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Biomedical subjects

R M King

Publications and source records attributed to R M King.

At least 19 recordsLinked to original sources
PubMed1991

Mechanical circulatory assistance after heart transplantation.

From October 1985 through December 1989, 92 heart transplant procedures were performed in 89 patients. Nine patients (aged 19 to 66 years; 7 male, 2 female) required mechanical circulatory support after transplantation because of primary idiopathic organ failure (n = 2), implant difficulty (2), poor organ quality (2), or acute right heart failure (3). Devices used included the intraaortic balloon pump (6), centrifugal right ventricular assist device (2), left ventricular assist (1), biventricular assists (2), and total artificial heart (1). Two patients required multiple devices. One patient underwent retransplantation. Implant time ranged from 1 to 18 days. One early death occurred owing to right heart failure 6 days after transplantation, 7 hours after removal of a right ventricular assist device, for an overall mortality of 11%. The remaining 8 patients are alive 4 months to 28 months after transplantation. The actuarial 1-year survival of 89% +/- 10% compares well with the survival of 87% +/- 4% for the entire transplant group. All surviving patients are in functional class I. Echocardiographic examination in all patients revealed left ventricular ejection fraction to be normal in 7 and depressed in 1. Extending the criteria for organ donors or difficulty with the implant procedure can lead to early organ failure, which may be reversible with circulatory assistance allowing excellent survival.

Adult↗
PubMed1991

Use of a diary technique to investigate psychosomatic relations in atopic dermatitis.

Previous research on the relationship between stress and atopic dermatitis has employed retrospective approaches such as interviews and measurement of life events and daily hassles. These studies have yielded inconsistent results. In the current study, 50 atopic dermatitis sufferers completed a diary for a fortnight, recording their daily emotional states and skin condition. The results of meta-analyses indicated that both interpersonal stress and depression were significantly related to changes in skin condition. Meta-analyses of lag sequential analyses indicated that interpersonal stress on Day X predicted skin condition on Day X + 1 and that this relationship was reciprocal. Depression was predicted by the skin condition of the previous day but this relationship was not reciprocal. These results were integrated and their implications for psychosomatic relationships between stress, depression, and atopic dermatitis were discussed.

Adult↗
PubMed1988

Genes specifically expressed at growth arrest of mammalian cells.

A subtraction cDNA library enriched for RNA sequences preferentially expressed in growth-arrested cells was prepared. Six cDNA clones were identified, varying in abundance from 2% to 0.0002% of the library and in size from 0.8 to 10 kb. The corresponding mRNAs are downregulated with different kinetics upon induction of growth by serum. The kinetics of induction after serum starvation and density-dependent inhibition of two of these growth-arrest-specific (gas) genes were investigated in more detail. Two cell lines transformed by viral onc genes did not express the two gas genes. The full-length cDNA for one gene has been sequenced and the protein product preliminarily characterized by in vitro translation.

Amino Acid Sequence↗
PubMed1988

Electrohydraulic shock wave decalcification of stenotic aortic valves: postmortem and intraoperative studies.

Decalcification of stenotic aortic valves is limited by the difficulty in removing sufficient calcium to restore valve function without cusp perforation. The present study demonstrates that electrohydraulic shock waves generated by a hand-held lithotriptor fragmented the calcifications contained within the cusps of four necropsy specimens of stenotic aortic valves. The electrohydraulic shock waves appeared to create a cleavage plane between the valve tissue and the fragmented calcific deposits, allowing the fragmented calcified masses to be removed without cusp perforation. Five patients with severe aortic stenosis also underwent successful aortic valve decalcification augmented by electrohydraulic shock waves generated with the hand-held lithotriptor, without significant complication. The shock waves permitted removal, from the aortic valve, of calcium that had not been removed by mechanical means. These results indicate that the addition of electrohydraulic shock waves to mechanical aortic valve decalcification may facilitate successful decalcification in patients undergoing operative treatment for aortic stenosis and may allow patients to avoid the need for aortic valve replacement.

Aged↗
PubMed1987

Ivor Lewis esophagogastrectomy for carcinoma of the esophagus: early and late functional results.

One hundred adult patients underwent Ivor Lewis esophagogastrectomy for documented carcinoma of the esophagus from 1980 through 1982. After operation, 7 patients were classified in Stage I, 11 in Stage II, and 82 in Stage III. Major postoperative complications occurred in 27 patients and included pulmonary problems in 11, suture line leak in 9, wound infection in 5, empyema in 4, renal failure in 4, abdominal abscess in 4, bleeding in 2, myocardial infarction in 2, and chylothorax in 1. There were 3 deaths within 30 days of operation. Five-year survival was 85.7% for patients with Stage I disease, 34.1% for patients with Stage II disease (p = .052), and 15.2% for patients with Stage III disease (p = .001). Late morbidity included weight loss in 60 patients, dysphagia in 40, gastroesophageal reflux in 14, and gastroduodenal dumping in 5. Thirty-one patients required postoperative esophageal dilations (mean, 3.4). Most patients, however, were eating without dysphagia at the time of last follow-up or death. We conclude that the Ivor Lewis esophagogastrectomy can be performed with low mortality, can provide adequate palliation, and does result in satisfactory long-term survival for those patients with more favorable postsurgical stages of cancer. These results support the continued use of the Ivor Lewis esophagogastrectomy for treatment of carcinoma of the esophagus.

Adenocarcinoma↗
PubMed1987

The association of unexplained gastrointestinal bleeding with calcific aortic stenosis.

The association of chronic gastrointestinal bleeding and aortic stenosis remains problematical. The cases of 91 patients (age 38 to 80 years) with these disorders who were examined between 1955 and 1975 were reviewed to address this controversy. All patients underwent upper and lower gastrointestinal radiography, small bowel series, and proctoscopy. Other studies were endoscopy in 84 patients, colonoscopy in 61, and visceral angiography in 16. Of the 37 patients who underwent abdominal exploration, 35 (95%) continued to bleed postoperatively, including 8 of 10 patients who had bowel resection for angiodysplasia. Forty patients did not have an abdominal operation, and all have continued to bleed. Sixteen patients (2 of whom had had an abdominal procedure) underwent aortic valve replacement for aortic stenosis. There were 2 intraoperative deaths among these 16 patients. At follow-up, which ranged from 8 to 12 years, only 1 patient who underwent aortic valve replacement had recurrent bleeding secondary to excessive anticoagulation. Thus, overall, gastrointestinal operation was successful in only 5% of patients, but aortic valve replacement was effective in 93%. For unexplained gastrointestinal bleeding associated with aortic stenosis, aortic valve replacement should be considered because of the likelihood of cure.

Adult↗
PubMed1987

Repair of ascending aortic dissection. Influence of associated aortic valve insufficiency on early and late results.

Operative treatment of dissections of the ascending aorta differs from that for the descending aorta, not only because of the need for cardiopulmonary bypass, but also because of the frequent occurrence of aortic valve insufficiency. To determine the early and late results of operative repair, we have reviewed the case histories of 121 consecutive patients who underwent repair of ascending aortic dissections between 1962 and 1985. Ages ranged from 16 to 79 years (mean 56 +/- 14 years); 54 patients had operation within 2 weeks of onset of symptoms (acute), and the remainder had later repair (chronic). Seventy patients (58%) had clinical evidence of aortic insufficiency at the time of admission. During repair of acute dissection, 10 patients (19%) had aortic valve resuspension and 15 patients (28%) had aortic valve replacement. During repair of chronic dissection, eight patients (12%) had resuspension and 43 patients (64%) had replacement. Overall operative mortality was 22%, significantly higher for patients with acute than for those with chronic dissections (39% versus 9%, p less than 0.01). Operative risk was similar for patients who underwent repair of ascending aortic dissections without valve resuspension or replacement (31%) versus those who had repair with aortic valve resuspension (17%) or replacement (17%). During a follow-up period ranging from 1 to 208 months, aortic regurgitation developed in only two patients who did not have aortic insufficiency at the time of repair. Late aortic regurgitation necessitating reoperation developed in one of the 15 survivors who had aortic valve resuspension. Eight patients undergoing aortic valve replacement had complications of their prostheses, including one periprosthetic leak and four mechanical failures. We conclude that resuspension or replacement of the aortic valve does not increase the risk of repair of ascending aortic dissections. Selective management of aortic insufficiency (with valve repair whenever possible) yields satisfactory long-term results.

Aortic Dissection↗
PubMed1986

Mechanical decalcification of the aortic valve.

Thromboembolism and anticoagulant-related complications secondary to prosthetic aortic valve replacement constitute a significant risk (28% at 5 years). From 1978 through 1984, decalcification of the aortic valve was performed in 8 patients who were undergoing coronary artery revascularization. Preoperative gradients of between 30 and 80 mm Hg (mean, 50 mm Hg) were abolished after operation. To determine the viability of decalcification, the records of 84 additional patients who had undergone this procedure between 1959 and 1978 were reviewed (86% before 1965). There were 60 male and 32 female patients ranging from 14 to 74 years old (mean, 49 years). The cause of the calcification was a bicuspid valve in 32 patients (35%), senile calcification in 9 (10%), and rheumatic fever in 50 (54%); the cause in 1 patient was unknown. Thirty-day mortality was 13%. Follow-up was 98% complete and ranged from 6 months to 22 years (mean, 7 years). Aortic valve replacement was subsequently required in 25 patients. Freedom from reoperation at 1, 5, 10, and 15 years was 98%, 75%, 43%, and 26%, respectively, for patients with rheumatic valves compared with 97%, 76%, 57%, and 51%, respectively, for those with bicuspid valves. Survival for patients with rheumatic valves at 1, 5, 10, 15, and 20 years was 93%, 70%, 48%, 40%, and 35%, respectively, compared with 100%, 66%, 57%, 46%, and 46% for patients with bicuspid valves. At follow-up, 61% of the patients were in New York Heart Association Functional Class I or II. Causes of late death were valve related (30%), congestive heart failure (27%), and myocardial infarction (24%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Primary chest wall tumors: factors affecting survival.

Between 1955 and 1975, chest wall resection was done in 90 patients for primary chest wall tumors. Ages ranged from 8 to 96 years (mean, 44.3 years). A painful mass was the most common sign and symptom. Eighty-two tumors (91.1%) were located in the lateral chest wall and eight, in the anterior thorax. The tumor was malignant in 71 patients (78.9%) and benign in 19. All patients with benign tumors had complete excision and are currently free from disease. Malignant fibrous histiocytoma, chondrosarcoma, and rhabdomyosarcoma constituted 62% of the malignant neoplasms. Most malignancies were treated by wide resection. There were no thirty-day operative deaths. Overall 1-, 5-, and 10-year survival was 89%, 57%, and 49%, respectively. Recurrent tumor developed in 37 patients (52%); 5-year survival, however, was only 17% after recurrence. Cell type and extent of invasion significantly influenced survival. Both chondrosarcoma and rhabdomyosarcoma had a better prognosis than malignant fibrous histiocytoma (p less than 0.05). We conclude that early resection is the treatment of choice for primary malignant chest wall tumors and that development of recurrent disease is an ominous event.

Adolescent↗
PubMed1986

Early and late results following repair of dissections of the descending thoracic aorta.

Management of dissections of the descending thoracic aorta remains controversial, especially with regard to timing and method of repair. To clarify these and other issues we have reviewed our total experience with repair of descending aortic dissections between 1962 and 1983. The 44 men and 20 women had a mean (+/- SEM) age of 59 +/- 2 years (range, 19 to 83 years), and in all patients the dissection originated in and was limited to the aorta distal to the left carotid artery (Stanford type B, DeBakey types IIIa and IIIb). Twenty-nine patients underwent operation within 2 weeks of the onset of symptoms (acute), and the remainder had later repair (chronic). During repair, circulation distal to the aortic cross-clamp was supported with cardiopulmonary bypass or shunt in two thirds of patients. Overall, 18 deaths occurred less than or equal to 30 days postoperatively (operative risk 28%), and risk was higher in acute (45%) than in chronic (14%) dissections. Operative risk was not significantly related to protection of the distal circulation. The most serious postoperative complication was spinal cord ischemia manifested by paraplegia in five patients (8%) and transient or permanent paraparesis in six patients (9%). Risk of spinal cord ischemia was significantly lower in patients who had protection of the distal circulation during operative repair (8% vs. 44%, p = 0.003). Late survival, including hospital deaths, was 49% +/- 7% at 5 years after operation; 22 of the 46 patients who survived repair were found to have aneurysms involving the thoracic and/or abdominal segments of the aorta. Our results indicate that repair of chronic dissection of the thoracic aorta has a lower operative risk than repair of acute dissections, and initial medical management of acute dissection may be indicated if no early complications occur. Risk of spinal cord ischemia is significantly reduced by cardiopulmonary bypass or shunt and is preferred over aortic cross-clamping alone. Finally, these patients require careful long-term follow-up because of the high incidence of residual or recurrent aortic aneurysms.

Acute Disease↗
PubMed1986

Concomitant mitral valve repair or replacement and coronary revascularization.

Patients undergoing combined mitral valve replacement and coronary revascularization require surgical skill and especially judgment for optimal results. In our hands, cardioplegia has not been a pivotal event in affecting survival, and this probably relates to our previous philosophy of limiting the hypothermic ischemic episodes to 15-minute intervals. Currently, we believe that valve repair, when it can be accomplished, is preferable to valve replacement, especially in the patient with ischemic mitral valve disease. When repair cannot be satisfactorily accomplished, replacement with retention of the posterior leaflet seems clinically to be associated with less disturbance of left ventricular function.

Anesthesia↗
PubMed1986

Prognostic factors and surgical treatment of partial atrioventricular canal.

In this study we sought to determine the prognostic factors that influence early and late survival after repair of partial atrioventricular canal and the need for reoperation. From January 1962 to January 1984, 199 patients underwent correction of partial atrioventricular canal. There were 73 male and 126 female patients, ranging in age from 5 months to 71 years (mean 11.2 years). Total 30 day operative mortality was 5.5%. Since 1980, the mortality has declined to 3%. Significant determinants of operative mortality were congestive heart failure, cyanosis, failure to thrive, age less than 4 years, and moderate-to-severe mitral valve insufficiency (p less than .01). Sex, cardiomegaly, radiographically increased pulmonary vasculature, intraoperative postrepair right ventricular-to-left ventricular pressure ratio, and pulmonary-to-systemic flow ratio were not significant in determining early mortality. Follow-up ranged from 1 to 21.4 years (mean 15.2). There were seven late deaths, primarily in older patients from atherosclerotic disease or malignancy. Late survival was 98% at 1 year and 96% at 20 years. Reoperation was performed on 18 patients, 15 for mitral incompetence, and three for subaortic stenosis. The need for reoperation correlated with severity of postrepair mitral insufficiency. Longterm survival is excellent after repair of the partial form of atrioventricular canal.

Aged↗
PubMed1985

Surgical palliation of respiratory insufficiency secondary to massive exuberant polyostotic fibrous dysplasia of the ribs.

A middle-aged man with long-standing polyostotic fibrous dysplasia had severe progressive restrictive lung disease with hypoxemia and pulmonary hypertension with heart failure because of exuberant intrathoracic, extraosseous proliferation of dysplastic tissue. Subtotal resection of this benign tissue mass ameliorated the respiratory insufficiency and led to sustained improvement in exercise tolerance, increase in pulmonary reserve, and decrease in signs of heart failure and pulmonary hypertension.

Fibrous Dysplasia of Bone↗
PubMed1985

Enterobacter mediastinitis following cardiac surgery.

Eight cases of sternal/mediastinal infection due to Enterobacter species were seen in postoperative cardiac patients during 1980 to 1981. The attack rate was 14.5% (8/55), compared to 3.7% (2/54) for an identical period in 1979 to 1980 (p less than 0.05). Cases varied in severity from fulminant, acute bacteremic infections (one death) to less severe wound infection. Late complications or recurrences were not seen. There was a hospital-wide increase, relative to all other gram-negative bacillary isolates, in Enterobacter laboratory isolations, but no increased rate of infection in any other specific surgical condition. No personnel, materials, or techniques were associated with the outbreak, and all but two environmental cultures were negative. Case-control analysis suggested that surgical complications and prophylactic cephalosporins were associated with infection. Prospectively, an additional 85 cardiac surgery patients had increased Enterobacter skin/wound colonization following perioperative prophylaxis with cephalosporin antibiotics. After introduction of barrier isolation and restriction of contacts no further mediastinitis occurred in 100 subsequent cardiac surgery patients. This study indicates that Enterobacter may be major pathogens causing post-cardiac-surgery infection not prevented by cephalosporin prophylaxis.

Cardiac Surgical Procedures↗
PubMed1985

Carcinoma of the breast associated with pregnancy.

Sixty-three pregnant patients were treated for primary carcinoma of the breast at the Mayo Clinic between 1950 and 1980. These patients had a greater incidence of nodal metastasis and scirrhous histopathologic factors than did non-pregnant patients with a malignant condition of the breast. The five year survival rate of pregnant patients with localized malignant growths of the breast was 80 per cent. Improved survival time was not demonstrated for patients who terminated the pregnancy.

Abortion, Therapeutic↗
PubMed1984

Multidrug-resistant Serratia marcescens bacteriuria related to urologic instrumentation.

An outbreak of urinary tract infections caused by multidrug-resistant Serratia marcescens lasted for 12 months and was found to be related to urologic instrumentation. Thirty-four patients had primary infections; four had cross-infections. Only six patients had indwelling bladder catheters. The median interval between instrumentation and initial isolation of Serratia was six days. Seventy-three percent of patients were symptomatic, two were bacteremic. No common instruments, personnel, or wards were identified, and environmental cultures failed to reveal the epidemic strain of Serratia. The outbreak ended when the instrument disinfectant was changed. Serotyping was identical in nine of ten isolates. Intraspecies conjugation demonstrated resistance transfer of gentamicin, tobramycin, carbenicillin, chloramphenicol, and co-trimoxazole. The enzyme 6'-N-acetyl transferase was responsible for gentamicin-inactivation in patient isolates and a transconjugate. Although no significant spread of this multidrug-resistance plasmid to other Enterobacteriaceae occurred in the hospital, two instances of apparent in vivo transfer to other bladder organisms occurred.

Adult↗
PubMed1984

The reaction of the anti-interferon-alpha monoclonal antibody, NK2, with different interferons.

Analysis of the neutralization of human interferon-alpha by the monoclonal antibody NK2 showed, by three different methods, that the avidity constant was about 10(10)M-1. A small decrease in the avidity constant (and in the antibody titre) with increasing interferon concentrations was observed, suggesting that the antibody-interferon complex had a little biological activity. The antibody neutralizes the interferon by preventing the binding of interferon to susceptible cells. It does not react with human-gamma, mouse-alpha, monkey, bovine or rabbit interferons.

Antibodies, Monoclonal↗