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Biomedical subjects

J V Richardson

Publications and source records attributed to J V Richardson.

At least 19 recordsLinked to original sources
PubMed1997

Bronchopleural fistula and lymphocytic empyema due to Histoplasma capsulatum.

A patient presented with chest pain, fever, and chills and developed a large pleural effusion while receiving antibiotic therapy. On a CT scan of the chest, multiple loculi of fluid were noted, and at surgery, a complex empyema with an associated bronchopleural fistula related to a granulomatous process in the lower lobe of the right lung was demonstrated. Cultures revealed Histoplasma capsulatum in the pleural fluid as well as in the pulmonary parenchymal process.

Bronchial Fistula↗
PubMed1991

Contemporary results of carotid endarterectomy.

Forty-four patients underwent fifty carotid endarterectomies in the first eighteen months of a new solo practice of cardiovascular and thoracic surgery in Montgomery. Thirty-six of the patients (82%) were symptomatic. Important operative details including continuous EEG monitoring, "selective" shunting, "open" endarterectomy and complete heparinization were employed throughout the study. There were no deaths and no strokes. Two patients (4%) had transient cranial nerve palsy and one patient (2%) had a transient ischemic attack consisting of dysarthria. One patient (2%) had a wound hematoma requiring reoperation. These results, in light of recent medical trials and randomized medical and surgical studies, encourage the continued place of carotid endarterectomy in the treatment of significant carotid disease in both symptomatic and asymptomatic patients.

Aged↗
PubMed1986

Reduced efficacy of coronary artery bypass grafting in women.

During a six-year period (August, 1978-May, 1985), 1,089 patients underwent isolated, primary, elective coronary artery bypass grafting (CABG) at St. Margaret's Hospital, Montgomery, Alabama. The group consisted of 833 (76.5%) men and 256 (23.5%) women. The women were older (mean age, 59.7 years vs. 55.4 years for men) (p = .0001), had more severe preoperative angina pectoris (mean New York Heart Association functional class 3.3 vs. 3.1) (p = .008), and had higher incidences of adult-onset diabetes mellitus (24% vs. 13.5%) (p = .0001) and preoperative congestive heart failure (8.2% vs. 3.7%) (p = .003). The overall mortality was 1.9% (21/1,089 patients); there were 10 deaths among the men (1.2%) and 11 deaths among the women (4.3%) (p = .001). Univariate and multivariate analysis of preoperative variables indicated that the female gender factor (p = .002), age of 70 years or older at operation (p less than .001), preoperative left ventricular dysfunction (p = .026), preoperative congestive heart failure (p less than .001), renal insufficiency (p = .036), peripheral occlusive disease (p = .002), extracranial occlusive disease (p = .001), and chronic obstructive pulmonary disease (p = 0.17) all had significant influences on hospital mortality. Perioperative myocardial infarction (p = .017), low cardiac output (p less than .001), and respiratory failure (p less than .001) significantly influenced outcome as well. Long-term (five-year) overall survival (90%) indicates a significantly superior overall survival among men (p = .0008). Event-free survival (absence of cardiac death, myocardial infarction, or recurrent angina pectoris) was significantly superior among the men (p = .03) as well.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Ventricular septal rupture with "normal" coronary arteries.

A 73-year-old woman was admitted to St. Margaret's Hospital with a history of an acute anteroseptal infarction, a loud cardiac murmur, and low cardiac output. Cardiac catheterization revealed a large, high ventricular septal defect and normal coronary arteries. Despite successful closure of the ventricular septal rupture, death occurred in the operating room due to severe right ventricular dysfunction. Although this patient had normal major coronary arteries, a ventricular septal rupture developed, which was probably caused by spasm or isolated atherosclerotic disease of a large septal perforator.

Journal Article↗
PubMed1984

Elective coronary artery bypass in the elderly: experience in a community hospital.

Elective coronary artery bypass can now be safely done in elderly patients. Seventy-four patients, aged 70 to 81 years (mean, 73 years), had elective primary coronary artery bypass in a community hospital between August 1978 and November 1982. Two patients (3%) died within 30 days of operation. Late deaths (range, one to 38 months; mean, 19 months) have occurred in three patients (4%). Sixty-five patients (94%) are New York Heart Association classes I or II postoperatively. These results seem to justify continued application of this operation in carefully selected patients.

Aged↗
PubMed1982

Repair of large ventricular septal defects in infants and small children.

It is possible to achieve excellent results for primary closure of ventricular septal defects regardless of the age of the patients when surgical intervention is required. Thirty-two severely symptomatic patients, age 1-24 months, with large ventricular septal defects (m Qp/Qs = 3.4, m R VSD = 4.0), had primary repair of the defects with one (3%) hospital death. Seven patients (22%) had increased pulmonary vascular resistance ranging from 5.4 to 12 units/m2. It was possible to close the ventricular septal defect through the right atrium in 26 patients (81%). Pulmonary artery banding was not performed in any patient with isolated ventricular septal defect during the period of this study. The 31 survivors have been followed an average of four years, and 30 of them are remarkably improved and remain New York Heart Association Class I or II. Only one patient, with obstructive pulmonary vascular disease (pulmonary resistance = 12 U/m2), died suddenly 16 months after operation. Follow-up catheterization was offered to all patients, and to date, 18 (60%) have been restudied. These hemodynamic data show that pulmonary vascular resistance after surgery is usually normal or only minimally elevated; except for one patient with a large residual ventricular septal defect, functionally significant left to right shunts were eliminated. These results and the analysis of results of combined series reported in the literature for primary and staged operations for the continued practice of primary repair of isolated large ventricular septal defects in infants and children who require surgery.

Age Factors↗
PubMed1981

Tined transvenous endocardial electrodes: results of a randomized prospective study.

The early (30-day) dislodgment rate of standard-use flange-tipped and of tined endocardial electrodes was compared in a randomized prospective clinical trial. Four of 16 (25%) of the flange-tipped leads and none of the 18 tined leads dislodged within 30 days of implantation (p = 0.01). We believe that the tined electrode represents a major improvement in electrode design and is clearly superior to the flange-tipped electrode in reducing the incidence of early dislodgment.

Clinical Trials as Topic↗
PubMed1981

Operation for aortic arch anomalies.

Forty-two patients with aortic arch anomalies resulting in tracheoesophageal compression were treated during the period 1948 through 1978. These anomalies are important causes of upper respiratory and esophageal obstruction in babies and small children and can be corrected safely with excellent relief of symptoms. Nineteen patients (45%) had a right aortic arch with a ligamentum arteriosum, 17 patients (40%) had double aortic arches, and 6 patients (15%) had aberrant right subclavian arteries. Other associated congenital malformation and mental retardation were seen in 15 patients (36%). Diagnosis was accurately made in 38 patients (90%) by barium esophagogram. Basic surgical principles include exposure through a left thoracotomy, complete identification of the aortic arch anatomy, and division of the constricting ring. Surgical treatment resulted in 2 deaths (5%), and 1 patient died late. Early postoperative respiratory complications were common. All survivors were relieved of their symptoms late (median, 94 months) postoperatively.

Adolescent↗
PubMed1981

Aortopulmonary septal defect: hemodynamics, angiography, and operation.

Twenty-five patients with malseptation of the aortopulmonary trunk resulting in aortopulmonary septal defect (window) were evaluated in a unique combined surgical series assembled from two institutions participating in the USA-USSR Health Exchange Program. Typical aortopulmonary septal defect or window (type I) with the connection between the ascending aorta and main pulmonary artery was found in 21 patients. Four had a more cephalad defect (type II) between the ascending aorta and the origin of the right pulmonary artery. Hemodynamics were the consequence of a large left-to-right shunt (mean ratio of pulmonary to systemic flow, 3.0) with right ventricular hypertension (mean right ventricular pressure, 86 mm Hg) and increased pulmonary vascular resistance (mean, 7.4 U) (mean ratio of pulmonary to systemic vascular resistance, 0.33). Angiography may provide patterns that allow preoperative distinction between the two types of aortopulmonary septal defect and provide information important in planning the details of corrective operation. Operative techniques included ligation, direct suture, and patch closure of the aortopulmonary septal defect. The best method appeared to be patch closure by the transaortic approach; real and potential problems were associated with other techniques.

Aorta, Thoracic↗
PubMed1981

Intramyocardial electrical and metabolic activity during hypothermia and potassium cardioplegia.

Hypothermic potassium cardioplegia is widely used to reduce myocardial metabolism as a means of myocardial protection. To investigate the efficacy of intramyocardial electrical activity as an indicator of myocardial metabolism, 12 dogs were placed on cardiopulmonary bypass and myocardial oxygen consumption, partial pressure of carbon dioxide (PCO2) in the coronary sinus, myocardial temperature, and intramyocardial and surface electrocardiograms were measured. The hearts were fibrillated and cooled to 15 degrees C. In Group 1 (6 dogs), potassium cardioplegia was given at 15 degrees C. In Group 2 (6 dogs), it was given at 25 degrees C. Maximum coronary sinus PCO2 and oxygen consumption occurred at 36 degrees C and gradually decreased, but there was still evidence of metabolic activity and intramyocardial electrical activity at 15 degrees C. When cardioplegia was given at 15 degrees C, all electrical activity ceased and there was a further significant reduction in metabolic activity (coronary sinus PCO2 and oxygen consumption). In Group 2 similar findings were found at 25 degrees C, and there was no further reduction in metabolic activity at 15 degrees C. These data indicate that: (1) myocardial metabolic activity is lowest when there is electrical quiescence as measured with an intramyocardial electrode; (2) potassium arrest and hypothermia are both necessary to achieve electrical quiescence; and (3) in the potassium-arrested heart, lowering temperature from 25 degrees to 15 degrees C does not result in a further reduction of metabolic activity.

Animals↗
PubMed1981

Cor triatriatum (subdivided left atrium).

Twenty-one patients (age 1 day to 156 months) with cor triatriatum sinister (subdivided left atrium) were treated over a 23 year period at two institutions. Anatomic classification of the hearts revealed 20 (95%) with classical cor triatriatum and normal pulmonary venous connections. One other patient had partial anomalous pulmonary venous connection. Three of these patients (14%) had other severe associated cardiac anomalies. Surgical correction of isolated cor triatriatum was performed in 13 patients of whom eight (62%) survived. Long-term results were excellent in seven (88%) patients; one late death occurred. A right atrial approach for infants and small children is recommended, while the left atrial approach appears satisfactory for larger children.

Adolescent↗
PubMed1980

Esophageal atresia and tracheoesophageal fistula.

Fifty-seven babies were surgically treated for esophageal atresia and tracheoesophageal fistula between 1968 and 1978. Forty-eight (84%) had proximal esophageal atresia and a distal tracheoesophageal fistula, 2 (4%) had proximal and distal esophageal atresia and no tracheosophageal fistula, and 7 (12%) had a tracheosophageal fistula without esophageal atresia. Primary repair was accomplished in 43 patients (75%), colon interposition was required in 5 (9%), while the remainder had staged or palliative reapirs. Forty-six (81%) survived surgical treatment. All 21 babies in Waterston Category A, 90% of 20 in Category B, and 44% of 16 in Category C survived surgical treatment. Serious complications occurred in 17 (30%), and dilatable strictures and other minor problems developed in 27 (47%). Late follow-up (mean, 48 months) revealed 3 (7%) late deaths, 2 of which were due to congenital heart disease. Three patients required late colon interposition, and several require frequent dilatations of the esophagus. The Category A and B survivors are all functionally well, while the 5 surviving Category C patients are all significantly impaired by associated anomalies.

Child, Preschool↗
PubMed1980

Surgical management of ruptured abdominal aortic aneurysms.

During a 12 year period ending in 1977, 65 patients had surgical treatment of ruptured abdominal aortic aneurysms. Hospital mortality was 48 per cent (31/65 patients). Preoperative shock (P = 0.05), intraoperative blood loss (P less than 0.01), postoperative respiratory complications (P less than 0.05) and renal failure (P less than 0.05) all significantly influenced early mortality as did multiple subsystem complications (P less than 0.01). Late mortality was 26 per cent, comparable to series of unruptured aortic aneurysm resection survivors. Increased awareness of the problem by physicians, and hence, more aggressive elective treatment of abdominal aortic aneurysms should lower the frequency of this problem, and improved intraoperative and postoperative care should improve survival of those patients whose aneurysms rupture.

Aged↗