Biomedical subjects
Publications and source records attributed to O B Harrington.
A 75-year-old man with a Greenfield filter in the inferior vena cava for previous pulmonary emboli had recurrent pulmonary emboli. He was unable to take anticoagulants due to gastric ulcer disease. Contrast studies revealed a large thrombus in the left brachiocephalic vein. A Greenfield filter was placed in the superior vena cava through the right internal jugular vein using the femoral insertion apparatus.
We randomized 400 patients who were scheduled for an elective cardiovascular operation involving median sternotomy to receive cefamandole nafate or cefonicid in a prospective double-blind study. Three hundred fifty-seven patients were evaluable for prophylactic efficacy. Chest wound and donor site infections and early prosthetic valve endocarditis occurred more frequently with cefonicid (11 patients, 6.3%) than with cefamandole (4 patients, 2.2%) (p = 0.05). Three patients, all in the cefonicid group, required sternal debridement to control postoperative deep wound infections. Twenty-five miscellaneous postoperative infections (urinary tract infection, pneumonia, intravenous site infection, bacteremia, sepsis, Clostridium difficile diarrhea) occurred in 16 patients (9.19%) in the cefonicid group and four in 4 patients (2.19%) in the cefamandole group (p = 0.003). These data indicate that cefamandole is superior to cefonicid in preventing both surgical wound infections and miscellaneous nonsurgical infections after cardiovascular operations.
Twenty-one patients undergoing a coronary artery bypass graft operation for the third time were retrospectively reviewed to assess the factors of importance in the management of these patients. The study spans 5.8 years and represents 6.2% of coronary bypass reoperations and 0.6% (21/3500) of total bypass operations during that time. The indication for reoperation was disabling angina pectoris not responsive to medical treatment in 20 patients (95%) and unstable angina pectoris with an intraaortic balloon pump present in one patient (5%). Median sternotomy was used in all and cardiopulmonary bypass in all but one who had an interposition vein graft without cardiopulmonary bypass. Internal mammary artery grafting was used in 86% of patients. There were no operative deaths. One patient died 12 months after his operation. Four patients (19%) required intraaortic balloon pump support postoperatively for up to 6 days. There were no reexplorations for bleeding. One patient required sternal rewiring for an early dehiscence (5%). Respiratory failure occurred in eight patients (38%). Average stay was 4.4 days in the intensive care unit and postoperative hospital stay was 13.7 days. No new Q waves were noted postoperatively. Detailed follow-up was obtained on 18 of the 20 survivors (90%). The two remaining are alive but declined interview efforts. All patients interviewed reported feeling subjectively better than before operation; however 61% of these interviewed continue to have some degree of angina pectoris. One patient has had a late myocardial infarction. This report suggests that the third time coronary bypass can be done with good results when myocardial revascularization is indicated.
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This is an account on combined procedures in 124 patients suffering from arteriosclerotic vessel disease. In order to judge the proceedings and the results the patients were divided up into two groups. in 15 patients (group I) a carotid endarterectomy combined with an aorto-coronary bypass operation was performed; once a subclavian artery stenosis was resected at the same time. One patient of that group died after 31 days (7%). In group II 108 heart valve operations were performed together with a coronary artery revascularisation. Early and late mortality divided up as follows: aortic stenosis 6/44 (14%) respectively 2/44 (5%); aortic insufficiency 1/14 (7%) resp. 0; combined aortic disease 1/8 )13%) resp. 0; mitral stenosis 1/11 (9%) resp. 0; mitral insufficiency 6/26 (23%) resp. 2/26 (8%); combined mitral valve disease 1/2 (50%) resp. 0; three times both valves (aorta, mitral) were replaced without mortality. In our opinion combined procedures, resection of supraaortic artery stenosis respectively cardiac valve operations and aorto-coronary bypass are indicated especially since the functional long-term results are excellent. Though one should consider the high operative risk in patients with mitral insufficiency and combined mitral valve disease.
Early electrode dislodgment from the ventricular apex is a major complication associated with transvenous cardiac pacing. A new lead with flexible tines proximal to the tip electrode has been developed to minimize acute dislodgment incidence. The bipolar tined lead was implanted in 79 patients. This experience was compared to 48 implants of a standard bipolar endocardial lead. Stimulation threshold, sensing, and resistance measurements from both leads were comparable. Although the cephalic vein was the preferred venous route, the jugular vein was needed more often for tined lead insertion than for standard lead insertion. The incidence of early dislodgment with the tined lead was 2.5 percent compared to 8 percent with the standard lead (no significant difference). This preliminary experience can only suggest that the addition of flexible tined leads may reduce early electrode dislodgment.
The results of 53 femoral to tibial artery bypass grafts have been reviewed. All were carried out in an attempt to salvage severely ischemic extremities which resulted from arteriosclerotic occlusive disease involving the femoral, popliteal, and tibial arterial systems as demonstrated by arteriography. Most grafts were done with autogenous vein; however, composite grafts comprised of a Dacron prosthesis and an autogenous vein and homologous veins were used in several patients. The initial salvage rate in these pregangrenous extremities was 74%. Fifty-two percent of the grafts remain patent at this writing, a period of 56 months in some instances. This study indicates that most patients with a severely ischemic extremity are candidates for revascularization and should have angiographic studies before amputation is considered.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.