon for angina (p less than 0.0001, F = 14.3) and left ventricular score (p less than 0.005, F = 11.1) were significant independent predictors in the multivariate model. For perioperative myocardial infarction, only diabetes requiring insulin (p less than 0.005) was a significant predictor.

Adult↗

PubMed1986

Intrauterine herpes simplex infection resembling mechanobullous disease in a newborn infant.

We present a case of transplacentally acquired intrauterine herpes simplex virus infection in a newborn delivered at 36 weeks' gestation by cesarean section because of intrauterine growth retardation and maternal preeclampsia. The mother experienced a single episode of serotype 2 herpes progenitalis at 14 weeks' gestation. At birth the infant manifested clinical findings of herpes simplex virus infection, which resembled epidermolysis bullosa and aplasia cutis congenita. Preexisting cutaneous lesions and intact fetal membranes at delivery strongly support a transplacentally acquired intrauterine herpes simplex virus infection. Repeated Tzanck smears, viral cultures, and immunohistochemical studies of the skin were required to confirm the diagnosis. Intrauterine herpes simplex virus infection is associated with significant morbidity and mortality but responds to antiviral therapy. Therefore this diagnosis must be considered in the neonate born with bullous or eroded skin lesions.

Adult↗

PubMed1978

Cerebrospinal otorrhea and recurring meningitis: report of three cases.

Recurrent attacks of meningitis occurring independent of a systemic bacterial infection should be considered as a cerebrospinal leak either otorrhea or rhinorrhea. Three cases each with a different cause were diagnosed chiefly on the basis of the history and a bulging noninflammatory eardrum. Subsequent use of fluorescein intrathecally not only helped to confirm the diagnosis but was very useful at surgery in locating the leak in the dura of the oval window of the ear. Many materials have been used but autogenous temporal fascia or fascia lata seemed to be most effective in these cases. The sandwiching of the dura between two pieces of fascia is not only realistic but was found to be very effective. One piece of fascia between the arachnoid and dura and another between the dura and bone give a tight seal.

Adult↗

PubMed1978

Granular cell tumor of the floor of the mouth - a case report.

The granular cell tumor is an uncommon lesion and, when arising in the head and neck, principally involves the tongue and larynx. A patient with a granular cell tumor of the floor of the mouth is reported. Management is usually accomplished by complete local excision, but longterm follow-up is mandatory. Distinguishing the epithelial (pseudo-epitheliomatous) hyperplasia from a well differentiated squamous cell carcinoma is critical to avoid unnecessary radical surgery. At present the lesion is considered to be a true neoplasm, likely of Schwann cell origin, and clinically benign.

Cell Nucleus↗

PubMed1972