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Biomedical subjects

James M Brown

Publications and source records attributed to James M Brown.

12 recordsLinked to original sources
PubMed2006

Aortic valve bypass for aortic stenosis: imaging appearances on multidetector CT.

OBJECT: Aortic valve bypass is a technique used in high-risk patients with critical aortic stenosis that consists of placement of a conduit from the left ventricular apex to descending aorta. We describe the imaging appearances of this apicoaortic conduit on multidetector CT (MDCT). METHODS: Each patient underwent retrospective ECG-gated MDCT using a 16-detector-row scanner several days after placement of an apicoaortic conduit. All images were assessed by two radiologists who reviewed the appearance of the apicoaortic conduit and any post-operative complications. Follow-up studies were available for several patients. RESULTS: Twelve patients (9 men, 3 women, mean age - 78 years) underwent evaluation and the conduit was visible in each. The valve within the conduit was visible in ten (91%) of the 11 patients who received intravenous contrast material. Common findings were periconduit outpouching and hypoperfusion involving the left ventricle. Complications included pericardial hemorrhage, hemothorax and ventricular pseudoaneurysm. Mild to moderate increase in wall thinning was identified in the three patients who underwent follow-up imaging. CONCLUSION: Aortic valve bypass with an apicoaortic conduit appears to be a feasible alternative to aortic valve replacement in high-risk patients. MDCT is an excellent method to assess the imaging features of such conduits.

Aged↗
PubMed2006

The path of visual attention.

Visual cuing is one paradigm often used to study object- and space-based visual selective attention. A primary finding is that shifts of attention within an object can be accomplished faster than equidistant shifts between objects. The present study used a visual cuing paradigm to examine how an object's size (i.e., internal distance) and shape, influences object- and space-based visual selective attention. The first two experiments manipulated object size and compared attentional shift performance with objects where the within-object distance between cued and uncued target locations was either equal to the between-object distance (1:1 ratio condition) or three times the between-object distance (3:1 ratio condition). Within-object shifts took longer for the larger objects, but an advantage over between-object shifts was still evident. Influences associated with the shapes of the larger objects suggested by the results of the first two experiments were tested and rejected in Experiment 3. Overall, the results indicate that within-object shifts of attention become slower as the within-object distance increases, but nevertheless are still accomplished faster than between-object shifts.

Analysis of Variance↗
PubMed2006

Off-pump versus on-pump coronary artery bypass grafting in consecutive patients: decision-making algorithm and outcomes.

BACKGROUND: Debate continues between on-pump or off-pump approach for coronary artery bypass grafting (CABG). We used off-pump coronary artery bypass grafting (OPCAB) as a tool within a decision-making algorithm driven by the patient-related factors of coronary anatomy and comorbidity. Our analysis presents this decision algorithm and describes outcomes using this approach. METHODS: From January 2000 to December 2003, 592 consecutive patients undergoing isolated CABG were assigned by one surgeon to a technique: on-pump CABG or OPCAB according to (1) anatomy and (2) predicted risk. Anatomic factors against OPCAB were target vessel size less than 1.25 mm, calcification, poor quality, intramyocardial location, and multiple stenoses. Given that OPCAB could be performed safely, patients in the moderate risk range, ie, those elderly with multiple comorbidities, were preferentially treated using OPCAB. RESULTS: The OPCAB group had higher predicted 30-day mortality compared with the on-pump CABG group, consistent with the protocol's intent. However, morbidity and mortality were similar between on-pump CABG and OPCAB. The OPCAB patients received the same number of internal mammary artery grafts but fewer distal grafts. Mortality and observed to expected ratios were favorable for both groups and below those The Society of Thoracic Surgeons' predicted for OPCAB. CONCLUSIONS: Matching surgical strategy to patient-related factors and needs resulted in excellent outcomes. Our data support the use of a protocol based on patient characteristics to drive the surgeon's choice between an on-pump CABG or OPCAB approach. As such, OPCAB can be viewed as a tool to be used by the surgeon developing a best practice in treating coronary artery disease.

Aged↗
PubMed2006

Effects of endogenous spatial attention on the detection and discrimination of spatial frequencies.

Two experiments were designed to explore the relationship between visual attention and spatial-frequency processing using a cuing paradigm. In both experiments, the targets were a sharp-edged line segment with high spatial frequencies present and a blurred line segment with only low spatial frequencies present. In each trial an endogenous cue appeared at fixation indicating the probable location, left or right, in which a stimulus would appear. In experiment 1, a typical cuing effect was found with simple reaction times (RTs) for detecting the stimuli being faster when they appeared at a cued (ie attended) compared to an uncued (ie unattended) location. In experiment 2, choice RTs were measured, with participants indicating whether the sharp-edged line segment or the blurred line segment was presented in each trial. In this case, when it was necessary to process the spatial-frequency content of the stimuli, RTs were significantly faster at the attended location only for the sharp-edged line segment. For the blurred line segment without high spatial frequencies, RTs did not differ for attended and unattended locations. The results indicate that endogenous spatial attention interacts differently with high-spatial-frequency and low-spatial-frequency selective mechanisms depending on whether the task is to detect a stimulus or identify it on the basis of its spatial-frequency content.

Adult↗
PubMed2006

Schizophrenia and red light: fMRI evidence for a novel biobehavioral marker.

Previous research has demonstrated the ability of diffuse red light to suppress activity in the magnocellular (M) visual pathway. An earlier psychophysical study found that a subset of nonpsychotic relatives of persons with schizophrenia showed the opposite effect when compared to healthy adults (Bedwell et al., 2003), suggesting a novel biobehavioral marker for the disorder. The present study attempted to replicate and explore the mechanism for this effect using fMRI. Results provide physiological evidence that the M pathway response to red light is in the opposite direction than expected in a subset of nonpsychotic relatives of persons with schizophrenia.

Adult↗
PubMed2005

Endothelial injury and acquired aspirin resistance as promoters of regional thrombin formation and early vein graft failure after coronary artery bypass grafting.

OBJECTIVE: The predominant mechanism of early graft failure after coronary artery bypass grafting remains in doubt. Aspirin administered in the initial hours after coronary artery bypass grafting improves graft patency, implicating prostanoid synthesis in the pathogenesis. We hypothesized that synergy between endothelial disruption in the venous conduit and aspirin resistance would cause vein graft failure. METHODS: Aspirin resistance, defined by diagnostic findings on at least two of three separate assays, was serially assessed in 225 patients undergoing off-pump coronary artery bypass grafting. Endothelial cell integrity was determined in surplus segments obtained from 408 vein grafts. The deposition of intraluminal thrombin within the vein was determined by comparing serum F1.2 levels between the coronary sinus and the aorta after grafting. Intraoperative blood flow in the grafts was measured with transit-time technology, and patency was assessed with electrocardiographically gated multichannel computed tomographic coronary angiography on day 5. Aspirin was the sole antithrombotic agent used during the study. RESULTS: Thrombosed grafts (16/408) showed more endothelial cell loss at the time of grafting than did those grafts that remained patent (10.8% +/- 21.5% vs 51.4% +/- 39.1% integrity, P < .01). Aspirin resistance occurred in 67 patients (30%). Graft thrombosis was associated with aspirin resistance (P < .04) and reduced endothelial integrity (P < .01). These factors coexisted in 14 of 16 grafts that failed and were associated with elevated coronary sinus F1.2 levels. CONCLUSION: Aspirin resistance and relatively compromised venous endothelial cell integrity together marked patients whose vein grafts failed within days after off-pump coronary artery bypass grafting. These observations form a basis for identifying patients at risk and developing approaches to prevent vein injury or to selectively intervene in high-risk circumstances.

Aged↗
PubMed2005

A novel approach to tricuspid valve replacement: the upside down stentless aortic bioprosthesis.

BACKGROUND: Tricuspid valve replacement (TVR) is a rarely needed operation. Choices between mechanical and biological prosthesis still generate controversy. We present our initial clinical experience with a stentless aortic root placed inverted in the tricuspid annulus. METHODS: Between August 2000 and September 2003, TVR for severe tricuspid insufficiency was performed in 8 patients. Indications were infective endocarditis (7) and iatrogenic damage (1). Mean age was 42.2 years old (20 to 58 years old). Five patients were male and 3 patients had a concomitant procedure (mitral valvuloplasty, coronary bypass grafting, and aortic valve replacement). A stentless aortic root, size 27 mm (n = 5) or 29 mm (n = 3) was placed inverted in the tricuspid position after the valsalva sinuses were scalloped. Interrupted 4-0 polypropylene sutures were used between the tricuspid valve annulus and the sewing ring. The struts equivalent on the stentless valve were anchored to the septal, anterior and posteroinferior wall of the right ventricle using 5-0 PTFE pledgeted sutures. RESULTS: Hospital survival was 100% and mean hospital stay was 12.5 days (3 to 18 days). Intraoperative and follow-up echocardiograms revealed no stenosis or insufficiency. Mean follow-up was 17.2 months (1-38 months). There were 3 late deaths due to continued IV drug use (n = 2) and end-stage renal failure (n = 1). CONCLUSIONS: This is a novel surgical alternative for a very high risk population. Potential advantages over current options include minimization of blood contact with nonbiological surfaces, preservation of annular motion, freedom from anticoagulation, and a theoretical lower rate of calcification.

Adult↗
PubMed2005

A multi-institutional experience with the CryoMaze procedure.

BACKGROUND: The Cox Maze III operation remains the gold standard for the surgical treatment of atrial fibrillation (AF). We report our experience using a flexible argon-powered metal cryoprobe for creation of the complete Cox-Maze III lesion set in patients with AF (the CryoMaze operation). METHODS: Beginning July 2002, 38 patients underwent the CryoMaze operation. Two patients had isolated CryoMaze procedures, whereas 36 patients had the CryoMaze performed in combination with coronary, valvular, or aortic surgery. All patients had electrocardiographic follow-up. Atrial fibrillation was continuous in 79%. Mean duration of AF before operation was 48 months. RESULTS: There were no complications related to the use of cryoenergy. There was 1 hospital death (2.6%) and no late deaths. At a mean follow-up of 12 months, 35 of 37 patients (95%) were in normal sinus rhythm. One patient required pacemaker implantation 3 months after surgery, and 1 patient refused follow-up. There have been no early or late thromboembolic events. CONCLUSIONS: The CryoMaze operation reliably cures atrial fibrillation at medium term follow-up, with rates identical to those reported for the classic Cox-Maze III operation.

Adult↗
PubMed2003

The magnocellular visual system and schizophrenia: what can the color red tell us?

Previous research has suggested that genetic loading for schizophrenia is related to a dysfunctional magnocellular (M) subcortical visual pathway-responsible for processing movement and location. However, data substantiating this mechanism remains inconclusive. The present study used a novel technique to selectively suppress the M system in order to investigate the impact of genetic loading for schizophrenia on its functioning. A visual backward masking task was administered to 28 healthy first-degree relatives of persons with schizophrenia and 31 healthy controls. The task was administered on both a red and neutral background, as diffuse red light has been shown to selectively suppress the M system in basic vision research. On a location condition of backward masking, controls demonstrated reduced accuracy on the red compared to the neutral background. In contrast, relatives did not display differential performance between the two backgrounds. The differential effect on the two groups appears to be attributable to a difference in activity of the M pathway. Performance in the relatives was consistent with the notion of a hyperactive M pathway.

Adult↗
PubMed2002

Management of traumatic aortic rupture: a 30-year experience.

OBJECTIVE: To present the authors' 30-year experience with traumatic aortic rupture (TAR). SUMMARY BACKGROUND DATA: TAR is a highly lethal injury. Most institutions manage a small number of cases, and most surgeons receive only modest exposure during training. METHODS: Between 1971 and 2001, the authors operated on 219 patients with a diagnosis of TAR. Diagnosis of TAR since 1994 has been based exclusively on the use of contrast-enhanced spiral computed tomography, with angiography reserved for equivocal cases (periaortic mediastinal hematoma without aortic wall abnormalities). Patients were divided according to surgical technique. Eighty-two patients (group A) were operated on with a clamp-and-sew technique. Sixty-four patients (group B) underwent surgery with the use of a passive shunt, and 73 patients (group C) were treated using heparin-less partial cardiopulmonary bypass. RESULTS: Mortality was 18 patients for group A (21.9%), 23 patients for group B (35.9%), and 13 patients for group C (17.8%) (P =.03). Paraplegia occurred in 15 of 64 survivors in group A (23.4%), 7 of 41 survivors in group B (17%), and 0 of 60 survivors in group C ( P=.0005). Aortic occlusion without lower body perfusion for longer than 30 minutes (P =.004) and surgical technique without lower body bypass support (P =.0005) were associated with paraplegia. CONCLUSIONS: Surgery for TAR based on spiral computed tomography screening and diagnosis is reliable. The use of heparin-less distal cardiopulmonary bypass in the authors' hands is safe and is associated with a reduced incidence of paraplegia.

Adolescent↗
PubMed2002

No sex differences in contrast sensitivity and reaction time to spatial frequency.

This study investigated the possibility of sex differences in spatial frequency processing by measuring contrast sensitivity and reaction time to spatial frequency in the same 20 men and 20 women. This is the first study to investigate sex differences in reaction time to spatial frequency and the first to study sex differences in contrast sensitivity and reaction time within the same participants. No sex differences were found in either contrast sensitivity or reaction time measures, suggesting that women and men process spatial frequency information similarly.

Adolescent↗