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Biomedical subjects

R L Greenstreet

Publications and source records attributed to R L Greenstreet.

13 recordsLinked to original sources
PubMed1983

Selective coronary arteriography: a clinical comparison of two contrast agents.

The radiopacity and complications of meglumine iothalamate 52% and sodium iothalamate 26% (Vascoray) were compared with those of meglumine diatrizoate 66% and sodium diatrizoate 10% (Renografin -76) in 2258 patients with and without cardiac disease. There was no difference in radiopacity and the type and incidence of adverse reactions were similar, but the frequency was significantly higher (p less than 0.05) with Vascoray in patients with constrictive pericarditis, dissecting aortic aneurysm, and primary pulmonary hypertension. The difference in the frequency of hypotension, sinus bradycardia, and transient asystole in the Renografin -76 and Vascoray groups was statistically significant. Ventricular arrhythmias occurred in 6% of the patients with primary myocardial disease compared to an average of 0.7% in those without this cardiac abnormality (p less than 0.01), but there was no significant difference in the frequency in the two contrast agent groups. All reactions were treated and the studies were performed without mortality. Results of this study show that iothalamate formulation with sodium to meglumine ratio of 1:2 containing 410 mEq/L of sodium (Vascoray) is suitable and safe for clinical use for roentgenographic studies of the heart, and coronary artery circulation.

Adult↗
PubMed1983

Breast reconstruction--selection, timing, and local recurrence.

Although reconstruction is now a standard part of the care of breast cancer patients, certain unresolved issues surround local recurrence. A percentage of women can be expected to develop local recurrence after mastectomy, whether or not they have reconstruction. This study provides a baseline for local recurrence in breast reconstruction candidates. Between 1955 and 1975, 1,110 patients underwent modified radical mastectomy at the Cleveland Clinic. This group of patients was analyzed to provide information about local recurrence in breast reconstruction candidates. The data were also analyzed for the effects of timing and nodal status. On the basis of this study, we have concluded that the number of involved axillary lymph nodes alone should not exclude a woman from having reconstruction. We also conclude that there is no oncological justification for imposing a specified waiting time between mastectomy and reconstruction.

Breast↗
PubMed1982

Peripheral nervous system complications of coronary artery bypass graft surgery.

Among 421 patients undergoing coronary artery bypass graft surgery, 55 (13%) developed 63 new peripheral nervous system (PNS) complications postoperatively. Most common was a brachial radiculoplexopathy, which occurred in 23 patients. Of these, 21 involved lower trunk or medial cord fibers. In 17 there was a correlation between the site of jugular vein cannulation and the side affected, suggesting that needle trauma played a role. Stretching from chest wall retraction may have caused some cases. Other deficits included 13 saphenous, 8 common peroneal, and 5 ulnar mononeuropathies. Six patients had persistent singultus, suggesting phrenic nerve involvement. Unilateral vocal cord paralysis was found in 5. An isolated partial Horner syndrome and a facial neuropathy were also identified. Males were more likely to develop PNS complications. Hypothermia during surgery was associated with increased risk. Most PNS deficits were transient, and lasting disability was rare.

Adult↗
PubMed1980

HDL-cholesterol concentration and severity of coronary atherosclerosis determined by cine-angiography.

We studied 226 adult male subjects (mean=52yr) who underwent coronary arteriography. Their serum lipid and lipoprotein levels [total cholesterol (TC), triglycerides (TG), HDL-cholesterol (HDL-C), LDL-C, HDL-phospholipid (HDL-P), HDL-TG, HDL-C/TC, HDL-P/TC, LDL-C/TC, LDL-C/HDL-C and LDL-C/HDL-P] were correlated with the severity of coronary artery disease (CAD). Studies showed a slight but statistically significant correlation (linear regression) between CAD and HDL-P/TC (r=-0.24, P < 0.001), HDL-C/TC (r=-0.20, P < 0.002), followed by LDL-C/HDL-P (r=0.19, P < 0.004) and HDL-P (r=-0.18, P < 0.008). HDL-C, LDL-C and TC were significant at the P < 0.05 level; P value of TG was non-significant. Subjects were conveniently grouped based on degree of coronary artery narrowing: normal, mild (1-50%); moderate-severe (51-99%) and very severe (100% occlusion). Of the 11 lipid variables, the best predictor of the stage of the CAD was HDL-P/TC as measured by one-way analysis of variance. This trend was unaltered even after adjustment for covariates. HDL-P, LDL-C/HDL-P and HDL-C/TC were also significant, but the other lipid parameters were not. The study indicates that HDL-C, by itself, is not as effective a predictor of CAD as HDL-P/TC. Also, the small but statistically significant inverse relationship between HDL-P/TC and CAD suggests that a low HDL-P/TC ratio can be considered a risk factor for CAD but not as a dependable clinical diagnostic aid for predicting the severity of CAD on an individual basis.

Adult↗
PubMedDate not supplied

Sympathetic contribution to the cardiac response to stress in hypertension.

Studies of cardiac performance in hypertension have often been restricted to cardiac output determinations, although the latter alone are inadequate for that purpose. To define the range of cardiac performance in hypertension, the response of left ventricular filling pressure to increased workload (static exercise) was determined in 39 subjects--eight normotensive (NT) volunteers, seven patients with borderline hypertension (BLH), and 24 essential hypertensives (EH), of age-matched groups. A rise of mean pulmonary wedge pressure (PWP) by 5 mm Hg or more during maximum handgrip (HG) was considered "abnormal" for a workload (SBP x HR x 10(-3)) increase of greater than or equal to 25%. All NT subjects and all patients with BLH as well as 16 of the 24 EH (EH-I) showed normal cardiac performance by this definition. In contrast, PWP increased greater than or equal to 5 mm Hg during HG in eight patients with EH (EH-II). The calculated increase in cardiac workload was not significantly different among the four groups (+5, 5.8, 5.4 and 5.5 respectively). Beta blockade (propranolol, 10 mg i.v.) slowed heart rate in all subjects and reduced SBP x HR product in all groups both at rest and during HG. Responses of PWP to HG were widely divergent in the different patients. However, as a group those patients with "impaired cardiac performance" before propranolol (EH-II) had a greater reduction in performance following propranolol than EH-I or NT. This study suggests that adrenergic support of cardiac performance might be important in some hypertensive patients with no evidence of heart failure.

Adult↗
PubMedDate not supplied

Central nervous system complications of coronary artery bypass graft surgery: prospective analysis of 421 patients.

A prospective analysis of 421 patients undergoing coronary artery bypass graft (CABG) surgery as the sole cardiac procedure was carried out to assess the frequency of central nervous system (CNS) complications. In all, 451 variables were assessed in each patient. Stroke occurred in 5.2% but was severe in only 2%. Prolonged encephalopathy occurred in 11.6% but usually resolved before discharge. No statistically significant pre- or intraoperative risk variables for CNS complications were found; specifically, age or pump times in excess of two hours were not significant factors. Postoperative use of an intraaortic balloon pump and pressor agents were significantly correlated with prolonged encephalopathy. The frequency of CNS injury in CABG surgery is similar to that in other forms of open heart surgery, and there has been little change in the frequency of CNS complications over the past seven years. Possible mechanisms of CNS damage during CABG surgery are discussed.

Adult↗