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Biomedical subjects

L A Brewer

Publications and source records attributed to L A Brewer.

12 recordsLinked to original sources
PubMed1990

Radioisotopic pulmonary lobectomy: feasibility study in dogs.

In search for an alternate treatment for inoperable cancer of the lung in humans, we investigated the possibility that introduction of radioactive material into a selected lobe of the canine lung would effectively destroy that lobe without systemic effects or radiation injury to adjacent organs. Ten million ion exchange microspheres labeled with 740 MBq of phosphorus-32 (32P) were injected through a catheter placed in a selected lobar branch of a pulmonary artery in 12 anesthetized dogs. Six additional dogs served as controls and received 10 million microspheres not labeled with 32P. Organs were harvested from 1 wk to 12 mo after injection and examined grossly and histologically. There was progressive organization and contraction of each necrosed 32P treated lobe which was reduced to a scarred remnant by 12 mo, whereas only minimal inflammatory changes occurred in controls. Of the 32P injected dose, 94% remained in injected lobe, 4%-5% in nontargeted lobes and less than 0.08% in blood. Radioactivity in liver, kidneys, spleen, heart, and bone marrow was less than 0.1% for each organ. Thus, large doses of radiation in the order of 1,500 Gy can be effectively delivered to a selected lobe to produce a "radioisotopic pulmonary lobectomy."

Animals↗
PubMed1978

Aortoesophageal fistula.

With the advent of cardiovascular and bypass procedures, aortoesophageal fistula has progressed from the stage of a pathologic curiosity to a treatable lesion. Although the causes of aortoesophageal fistula are varied, a remarkably consistent clinical picture emerges from study of this condition. Chiari's triad of midthoracic pain, sentinel hemorrhage, and a symptom-free interval followed by fatal exsanguination remains the most important clinical finding today. Although contrast esophagography, esophagoscopy, and aortography are important diagnositc aids, immediate left thoracotomy may be the only means of making the diagnosis and saving the patient when hemorrhage is profuse. In most cases (80 per cent of the present series) there is a symptom-free period varying from hours to days from the original sentinel hemorrhage to the final exsanguination. This permits the informed surgeon trained in cardiovascular technics an opportunity to salvage some of these patients. The various methods of aortic and esophageal repair are discussed.

Aorta↗
PubMed1977

Open-heart surgical centers. Standards and monitoring.

This article contains the essence of a report presented to the Council of The American Association for Thoracic Surgery (AATS) by an Ad Hoc Committee on Issues composed of the authors, on October 13, 1976. Because of urgent demand to have this information immediately available, early publication was desirable. However, to have official endorsement of the AATS would have necessitated waiting until April, 1977, the date of the next meeting of the Association. Since this would delay publication of this information for more than one year, it was considered reasonable by the Council that it be published as a free-standing statement of the authors.

Arteries↗
PubMed1976

Technique for using soft, flexible catheter stents in aortocoronary vein bypass operations.

A technique using soft, flexible catheter stents in performing coronary vein bypass surgery is presented which makes small vessel anastomoses easy and assures accuracy of suture placement with clear identification of the vessel lumen and an anastomosis without stenosis. It provides an essentially bloodless field without having to cross-clamp the aorta. The technique has been used to our complete satisfaction in all patients since we first started vein bypass operations in 1970. A review of the last 205 elective aortocoronary bypass grafts in 100 consecutive patients using this technique reveals a mortality of only 1% and an operative and postoperative myocardial infarction rate of 5%. About half the patients had left ventricular dysfunction with elevated end-distolic pressures, and 68% had had previous myocardial infarctions. Seventy percent of the patients are at present asymptomatic, 24% are improved, and only 4% show no improvement over their preoperative status during follow-up of one to three and one-half years.

Adult↗
PubMed1975

A clinical method for detecting subendocardial ischemia after cardiopulmonary bypass.

Subendocardial ischemia with consequent subendocardial necrosis is a frequent cause of death after cardiopulmonary bypass. The problem is caused by an inequity in the oxygen requirements of the subendocardium and the available blood supply. We have developed a means of detecting ischemia early in the postperfusion period. Using an analogue computer, we determine the endocardial viability ratio (EVR). This value may decrease before either systemic or central venous pressure changes. Thus the ratio can reflect early the danger of subendocardial ischemia. Another advantage is that equipment now common in coronary care units can be used to determine the EVR.

Adolescent↗