Biomedical subjects
Publications and source records attributed to M C Robinson.
During the first 18 months of its establishment, the cardiac transplant unit at Green Lane Hospital has undertaken 10 transplant operations. Fifty potential recipients have been referred and 15 were accepted for transplantation. Of the ten who have had surgery, 2 are making good progress at school, 1 is active at home and 5 have returned to work. Two patients have died.
Twelve patients with refractory symptomatic atrial arrhythmias were evaluated for closed chest ablation and permanent pacemaker implantation. This was successful in nine of the 11 patients in whom ablation was attempted. Two of these nine patients required two separate ablative procedures. Three patients underwent open surgical ablation. Electrical ablation had failed in two of these patients and had not been undertaken in the remaining patient (inadequate His recording). The mean His amplitude and delivered energy levels were not significantly different between the two groups. Complications occurred in three patients and were minor. Because ventricular arrhythmias and late sudden death are recognised complications in a minority of patients undergoing closed chest ablation of the A-V junction it should be restricted to patients with symptomatic atrial arrhythmias who have failed maximal medical treatment.
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Aortic valve replacement using human allograft valves is a well established procedure, following which histological evidence of a host-graft interaction is seen. This varies in intensity, depending on the types of sterilizing and storage agents to which the allograft is exposed prior to insertion. A canine experimental model which enables study of these tissue ingrowth patterns in variously treated allografts has been devised. The technique is described in detail.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
A case of acute traumatic dissection of the right internal mammary artery is presented in a patient who had both IMAs grafted for recurrent angina 10 years after initial vein coronary revascularisation. The event was mistaken for spasm, but because of severe circulatory collapse no time was available to treat the patient appropriately. The purpose of this report is to facilitate the early recognition and avoidance of this potentially fatal complication.
Examination of saphenous vein (SV) and internal thoracic artery (ITA) endothelium at the time of coronary bypass surgery has confirmed the known susceptibility of SV to endothelial cell loss during preparation for grafting. In contrast the ITA showed only minimal cell loss. An ultrastructural morphometric analysis of the abluminal surface of the endothelium of both vessels showed significant differences in the numbers and depth of penetration of cytoplasmic processes or folds. Whereas the SV, perfusion-fixed at 110 mmHg, possessed relatively few (15/100 micron) and shallow (less than 1 micron deep) processes the ITA had significantly more (27/100 micron) and deeper (18% greater than 1 micron) processes. The ITA endothelial cells were also smaller and thicker. We suggest that the differences in the numbers and depth of the processes, which are believed to play a role in endothelial attachment, may account for the differing susceptibility of the two vessels to endothelial damage during grafting. This in turn correlates with the known susceptibility of SV grafts and resistance of ITA grafts to atherosclerotic changes.