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Biomedical subjects

J K Ross

Publications and source records attributed to J K Ross.

At least 19 recordsLinked to original sources
PubMed1990

Reoperation for recurrent angina after aortocoronary bypass surgery.

One hundred reoperations were performed on 93 patients of a total of 2287 patients who underwent initial coronary artery bypass surgery (CABG) between September 1972 and August 1988. The mean age of the 84 males and 9 females was 55.5 years (range 31-75 years). All patients prior to reoperation had severe angina and were judged to be in NYHA class III or class IV. Late graft failure alone or in combination with progressive atherosclerosis accounted for more than 60% of the cases requiring reoperation. The early mortality for reoperation was 1% compared with 1.4% for initial CABG. Perioperative myocardial infarction was recorded as a complication in 3.2% of cases at initial operation compared with 1% at reoperation. Symptomatic improvement occurred in 89.1% of cases after reoperation and almost 60% became entirely asymptomatic (mean follow-up interval 17 months).

Adult↗
PubMed1990

Dietary and hormonal evaluation of men at different risks for prostate cancer: fiber intake, excretion, and composition, with in vitro evidence for an association between steroid hormones and specific fiber components.

Dietary fiber intake and fecal fiber excretion were investigated in 53 Seventh-day Adventist men: 18 nonvegetarians (NVs), 20 lactoovovegetarians (LOVs), and 15 vegans (Vs). Three-day composite diets and stools were analyzed for neutral detergent fiber (NDF), hemicellulose, cellulose, lignin, and pectin. In vitro binding of estrone (E1), estradiol-17 beta (E2), and testosterone (T) to a water-insoluble fiber fraction obtained from these diets was correlated with the intake of specific dietary fiber components. Vs consumed and excreted significantly more of all fiber components than did LOVs or NVs. LOVs consumed more of all fiber components (except cellulose) than did omnivores and excreted more NDF, hemicellulose, and cellulose. Dietary lignin was positively correlated with T binding in the V group. There were significant relationships for all groups combined between lignin and water-insoluble fiber binding of E1, E2, and T. Further study is needed to clarify relationships between fiber components, steroid-hormone metabolism, and risk of prostate cancer.

Adult↗
PubMed1990

Dietary and hormonal evaluation of men at different risks for prostate cancer: plasma and fecal hormone-nutrient interrelationships.

Relationships between dietary nutrients and plasma and fecal estrone, estradiol-17 beta, testosterone, and plasma prolactin concentrations were studied in young Seventh-day Adventist men: 18 nonvegetarians (NVs), 20 lactoovovegetarians (LOVs), and 15 vegans (V). Blood samples and 3-d dietary records were obtained. Contemporaneously collected diet composites and stool samples were analyzed for fiber. Vs and LOVs consumed significantly more fiber than did the omnivores, whereas NVs and LOVs consumed more saturated fatty acids than did Vs. Although plasma steroid-hormone status did not differ, Vs had significantly higher fecal estrogen concentrations than did NVs or LOVs. Plasma prolactin concentrations were significantly higher in NVs and LOVs than in Vs. Significant relationships were observed for the combined groups between dietary and fecal fiber components and fecal, but not plasma, steroid hormones. For the combined groups, prolactin concentrations were positively correlated with saturated fatty acid intake. Further research on the effects of dietary nutrients on endocrine homeostasis in other age groups is warranted.

Adult↗
PubMed1990

Surgical treatment for infarct-related ventricular septal defects. Improved early results combined with analysis of late functional status.

A total of 101 patients (mean age 64.9 years) underwent surgical correction of postinfarction ventricular septal defect at this institution over a 15-year period (1973 to 1988). The overall early mortality rate was 20.8%, although the most recent experience with 36 patients (January 1987 to October 1988) has seen this decline to 11.1%. Factors found to influence early death significantly, when analyzed univariately, were as follows: (1) site of infarction (anterior 12.1%, inferior 32.6%, p = 0.02); (2) time interval between infarction and operation (less than 1 week 34.1%, greater than 1 week 10.5%, p = 0.008); (3) cardiogenic shock (present 38.1%, absent 8.5%, p = 0.001). Nonsignificant variables included preoperative renal function, age, and concomitant coronary artery bypass, although older age (greater than 65 years) became significant when examined in a multivariate fashion. Of the 80 hospital survivors, eight were subsequently found to have a recurrent or residual defect necessitating reoperation, with survival in seven. Late follow-up is 99% complete and reveals an actuarial survival rate for 100 patients of 71.1% at 5 years (95% confidence interval 60.6 to 80.0), and 40.0% at 10 years (95% confidence interval 21.7 to 58.4). A significant recent change in policy of not using coronary angiography in patients with a ventricular septal defect caused by anterior wall infarction has not resulted in any increase in either the early mortality or in the late prevalence of angina. The functional status of 38 surviving patients has been analyzed by a graded treadmill exercise protocol, whereas left ventricular functional assessment was by nuclear scan with additional information on mitral valve function by echocardiogram. Color Doppler flow mapping has been used to determine the presence of a residual defect. Most late survivors have limited exercise tolerance related to both cardiac and noncardiac factors. Left ventricular function is moderately impaired (mean ejection fraction = 0.39). However, many patients are elderly and have adapted to their residual symptoms without significant changes in life-style.

Age Factors↗
PubMed1989

Surgical treatment of the ascending aorta. Fourteen years' experience with 83 patients.

Between December 1972 and December 1986, 83 patients with aneurysmal disease (n = 37) or dissection (n = 46) involving the ascending aorta underwent a variety of operations, including composite value-graft repairs (n = 39), separated replacements of the aortic valve and ascending aorta (n = 18), resuspension and graft replacement of the ascending aorta (n = 9), graft replacement of the ascending aorta only (n = 8), homograft root replacement (n = 3), aortic valve replacement with aortorrhaphy (n = 3), aotorrhaphy alone (n = 2), and use of a sutureless intraluminal prosthesis (n = 1). The inclusion method was used in nine patients. The hospital mortality rate was 10% for patients with annuloaortic ectasia, 21% (70% confidence interval 13% to 30%) for acute dissection, and 18% (70% confidence interval 14% to 22%) for the entire group. Logistic regression analysis showed age and cumulative bypass time to be significant for hospital death. The estimated 5-year survival rates are 69.5% +/- 7.2% and 67.0% +/- 9.0% and 10-year estimates are 34.6% +/- 10.6% and 61.4% +/- 9.8% for dissection and aneurysm, respectively. Patient survival was related to differing pathology and type of operation, and log-rank testing showed no differences at the 5% level. Attrition (17 late deaths) was mostly due to left ventricular dysfunction, myocardial infarction, or aneurysmal disease in ungrafted aorta. Actuarial freedom from thromboembolism in patients with prosthetic valves is 92.0% +/- 4.0% and 83.5% +/- 6.8% at 5 and 10 years. Freedom from all late graft and cardiac complications is 72.5% +/- 9.1% and 48.8% +/- 13.1% at 5 and 10 years for aneurysmal disease and 79.1% +/- 7.3% and 67.3% +/- 9.9% at 5 and 10 years for dissection. Reoperation in nine patients was required for pseudoaneurysms (n = 3), other aortic aneurysms (n = 3), persistent aortic regurgitation (n = 1), and obsolescent valve prosthesis (n = 2). Thus hospital mortality does not seem to be significantly related to the type of operation used for pathologic conditions of the ascending aorta unless cumulative bypass time exceeds about 2 hours. Many nonfatal late complications are associated with a prosthetic valve, but late death is due primarily to cardiac causes and residual disease in other parts of the aorta.

Aortic Dissection↗
PubMed1987

An abnormality of nail growth associated with median nerve damage.

It has been recognised for a long time that damage to the median or ulnar nerves is usually followed by slowing of growth of the fingernails. In the past, this has always been ascribed to immobilization of the appropriate digits, rather than to a neurotrophic factor. No other nail changes appear to have been described in association with nerve damage. We present two patients with marked nail changes following median nerve injury, in which immobilization does not appear to be responsible.

Adolescent↗
PubMed1986

Eleven year experience of aortic valve replacement with antibiotic sterilized homograft valves in Southampton.

Aortic valve replacement with an antibiotic-treated aortic valve homograft was performed in 200 patients between April 1973 and December 1984. In all cases, a two-layered freehand technique of valve implantation was used. Tailoring of the annulus was performed in 39 cases and a gusset in the non-coronary sinus was used to maintain the shape of the aortic root in 67 patients. There were 6 early deaths (3%) and 14 late deaths (7.2%); 4 of these were related to homograft regurgitation. The 11 years survival rate on actuarial analysis was 83%. The overall incidence of early diastolic murmurs was 27.3%; being significantly higher in those with tailored roots (P less than 0.001). Severe homograft aortic valve incompetence requiring re-operation developed in 3.1%. Anticoagulant therapy was not used routinely, and there was no major thromboembolic episode in those who had isolated homograft aortic valve replacement. There was one case of miliary tuberculosis but pyogenic and fungal endocarditis were not encountered. No hemolysis, valvular calcification or stenosis was observed.

Adolescent↗
PubMed1985

Oral verapamil fails to prevent supraventricular tachycardia following coronary artery surgery.

A prospective randomised trial was performed on 100 patients undergoing coronary artery bypass grafting without concomitant procedure. The study group commenced oral verapamil 40 mg three times daily on the first post-operative day while the control group received no antiarrhythmic agents. The pre-operative characteristics of both groups were similar with the exception of the incidence of hyperlipidemia which was greater in the verapamil group (P = 0.04). Myocardial protection was achieved with cold crystalloid cardioplegia. Cardiopulmonary bypass times, aortic cross clamp times and graft numbers were similar for both groups. Nine patients were excluded on the first post-operative day; the remainder were studied for 8 days. Supraventricular tachyarrhythmias (atrial fibrillation, atrial flutter or paroxysmal supraventricular tachycardia) were detected in 8 patients in the study group (n = 44) and in 5 patients in the control group (n = 47). The difference was not significant (P = 0.3). The ventricular rate in patients taking verapamil who developed supraventricular tachycardia was 138 +/- 14.9 compared with 156.8 +/- 17.9 in the control group, but the difference failed to reach significant levels (P = 0.065). In conclusion, prophylactic oral verapamil 40 mg given three times daily after coronary artery surgery failed to decrease the incidence of post-operative supraventricular tachycardia or to significantly influence the ventricular rate if tachycardia developed.

Administration, Oral↗
PubMed1985

Study of the risk factors related to early mortality following combined mitral valve replacement and coronary artery bypass grafting.

Combined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) operation was performed in 62 consecutive patients at the Wessex Cardiothoracic Centre, Southampton, from 1972 to 1983. There were 43 men and 19 women. The mean age was 61 years. Ten patients were in New York Heart Association (NYHA) functional class II, 34 in class III and 18 were in functional class IV. Mitral regurgitation was predominant in 50 patients and mitral stenosis in 12. Emergency operations were performed in 9 patients and elective operations in 53. There were 5 operative deaths (8.06%), 2 in patients having elective operations (2/53 = 3.7%) and 3 in those having emergency operations (3/9 = 33.3%). Significant factors related to early death were NYHA functional class, timing of surgery, etiology and type of valve lesion, increased pulmonary vascular resistance and low cardiac index.

Adult↗
PubMed1985

Aortic root enlargement with glycerol-preserved homologous dura mater patch during aortic valve replacement.

Aortic root enlargement with a patch is sometimes indicated either to prevent aortic homograft valve distortion during implantation or to facilitate easy, tension-free closure of the aortotomy. Patches made of prosthetic material have been widely used for this purpose. The use of autogenous pericardium has recently been reported. Although dura mater has been shown to have great strength, low antigenicity, athrombogenicity, easy availability in large sizes and rapid bonding to most tissues, its use for patch enlargement of the aortic root has not been previously documented. From 1979 to 1983, 38 patients had dura mater aortic root gussets placed during aortic valve replacement at the Southampton General Hospital. In all cases, the patches were placed to facilitate aortic closure, or to prevent homograft valve distortion by enlarging the non-coronary sinus. Aortic homografts were implanted in 11 patients, Carpentier Edwards' Xenograft valves in 16, Björk-Shiley valves in 8 and Wessex Xenografts in 3 patients. All the patients survived and in a mean follow-up of 30 +/- 12.8 months (range 3 to 48 months) there has been no clinical evidence of patch failure due to leakage, rupture or aneurysm formation. These results suggest that glycerol-preserved dura mater is a satisfactory patch material for aortic root enlargement during aortic valve replacement.

Adolescent↗
PubMed1985

Left ventricular aneurysm. The Wessex experience.

One hundred patients with left ventricular aneurysms were operated on between February 1973 and January 1983. The principal indications for operation were left ventricular failure in 58, angina in 23, both in 17, with arrhythmia and systemic emboli accounting for one case each. Eighty five had had anterior infarction causing 82 anteroapical and three lateral aneurysms, while the remainder had had inferior infarcts resulting in 14 inferior aneurysms and one lateral aneurysm. Coronary angiography detected a single coronary lesion in 46%. Three patients had aneurysmal plication and the remainder had aneurysmectomy. Eleven mitral valve replacements were performed. Forty patients underwent coronary artery bypass grafting with a mean number of grafts per patients of 1.4. The early mortality was 7% with no early deaths since 1978. The actuarial five year survival was 68%, and 82% of survivors are in New York Heart Association class I or II (mean follow up three years). Left ventricular aneurysmectomy may be performed with a low operative mortality and good long term results.

Coronary Artery Bypass↗
PubMed1985

Dietary fiber constituents of selected fruits and vegetables.

This study compared the dietary fiber (DF), neutral detergent fiber (NDF), cellulose, hemicellulose, lignin, and pectin content of selected fruits and vegetables. Apples and peaches (fresh and canned), oranges (fresh), strawberries (fresh, canned, and frozen), carrots, green beans, and potatoes (fresh, fresh cooked, canned, and frozen), and tomatoes (fresh, fresh cooked, and canned) were studied. When possible, two varieties, two stores, and name and store brands were chosen. Samples were analyzed for NDF, acid detergent fiber, 72% sulfuric acid, lignin, and pectin. From those values, DF, cellulose, and hemicellulose were calculated. Fresh fruits in gm/100gm wet weight had decreasing DF, NDF, and hemicellulose values as follows: apples, peaches, strawberries, and oranges. Apples were highest in cellulose; strawberries, highest in lignin; and oranges, highest in pectin. Fresh-cooked vegetables in gm/100gm wet weight have decreasing DF and NDF values as follows: green beans, carrots, potatoes, and tomatoes. Green beans were highest in cellulose and hemicellulose; potatoes highest in lignin; and carrots highest in pectin. On a wet-weight basis, fresh apples and peaches, fresh-cooked green beans, canned carrots, and canned and frozen potatoes were higher in DF and NDF than other forms of the fruit or vegetable. There were few differences according to stores, brands, or varieties of fruits and vegetables. On a dry-weight basis, fresh apples, peaches, strawberries, green beans, and tomatoes appear to have higher DF and NDF contents than their processed counterparts. Fresh-cooked carrots and fresh potatoes appear to have less DF and NDF than their canned and frozen counterparts.

Cellulose↗
PubMed1979

Surgery of the ascending aorta: five years' experience at a regional cardiac centre.

Between 1972 and 1978, 31 patients underwent replacement of the ascending aorta, with or without aortic valve surgery, at the Wessex Regional Cardiac Centre. The commonest indications for operation were aneurysmal dilatation of the ascending aorta causing aortic regurgitation and acute dissection of the ascending aorta. Eleven of the 31 patients had features of Marfan's syndrome. The overall hospital mortality was 19.4%, a figure comparable with those reported in other series; ventricular failure secondary to ischaemia during operation was the commonest cause of death. The long-term symptomatic results were excellent, except in the two patients who underwent resuspension of the aortic valve for aortic regurgiation associated with acute dissections. For aneurysms of the ascending aorta with associated aortic regurgitation, replacement of the valve and ascending aorta with a combined valve prosthesis and synthetic tube graft, with reimplantation of the coronary ostia, is the procedure of choice if the aortic valve ring is diseased. Experience to date indicates that replacement of the ascending aorta and aortic valve with separate prostheses, leaving the coronary ostia undisturbed, is a satisfactory alternative provided the aortic annulus is of suitable size and quality; this is more likely to be the case in dissections than in aneurysmal dilatation of the ascending aorta. Replacement of the ascending aorta may also be indicated in some cases of dilatation of the ascending aorta secondary to aortic valve disease if the aortic wall is unusually thin.

Adult↗
PubMed1978

The cost of cardiac surgery.

A study in Wessex has shown that at 1977 prices, and excluding the cost of equipment already installed in the unit, the cost of replacing a man's aortic valve in this unit is about 1800 pounds. Nevertheless, this seems a small price to pay for return to health and full working capacity, particularly since such patients no longer need to draw social security benefits and their tax contributions will return to normal, thus probably paying for the operation within two years.

Adult↗