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Biomedical subjects

R Guyton

Publications and source records attributed to R Guyton.

14 recordsLinked to original sources
PubMed1990

Changing use of coronary angioplasty and coronary bypass surgery in the treatment of chronic coronary artery disease.

Changes in the use of coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) over the last several years have resulted in a new and different environment for the interventional treatment of coronary artery disease. This study explores these changes as applied to the treatment of chronic coronary artery disease. The study population comprised 14,078 patients undergoing diagnostic cardiac catheterization between 1981 and 1988. In 1981, 1,704 patients underwent a first known cardiac catheterization at Emory University Hospital or Crawford W. Long Hospital and were found to have significant coronary artery disease. Of these patients, 51.7% were treated medically, 44.0% by CABG and 4.3% with PTCA. A similar group comprised 1,719 patients in 1988. Of this group 41.2% were treated medically, 28.5% with CABG and 30.3% with PTCA. The data reveal a much more complex phenomenon than a simple increase in PTCA for the treatment of coronary disease at the expense of CABG. The CABG group aged such that the percent of the CABG population more than 65 years old increased from 26.0% of the total in 1981 to 44.9% of the total in 1988. The percent of patients with ejection fractions less than 50% in the CABG population increased from 24.5% in 1981 to 29.7% in 1988. The PTCA population had less severe disease, was younger and had better left ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

Results of coronary surgery after failed elective coronary angioplasty in patients with prior coronary surgery.

The results of coronary artery bypass surgery after failed elective coronary angioplasty in patients who have undergone prior coronary surgery are unknown. Coronary angioplasty may be performed to relieve angina after surgery either to the native coronary vessels or to grafts. Failure of attempted coronary angioplasty may mandate repeat coronary surgery, often in the setting of acute ischemia. From 1980 to 1989, 1,263 patients with prior coronary bypass surgery underwent angioplasty; of these patients, 46 (3.6%) underwent reoperation for failed angioplasty during the same hospital stay. Of the 46 patients who underwent reoperation, 33 had and 13 did not have acute ischemia. In the group with ischemia, 3 patients (9.1%) died and 14 (42.4%) died or had a Q wave myocardial infarction in the hospital compared with no deaths (p = NS) and no deaths or Q wave myocardial infarction (p = 0.005) in the group without ischemia. At 3 years, the actuarial survival rate was 88 +/- 6% in the group with ischemia, whereas there were no deaths in the group without ischemia (p = NS), and freedom from death or myocardial infarction was 51 +/- 10% in the group with ischemia, versus no events in the group without ischemia (p = 0.006). In most patients with prior coronary bypass surgery, coronary angioplasty was performed without the need for repeat coronary bypass surgery. Should coronary angioplasty fail, reoperation in patients without acute ischemia can be performed with overall patient survival comparable to that of elective reoperative coronary bypass without coronary angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Modeling and guided practice as components within a comprehensive testicular self-examination cancer education program.

This study sought to assess the effects of modeling and guided practice as components within a comprehensive testicular self-examination education program for college-aged men. We studied three treatment groups (N = 161) at two Arkansas universities. The variables investigated were knowledge of testicular cancer, attitudes toward testicular cancer, and frequency of self-reported testicular self-examination. A summary of the major findings revealed a significant difference in knowledge of testicular cancer and attitudes toward testicular cancer and a significant difference in frequency of testicular self-examination for all treatment groups. Modeling and guided practice yielded no significant differences in knowledge of testicular cancer or frequency of self-reported testicular self-examination but some significant attitudinal differences. Results indicated that subjects were not knowledgeable about testicular cancer and that most (91.7%) were not practicing testicular self-examination. Three months after participation in one of three education programs, 78.9% of the subjects indicated they had performed testicular self-examination. Modeling and guided practice as components of one education approach used appear to be an essential strategy to increase the practice of regular testicular self-examination.

Adolescent↗
PubMed1989

Determinants of prolonged length of hospital stay after coronary bypass surgery.

The length of hospital stay after coronary surgery was studied in 4,683 patients undergoing cardiac catheterization followed by coronary surgery at Emory University Hospital or Crawford Long Hospital between the years 1981 and 1986. Length of stay after coronary surgery had a median and modal value of 7 days. There was, however, a long statistical tail of patients with a prolonged length of stay extending out to more than 180 days. Prolonged length of stay (greater than 10 days) could be correlated with preprocedural variables such as age, elective versus emergency status, angina class, ejection fraction, and gender. Length of stay increased from a mean of 6.9 +/- 1.4 days under the age of 40 years to 10.9 +/- 12.1 days over the age of 70 years (p less than 0.0001). Length of stay was correlated with the periprocedural variables of wound infection, neurologic event, arrhythmias, pneumonia, postoperative myocardial infarction, mortality, and pericarditis. Length of stay increased from 8.8 +/- 9.6 days without a neurologic event to 21.1 +/- 17.9 days with a neurologic event (p less than 0.0001). Similarly, without a wound infection, the average stay was 8.7 +/- 8.9 days; with a wound infection, the average stay was 32.2 +/- 25.8 days (p less than 0.0001). The correlates of prolonged stay were tested in another population comprising 781 patients undergoing cardiac catheterization followed by coronary artery bypass grafting in 1987. The predictors of prolonged stay in the 1987 population were wound infection, pneumonia, arrhythmias, age, neurologic events, postoperative infarction, and ejection fraction. Thus, length of hospital stay after coronary surgery may be predicted by multiple preprocedural and periprocedural variables.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Smokeless tobacco use among rural high school students in Arkansas.

This study determined the prevalence of smokeless tobacco use among high school students in selected rural communities in Arkansas, and identified factors associated with initiation and maintenance of use. A questionnaire was distributed to 1,237 students in 13 rural high schools in different educational service regions of Arkansas during spring 1985. Results indicated 34.5% of males and 2.5% of females reported regular use of smokeless tobacco. The factor contributing most to initiation of this practice was the influence of a parent who used smokeless tobacco products. Comparisons to other recent studies and implications for health educators are discussed.

Adolescent↗
PubMed1983

Percutaneous transluminal coronary angioplasty in patients with prior coronary bypass surgery.

To improve symptomatic status and avoid reoperation, 122 initial and 7 repeat percutaneous transluminal coronary angioplasty procedures were performed in 116 patients with disabling angina pectoris at a mean of 26.8 months (range 2 to 132) after coronary bypass surgery. Marked angiographic improvement (greater than 30% reduction in diameter stenosis) was obtained in 107 (88%) of the 122 initial procedures and in all 7 repetitions. Mean stenosis was reduced from 78 +/- 13% (mean +/- standard deviation) to 25 +/- 13% (p less than 0.0001) and mean pressure gradient from 49 +/- 15 to 11 +/- 8 mm Hg (p less than 0.0001). Complications were: emergency surgery (three patients), Q wave infarction (one patient), myocardial infarction by enzyme criteria only (four patients) and non-occluding coronary dissection (one patient). There were no neurologic or peripheral vascular complications and no early deaths. One late death occurred 14 months after an unsuccessful but uncomplicated angioplasty procedure. At a mean follow-up of 8.3 months, 88 patients (76%) were free of angina or in improved condition. In patients followed up for at least 6 months, evidence of restenosis occurred in 9 (53%) of 17 saphenous veins, 1 (50%) of 2 proximal graft anastomoses, 4 (18%) of 22 distal graft anastomoses and 5 (14%) of 37 native coronary arteries. When coronary anatomy is suitable, percutaneous transluminal angioplasty is an attractive alternative to reoperation in symptomatic patients with prior coronary bypass surgery.

Adult↗