Biomedical subjects
Publications and source records attributed to J C Lincoln.
Two patients presenting with superior venal caval syndrome have been treated surgically. In one patient the obstruction was caused by benign idiopathic mediastinal fibrosis; in the other it was secondary to carcinoma. In both cases venous decompression was achieved by using a segment of autogenous femoral vein to bypass the obstruction.
The sympathoadrenal response to surface cooling, limited cardiopulmonary bypass, and deep hypothermic circulatory arrest was investigated in 22 infants undergoing correction of congenital heart defects. Surface cooling to 26 degrees C was associated with a significant rise in plasma epinephrine and norepinephrine levels. Both levels fell during the period of core cooling on bypass, presumably because of hemodilution. Following the period of circulatory arrest there was a rise in both catecholamine levels that correlated nonlinearly with the duration of circulatory arrest. The catecholamine levels remained high after rewarming until the chest was closed. The results suggest that this type of surgical procedure produces severe sympathoadrenal stress. The extremely high values found in the postarrest period in some patients, who had had a long period of arrest (greater than 40 minutes), may indicate hypoxic stress. The biological effect of high circulating plasma catecholamines during hypothermia is difficult to assess. The heart rate response to plasma catecholamine levels tended to diminish on cooling in our patients.
Nucleoplasmic and non-histone chromatin proteins from two unrelated and four related mouse plasmacytoma cell lines have been analysed by biosynthetic labelling with [35S]-methionine followed by one- and two-dimensional polyacrylamide gel electrophoresis. We have attempted to find a relationship between the patterns of nuclear proteins and gene expression in mutant plasmacytoma cell lines. The majority of nuclear proteins are common to all of the cell lines studied as would be expected if the majority of nuclear proteins are concerned with functions common to all plasma cells. There are, however, both qualitative and quantitative differences in the nuclear protein patterns of mutant and parent cell lines which appear to correlate with differences in gene expression. The turnover of nuclear proteins in two of the cell lines, MOPC 315.40 (IgA producer) and MOPC 315.32 (lambda 2 chain producer) was studied using pulse-chase techniques.
We present a series of 90 patients who underwent sleeve lobectomy for malignant bronchial tumors at the Brompton Hospital, London, between 1964 and 1974. The operative mortality was low (1%), and technical complications were infrequent. Bronchial stenosis, which occurred in 6% of patients, was due to recurrence of tumor in 4% and cicatrization in 2%. The majority of patients had squamous cell carcinomas of the upper lobe (76/90). In this group, the 5-year survival was 71% when the hilar lymph nodes were clear of tumor at the time of operation and 17% when the hilar lymph nodes were involved. Because these 5-year survival figures suggest that tumor-free survival is not significantly compromised by this conservative approach, we believe that sleeve lobectomy rather than pneumonectomy should be considered the operation of choice for squamous cell carcinomas of the upper lobe orifice involving the main bronchus.
Analysis of 26 autopsy specimens with interruption of the aortic arch has led to a clearer understanding of the vital importance of associated cardiovascular abnormalities. In all cases there was an associated patent ductus arteriosus "supporting" the distal systemic circulation. "Proximal" septal defects, 22 ventricular septal defects and 3 aorto-pulmonary windows, were found in all but one specimen. The infundibular component of the ventricular septum was displaced posteriorly and leftward in 9 hearts resulting in significant left ventricular outflow obstruction in 8. In one specimen the infundibular septum was displaced anteriorly giving the effect of a "Fallot type" obstruction to the right ventricular outflow tract. Abnormal ventriculo-arterial connections were found in 7 hearts; 2 with discordant connection, 2 with double outlet, and 3 with single outlet of the heart. In 6 specimens there was an aberrant origin of the right subclavian from the distal aorta passing behind the esophagus to the right side. Various other arterial abnormalities were identified including a truncus arteriosus with separate but "transposed" origins of the pulmonary arteries. In short, in these hearts there were no examples of the rare situation where aortic arch interruption exists in isolation. This study therefore makes it very clear that a detailed understanding of associated anatomical abnormalities must accompany any attempt at surgical correction. Certainly in many of these cases management of the associated lesion will present more of a challenge than the difficult problem of dealing with the interrupted arch itself.
Histamine release has been detected biologically after exposure of human right atrial biopsy samples to compound 48/80. Human right atrial samples contain large quantities of histamine, 1035 +/- 65 ng/g fresh weight. Exposure of untreated electrically paced atrial strips to compound 84/80, 300 micro/ml, caused an increase in the force of atrial contraction similar to that caused by histamine. Pretreatment of strips with cimetidine, 3.16 x 10(-5) M, prevented the inotropic response to compound 48/80. It is concluded that mast cell degranulation in human atrial tissue can cause sufficient release of histamine to modify the function of the heart.
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Pulmonary pseudolymphoma is a rare lesion; only 30 cases have been previously reported. It presents as a solitary nodule which clinically and roentgenographically can resemble bronchogenic carcinoma. A further case is reported in which preoperative needle aspiration cytology played a role in diagnosis. Although the lesion was originally believed to be benign, a review of the literature has revealed the apparent subsequent development of lymphoma in four cases. The significance of this is discussed, and the need for prolonged follow-up is emphasized, since the prognosis of untreated pseudolymphoma is unknown.
The development of a miniature polarographic electrode mounted in the tip of a double-lumen plastic catheter has made possible continuous in-vivo monitoring of oxygen tension. Inexpensive catheters of this type have already proved of value as a means of continuously monitoring arterial oxygen tension in the newborn. In 25 patients with acute respiratory failure we found that these catheters could be safely and easily flow-guided into the pulmonary artery. In this way continuous recordings of mixed venous oxygen tension (PvO2) could be made for a period of several days. In our experience a sustained fall of PvO2 below 40 mm Hg proved to be a reliable indicator of respiratory or cardiac deterioration not always obvious by observation. In the patients described, falls of this order were seen after reductions in inspired oxygen concentration, in acute respiratory failure, in accidental underventilation, and in hypovolaemia and cardiac arrythmias. In some very ill patients routine nursing care involving movement of the patient caused pronounced falls of PvO2. Although electrode drift was an occasional problem, this could be checked by intermittent blood-sampling and recalibration if necessary.
The covalent binding of acetylaminofluorene (AAF) to rat liver nuclear protein fractions and DNA has been examined after 2 doses of 14C-labelled carcinogen (100 micronCi intraperitoneally) given at 24-h intervals. Most of the AAF (approx. 80%) was bound to the NHP which had the highest specific activity, relatively small amounts were bound to histones, residual proteins and DNA. After 2 weeks the label was more evenly distributed but little remained bound to the DNA. Pre-feeding rats with phenobarbitone (1 mg/ml in drinking water) reduced binding in all fractions. Pre-feeding rats with sodium sulphate (1 mg/ml in drinking water) also slightly lowered the binding to all fractions. Isoelectric focusing analysis (in polyacrylamide gels) of the NHP showed a complex binding pattern with no one component predominantly labelled, variations in the pattern were found after feeding sulphate and phenobarbitone. Normal histone components in the histone fraction (acid extract) contained only 25% of the labelled carcinogen present.
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A case of right ventricular outflow obstruction is described in which the electrocardiogram and chest x-ray film suggested a cardiac tumour. Cardiac catheterisation confirmed outflow obstruction and angiography showed a tumour. At operation a haemangioendothelioma was found.
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Congenital lobar emphysema (CLE) is a clinical and radiological entity with a multiplicity of etiological factors. Six patients are presented with CLE of the left upper lobe. In three of them CLE was associated with cardiovascular malformation i.e. persisting ductus arteriosus and in one case additionally with double aortic arch. These infants were treated by division of the compressing vascular structure without lobectomy. Only one required secondary resection. Left sided CLE presumably caused by vascular compression should be considered a special group in which surgical correction without lung resection is justified.
This report represents the Brompton Hospital experience of infants and neonates with critical pulmonary valve stenosis and aortic valve stenosis. There were 25 patients with critical pulmonary valve stenosis and 8 with critical aortic valve stenosis. Critical pulmonary stenosis: Among the 25 patients up to one year of age, 11 were girls and the commonest presenting symptom was cyanosis seen in 15, the commonest physical sign being a systolic ejection murmur with a single 2nd sound. A more detailed analysis of the symptoms, signs and findings at special investigation will be presented. The evolution of a satisfactory technique of operation will be indicated in these critically ill patients, and the late follow-up will be presented. Critical aortic stenosis: There were 8 patients in this group all of whom were male. Dyspnoea was the commonest presenting symptom with a systolic ejection murmur and hepatomegaly as the commonest signs. All patients in this group underwent open aortic valvotomy and/or valvuloplasty with 3 deaths. A late follow-up of the survivors will be presented. In summary, a series of 33 patients up to the age of one year with critical obstruction of either the pulmonary or aortic valves will be presented. (his is one of the larger series to be reported in this age group.
Two patients with right aortic arch, anomalous left subclavian artery, and coarctation of theaorta, have been operations for the relief of coarctation, successful in one but only partially successful in the other: in one case, a 'dacron' patch was inserted into the narrowed segment, but a mild recurrence of coarctation was found a year later; in the other, the proximal segment of the anomalous left subclavian artery was used for the repair, with complete relief of the coarctation, both immediately and at late follow-up. The first case had multiple associated congenital abnormalities, including anomalous origin of the left circumflex coronary artery from the right pulmonary artery, which was also corrected surgically: this anomaly has only been recorded once hitherto. The second had facial haemangiomata and a small ventricular septal defect. Four previously reported cases of coarctation and right arch are reviewed. These 6 cases are considered in the light of current views on the development and classification of aortic arch anomalies.
The accuracy of the thermal dilution technique for measuring cardiac output in infants and children has been assessed by comparison with the direct Fick technique. Satisfactory correlation between the two methods has been demonstrated, and it is concluded that a commercially available monitor can be used to determine cardiac output by thermal dilution in acutely sick infants and children. The volume of injectate should be selected according to the weight of the child, and the value displayed by the monitor should be adjusted by the appropriate fraction.