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Biomedical subjects

R C Shaw

Publications and source records attributed to R C Shaw.

16 recordsLinked to original sources
PubMed1978

Posterior ventricular aneurysm, severe mitral regurgitation, and rupture of the left ventricle after acute myocardial infarction: six-year survival after surgical correction.

Posterior ventricular aneurysm and severe mitral regurgitation due to acute myocardial infarction are rarely recognized during life. This report describes the successful surgical treatment of a patient with this combination of lesions who at operation was found to have rupture of the left ventricle as well. Aneurysmectomy, mitral valve replacement, and coronary artery bypass were performed with a gratifying late result. Aggressive investigation of patients with hemodynamic deterioration after posterior myocardial infarction may identify surgically correctable mechanical complications.

Adult↗
PubMed1978

Left ventricular aneurysm resection: indications and long-term follow-up.

Forty-four patients had resection of a chronic postinfarction left ventricular aneurysm. Operative indications were heart failure, angina, and ventricular arrhythmias. Twenty-six patients (59%) had coronary grafting in addition to aneurysmectomy. The operative mortality rate was 4.5% (2/44), and late mortality (mean follow-up, 31 months) was 17.9% (7/39). Preoperatively all patients were in New York Heart Association Functional Class III or IV; 91% were Class I or II postoperatively. Coronary bypass grafting did not increase the operative mortality rate, and long-term survival was similar between those receiving coronary grafts and those not receiving grafts. Postoperative ventriculograms were evaluated in 10 patients by means of a system of internal grids. Amount of regional myocardial contraction correlated well with the patient's postoperative functional capacity. It is concluded that ventricular aneurysmectomy in combination with coronary bypass grafting is safe and effective, resulting in marked improvement in the patients' functional capacity and longevity.

Adult↗
PubMed1978

Considerations in the management of open-heart surgery in uremic patients.

Life-threatening complications involving the central circulation commonly occur in uremic patients. The growing number of individuals maintained on long-term hemodialysis along with repeated demonstrations of their ability to tolerate major operative procedures are responsible for increasing surgical experience in this group. Despite a high incidence of subacute bacterial endocarditis (SBE) and accelerated coronary atherosclerosis, exposure of such patients to open-heart operations has been limited. Our management of two patients who recently underwent valvular replacement is outlined and a review of the literature revealed that, during the past decade, 20 uremic patients have undergone a variety of cardiac procedures. The catastrophic results of medical therapy in such individuals with SBE are emphasized and early surgical intervention is recommended.

Adolescent↗
PubMed1977

Postoperative investigation of left ventricular aneurysm resection.

We reviewed 35 patients undergoing resection of a chronic postinfarction left ventricular aneurysm. There was 5.7% operative mortality. Of the long-term survivors, 80% are functional class I or II. Ten patients had postoperative left ventriculograms studied by means of a computerized analysis of endocardial motion using internal orthogonal and radial grids. Postoperative end-diastolic volumes were much greater than normal and large akinetic areas were present although there was good improvement in the patient's functional capacity. Grid analysis of endocardial motion correlated better with the patient's postoperative clinical status than did measurements of end-diastolic pressure and volume, ejection fraction, or visual inspection of the postoperative left ventriculogram.

Adult↗
PubMed1976

Massive pulmonary embolism permitting paradoxical systemic arterial embolism: successful surgical management.

The case of a young woman, receiving oral contraceptives, who developed massive pulmonary embolism producing circulatory collapse and paradoxical arterial embolism through a patent foramen ovale is documented.. Limb viability was threatened. Emergency management included removal of arterial and pulmonary emboli, surgical closure of the patent foramen ovale, inferior caval partitioning, ovarian vein ligation, and short-term anticoagulation. Recovery was rapid and complete.

Adult↗
PubMed1976

The indications for pericardiectomy in the uremic pericardial effusion.

Uremic pericarditis developed in 37 of 295 patients (8 percent) admitted to the chronic hemodialysis program at our institution. Sixteen patients (43%) underwent limited pericardiectomy through a left anterior thoracotomy approach with no operative deaths and minimal morbidity (19%). Twenty-one patients (57%) were treated successfully with intensive hemodialysis. The use of pericardiocentesis did not avert cardiac tamponade in any patient in our series. The procedure was associated with two life-threatening complications and its use, therefore, has been limited in the therapy of uremic pericarditis. We recommend surgical intervention in all patients with hemodynamic instability and echocardiographic evidence of enlarging effusions or an effusion unchanged in size following 10 days of intensive hemodialysis.

Adult↗
PubMed1975

Peripheral intravenous infiltration necrosis.

Peripheral extravasation of intravenous solutions containing calcium salts and/or 10% dextrose has caused significant local tissue necrosis in 8 patients, including 6 infants. These incidents prolonged hospitalization and in 5 cases caused severe disfigurement or imperiled limb function. Treatment followed established principles of debridement, early skin grafting and secondary reconstruction as needed. While intravenous alimentation or the administration of calcium salts if often indicated by the clinical situation, the physician administering these drugs must realize that extravasation may cause serious sequelae.

Adult↗
PubMed1975

Exposure through a coronal incision for initial treatment of facial fractures.

The coronal incision approach to Le Fort III fractures gives excellent exposure for anatomical reduction and internal fixation of the fracture sites. Either an extracranial, or a combined intracranial procedure, is feasible. The exposure obtained not only facilitates the reduction and the fixation but, with the addition of transconjunctival incisions, the patient benefits by not having multiple surgical scars in the face.

Accidents, Traffic↗
PubMed1975

Reconstruction of cranial defects.

We have found that small defects, particularly those within the hairline, are easily reconstructed with methy methacrylate prepared at the operating table. Larger defects, especially in children and active adults, are benefited by autogenous bone grafts and we prefer split rib. When the fabrication facilities are available the preformed silicone implants offer much to the surgeon. They may be sculptured to correct difficult contour problems such as in the supraorbital or forehead region and are especially useful to fill in defects where the bone is present, but depressed. These three methods have many advantages over the metallic implants. There is little complaint of the implant being cold when the patient is exposed to cold weather and a very important fact is that these methods not only provide a radiolucent reconstruction, but also do not affect EEG examination.

Bone Transplantation↗