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Biomedical subjects

L S Annest

Publications and source records attributed to L S Annest.

7 recordsLinked to original sources
PubMed1986

Pericardial closure.

Closure of the pericardium after operation for coronary bypass is recommended. It affords protection for the right ventricle and overlying bypass grafts if repeat sternotomy is necessary, and may decrease the incidence of tamponade. A mild compressive effect on the heart has been noted at the time of pericardial closure that does not appear to affect clinical outcome. Hemodynamic studies support this impression. The supracardiac portion of this layer is not closed, and permits use of internal mammary artery conduits. Pericardial closure is not feasible in all instances, however. The need for increased filling pressures, the anticipation of cardiac rather than mediastinal postoperative bleeding, and occasional interference with the course of internal mammary pedicles may preclude closure.

Cardiac Tamponade↗
PubMed1986

Reoperation without medical records: avoidable?

Coronary bypass graft reoperations are performed at increased risk if prior operative records are unavailable. A durable record of the operation, carried by the patient, may offer the most rapid access to this information.

Coronary Artery Bypass↗
PubMed1985

Perioperative ischemic injury after coronary bypass graft surgery.

Two hundred twelve patients who underwent isolated coronary bypass graft surgery were prospectively evaluated for perioperative ischemic injury. All patients underwent preoperative and postoperative testing with technetium 99m pyrophosphate first-pass ventriculography combined with myocardial uptake scans, 12-lead electrocardiography, and serial creatinine phosphokinase MB determination. Fifteen percent of the patients had ischemic injury with at least two test results positive, but only 4 percent had positive results of all three tests. No single test proved adequate. Enzyme levels were highly sensitive and had value as a screening test. The electrocardiogram was specific but only moderately sensitive. The single best test was the radionuclide scan with good sensitivity and no false-positive results. All three tests are required to rigorously diagnose ischemic injury.

Coronary Artery Bypass↗
PubMed1983

Coronary artery disease following mediastinal radiation therapy.

Coronary artery disease occurred in four young men (mean age 41 years) who had received curative irradiation therapy for mediastinal malignancies 12 to 18 (mean 15) years previously. None was at high risk for developing coronary artery disease by Framingham criteria. Angiography demonstrated proximal coronary artery disease with normal distal vessels. Distribution of the lesions correlated with radiation dosimetry in that vessels exposed to higher radiation intensity were more frequently diseased. Three patients had coronary bypass grafting for intractable angina and are asymptomatic at 10 to 43 months. A total of 163 patients underwent mediastinal irradiation for lymphoma or thymoma between 1959 and 1980. Among the 29 who survived 10 or more years, five (18%) developed severe coronary artery disease, implicating thoracic radiotherapy as an important risk factor. Because of the importance of mantle irradiation in the treatment of lymphomas, the prevalence of these neoplasms, and the survival patterns following treatment, many long-term survivors may be at increased risk for the development of coronary artery disease. Recognition of the relationship between radiotherapy and coronary artery disease may lead to earlier diagnosis and more timely intervention. Standard surgical treatment may be particularly beneficial because of the relative youth of most of these patients and because the proximal distribution of typical lesions increases the likelihood of complete revascularization.

Adult↗
PubMed1982

Use of a split-sheath vein introducer for subclavian venipuncture in the placement of silicone catheters for chronic venous access.

The technique of venous cutdown for placement of silicone catheters can be difficult, uncomfortable for the patient, and very time-consuming. Adapting a technique used for the placement of permanent transvenous pacemaker leads, subclavian venotomy and a split-sheath dilator can be used for direct placement of large-bore catheters into the superior vena cava. This approach decreases patient discomfort and the likelihood of infectious or hemorrhagic complications of silicone catheter placement, and has greatly simplified and shortened this procedure.

Catheterization↗
PubMed1979

The results of surgical treatment of bowel obstruction caused by peritoneal carcinomatosis.

Thirty-four patients with malignant bowel obstruction have been evaluated with particular regard to survival, success of decompression and incidence of reobstruction. In patients with intestinal obstruction caused by peritoneal carcinomatosis the following have been determined: 1) surgery is not urgent, 2) surgical decompression usually is possible, 3) surgical decompression may facilitate additional adjuvant therapy, and 4) death is usually not caused by reobstruction after surgical decompression.

Adult↗