Surgical repair of coarctation of the aorta using the internal mammary artery as a free autogenous graft.
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Adolescent↗
Biomedical subjects
R K Firmin
Publications and source records attributed to R K Firmin.
Sleeve lobectomy (lobectomy and bronchoplasty) for bronchial carcinoma.
We present a series of 90 patients who underwent sleeve lobectomy for malignant bronchial tumors at the Brompton Hospital, London, between 1964 and 1974. The operative mortality was low (1%), and technical complications were infrequent. Bronchial stenosis, which occurred in 6% of patients, was due to recurrence of tumor in 4% and cicatrization in 2%. The majority of patients had squamous cell carcinomas of the upper lobe (76/90). In this group, the 5-year survival was 71% when the hilar lymph nodes were clear of tumor at the time of operation and 17% when the hilar lymph nodes were involved. Because these 5-year survival figures suggest that tumor-free survival is not significantly compromised by this conservative approach, we believe that sleeve lobectomy rather than pneumonectomy should be considered the operation of choice for squamous cell carcinomas of the upper lobe orifice involving the main bronchus.
Adult↗
Anatomic problems associated with arterial switch procedures for double outlet right ventricle with subpulmonary ventricular septal defect.
Two cases of double outlet right ventricle with subpulmonary ventricular septal defect treated by arterial switch operations are reported. The anatomical problems of coronary artery transfer, occult outflow tract obstruction and position of the pulmonary bifurcation are discussed. Cases of double outlet right ventricle and subpulmonary ventricular septal defect with anterior-to-posterior relation of the great arteries are suited to the repair techniques pioneered by Jatene for complete transposition and ventricular septal defect. Cases in which the great arteries are side-by-side pose more difficult problems, partly because of the more complex and varied anatomy of the coronary arteries, and because of the spatial relation of the roots of the great arteries. Although it may be possible to overcome these technical problems, we have reservations about the reproducibility of such a procedure. We believe, however, that cases of this type are best treated without recourse to "inflow" correction. The options are either the arterial switch procedure or a modified Rastelli operation.
Child, Preschool↗
One very rare and one new tracheal tumour found by electron microscopy: glomus tumour and acinic cell tumour resembling carcinoid tumours by light microscopy.
Tracheal tumours were removed surgically from two patients and diagnosed as carcinoid tumours by routine light microscopy. At a later date, electron microscopy was performed on stored tumour tissue and no neurosecretory granules were found in either case. One showed features of a glomus tumour and the other of an acinic cell tumour. Only two glomus tumours appear to have been reported previously in the trachea, and no acinic cell tumours. Electron microscopy is thus sometimes of great assistance in diagnosing accurately unusual tumours of the lower respiratory tract.
Carcinoid Tumor↗
[Limited axillary thoracotomy in the management of recurrent spontaneous pneumothorax].
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Adult↗
Complete cleft sternum.
A case of complete cleft sternum is presented along with the nomenclature of sternal defects. It is recommended that the term ectopia cordis should be applied only to cases in which the heart and thoracic viscera are genuinely ectopic. Surgical correction of complete cleft sternum should be performed in the neonatal period whether the infant is symptomatic or not. Simple closure of the defect, as for a median sternotomy, is possible during the first month of life and this avoids the more complex reconsructions necessary in older children.
Female↗
Total one-stage repair of aortopulmonary window and interrupted aortic arch in a neonate.
The congenital anomaly of aortopulmonary window is rare. Its combination with interruption of the aortic arch has been previously recognized and reported in infants and children. Early and complete repair of such a congenital anomaly may prevent progression to cardiac failure and premature death. We describe the successful echocardiographic diagnosis and one-stage surgical repair, via a median sternotomy, of the aortopulmonary window, interrupted aortic arch, patent ductus arteriosus, and patent foramen ovale in a 3-day-old neonate. The literature is also reviewed.
Aorta, Thoracic↗
Glove perforation during sternotomy closure.
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Cardiac Surgical Procedures↗
The inflammatory and coagulative response to prolonged extracorporeal membrane oxygenation.
Extracorporeal circulation is used therapeutically during renal dialysis, cardiopulmonary bypass (CPB), and extracorporeal membrane oxygenation (ECMO). All of these procedures result in activation of the body's natural defense mechanisms against "nonself" and foreign invasion. The prolonged duration of ECMO compared with other applications and the absence of hypothermia, hemodilution, ischemia/reperfusion, and protamine administration make the host response to ECMO subtly distinct. In this review, the host response to ECMO is discussed and contrasted to CPB. The use of aprotinin and other response modifiers is also considered.
Aprotinin↗
A porcine model of prolonged closed chest venovenous extracorporeal membrane oxygenation.
The sheep has been the standard laboratory animal for extracorporeal membrane oxygenation (ECMO) research for many years and has proven to be an invaluable and reliable model. However the coagulation system of the sheep is significantly different from humans. These differences make it difficult to investigate the coagulative and inflammatory response to ECMO in sheep. The pig has a very similar coagulation system to humans and therefore makes a more appropriate model. We describe a porcine model of prolonged (48 hours) closed chest venovenous (VV) ECMO that we developed to investigate the inflammatory and coagulative response to different ECMO tubing materials. This model could be used to investigate any aspect of venovenous ECMO.
Animals↗
Plasma concentrations of midazolam in neonates receiving extracorporeal membrane oxygenation.
Drug disposition is affected during extracorporeal membrane oxygenation (ECMO). This study investigates the dose-concentration relationship of midazolam in neonates requiring ECMO during continuous infusion into the circuit (extracorporeally; n = 10) and intravenously (n = 10). Data on hourly doses and sedation scores were collected for 120 hours. Plasma concentrations were analyzed at times 0, 2, 4, 6, 12, 18, and 24, and every 12 hours thereafter. Both groups were clinically similar. Mean (standard deviation) dose for all patients was 250 (185) microg/kg/h, four times greater than previously reported. Doses administered in the first 24 hours were significantly greater extracorporeally [361 (300)] compared with intravenous [258 (190) microg/kg/h, p < 0.001]. Mean (standard deviation) plasma concentrations in all patients at 24, 48, and 72 hours were 1.4 (0.9), 1.8 (1.2), and 2.6 (1.8) microg/ml, respectively. Satisfactory sedation levels were achieved in all patients. Comparison of the actual observed with predicted (simulated) midazolam concentrations suggested significant attenuation of plasma levels during the first 24 hours of ECMO. However, at 48 hours, observed concentrations exceeded those predicted, suggesting accumulation. We conclude that in the first 24 hours of ECMO, because of an expanded circulating volume and sequestration by the circuit, significantly more midazolam is required to achieve adequate sedation. Subsequently, and because of circuit saturation, maintenance doses should be reduced.
Blood Volume↗
Neonatal extracorporeal membrane oxygenation.
Extracorporeal membrane oxygenation is an effective life support technique that has had most success in the treatment of neonatal cardiopulmonary failure. We review the technique and its potential indications and present the latest UK and worldwide survival data.
Extracorporeal Membrane Oxygenation↗
Current concepts in the use of intra-aortic balloon counterpulsation.
Mechanical support of the circulation using intra-aortic balloon counterpulsation has thus far largely been confined to cardiac units. With improved techniques of insertion, many critically ill patients may now benefit. This article reviews the physiology of counterpulsation, the indications and contraindications for its use, and the complications that may occur.
Cardiac Output, Low↗