Biomedical subjects
R F Galloway
Publications and source records attributed to R F Galloway.
Mechanical assistance for cardiogenic shock following cardiac surgery, myocardial infarction, and cardiac transplantation.
From January, 1982, to October, 1986, 33 patients were treated with either the Pierce-Donachy prosthetic ventricle or the Bio-Medicus ventricular assist device for cardiogenic shock following a cardiac operation, myocardial infarction, or cardiac transplantation. Twenty-five patients required the assistance for postcardiotomy shock and 8, for a variety of conditions including myocardial infarction shock and myocarditis, and as a bridge to cardiac transplantation. Complications were frequent and usually secondary to prolonged cardiopulmonary bypass. Results were poorest in the group with postcardiotomy shock. Earlier application of an assist device could lead to more frequent survival and avoidance of the detrimental effects of prolonged extracorporeal circulation.
Cardiac transplantation in Georgia.
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Mechanical assistance for biventricular failure following coronary bypass operation and heart transplantation.
From September 1983 to March 1985, five patients who could not be weaned from extracorporeal circulation or who deteriorated in the recovery room have been treated with biventricular mechanical support using two vortex pumps, standard cannulas and tubing. One patient was supported for six hours following heart transplantation and acute graft failure until another donor heart could be found. Intraaortic balloon pumping was utilized in each patient to augment the circulation and produce pulsatile flow. Four of the five patients were weaned from the device. Only one patient is currently a long-term survivor. Although long-term survival has been low, the ability of the myocardium to recover was impressive and warrants the efforts at assisting the heart in biventricular failure.
A prospective evaluation of the pulsatile assist device.
Conversion of roller pump flow to pulsatile flow by the pulsatile assist device (PAD) is said to result in improved myocardial preservation and a decrease in the incidence of perioperative myocardial infarction. The clinical advantages of the PAD were evaluated in a prospective randomized study of 100 consecutive coronary artery bypass operations. Serial electrocardiograms, creatine phosphokinase isoenzyme studies, and myocardial scans with technetium-labeled pyrophosphate failed to demonstrate any signficiant difference between patients with the PAD and those receiving nonpulsatile flow. Plasma hemoglobin levels were significantly higher in the PAD group indicating increased blood trauma. Other potential disadvantages of the PAD are discussed. Based on this study, we see few advantages of the PAD in routine coronary bypass operations.
Traumatic aortorenal vein fistula: repair using total circulatory arrest.
Fistulas between the abdominal aorta and renal vein are exceedingly rare. Diagnostic delays are not unusual. Correction can be extremely difficult because of anatomical distortion and size of the arterialized veins. A young woman with such a fistula following a gunshot wound is presented. Four years following injury, the fistula was repaired successfully during intentional arrest of the circulation for 7 minutes. This was accomplished with deep hypothermia and cardiopulmonary bypass. No serious problems occurred during the operation. The patient tolerated the procedure well and has been relieved of her symptoms completely. Most patients with traumatic or spontaneous arteriovenous fistulas can be managed safely and effectively by conventional operative techniques. In selected situations, the risk of total circulatory arrest and deep hypothermia may be less than the risk of uncontrollable bleeding inherent in conventional techniques. Suggested indications for use of total circulatory arrest in vascular surgery are (1) inability to achieve vascular control by more conventional means, (2) massive distention of regional veins as occurrs in well established fistulas of the trunk, (3) one or more prior corrective attempts with use of conventional techniques, and (4) anticipated anatomical distortion and/or multiple abnormal vascular communications. This technique is a valuable approach to the correction of otherwise inoperable cardiovascular lesions.
Strut fracture in De Bakey valve. Successful reoperation and valve replacement.
Strut fracture in a De Bakey aortic valve is reported. The theoretical disadvantage of a Pyrolite carbon--coated ball and titanium struts is mentioned. Periodic cinefluoroscopy is recommended in all patients with a De Bakey aortic valve to avoid the complications associated with strut wear or fracture.
Primary pulmonary botryomycosis.
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The value of bronchial washing cytology in the diagnosis of bronchogenic cancer.
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The responsibilities of a County Medical Society President.
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Care of tuberculosis patients in a general hospital.
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