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Biomedical subjects

M Goormastic

Publications and source records attributed to M Goormastic.

At least 55 records · Page 3Linked to original sources
PubMed1988

A multivariate analysis of the risk of cytomegalovirus infection in heart transplant recipients.

Thirty-four consecutive heart transplant recipients were studied over a two-year period for evidence of cytomegalovirus (CMV) infection. Twenty-three episodes of CMV infection were identified; 19 of these occurred within 120 d after transplantation and were statistically analyzed. Fifteen potential risk factors were evaluated, including the following: pretransplant CMV serological status of donor and recipient; recipient's age, sex, race, and cardiac disease; number and type of blood products transfused; type and intensity of immunosuppression; occurrence of rejection; and leukopenia. The Cox proportional hazards model identified both greater than average steroid dosage and positive recipient CMV serology as significant risk factors for CMV infection (P = .014 and .048, respectively). In a separate analysis, however, only greater than average steroid dosage was associated with clinically significant CMV infection (P = .005).

Adrenal Cortex Hormones↗
PubMed1988

A multivariate analysis of risk factors for pneumonia following cardiac transplantation.

Fifty cardiac transplant recipients were followed over a 34-month period for evidence of pneumonia that developed in twelve patients. Potential risk factors evaluated fell into three categories: demographic (age, sex, race, and underlying cardiac disease); pretransplant status (hospitalized, intubated, pulmonary infiltrate, requirement for antibiotics, or the need for a ventricular assist device); and posttransplant therapy (amount and type of blood products, prolonged endotracheal intubation or reintubation, use of ventricular assist devices, immunosuppressive protocols, lymphocyte subset ratios, and occurrence of rejection, leukopenia, or CMV infection). The Cox proportional hazards model identified posttransplant reintubation (P = 0.009) and the use of protocols employing larger steroid dosages (P = 0.02) as significant risk factors for pneumonia. In a separate analysis, the occurrence of pneumonia was shown to be a significant risk factor for mortality (P = 0.018).

Heart Transplantation↗
PubMed1988

Survival of patients with mild angina or myocardial infarction without angina: a comparison of medical and surgical treatment.

A group of 390 patients with mild angina pectoris or myocardial infarction without subsequent angina had early coronary bypass operation. Five year survival was significantly higher (95.4%) than in a similarly selected medically treated group (88.5%) reported before. One death occurred in the 30 day postoperative period. Five year survival in the 179 patients who had internal mammary artery grafts was 98.9%. Survival for patients with mild angina and satisfactory left ventricular function (96.2%) was significantly higher than in the medical subset (91.3%). In the patient population studied, five year survival was higher in patients who had early bypass operations than in those who did not.

Adult↗
PubMed1988

Aortic valve replacement combined with myocardial revascularization. Late results and determinants of risk for 471 in-hospital survivors.

Among 500 patients consecutively undergoing primary aortic valve replacement combined with coronary bypass grafting from 1967 to 1981, there were 29 (5.8%) perioperative deaths. Follow-up of the late survivors ranged from 43 to 181 months (mean 85 months); actuarial survival rates were 88%, 77%, and 52% and event-free survival rates were 80%, 65%, and 32% at 2, 5, and 10 postoperative years. Cox proportional hazard analyses were used to identify determinants of late risk. Patient-related variables associated with decreased late survival rates included advanced age, cardiothoracic ratio 50% or greater, and preoperative New York Heart Association class III or IV symptoms. Moderate or severe impairment of left ventricular function as determined by angiography and advanced age were variables that decreased late event-free survival rates. Patients with bioprostheses had better survival rates (p less than 0.001) and event-free survival rates (p = 0.012) than did patients with mechanical valves. Analyses of subgroups according to the type of valve and postoperative anticoagulant management showed that both survival and event-free survival rates were decreased for patients with mechanical valves who were not taking warfarin and were enhanced for patients with bioprostheses who were not taking warfarin.

Aged↗
PubMed1988

Does bilateral internal mammary artery grafting increase surgical risk?

The risk of bilateral internal mammary artery grafting was studied in three groups of patients who were computer matched for recognized risk factors: year of operation, age, gender, extent of coronary artery disease, left ventricular function, completeness of myocardial revascularization, and history of congestive heart failure. The patient groups differed in the fact that they received veins only, one internal mammary artery graft, or two internal mammary artery grafts. The operative mortality rates for these three groups were 1.8%, 0.3%, and 0.9%, respectively (no significant difference). Analysis of perioperative morbidity demonstrated no significant differences except for a slight increase in transfusion requirements in the group receiving two internal mammary artery grafts (p = 0.04). None of the patients with only vein grafts had wound complications. One patient in the group with one internal mammary artery graft had a wound complication (0.03%). Eight patients receiving two internal mammary artery grafts had wound complications (2.4%) (p = 0.002). The prevalence of wound complications in patients with diabetes mellitus was 5.7% and in those without diabetes mellitus, 0.3% (p = 0.01). The prevalence of wound complications in patients less than 60 years of age was 0.2%, in patients in their 60s, 1.6%, and in patients older than 70, 3.1% (p = 0.01). Multivariate logistic regression analysis identified diabetes mellitus and age and not bilateral internal mammary artery grafting as risk factors for wound complications. We conclude that bilateral internal mammary artery grafting does not increase surgical mortality and increases surgical morbidity by a slight increase in the mean transfusion requirement.

Blood Transfusion↗
PubMed1987

Renal transplantation for end-stage polycystic kidney disease.

From 1963 to 1984, 56 renal transplants were performed in 51 patients with end-stage renal failure due to autosomal dominant polycystic kidney disease (ADPKD). There were 49 cadaver and 7 living-related transplants. Overall patient and graft survival was 88 per cent and 66 per cent at one year, 59 per cent and 49 per cent at five years, respectively. There was no significant difference in patient or graft outcome with cadaver versus living-related donor kidneys. One-year graft success with and without pretransplant bilateral nephrectomy (BN) was 78 per cent versus 58 per cent, respectively (n.s.). Patient survival after return to dialysis after graft loss was not compromised by the earlier performance of BN. In patients who did not undergo pretransplant BN, there were no complications from the retained native kidneys after transplantation. In cadaver recipients, the two-year graft success rate with and without preliminary blood transfusions was 54 per cent versus 61 per cent, respectively (n.s.). Cadaver graft survival with and without adjunctive antilymphocyte globulin (ALG), excluding 3 recipients managed with cyclosporine, was 88 per cent versus 50 per cent at one year, and 70 per cent versus 32 per cent at five years, respectively (p less than 0.05). This beneficial effect of ALG was still evident when only transfused cadaver recipients were analyzed and was achieved with no resulting compromise in patient survival. Follow-up computerized tomography (CT) scanning of the transplant kidney in 10 recipients with a long-term (1-9 years) functioning allograft showed no evidence of recurrent ADKPKD.

Adult↗
PubMed1987

Measuring common public misperceptions about cancer.

A 32 item criterion-referenced knowledge questionnaire was developed to measure the level of common misperceptions about the nature of cancer and cancer treatments held by the public. A sample of 353 respondents were contacted and agreed to complete the questionnaire through a random telephone survey technique (Random Digit Dialing). An extensive analysis of the responses to the survey was performed and supported the validity and reliability of the instrument. Results of the survey indicate that the prevalence of misperceptions held by the public is high. The total mean score correct on the questionnaire was only 17.2 out of a possible 32. No differences were found for total mean score on the questionnaire based on the respondents' age, sex, or whether they or someone close to them had ever had cancer. Statistically significant differences, however, were found for the total mean score on the questionnaire based on the respondent's level of education and how they responded to two attitudinal questions on the questionnaire. The most prevalent misperceptions about cancer related to questions about side effects from the treatment for cancer, followed by questions about proven cancer treatments and unproven or quack cancer treatments. The least prevalent misperceptions about cancer related to questions about the nature of cancer.

Adult↗
PubMed1987

Fifteen hundred coronary reoperations. Results and determinants of early and late survival.

Fifteen hundred consecutive patients undergoing a first reoperation for coronary revascularization were reviewed to determine early and late results and predictors of survival. Patients were subdivided into cohorts on the basis of the year of reoperation: Group A (1967 to 1978, 436 patients); Group B (1979 to 1981, 439 patients); and Group C (1982 to 1984, 625 patients). Overall operative mortality was 3.4% (51 deaths): 4.6%, 2.3%, and 3.4% for Groups A, B, and C, respectively. Group C had significantly more women (p = 0.01) and patients with triple-vessel disease, left main coronary artery stenosis (greater than or equal to 50%), abnormal left ventricular function, age greater than or equal to 70 years, and graft failure as a surgical indication (all p less than 0.001). The mean interval between operations increased from 50 months for Group A to 84 months for Group C. At reoperation, Group C patients received more grafts, more internal mammary artery grafts, and had a higher prevalence of complete revascularization (all p less than 0.001). Univariate and multivariate analyses identified left main stenosis (p less than 0.0001), Class III or IV symptoms (p = 0.0002), advanced age (p = 0.0006), Group A (p = 0.02), and incomplete revascularization (p = 0.004) as predictors of increased in-hospital mortality. Follow-up of in-hospital survivors (mean interval 54 months, range 13 to 171 months) documented a 5 year survival rate of 90% and a 10 year survival rate of 75%. Multivariate testing identified advanced age (p less than 0.0001), hypertension (p less than 0.0001), and abnormal left ventricular function (p less than 0.0001) as predictors of decreased late survival.

Aged↗
PubMed1987

Repeat mitral commissurotomy: long-term results.

Fifty-three patients underwent reoperation for open mitral commissurotomy (OMC) with one (1.9%) in-hospital death. The previous mitral operation was an OMC in 14 patients and a closed commissurotomy in 39. Mean age at the time of repeat OMC was 46 years (range 27 to 64), and NYHA functional class was II in 19 patients, III in 31, and IV in three. Follow-up of the 52 in-hospital survivors at a postoperative interval of 1 to 23 years (mean 10) documented 13 late deaths (mean interval 117 months, range 17 to 209) and survival of 96%, 83%, and 63% at 5, 10, and 15 postoperative years, respectively. Sixteen patients underwent subsequent mitral valve surgery (one OMC and 15 mitral valve replacements) 1 to 223 months after repeat OMC (mean 99), three patients within 5 years of repeat OMC. Reoperation-free survival was 94%, 74%, and 52% at 5, 10, and 15 postoperative years, respectively. Univariate testing did not document any correlation between age, functional class, rhythm, and either survival or reoperation-free survival. When feasible, repeat OMC can afford patients excellent long-term survival and relative freedom from prosthetic valve replacement.

Adult↗
PubMed1986

Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events.

We compared patients who received an internal-mammary-artery graft to the anterior descending coronary artery alone or combined with one or more saphenous-vein grafts (n = 2306) with patients who had only saphenous-vein bypass grafts (n = 3625). The 10-year actuarial survival rate among the group receiving the internal-mammary-artery graft, as compared with the group who received the vein grafts (exclusive of hospital deaths), was 93.4 percent versus 88.0 percent (P = 0.05) for those with one-vessel disease; 90.0 percent versus 79.5 percent (P less than 0.0001) for those with two-vessel disease; and 82.6 percent versus 71.0 percent (P less than 0.0001) for those with three-vessel disease. After an adjustment for demographic and clinical differences by Cox multivariate analysis, we found that patients who had only vein grafts had a 1.61 times greater risk of death throughout the 10 years, as compared with those who received an internal-mammary-artery graft. In addition, patients who received only vein grafts had 1.41 times the risk of late myocardial infarction (P less than 0.0001), 1.25 times the risk of hospitalization for cardiac events (P less than 0.0001), 2.00 times the risk of cardiac reoperation (P less than 0.0001), and 1.27 times the risk of all late cardiac events (P less than 0.0001), as compared with patients who received internal-mammary-artery grafts. Internal-mammary-artery grafting for lesions of the anterior descending coronary artery is preferable whenever indicated and technically feasible.

Coronary Artery Bypass↗
PubMed1986

Reoperations for valve surgery: perioperative mortality and determinants of risk for 1,000 patients, 1958-1984.

One thousand consecutive cardiac reoperations for valve surgery in 897 patients were reviewed to determine in-hospital mortality and indicators of risk. Subgroups based on the number of previous cardiac procedures and the valve or valves replaced or repaired at reoperation (aortic valve, mitral valve, tricuspid valve, or multiple valves and mortality [deaths/number of procedures (% mortality)]) for those subgroups are as follows: (Table: see text) Predictors of increased risk for a first aortic valve reoperation were advanced age (p = .0002), endocarditis (p = .0018), female sex (p = .014), impaired left ventricular function (p = .039), and number of coronary vessels obstructed by 70% or more (p = .055). For a first mitral valve reoperation, the predictors were advanced age (p less than .0001), preoperative shock or cardiac arrest (p = .01), previous aortic or tricuspid valve operations (p = .02), type of mitral valve procedure (risk for repair of periprosthetic leak was greater than mitral valve replacement which was greater than mitral valve-conserving operation [p = .05]), and impaired left ventricular function (p = .059). For a first multiple valve reoperation, the predictors were diabetes (p = .04) and ascites (p = .02), whereas patients undergoing mitral valve replacement and tricuspid valve operations were at decreased risk (p = .01). Comparison of second reoperations with first reoperations indicates risk increases for multiple operations (p = .01) but not for aortic or mitral valve procedures. Rereplacement of a prosthesis (p = .007), coronary bypass grafting at reoperation (p = .006), and advanced age (p = .06) increased the risk for second reoperations. Age is the most consistent predictor of risk for patients undergoing valve reoperations.

Aortic Valve↗
PubMed1986

Detrimental effect of cyclosporine on initial function of cadaver renal allografts following extended preservation. Results of a randomized prospective study.

We report herein the results of a randomized prospective trial comparing maintenance cyclosporine (CsA)-prednisone immunosuppression to a regimen of azathioprine-prednisone-antilymphocyte globulin (ALG) in cadaver renal transplant recipients. Fifty-six patients were entered into this study with 31 assigned to the ALG group and 25 to the CsA group. These two groups were well matched for most major determinants of graft outcome and the mean renal preservation time was 37 hr in each group. The incidence of acute tubular necrosis (ATN) was high in both groups (58% ALG, 72% CsA, NS). There were five cases of primary nonfunction in the CsA group and only one in the ALG group (P = .05). Of the kidneys that functioned, the mean serum creatinine nadir (1.5 vs. 2.2 mg/dl, P = .06) and the mean number of days to reach the serum creatinine nadir (24.2 vs. 43.3 days, P = .03) were both less in the ALG group. The actuarial one-year graft survival rate in the ALG and CsA groups is 78% and 48%, respectively (P less than .05). This difference is mainly due to the large number of primary nonfunctioning grafts in the latter group, which we attribute to the effect of CsA's nephrotoxicity superimposed on renal ischemia incurred prior to transplantation. These data emphasize that, in order to realize the full benefit of CsA in cadaver transplantation, renewed emphasis must be placed on minimizing ischemic renal damage.

Adolescent↗
PubMed1986

Survival of non-surgical patients with mild angina or myocardial infarction without angina.

A group of 408 catheterised patients who had mild angina or myocardial infarction without angina was selected in conformity with the criteria for entry into a previously reported randomised trial. Medical treatment had been chosen initially by the cardiologist, referring physician, or the patient, although 27% had late operation. Five year survival rates were 91% and 72% for mild angina with high or low ejection fractions and 85% for those who had myocardial infarction without subsequent angina. Survival rates were 95%, 88%, and 80% for one, two, and three artery disease respectively. For patients who had ejection fractions of at least 0.50, five year survivals were 95%, 89%, and 83% for one, two, and three artery involvement respectively. Good left ventricular function, single artery disease, and a short history were favourable prognostic variables in multivariate analysis of patients who had angina pectoris. Statistical methods of dealing with patients who had late operation influenced calculated survival, especially for patients at relatively high risk. The lower survival rates for the whole group and most subsets compared with survival rates in the randomised trial may be of clinical importance.

Angina Pectoris↗
PubMed1986

Lumbar herniated disk disease and canal stenosis: prospective evaluation by surface coil MR, CT, and myelography.

Sixty patients with suspected lumbar herniated disk and/or canal stenosis were studied prospectively with surface coil MRI, CT, and/or myelography, and the results were compared with the surgically confirmed abnormality. Forty-eight patients had lumbar surgery at 62 levels. There were no negative explorations. Thirty-nine patients had a myelogram and CT. Thirty of the CTs were performed following the injection of metrizamide for myelography. Nine patients had a CT without intrathecal contrast material 1 to several days before the myelogram. Six patients had myelography only, and three patients had CT only. All studies were evaluated for the location and type of disease in a forced choice fashion. Independent of the surgically correlated levels, there was 86.8% agreement between the MR and CT studies in all patients at 151 levels and 87.2% agreement between MR and myelography at 218 levels. At the operative levels, there was 82.6% agreement between MR and surgical findings for both type and location of disease; 83% agreement between CT and surgical findings; and 71.8% agreement between myelography and surgical findings. There was 92.5% agreement when MR and CT were used jointly, and 89.4% agreement when CT and myelography were used jointly. The results of this study indicate that a technically adequate MR examination was equivalent to CT and myelography in the diagnosis of lumbar canal stenosis and herniated disk disease. CT and MR can be complementary studies, and surface coil MR can be viewed as an alternative to myelography.

Adult↗
PubMed1986

Perioperative risk of bilateral internal mammary artery grafting: analysis of 500 cases from 1971 to 1984.

The records of the first 500 patients (420 men, 80 women, mean age 55 years, range 24 to 78) undergoing bilateral internal mammary artery (IMA) grafting were reviewed to determine in-hospital morbidity and mortality. Sixty patients (12%) had had previous cardiac operations and 130 (26%) previous saphenous vein removal. From two to seven total grafts (mean 3.2) were performed, including 595 IMA grafts to the anterior descending or diagonal artery, 355 to the circumflex, and 105 to the right coronary system. To assess changing risks, the first 125 patients (group A, 1971 to 1982) were compared with the next 375 (group B, 1982 to 1984). Major complications in groups A and B included stroke, four (3.2%) vs ine (2.4%); wound complications requiring reoperation, three (2.4%) vs five (1.3%); prolonged (greater than 48 hr) respiratory care, seven (5.6%) vs 19 (5.1%); and death, two (1.6%) vs five (1.3%) (no p value less than .05). Complications significantly less frequent in group B were new Q waves in nine (7.2%) vs 10 (2.7%) in group A (p = .02) and reoperation for bleeding in 17 (13.6%) vs 16 (4.3%) in group A (p = .0003). Logistic regression analysis showed that major complications did not correlate with gender, diabetes, number of grafts, or preoperative left ventricular function but were associated with increasing age (p = .0001) and previous cardiac surgery (p = .009) and were decreased by the use of cardioplegia (p = .002). The excellent long-term patency of IMA grafts, combined with low and decreasing perioperative risk, supports the continued use of bilateral IMA grafting.

Adult↗