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Biomedical subjects

J C McCabe

Publications and source records attributed to J C McCabe.

At least 19 recordsLinked to original sources
PubMed1997

Minimally invasive direct coronary artery bypass grafting: two-year clinical experience.

BACKGROUND: Interest in minimally invasive coronary artery bypass grafting has been increasing. METHODS: From April 1994 through December 1996, 199 patients (age, 36 to 93 years) underwent minimally invasive coronary artery bypass grafting through minithoracotomy, subxiphoid, and lateral thoracotomy incisions, with internal mammary artery, gastroepiploic artery, and composite grafts placed using local coronary artery occlusion. RESULTS: The conversion rate to sternotomy was 7% (14/199). Preoperative risk factors included unstable angina (n = 83), reoperative coronary artery bypass grafting (n = 54), low ejection fraction (n = 53), congestive heart failure (n = 44), renal insufficiency (n = 25), chronic obstructive pulmonary disease (n = 36), cerebrovascular accident (n = 22), and diffuse vascular disease (n = 47). Morbidity included wound infections (n = 5), reoperation for management of bleeding (n = 6) and acute graft occlusion (n = 2), perioperative stroke (n = 1), atrial fibrillation (n = 14), and perioperative myocardial infarction (n = 7). The operative mortality was 3.8% (7/185). The number of grafts placed in 185 patients was as follows: single, 156; double, 28; and triple, 1. Early (less than 36 hours) angiography and Doppler flow assessment of the coronary anastomoses in 85% of the patients showed that 92% were patent. Routine use of mechanical stabilization of the coronary artery since April 1996 was found to be associated with an increase in the patency rate of the left internal mammary artery-left anterior descending coronary artery anastomosis to 97%, versus 89% (p = 0.055) associated with conventional immobilization techniques. Of the 148 patients followed up beyond 1 month (range, 1 to 32 months; mean, 9.2 +/- 7.4 months) postoperatively, 3 have died (3 to 7 months), and of the 145 survivors the cardiac-related event (percutaneous transluminal coronary angioplasty, reoperation, readmission for recurrent angina, and congestive heart failure)-free interval was 93%. CONCLUSIONS: The minimally invasive coronary artery bypass grafting operation is safe and effective. Regional cardiac wall mechanical immobilization enhances the early graft patency and must be considered an essential part of this operation.

Adult↗
PubMed1995

Case report: analgesic nephropathy: a soda and a powder.

Analgesic nephropathy has long been considered a potentially preventable cause of renal disease. Early reports were described in patients who consumed analgesics containing phenacetin. In recent data, the removal of phenacetin from analgesic preparations resulted in a reduction in analgesic-induced end stage renal disease in Europe and Australia. However, a reduction in the incidence of analgesic nephropathy has not occurred uniformly, suggesting that phenacetin is not the sole cause. Current data raise concerns regarding adverse renal effects of acetaminophen and nonsteroidal antiinflammatory drugs. Aspirin taken alone may be of least concern. The diagnosis of analgesic nephropathy is suggested in subjects with chronic renal failure, a history of daily consumption of analgesic preparations, small bumpy kidneys, and renal papillary necrosis or chronic interstitial nephritis. However, the spectrum of disease may be changing, because these agents also may increase the risk of cardiovascular disease and chronic renal disease due to nephrosclerosis, glomerulonephritis, and diabetes mellitus. Potential pathogenetic mechanisms in analgesic nephropathy include direct cellular injury induced by analgesics, prostaglandin inhibition with reduction or redistribution of renal blood flow, and interesting new concepts regarding the role of caffeine in increasing oxygen demand and reducing oxygen supply in the medulla. The primary goal of therapy is discontinuation of analgesic consumption. Because of the association between analgesic intake and uroepithelial tumors, surveillance of patients for neoplasm is suggested.

Analgesics↗
PubMed1982

Dysrhythmias caused by histamine release in guinea pig and human hearts.

Histamine is released into the systemic circulation during anaphylaxis, by drugs and by surgical procedures. Studies in animal models have conclusively demonstrated that released cardiac histamine is a major mediator of arrhythmias that occur during anaphylaxis and following the administration of histamine-releasing drugs. Several lines of evidence suggest a similar arrhythmogenic role for cardiac histamine in humans: (1) The human heart is rich in histamine; (2) cardiac histamine can be readily released from human heart in vitro by therapeutic concentrations of drugs; (3) histamine has potent arrhythmogenic effects on the human heart in vitro. Arrhythmogenic effects of histamine include enhancement of normal automaticity, induction of abnormal automaticity, induction of triggered tachyarrhythmias, depression of atrioventricular conduction, and increase in the vulnerability of the ventricles to fibrillation. A combination of H1 and H2 antihistamines is needed to block the arrhythmogenic effects of histamine. Certain arrhythmogenic effects of histamine (e.g. induction of slow responses and delayed afterdepolarizations) can also be blocked by drugs which inhibit the influx of cations through slow channels. In contrast, the commonly-used drug digitalis potentiates the arrhythmogenic effects of histamine. We propose that histamine release produced by drugs and surgical procedures may be an overlooked factor in fatal cardiac arrhythmias. Experimental studies suggest that selective pharmacological methods can be developed to block the arrhythmogenic effects of histamine.

Animals↗
PubMed1981

Complications of percutaneous intraaortic balloon pumping.

Eight-nine consecutive patients who were considered candidates for counterpulsation were reviewed for complications of the percutaneous intraaortic balloon pump (PIABP). Indications for counterpulsation were cardiogenic shock in 37 patients, refractory ischemia in 35, postcardiotomy shock in nine, acute infarction with threatened extension in four, septic shock in three and elective preoperative use in one patient. In 67 patients (75.3%), successful passage of the balloon was accomplished in a single attempt; the opposite-side attempt was successful in 10 patients (11.2%) and neither attempt was successful in 12 (13.5%). Seventy-seven patients who underwent PIABP had major complications, including limb ischemia in 12, bleeding at the puncture site in three, permanent foot drop in three, aortic dissection in three, renal embolism in one and false aneurysm at the puncture site in one. Fourteen patients had minor complications: asymptomatic loss of pedal pulses in eight, transient bacteremia in two, parasthesias in two and wound hematoma in two. No patient had free perforation, balloon rupture or wound infection. The rate and severity of complications of PIABP are similar to those with conventional IABP insertion. Ease of insertion alone should not be grounds for using PIABP in patients who can be managed without counterpulsation.

Aortic Rupture↗
PubMed1980

Simplified technique for intraaortic balloon insertion.

A simple technique for insertion and removal of an intraaortic balloon catheter is described. We have used it in 20 patients in the past six months, and the incidence of thrombi around the junction of the Dacron patch and the artery has been lessened. The prsence of a foreign body can be avoided also. We have not encountered any incidence or regional vascular compromise.

Assisted Circulation↗
PubMed1977

Surgical treatment of endocardial cushion defects.

A recent surgical experience with the spectrum of atrioventricular (A-V) canal is reviewed. Twenty-five patients underwent surgery for the partial and complete from of this defect in the 4 years from 1971 through 1974. Sixteen had a partial defect, two a transitional defect and seven complete A-V canal. The characteristic murmurs accompanied by cardiac enlargement, pulmonay overcirculation and left axis deviation in the electrocardiogram were sufficient for diagnosis in most cases. Cardiac catherization was performed in all patients preoperatively and in 11 postoperatively. The operative approach, including a double patch modification of the usual repair for complete canal, is considered. Definitive repair, rather than pulmonary arterial banding, is advocated regardless of the patient's age. The operative mortality rate is low in patients with the ostium primum type of defect but is related to associated intracardiac anomalies in those with the complete form of the defect. Residual mitral insufficiency is a common finding after surgical repair of both partial (75 percent) and complete (100 percent) A-V canal. Although no patient in the series died of florid mitral regurgitation, the long-range effects of this complication may lead to mitral valve replacement.

Adolescent↗
PubMed1977

Drug information centres: new role for pharmacists?

In the last few decades there has been a great increase in the number of new drugs available for general use. In consequence, drug information centres have been developed, particularly in U.S.A., to disseminate information on the uses, toxicity and cost of these drugs. Such centres have been slower to appear in the United Kingdom, with the exception of certain specialised centres, e.g. Poisons Information Bureaux. The present report describes the development of a drug information centre in Glasgow and gives preliminary data on its use during the last year. It is proposed that such centres provide a valuable aid in encouraging rational drug use particularly in hospitals. The centres may be run by a variety of interested personnel but in our view the professional group most likely to fill this role adequately is hospital pharmacists.

Drug Information Services↗