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Biomedical subjects

J R McCormick

Publications and source records attributed to J R McCormick.

At least 37 records · Page 2Linked to original sources
PubMed1987

Determinants of discharge following coronary artery bypass graft surgery.

The optimal time for discharge following coronary artery bypass graft (CABG) surgery is uncertain and varies among institutions. This study was undertaken to determine what factors may discriminate between early and late discharge following surgery. In 177 consecutive patients undergoing isolated CABG procedures, three groups were formed retrospectively according to the number of days hospitalized post CABG: group 1, less than or equal to 8; group 2, 9 to 11; group 3, greater than or equal to 12. Parameters found to discriminate between group 1 and group 3 (p less than .05; chi square analysis) included female sex, unstable angina, congestive heart failure (CHF), age greater than or equal to 65 years, and the development of major postoperative complications. Angina class, prior myocardial infarction, extent of coronary artery disease, aortic cross-clamp time, number of bypass grafts, ejection fraction less than 40 percent, or "minor" postoperative complications were not different among groups. Patients discharged less than or equal to 8 days following CABG had no increase in return visits or readmissions less than 60 days post CABG. We conclude that while certain patients can be safely discharged less than or equal to 8 days post CABG, patients who are female, greater than or equal to 65 years, have unstable angina, CHF, or a major postoperative complication are likely to be hospitalized longer.

Aged↗
PubMed1987

A model of pulmonary granulomata induced by beryllium sulfate in the rat.

In humans beryllium is known to cause pulmonary granulomata which are histologically indistinguishable from sarcoidosis. There is some evidence in man that beryllium-induced pulmonary granulomata are immunologically mediated. We set out to develop an animal model to study the immunopathogenesis of beryllium-induced granulomatous lung disease. Beryllium sulfate (BeSO4) was injected intratracheally (i.t.) into F344 rats previously immunized to BeSO4. This results in well-formed, sarcoid-like lung granulomata at 6 weeks post BeSO4. There was a conspicuous presence at 4 weeks post BeSO4 of numerous, perivascularly located Langhans' giant cells which preceded the development of well-formed granulomas at 6 weeks. Rats were sacrificed at 4, 6, 8 and 12 weeks after i.t. BeSO4. At the time of sacrifice bronchoalveolar lavage (BAL) was performed; B and T (W3/25+ helper 0X8+ suppressor/cytotoxic) lymphocyte populations were quantitated and compared to lymphocyte populations obtained from lung tissue. Both B and T cells were significantly elevated in lung tissue post BeSO4. At 4 weeks when granulomata were just developing, a W3/25+ to 0X8+ ratio of 20:1 in lavage and 2:1 in lung tissue was seen. At 6 weeks when granulomata were well-formed there was a predominance of W3/25+ cells in lavage but not in lung tissue. At 8 and 12 weeks, when the granulomata were regressing, lavage fluid still contained a W3/25+ predominance in contrast to lung tissue which contained a predominance of 0X8+ cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

The effect of alphanapthylthiourea (ANTU)-induced acute injury on lung binding of antibody to angiotensin converting enzyme (ACE).

The effects of ANTU-induced acute pulmonary capillary injury on lung and serum ACE functional activity and the specific accumulation of radio-labelled anti-ACE in lung were explored. Rats were injected either with ANTU or the solvent and sacrificed at various intervals up to one week after injection. All ANTU-injected animals developed pulmonary edema and bilateral pleural effusions which resolved by the one week time point. At no time was there any significant change in serum ACE levels. The specific activity of total lung ACE however rose from 11.0 +/- .95 (mean +/- SEM) to 18.4 +/- 1.1 by two hours after ANTU; by 24 hours, however, solubilized lung ACE had fallen significantly to 6.9 +/- .79 (p less than .01). Total lung ACE had returned to control values by one week. In parallel groups of animals the accumulation of 125I-labelled anti-ACE (AA) or normal sheep immunoglobulin (NSG) was compared in control and ANTU-treated rats. The ratio of the radioactivity in the lungs of AA--injected animals to that in NSG--injected animals fell significantly after ANTU administration (5.0 +/- .88 to 1.2 +/- .28 at 2 hours) suggesting that immunoreactive ACE had fallen despite an increase in ACE functional activity. The decreased binding of AA at the early time points perhaps reflects internalization of endothelial cell ACE in response to injury and an inability of the antibody to interact with the enzyme. The reduction in binding at 24 hours (1.38 +/- .47) correlates with a reduction in total lung ACE. ANTI-ACE may be a useful reagent for quantitating endothelial cell damage following lung injury.

Animals↗
PubMed1986

Corticosteroids in COPD. A clinical trial and reassessment of the literature.

A placebo-controlled, double-blind cross-over trial was conducted to assess whether 16 men with chronic obstructive pulmonary disease (COPD) would benefit from orally taken corticosteroids. Two weeks of treatment with 40 mg of prednisone daily did not result in improvement of pulmonary symptoms or function in the group as a whole, although one patient had small improvement in airflow. The baseline spirometric data and beta-agonist responsiveness of the patients in the study were then compared to a reference population consisting of 264 men who fulfilled a criteria for chronic obstruction out of 730 men who comprised a systematic sample drawn from all patients referred for spirometry at three hospitals. Our study subjects and those of five similar trials of corticosteroids in COPD had more severe obstruction than this reference group. Furthermore, the proportion of steroid responders found in each study was inversely related to the baseline FEV1 of the patients examined. It appears that previous studies of corticosteroids in COPD may have overestimated the number of COPD patients who might benefit from corticosteroids, due to a bias resulting from the selection of severely obstructed subjects.

Aged↗
PubMed1986

Intraoperative angioscopy of saphenous vein and coronary arteries.

During coronary artery bypass graft operations, the saphenous vein graft and native coronary arteries in 17 patients were examined with a 1.7 mm fiberoptic catheter to determine the feasibility of the procedure and its potential for clinical application. Good to excellent visualization in 10 of 11 proximal and 10 of 10 distal coronary anastomoses was obtained promptly and consistently. Good visualization of native coronary arteries was obtained in only six of 11 vessels. Three of three coronary arteries were visualized through the completed distal anastomosis, whereas only three of eight vessels could be visualized directly through the arteriotomy site before completion of the distal anastomosis. The image quality improved with operator experience. Vessel distention by cold crystalloid solution during catheter visualization was also important for obtaining better images. Limitations of the current "state of the art" fiberoptic catheters include the large size relative to the usual dimensions of the native coronary vessels, a lack of perfusion channel, and the absence of an angulation or guiding system. Potentially, angioscopic catheters may be useful as an instructional aid during bypass operations or as a diagnostic tool in monitoring arterial status after thrombolytic intervention, balloon angioplasty, or laser therapy.

Cardiac Catheterization↗
PubMed1985

Severe combined respiratory and myocardial failure treated with high-frequency ventilation.

High levels of positive end-expiratory pressure (PEEP) impair cardiac output. The subsequent lowering of mixed venous oxygenation, when coupled with a significant intrapulmonary shunt, may dramatically depress PaO2. We present a patient whose severe myocardial and respiratory insufficiency was unmanageable on conventional ventilation with high levels of PEEP and maximal inotropic support. High-frequency ventilation superimposed on conventional ventilation lowered peak airway pressure and dramatically improved both cardiac and pulmonary function.

Cardiac Output↗
PubMed1985

Pericardial complications in hepatic trauma.

During a 5-year period, 35 of 70 patients with liver trauma required entry of the thoracic cavity, with nine deaths. Pericardial complications developed in four of the nine survivors who had both thoracic and abdominal incisions. Two patients resolved their problems (postpericardiotomy syndrome, late pericarditis) with medical therapy. One patient required emergency thoracotomy for pericardial tamponade, and one patient developed constrictive pericarditis that required pericardiectomy. Available data support closure of the pericardium after pericardiotomy. Thoracic extension of abdominal incisions is often necessary. Pericardial complications may occur with hepatic trauma in the early or late postoperative periods and are potentially fatal.

Adolescent↗
PubMed1985

Delayed fatal pulmonary hemorrhage complicating use of a balloon flotation catheter.

A case of delayed fatal pulmonary hemorrhage caused by a balloon flotation catheter is described. The catheter was inserted preoperatively. The patient died on the 14th postoperative day from massive hemorrhage in the right pleural space after 12 days without any clinical symptoms. Pulmonary artery rupture is documented by the autopsy findings.

Aged↗
PubMed1985

Determinants of operative mortality and long-term survival in patients with unstable angina. The CASS experience.

To identify the factors that determine operative mortality and long-term survival, we analyzed the data from 3,311 patients who underwent surgical therapy for unstable angina according to clinical presentation. Overall operative mortality was 3.9% and no differences in operative mortality were found between patients with coronary insufficiency, new-onset angina, rest angina, or changing patterns of angina. Logistic regression analysis indicated that age, left ventricular score, and presence of a left main stenosis in a left dominant circulation were related to operative mortality. The 7 year cumulative survival rate was 79%. Features predictive of long-term outcome by Cox analysis included left ventricular score, congestive heart failure score, other illness, extent of coronary disease, and cardiomegaly. Operative mortality of those patients who underwent coronary bypass during their initial hospitalization with unstable angina was similar to that of patients who were discharged and readmitted for operation at a later date. Thus, patients with unstable angina demonstrate a relatively low operative mortality, which is unrelated to the clinical presentation. Long-term survival is primarily determined by clinical and angiographic markers of left ventricular dysfunction, associated illness, and the extent of coronary disease.

Angina Pectoris↗
PubMed1984

Production of monoclonal antibodies to rat lung angiotensin-converting enzyme.

Several monoclonal antibodies to rat lung angiotensin-converting enzyme (ACE) have been produced. The antibodies are of the IgG class, do not inhibit ACE catalytic activity, and do not cross-react with the human or bovine enzyme. They bind in a curvilinear fashion to lung capillary endothelium by immunofluorescence microscopy, and radiolabeled antibody localizes in lung and other organs after intravenous injection into living rats. Each antibody tested appears to bind preferentially to lung rather than kidney ACE by ELISA, a finding supported by weak or absent immunofluorescence of kidney slices in vitro. These antibodies may be used to probe structural differences between ACE in various tissues and, by quantitating changes in accumulation of radiolabeled antibody in experimental models of lung injury, should complement functional measurements in determining the presence of subtle and progressive endothelial damage.

Animals↗
PubMed1984

Removal of renal cell carcinoma extending into the right atrium using cardiopulmonary bypass, profound hypothermia and circulatory arrest.

An operation is indicated in patients with renal cancer growing into the inferior vena cava and right atrium because the tumor in the right atrium presents an immediate risk to life if acute obstruction of the tricuspid valve or pulmonary emboli occur. In addition, patients treated by such an operation may enjoy reasonable survivals. We believe that the best technique for operative management includes cardiopulmonary bypass, profound hypothermia and total circulatory arrest. Although perhaps seemingly complicated, it is the only technique that simplifies the operative dissection and permits as complete removal as possible of the cancer without the risk of tumor embolization or uncontrollable hemorrhage.

Adenocarcinoma↗
PubMed1984

Characterization of the anaphylatoxin inactivator and chemotactic factor inactivator activities during cardiopulmonary bypass.

Complement activation productive of phlogistic products has been suggested as one of the major mechanisms of the pump lung syndrome associated with cardiopulmonary bypass (CPB) surgery. Recent studies have demonstrated the presence of circulating C3a antigens in the serum of patients undergoing CPB and have suggested that the vasoactive nature of C3a may contribute directly to the interstitial edema and vascular changes seen in pump lung syndrome. In an effort to unravel the underlying mechanisms of pump lung syndrome, we undertook investigations to determine whether CPB and associated complement activation would alter the serum levels of the major regulators of both C3a and C5a complement split products. These serum regulators designated chemotactic factor inactivator (CFI) and anaphylatoxin inactivator (AI) were measured in the serum of patients undergoing CPB. In these studies, we demonstrated that during CPB a rapid and dramatic drop in the anaphylatoxin inactivator activities occurred within the first 10 minutes of CPB. These lowered AI levels were maintained throughout the CPB but AI levels returned to normal within 24 hours postsurgery. CFI levels were generally maintained throughout the CPB surgery with only minimal depressions in CFI levels during or after CPB surgery. These studies clearly demonstrate that the major regulator system of the complement-derived vasopermeability factors (C3a and C5a) is dramatically depressed during cardiopulmonary bypass and may suggest that the mechanisms of interstitial edema associated with pump lung syndrome may at least, in part, be related to the loss of the serum regulator enzyme carboxypeptidase N, also designated AI.

Anaphylatoxins↗
PubMed1982

Surgical therapy for Prinzmetal's variant angina.

Fifty-two patients underwent coronary artery bypass grafting between 1973 and 1979 for variant angina, defined as pain, usually at rest, associated with S-T segment elevation. Only patients with fixed occlusive coronary artery disease, defined as greater than 70% narrowing in diameter, were included. When fixed coronary artery stenosis is present, variant angina--whether presenting as stable, unstable, or postinfarction angina, and regardless of the number of vessels diseased--is effectively treated by myocardial revascularization. Preoperative intraaortic balloon pumping is a useful therapeutic adjunct in the unstable subset refractory to medical therapy. The results of revascularization in patients with Prinzmetal's variant angina and fixed coronary disease were no different from those in patients with classic angina pectoris of comparable clinical categories.

Adult↗
PubMed1982

Elevation of serum chemotactic factor inactivator activity during acute inflammatory reactions in patients with hypersensitivity pneumonitis.

Inflammatory mediators such as the vasoactive and chemotactic factors derived from the activation of the complement system are extremely potent biological peptides that are under rigid control of specific serum-derived regulators, e.g., the anaphylatoxin inactivator (AI) and the chemotactic factor inactivator (CFI). We have previously demonstrated that serum chemotactic factor inactivator concentrations are altered during chronic inflammatory states; here we demonstrate that a rapid elevation of serum CFI activity occurs during acute inflammatory reactions in patients suffering from hypersensitivity pneumonitis. Specifically, serum CFI concentrations were evaluated in patients with hypersensitivity pneumonitis (pigeon breeder's disease) and control subjects (asymptomatic) after aerosol challenge with 2 ml of sterile pigeon serum. At 4 h postchallenge, serum CFI concentrations in the patients with hypersensitivity pneumonitis increased rapidly to 3 times the prechallenge serum concentrations. Asymptomatic (control) subjects showed no increase in serum CFI concentrations after exposure to pigeon serum. In independent studies, we have also demonstrated that serum CFI concentrations are elevated in (1) rabbits with glycogen-induced peritonitis, (2) rabbits after intravenous infusion of C5-derived chemotactic factors, and (3) patients undergoing hemodialysis. These combined data clearly demonstrate that serum CFI activity is rapidly elevated during acute inflammatory reactions within both patient and animal populations, and suggest that serum CFI may represent a "hyperacute" phase reactant that is elevated during inflammation. Possibly, this elevation of CFI may be induced in response to inflammatory mediators produced during inflammation. Thus, the acute elevation of serum CFI concentrations that occurs during acute inflammation may represent the control system that would be responsive to the regulatory needs of the body during inflammatory reactions.

Alveolitis, Extrinsic Allergic↗