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Biomedical subjects

O H Frazier

Publications and source records attributed to O H Frazier.

At least 325 records · Page 18Linked to original sources
PubMed1985

Right hydrothorax after left subclavian and internal jugular vein catheterization: a delayed complication.

Central vein catheterization is a common procedure performed in major hospitals. Numerous complications have been described with the use of this technique. We present three patients in whom the positioning of a catheter at the junction of the right and left brachiocephalic veins caused hydrothorax. Placing the catheter at the junction of the superior vena cava and the right atrium is recommended.

Journal Article↗
PubMed1985

Heterotopic heart transplantation in three patients at the Texas Heart Institute.

Seventy-three orthotopic and three heterotopic transplantations have been done in our institution, and in this report, we describe the procedure and outcome of those who underwent heterotopic transplantation. Three patients were in critical condition while awaiting donors for heart transplantation, and in each case, a suitable donor could not be found. Smaller donor hearts became available, and knowing that these patients would die without some kind of immediate action, we performed heterotopic heart transplantations. Patient Number 1 was a 53-year-old diabetic man who was in the last stages of heart disease when a small donor heart became available. Because of his rapidly deteriorating condition, we did a heterotopic transplantation. The patient is presently well and functioning normally. Patient Number 2 was a 26-year-old woman who received the heart of a 13-year-old donor after it became obvious that she could not wait for a suitable donor. We performed a heterotopic transplantation, after which the patient continues to function well. Patient Number 3 was a 53-year-old man who weighed 260 lbs. When a suitable donor could not be found, the heart of a 170-lb man became available and was used in a heterotopic transplantation. This patient also continues to be active and well. After considering the various advantages and disadvantages of heterotopic transplantation, we are convinced that there is a definite place for this procedure in some patients with end-stage cardiac failure, although we still believe that orthotopic transplantation should be offered to most recipients.

Journal Article↗
PubMed1985

Successful treatment of invasive aspergillosis in a heart transplant patient.

Infection continues to be a major cause of mortality in cardiac transplant patients, and even though there has been significant progress in diagnosing and treating many infectious disease problems, invasive aspergillosis in the transplant patient represents a serious and usually fatal complication. Even with successful early diagnosis, the use of free amphotericin B (a polyene antibiotic) has failed to cure disseminated infection. We report the case of a 46-year-old transplant patient who failed to respond to treatment with free amphotericin B after a 7-day period of treatment for biopsy-proven pulmonary aspergillosis. However, a subsequent substitution of a liposomal form of amphotericin B was used, and the patient responded well to a total dose of 1.5 mg. After 7 months, the patient continues free of infection. This experience suggests that the introduction of liposomal amphotericin B may give new hope for treating an otherwise lethal infection.

Journal Article↗
PubMed1985

Legionella infections in cyclosporine-immunosuppressed cardiac transplants.

Pulmonary infections from bacterial or viral agents, as well as rare infectious agents, such as Toxoplasma gondii, Aspergillus, and Pneumocystis carinii, have been a bane to the clinician in charge of the care of transplant patients. One such opportunistic Organism, Legionella pneumophila, was responsible for four episodes of infection in three of our patients who survived due to better management of immunosuppression, together with aggressive therapy and early diagnosis of the infectious complications.

Journal Article↗
PubMed1985

Human cardiac explantation and autotransplantation: application in a patient with a large cardiac pheochromocytoma.

A rare paraganglioma of the chromaffin type, located intrapericardially, was removed from a 42-year-old man by autotransplantation of the heart. Although the results were unfavorable in this case, the technique of autotransplantation deserves consideration in resecting large tumors that encroach upon the heart. To our knowledge, this technique has not been previously used for surgical excision of cardiac tumors.

Journal Article↗
PubMed1985

Cardiac transplantation: indications, procurement, operation, and management.

Between July 1982 and April 1984, 22 patients underwent cardiac transplantations at the Texas Heart Institute with a cumulative follow-up of 188 patient-months (mean of 8.6 months and a range of 0.5 to 21). The actuarial survival rate at 20 months was 72%. Strict selection criteria for potential recipients and donors, optimal perioperative management, which includes endomyocardial biopsy, and most important the introduction of cyclosporine are the major factors that led to these increasing survival rates. The high incidence of cyclosporine-related complications, especially hypertension and myocardial fibrosis, will require long-term evaluation to adequately assess the therapeutic effectiveness of this new immunosuppressive agent.

Central Nervous System Diseases↗
PubMed1985

Valve failure with the Ionescu-Shiley bovine pericardial bioprosthesis: analysis of 2680 patients.

Early reports on the excellent hemodynamic function and low thromboembolic rates of the Ionescu-Shiley bovine pericardial bioprosthetic valve (BPV) encouraged us to use it as our choice for valve replacement in 2680 patients from 1978 through 1983. Analysis of these patients at 5-year follow-up (mean 21.6 months) demonstrated the following important trends. Despite anticoagulation therapy in 48%, thromboembolism occurred in 88 patients for a linearized rate of 1.87% emboli per patient-year and was not time-related. The highest incidence of thromboembolism was in mitral valve replacement (MVR) (2.76% per patient-year). The actuarial freedom from reoperation resulting from valve failure at 5 years was 82% in aortic valve replacement (AVR), 87.1% in MVR, and 92.6% in AVR/MVR. The most distressing causes for reoperation were valve calcification (33 patients, 0.68% per patient-year) and leaflet disruption (11 patients, 0.23% per patient-year). Valve calcification was related to age, small valve size, and AVR position and increased with time, especially at the 4- to 5-year intervals. In patients under 30 years of age, calcification occurred in 18.7% at a mean time of 40.8 months in AVR and in 8.2% at 44 months in MVR, for an overall rate of 11.6%. Over the age of 30 years, it occurred in 14 patients (0.6%) at a mean time of 44 months. Leaflet disruption was not related to age and occurred later in AVR (50 to 58 months) than MVR (1.5 to 61 months). Events increased with time (mean range 37 to 58 months). Because of calcification and leaflet disruption, valve failure causing reoperation has increased significantly at the 4- to 5-year intervals even when valve replacement in patients under 30 years of age is excluded. If this trend continues, the valve failure rate will be exceedingly high on further follow-up. Thus we have limited the use of the BPV to a selected group of patients in whom valve longevity is less important than effective orifice size, thromboembolic rate, and freedom from anticoagulation.

Actuarial Analysis↗
PubMed1985

Laser-assisted microvascular anastomoses: angiographic and anatomopathologic studies on growing microvascular anastomoses: preliminary report.

A low-powered carbon dioxide laser was used to perform end-to-end anastomoses of growing femoral arteries (mean diameter 1.6 mm) in miniature swine. Five microvascular conventional anastomoses were performed with 10-0 monofilament interrupted sutures. Nine laser-assisted vascular anastomoses were performed. The mean duration of each anastomosis was 30 +/- 3 minutes for the conventional anastomosis and 20 +/- 2 minutes for the laser-assisted vascular anastomosis (p less than 0.05). All anastomoses were patent at the completion of the procedure. Each laser-assisted anastomosis required an average of eight laser pulses of 2 to 4 seconds. After 13 weeks the external diameters of the conventional anastomoses were 1.8 mm (+15%), while the laser-assisted anastomoses averaged 3.0 mm (+81%) (p less than 0.05). All nine laser-assisted anastomoses were patent, functional, and free of stenosis compared with one out of five conventional anastomoses. Histologically the laser induced minimal or no fibrosis, allowing normal physiologic healing and growth patterns. Electron microscopy confirmed that the integrity of the arterial layers had been restored. These findings suggest that a low-energy carbon dioxide laser has potential clinical application for anastomosis of small growing vessels.

Animals↗
PubMed1985

Comparison of bioprosthetic and mechanical valve replacement for active endocarditis.

The choice between bioprosthetic or mechanical prosthetic valve replacement for active valvular endocarditis has been controversial. To establish the role of each, we reviewed the case histories of 185 patients who underwent valve replacement for active valvular endocarditis during the past 5 years. All patients had life-threatening, active bacterial endocarditis of a native or prosthetic valve. Group I (88 patients) had replacement with the Ionescu-Shiley pericardial valve and Group II (97 patients) with the St. Jude Medical valve. The male/female distribution, age range, and functional classification were the same in the two groups. Mean follow-up was approximately 20 months for both groups. Valve replacement was done because of native valve endocarditis in 76 patients in Group I and 49 patients in Group II. Of the remainder of the Group I patients, six had endocarditis of a bioprosthesis and six of a mechanical valve; of the remainder of Group II patients, 30 had endocarditis of a bioprosthesis and 18 of a mechanical valve. Early mortality was not significantly different between the two groups (14 deaths in each group). Of the 74 survivors in Group I, 15 underwent valve reoperation, 10 because of recurrent endocarditis and five because of sterile perivalvular leakage. The frequency of reoperation was significantly different (p less than 0.01) from that in Group II, in which only five patients underwent valve reoperation, four for recurrent endocarditis and one for sterile perivalvular leakage. The actuarial rate for freedom from reoperation was also significantly higher in Group II patients; 94.6% were free from reoperation at 4 years compared to 75% at 4 years in Group I patients (p less than 0.01). The actuarial survival rate, which also differed significantly between groups, was 78.7% at 4 years in Group I and 87.4% at 4 years in Group II (p less than 0.05). Patients receiving a bioprosthesis for active endocarditis had a significantly higher reoperation rate and a significantly greater incidence of recurrent endocarditis (p less than 0.01). Therefore, we prefer to use a mechanical valve for valve replacement in most patients who have active endocarditis.

Adolescent↗
PubMed1984

Systemic thermochemotherapy: toxicity and plasma pharmacokinetics of methotrexate and doxorubicin.

Chemotherapy administered during systemic hyperthermia is more tumoricidal than either modality used alone. The purpose of this study was to evaluate plasma drug pharmacokinetics and host toxicity when methotrexate (MTX) or doxorubicin (adriamycin--ADR) was given at 37 or 43 degrees C. Eight dogs were heated to 43 degrees C for 1 hr without chemotherapy; eight dogs received MTX (5 mg/kg) and four dogs received ADR (2 mg/kg) intravenously as a constant infusion at 43 or 37 degrees C. Blood samples were obtained at 0, 1, 2, 24, and 48 hr. Mean plasma MTX levels were not significantly different at 1, 2, and 6 hours in 43 and 37 degrees C dogs, but at 24 and 48 hr mean plasma MTX levels were significantly elevated in heated (43 degrees C) dogs compared with sham-heated (37 degrees C) dogs. Plasma MTX concentration multiplied by time (area under curve) was 131 g . hr/liter in 43 degrees C dogs compared with 73 g . hr/liter in 37 degrees C dogs (P less than 0.001). Vomiting and bloody diarrhea lasted an average of 4 days in heated control dogs (no drugs) 4 days in 37 degrees C dogs, and 5 to 7 days in 43 degrees C MTX dogs. Mean plasma ADR levels were similar in 37 and 43 degrees C dogs at all time intervals. Vomiting and bloody diarrhea lasted at least 7 days in 43 degrees C dogs compared with only 1 day in 37 degrees C dogs treated with ADR.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Early results of cardiac transplantation at the Texas Heart Institute.

From July 1982 to November 1983 18 patients (one female) underwent orthotopic cardiac transplantation at the Texas Heart Institute. Prednisone and cyclosporin were used for maintenance immunosuppression in all patients. Cumulative follow up has now been for 90 patient months (0.75-20 months). Rejection occurred in 10 recipients (56%) and was fatal in three, giving an incidence of rejection of 0.6 episodes per recipient and a mortality rate of 30% per episode. At one year 39% of recipients were free of infection and 73% free of fatal rejection. Infection episodes occurred on 32 occasions in 14 patients and 24 episodes required treatment. There were no infection related deaths, although the first year actuarial freedom from infection rate was only 24%. With 14 of the 18 patients surviving (78%), an actuarial one year survival of 74%, and freedom from major complications in the short term, the efficacy of cyclosporin immunosuppression for cardiac transplantation is confirmed.

Adult↗
PubMed1984

Cardiac transplantation: current results at the Texas heart institute.

The first series of cardiac transplants at the Texas Heart Institute began in May of 1968 but was discontinued because of the complications of infection and rejection. A second series of cardiac transplants was initiated in July of 1982 after the introduction of the immunosuppressant drug, cyclosporine. By August of 1984, 30 patients had undergone orthotopic cardiac transplantation for end-stage cardiac disease. Of the patients in this series, four have died of rejection, two of infectious complications, and one of an unknown cause. The remainder have all returned to Class I New York Heart Association (NYHA) cardiac status. All patients were reviewed in detail for suitability of cardiac transplantation and presented to a cardiac transplant review board. All transplanted patients were functional Class IV. Donor hearts were obtained locally or by long-distance procurement. Ten of the hearts were obtained from an average distance of 250 miles from Houston. Donors ranged in age from 16 to 37 years. Requirements were normal cardiac function with minimal use of inotropic support, no history of cardiac disease, absence of cardiac arrest and absence of active infection. Although only one of the patients in the initial group of transplants survived 1 year, to date there have been 11 survivors for more than 1 year in the current series. Advances in cardiac transplantation have resulted in an improved prognosis for the terminal cardiomyopathic patients requiring transplantation. The use of cyclosporine, an immunosuppressant that spares the nonspecific immune system, has been helpful in allowing patients to survive infections. The use of the drug must be carefully monitored, however, because of its numerous toxicities.

Journal Article↗
PubMed1984

Infection after cardiac transplantation: treatment and prognosis.

Since July 1982, 18 patients have undergone orthotopic cardiac transplantation at the Texas Heart Institute with steroid and cyclosporine immunosuppression. There have been no deaths from infection despite 15 bacterial, 8 viral, 6 fungal and 1 protozoal infection episodes. With a total follow-up of 90 patient months (mean follow-up, 5.0 months; range 0.1 to 18 months), the incidence of infection is 33 episodes per 100 patient months (1.7 episodes per patient). Only 23 episodes (77%) required drug treatment. Compared to conventional immunosuppressive regimes, cyclosporine treatment is associated with a substantial reduction in the incidence and severity of infection in cardiac allograft recipients.

Journal Article↗