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Biomedical subjects

J C Wiles

Publications and source records attributed to J C Wiles.

9 recordsLinked to original sources
PubMed1985

Postoperative (pressure) alopecia.

Postoperative localized alopecia has been reported most commonly after certain gynecologic and open heart surgery procedures, the likelihood of hair loss and the chance of permanence correlating with the length of the anesthesia and the intubation. Some cases of pressure-induced alopecia have been described after prolonged coma from other causes. Coma blisters have been reported after drug overdoses, but clinically similar blisters (not tested by biopsy) have been seen in other cases of coma. We present three cases of postoperative (pressure) alopecia and propose that both coma blisters and postoperative alopecia arise from the same phenomenon--probably pressure-induced ischemia.

Aged↗
PubMed1985

Urticarial vasculitis treated with colchicine.

Cutaneous vasculitis may present as an urticaria-like eruption in association with viral illness, systemic lupus erythematosus, Sjögren's syndrome, or serum sickness. Often, however, urticarial vasculitis presents as an immune complex-mediated disease without other associated connective-tissue disease or associated infection. Many forms of therapy have been tried, including antihistamines, prednisone, and immunosuppressive drugs without success in every patient. Because colchicine had been effective in some patients with non-urticarial cutaneous vasculitis, we decided to use it in two patients with urticarial vasculitis in whom other therapy had failed. Both responded dramatically, although severe hypocomplementemia persisted in one patient.

Adult↗
PubMed1978

Coronary surgery for unstable angina pectoris. Incidence and mortality of perioperative myocardial infarction.

The incidence of perioperative myocardial infarction determined by electrocardiogram was examined in 123 consecutive patients having only coronary artery bypass grafting for unstable angina pectoris, at Yale-New Haven Hospital from January 1974 to June 1975. The incidence of myocardial infarction and its mortality were correlated with clinical, haemodynamic, anatomical, and operative factors. Myocardial infarction occurred in 18% of all patients (22/123); 15 inferior, 6 anterior, and 1 anterolateral wall. Three factors appeared to be related to the occurrence of myocardial infarction: left main coronary artery disease (LMCD), (47%, 7/15), increased left ventricular end-diastolic pressure (LVEDP), (27%, 14/52), and cardiopulmonary bypass time more than 60 minutes (24%, 21/88). The mortality of perioperative myocardial infarcation was 13.6% (3/22), while for patients without perioperative myocardial infarction the mortality was 2% (2/101). The overall operative mortality was 4% (5/123). The risk of perioperative myocardial infarction is significantly increased by left main coronary artery disease, increased left ventricular end-diastolic pressure, and cardiopulmonary bypass time more than 60 minutes, in patients undergoing coronary artery surgery for unstable angina pectoris. The mortality of perioperative myocardial infarction is high (13.6%) in patients with unstable angina.

Adult↗
PubMed1977

Incidence and mortality of perioperative myocardial infarction in patients undergoing coronary artery bypass grafting.

The incidence of perioperative myocardial infarction (MI) determined by electrocardiogram was examined in 168 consecutive patients having only coronary artery bypass grafting at Yale-New Haven Hospital from July 1974 to June 1975. The incidence of MI and its mortality were correlated with clinical, hemodynamic, anatomic, and operative factors. Perioperative MI occurred in 23% of all patients (39/168); 26 in the inferior, 11 in the anterior, and two in the anterolateral wall. Three factors appeared related to the occurrence of MI: 1) abrupt propranolol withdrawal 24 hours prior to surgery (Prop) (32%, 33/103); 2) left main coronary artery disease (LMCD) (37%, 7/19); and 3) cardiopulmonary bypass longer than 60 minutes (CPB) (23%, 30/128). To more precisely predict MI, combinations of factors were examined. The combination of LMCD and CPB was 39%, (7/18) while the absence of either yielded an incidence of only 5.1% (2/39) (P less than 0.001). The mortality of patients with MI was 15.4% (6/39) while in patients without MI the mortality was 1.6% (2/129). We conclude that the risk of perioperative MI is significantly increased by abrupt propranolol withdrawal 24 hours before surgery, left main coronary artery disease, and cardiopulmonary bypass longer than 60 minutes in patients undergoing coronary artery bypass grafting. The mortality of perioperative MI is high, despite previous reports of the benignity of perioperative myocardial infarction.

Adult↗
PubMedDate not supplied

Predictors of operative mortality for coronary bypass grafting in patients with ischemic heart disease.

Predictors for operative mortality (OM) were studied in 172 consecutive patients (pts) undergoing coronary artery grafts (CAG) for angina pectoris.Seventy eight pts had Class IV angina; of the 147 patients given propranolol, 41 were gradually withdrawn from propranolol and finally discontinued 24 hours before surgery, and 106 were abruptly withdrawn from propranolol 24 hours before CAG; 20 pts had left main coronary disease; 156 pts had cardiopulmonary bypass (CPB) time shorter than 20 minutes, and 16 pts had a CPB longer than 120 minutes.The operative mortality was 5.2% (9/172) for the entire group. Class IV angina (OM 7%), abrupt propranolol withdrawal (OM 6.6%), left main coronary artery disease (OM 25%), and CPB longer than 120 minutes (OM 50%), all significantly increased OM. These variables were interdependent, however, as many pts belonged to several predictor categories, combinations of predictors were examined, in order to more accurately predict the risk of individual pts. The combination of left main coronary artery disease and CPB longer than 120 minutes; and Class IV angina and CPB longer than 120 minutes were significantly associated with higher operative mortality.We conclude that Class IV angina, abrupt propranolol withdrawal, left main coronary artery disease and prolonged CPB are potent, interdependent predictors of OM in pts undergoing CAG. Consideration of these predictors, alone and in combination, allows effective prediction of OM for CAG in patients with stable angina pectoris.

Adult↗