Biomedical subjects

Q Macmanus

Publications and source records attributed to Q Macmanus.

26 records · Page 2Linked to original sources

PubMed1978

Non--cloth-covered caged-ball prostheses. The second decade.

The Starr-Edwards Models 6120 mitral and 1200/60 aortic valves are caged-ball prostheses with cloth-covered sewing rings and bare-metal struts. Introduced in 1965, they have been in continuous clinical use longer than any other currently available heart valve prostheses. Late results with this valve are analyzed and compared with recent series employing other current valve prostheses. One hundred thirty-four mitral 6120 prostheses were inserted at the University of Oregon Health Sciences Center from 1965 through 1977, with 118 operative survivors followed for a mean of 5.4 years. Twelve-year survival rate (+/- standard error) was 50 (+/-8) percent. Twelve percent of late deaths were valve related. Eighty-eight (+/-5) percent of valves were still in place at 12 years. The embolic rate was 5.8 (+/-1.0) percent per patient-year for all emboli and 2.2(+/-0.6) percent per patient-year for serious emboli. Two hundred forty-nine operative survivors among 282 patients undergoing aortic valve replacement during the same period of time were followed for a mean of 4.3 years. Twelve-year survival was 61 (+/-6) percent and the removal-free rate was 92(+/-5) percent. Six percent of late deaths were valve related. Embolic rates were 5.0 (+/-.7) percent and 1.8 (+/-.4) percent per patient-year for all emboli and serius emboli, respectively. Structural failure, specifically ball variance, was not encountered with this prosthesis. Ninety percent of 10 year survivors are in N.Y.H.A. Functional Class I or II. There was one anticoagulant-related death in 1,698 patient-years of follow-up. The current non--cloth-covered caged-ball valves provide unquestionable durability and well-documented results into their second decade of use. They provide a base line for comparison with newer prostheses and offer a valid, current choice for both aortic and mitral valve replacement.

Aortic Valve↗

PubMed1977

Diastatic perforation of the cecum without distal obstruction. Case report and review of the literature.

We present the first reported case to our knowledge of diastatic rupture of the normal cecum following cardiac surgery. All other reported cases of diastatic rupture of the cecum are reviewed. Nasotracheal intubation, hypoxemia, and enemas are thought to contribute to this complication. Prophylactic cecostomy for cecal diameters greater than 9 cm is recommended. Cecostomy and drainage are generally the treatment of choice should perforation occur.

Cecal Diseases↗

PubMed1977

Correction of aortic coarctation in neonates: mortality and late results.

To determine those factors that affect mortality and to analyze long-term results, the records of 44 infants who underwent repair of aortic coarctation at less than 90 days of age were examined. There were 14 operative and 8 late deathes (mean, 4.3 months postoperatively). Subsequent operation, generally to repair or palliate associated anomalies, was required 22 times in 20 patients and was a source of considerable mortality. There is evidence that earlier total repair of associated anomalies might improve survival. Sufficient data were available on 17 of the 22 survivors to assess long-term results. The outcome was considered excellent in 8 patients, fair in 4, and poor in 5. Revision of the coarctation repair due to growth failure of the anastomosis was required in 1 patient. Aggressive surgical management is recommended in these infants because, despite a high early mortality, a considerable proportion of excellent results can be anticipated in what is otherwise a hopeless situation.

Aortic Coarctation↗

PubMed1977

The Starr-Edwards model 6000 valve. A fifteen-year follow-up of the first successful mitral prosthesis.

The Starr-Edwards model 6000 mitral valve was the first successful mitral prosthesis. A fifteen year follow-up of 110 patients undergoing isolated mitral valve replacement with this prosthesis from 1960 to 1966 is presented. There were 22 (20%) operative and 37 (42%) late deaths at a mean of 8.6 years postoperatively. Preoperative variables leading to late death and thromboembolism are analyzed. Seventeen of 25 operative survivors had improvement in their NYHA Functional Class status and eight other remained unchanged an average of 13.1 years after surgery. There are 5000 patients world-wide currently relying on this prosthesis. Despite a high rate of thromboembolism in the past, elective replacement is not recommended except in selected patients.

Aged↗

PubMed1976

Mediastinal wound infection and aortocoronary graft patency.

In our experience, eight of ten aortocoronary grafts in five patients remained patent in the face of mediastinal infection. Combining reports of seventeen other grafts from the literature, we conclude that patency can be anticipated in approximately 70 per cent of such grafts and that mediastinal infection does not necessarily adversely affect aortocoronary saphenous vein bypass graft patency. We recommend aggressive therapy of mediastinal infection in this setting due to the high survival rate which can be anticipated with modern methods of therapy, as well as the high probability of graft patency.

Coronary Artery Bypass↗

PubMed1976

Amyloidosis of the stomach: report of an unusual case and review of the literature.

Amyloidosis confined to the stomach is a rare occurrence; the second reported case is presented. Involvement of the stomach with widespread "primary" and "secondary" amyloidosis, the amyloidosis of multiple myeloma, and the familial forms is a common pathologic finding; the involvement is seen clinically less often. The incidence, clinical presentation, diagnosis, pathological findings and treatment are reviewed. The diagnosis should be kept in mind in all patients who have signs or symptoms compatible with peptic ulcer disease or gastric carcinoma. This is especially important for those with multiple myeloma, chronic debilitating diseases or a family history that predisposes them to the development of amyloidosis.

Adenocarcinoma↗

PubMed1975

Surgical considerations in patients undergoing repeat median sternotomy.

A retrospective review of 122 repeat median sternotomy incisions in 100 consecutive patients was made to evaluate complications and management. Eighty-one patients had one repeat sternotomy, )6 had two repeat sternotomies, and 3 had three repeat sternotomies. All had valve procedures in the past and were reoperated upon for progressive rheumatic valvular disease or for complications related to the prostheses. Complications included operative hemorrhage in 8 patients, postoperative hemorrhage in 2, seroma in 4, and dehiscence, wound infection, and hematoma in 1 patient each. The most serious complication was hemorrhage and was the cause of the only operative death. Seven other patients survived hemorrhage encountered during repeat sternotomy. Control of massive hemorrhage during repeat sternotomy has been possible due to an organized approach to the patient with adhesions from previous surgery.

Adolescent↗

PubMedDate not supplied

Mediastinitis complicating successful mechanical bridge to heart transplantation.

A 22-year-old man with severe end-stage cardiomyopathy required placement of a left ventricular assist device. Purulent mediastinitis and peritonitis developed while the device was in place. The patient survived a prolonged course of treatment, with mediastinal and peritoneal irrigation and parenteral antibiotics, before undergoing a successful heart transplantation 12 weeks after placement of the left ventricular assist device.

Adult↗