Biomedical subjects
Publications and source records attributed to M A Gardner.
Three cases of great vessel injury resulting from blunt chest trauma and associated with posterior dislocation of the sternoclavicular joint are presented. The diagnosis and management including the surgical approach to this uncommon injury are discussed.
An unusual case of pulmonary metastatic chondrosarcoma with intracardiac extension is presented. Echocardiography and right heart catheterization with pulmonary angiography demonstrated that resection using cardiopulmonary bypass was possible in a situation initially considered to be inoperable.
A case of bronchobiliary fistula due to transdiaphragmatic rupture of hepatic echinococcal cyst is described. The importance of excluding associated extrahepatic biliary obstruction is emphasized. Successful treatment involves relief of this obstruction as well as management of both the pleural space and pulmonary complications.
A case of bronchial infection with Syngamus laryngeus (Gapeworm) in a 42-year-old woman is described. Following presentation with chronic cough, haemoptysis and weight loss, a pair of worms was removed at bronchoscopy, with resolution of symptoms.
A series of 150 mediastinoscopic examinations, performed at The Prince Charles Hospital, Brisbane, is reported. The procedure was employed as a diagnostic aid in the care of patients known to be suffering from disease processes involving the superior mediastinum, and as a preoperative assessment in a group of patients known to have, or suspected of having, bronchogenic carcinoma, There was no mortality. The morbidity rate was 2%.
With the advent of direct coronary artery revascularization, the high mortality rate from cardiac disease associated with carotid endarterectomy can be favorably altered by simultaneous or staged revascularization for combined lesions. The choice for combined or sequential procedures is determined by the severity of the disease both clinically and anatomically in each system. Review of 32 patients with both severe coronary and carotid occlusive disease established that selective surgical intervention has been successful, with no deaths and only minimal morbidity. Simultaneous revascularization was carried out in 8 patients with preinfarctional angina, significant left main lesion or triple vessel disease producing a functional lesion of the left main coronary artery, and tight carotid lesion. Staged operations were performed in the remaining 24 patients. Priority of staging was determined by the extent of disease in each system.
This paper discusses the use made of the antigenic specificity of malignant tumours in the diagnosis and subsequent management of a patient with secondary malignant disease who had previously been treated for both carcinoma of the breast and malignant melanoma. A comparatively simple, rapid test (leucocyte adherence inhibition) was used to determine the patient's antitumour immunoreactivity. Cell-mediated immunity against both types of tumour was detected, but this was accompanied by serum-blocking factor corresponding to melanoma only, which indicated that the secondary malignant disease was melanoma.
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BACKGROUND: Patients with an abdominal aortic aneurysm (AAA) have a high prevalence of coronary disease and are at risk for cardiac events. This may offset the prognostic benefit of surgical repair. We investigated whether preoperative exercise equilibrium radionuclide angiography (ERNA) could be used to identify patients at high risk for cardiac events after successful AAA repair. METHODS: Between 1990 and 1995, 173 patients with an AAA were referred for supine bicycle exercise ERNA preoperatively. Follow-up information was obtained from a questionnaire sent to each patient's family physician. Cardiac events were defined as cardiac death or nonfatal myocardial infarction. RESULTS: A total of 139 patients were able to exercise and did not die or suffer myocardial infarction perioperatively. The median follow-up period was 3.8 years. Diabetes mellitus, an exercise ejection fraction (EF) below 0.50, and a fall in EF with exercise were univariable predictors of cardiac risk during the follow-up period (P < .05). On multivariable analysis, diabetes mellitus (risk ratio [RR], 6.9; 95% CI 1.5 to 32.0) and an EF fall (RR, 4.1; 95% CI 1.5 to 11.4) emerged as the most important predictors. CONCLUSIONS: Exercise ERNA predicts long-term cardiac events in patients being considered for elective AAA repair. Such predictive information may influence the decision to operate, for example, on small unthreatening aneurysms, or lead to invasive cardiological management to minimize risk.
BACKGROUND: The advantageous design of the Cryolife-O'Brien stentless porcine aortic valve permits specific quick, easy, supravalvular implantation using single layer continuous 3-0 polypropylene suture. The advantages, contraindications, and implantation errors to avoid are detailed. The use of this valve for aortic valve replacement in the elderly population has been directed to proving its efficacy and establishing its grounds for durability while maintaining all of the advantages of a stentless tissue valve. METHODS: From December 1992 to September 1998, this valve was used in 240 patients (mean age 73 years: 15% > 80 years), 45% receiving associated coronary artery grafting (2.4 grafts per patient). Left ventricular (LV) myomectomy was necessary in 12% of patients. Detailed postoperative follow-up (100%) analysis included 650 serial echocardiographic studies. RESULTS: The 30-day mortality was low at 1.2% (3 deaths of 240 elderly patients). Ten patients had late mortality (1.5 months to 5 years), all nonvalve related. No structural failure and one only explant for endocarditis have occurred. Echocardiographic analyses have shown low mean transvalvular gradients in relationship to time (8.18 mmHg at 18 months) and to valve size (8.52 mmHg for a 23-mm host aortic annulus). Incompetence has been zero or a trace in 97% of the patients at 21/2 years. No patient over the 6 years shows valve deterioration. CONCLUSION: Six years of experience with this stentless valve in 240 elderly patients has revealed the many advantages of this safe, composite, and truly stentless device that is assembled without the need for Dacron support. Excellent sustained hemodynamics with low gradients, minimal regurgitation, and a good effective orifice have been coupled with low immediate mortality, no intrinsic valve failure, and one explant for endocarditis. Marked LV regression and minimal late valve-related complications confirm the safety and advantages of this stentless valve.