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Biomedical subjects

J Utley

Publications and source records attributed to J Utley.

16 recordsLinked to original sources
PubMed1987

Thromboendarterectomy for chronic, major-vessel thromboembolic pulmonary hypertension. Immediate and long-term results in 42 patients.

Since 1970, forty-two patients with pulmonary hypertension due to chronic, thromboembolic obstruction of the major pulmonary arteries have had pulmonary thromboendarterectomy at the University of California, San Diego, and the San Diego Veterans Medical Centers. Duration of symptoms before admission averaged 4.4 years, with many alternative diagnoses having been made. At admission, 29 patients had class IV disease by New York Heart Association criteria, and 12, class III. Immediately after surgery, pulmonary vascular resistance declined significantly (p less than 0.001) from 897 +/- 352 dynes/s.cm-5 to 278 +/- 135 dynes/s.cm-5. Seven patients with class IV disease died in the postoperative period. Of the 35 survivors (mean follow-up, 28 months), 16 had class I disease; 18, class II; and 1, class III. Of the 17 patients who have returned for cardiac catheterization at 4 to 12 months after surgery, a further decline (p less than 0.05) in pulmonary vascular resistance has occurred. This experience indicates that the disorder is commoner than we previously suspected and that thromboendarterectomy is feasible, even in patients with severe and protracted hemodynamic compromise.

Adult↗
PubMed1984

The effect of delay on flap survival in an irradiated field.

Chronic radiation skin injury without ulceration was induced in rats by administering either 3000 or 5000 rads in staged doses. Either 4 or 8 months later, McFarlane et al. dorsal flaps were elevated, with half being delayed and half non-delayed. Measurements showed that flap survival in irradiated skin was significantly increased by delay [approximately two of four experimental groups (4 months, 5000 rads; and 8 months, 3000 rads)]; flap survival was increased with borderline significance in a third experimental group (8 months, 5000 rads). These data indicate that flap survival can be increased by delay in an irradiated field. The presence of the vascular delay phenomenon suggests that microvascular occlusion alone cannot account for radiation-induced complications in skin.

Animals↗
PubMed1983

Chronic thrombotic obstruction of major pulmonary arteries. Results of thromboendarterectomy in 15 patients.

Since 1969, 15 patients, ranging in age from 21 to 67 years, with pulmonary hypertension associated with chronic thrombotic obstruction of major pulmonary arteries have had pulmonary thromboendarterectomy. Symptoms compatible with embolism antedated surgery for periods of 8 months to 18 years; several alternative diagnoses were maintained for months to years. Only 2 of 15 were treated for the initial embolic episode. All patients had dyspnea on exertion and were in New York Heart Association class III-IV before surgery. Resting arterial hypoxemia was common. Resting preoperative mean pulmonary artery pressures ranged from 25 to 66 mm Hg; pulmonary vascular resistances, 420 to 1869 dynes/sec X cm-5. Partial or complete thromboendarterectomy was possible in patients using cardiopulmonary bypass with hypothermia and cardioplegia. All patients showed a fall in pulmonary vascular resistance. All developed some degree of "reperfusion" lung edema and arterial hypoxemia that lasted for a few days to several months. Two patients died during hospitalization. The 13 survivors have been followed for 8 to 144 months (mean, 38.3 months). All patients improved after surgery. One patient died of nonembolic causes; none had recurrent embolism.

Adult↗
PubMed1981

The ultrastructure of chronic radiation damage in rat skin.

Chronic radiation skin ulcers were produced in rats with the administration of 5,000 or 8,000 rads. Electron microscopy revealed two phases of damage, the first from seven to 14 weeks and the second from 14 to 54 weeks. In the first phase, significant nuclear and cytoplasmic degeneration was prominent. During the second phase, lysosomes were common along with unusual cytoplasmic inclusions. Myofibroblasts were observed in the second phase only, suggesting that delayed would contraction in radiation ulcers was the result of the delayed onset of myofibroblast development.

Animals↗
PubMed1977

Small cell cancer of the uterine cervix.

Forty-one patients with small cell carcinoma of the uterine cervix were evaluated and treated at the University of Kentucky Medical Center from 1962 to 1974. Eighteen patients (44%) developed widespread metastases and died of recurrent cancer within 2 years of therapy. Common sites of metastases included the lung, liver, and bone. There was a significantly lower incidence of lymphoplasmacytic infiltration in small cell cancers than the keratinizing or nonkeratinizing squanmous cell carcinomas of the cervix. In addition, there was a significant increase in the number of unstimulated regional lymph nodes in patients with small cell cancer when compared with the lymph nodes of patients with the other cell types of cervical cancer. These data suggest that small cell cancer of the cervix is a highly aggressive tumor similar to small cell carcinoma of the lung and behaves quite differently from other types of squamous cell carcinoma of the cervix. Radiation therapy was superior to radical surgery in eradicating pelvic disease, but prospective studies need to be undertaken to determine the effect of adjunctive chemotherapy in patients with this rare tumor.

Adult↗
PubMed1976

Intramyocardial distribution of blood flow in hemorrhagic shock in anesthetized dogs.

In 34 anesthetized, open-chest dogs aortic blood pressure was kept at 35-40 mmHg for 3 h to determine if maldistribution of coronary blood flow (CBF) could contribute to the irreversibility of hemorrhagic shock. Six dogs were pretreated with phenoxybenzamine (PBZ) and 11 dogs (3 with PBZ) received hypertonic mannitol infusions in late hemorrhage. Changes of heart rate, cardiac output, and peripheral resistance were similar to those described by others. In untreated dogs total and left ventricular CBF fell, as did coronary vascular resistance. However, minimal coronary resistance after transient ischemia rose progressively and the ratio of subendocardial:subepicardial flow fell, as did the percentage of diastolic coronary flow. Mannitol infusion returned CBF and steady-state and minimal postischemic coronary resistance to control values and also returned to normal the increased myocardial water content found in late hemorrhage. Phenoxybenzamine delayed but did not prevent the rise of coronary vascular resistance or decreased subendocardial flow. These studies suggest that there may be subendocardial ischemia, possibly due to myocardial edema, in hemorrhagic shock.

Animals↗
PubMed1975

Calvarial-scalp compensator for radiotherapy.

A universal compensator for megavoltage cobalt-60 radiotherapy of the skull was constructed and applied to clinical radiotherapy use. This compensator allows the skull to be treated with a more uniform dose.

Adult↗