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Biomedical subjects

R N Grantham

Publications and source records attributed to R N Grantham.

17 recordsLinked to original sources
PubMed1983

Femoral artery infection complicating intraaortic balloon pumping.

Infection of the femoral artery (endarteritis) complicating intraaortic balloon pumping has not been reported. Most reports of complications with this pump have not emphasized wound infection. Whether the balloon is inserted by open or percutaneous technique, infection remains a problem. During the past 7 years, 32 of 50 patients (64 percent) who had intraaortic balloon pump insertion survived balloon removal. In four patients, wound infection of the groin developed with involvement of the femoral artery. Sepsis was due to P. aeruginosa in three patients and E. cloacae in one. All patients required variable degrees of resection of the infected femoral artery wall. One had successful arterial reconstruction with vein patch angioplasty alone after debridement of the vessel wall. In a second patient, resection of the common femoral artery with interposition of a saphenous vein that had been reconstructed to enhance its diameter to that of the femoral artery was accomplished. Dehiscence of a vein patch angioplasty occurred in the remaining two patients with resultant hemorrhage. Further resection of the femoral artery was required with femoro-femoral saphenous vein grafting in one patient and iliofemoral vein grafting in another. Tissue coverage of the reconstructed vessel was best accomplished using a tensor fascis lata myocutaneous flap. All patients survived the infection without amputation.

Adult↗
PubMed1980

Hemophilus influenzae purulent pericarditis in children: diagnostic and therapeutic considerations.

Purulent pericarditis is an unusual complication of infection in infancy and has been associated with an extremely high mortality rate. Early diagnosis followed by combined antibiotic therapy and surgical drainage of the pericardium has markedly improved survival. Between APril, 1975, and February, 1979, nine patients with purulent pericarditis secondary to Hemophilus influenzae type B were treated at the Oklahoma Children's Memorial Hospital. In every case signs and symptoms of congestive heart failure were present, and a pericardial effusion was demonstrated by echocardiography and confirmed by pericardiocentesis. The organism was identified with countercurrent immunoelectrophoresis and antibiotic sensitivity determined by rapid beta lactamase assay. All patients were treated with a combination of parenteral antibiotics and open surgical drainage of the pericardium. There were no deaths and all patients demonstrated marked improvement following operation. Follow-up echocardiography revealed no evidence of pericardial effusion or signs of constriction in any patient.

Anti-Bacterial Agents↗
PubMed1979

Left ventricular decompression by sump drainage.

Decompression of the left ventricle during cardiopulmonary bypass is a useful adjunct to open-heart operation, primarily to preserve myocardial tissue and also to improve the exposure of the operative field. The addition of sump drainage to left ventricular decompression systems enhances the usefulness of this established technique. Technical aspects of this sump drainage are detailed.

Coronary Artery Bypass↗
PubMed1978

Reappraisal of solitary bronchiolar (alveolar cell) carcinoma of the lung.

Twelve patients with solitary bronchiolar carcinoma had lobectomy and were followed for up to 16 years. The concept of a multicentric origin of bronchiolar carcinoma, maintained for more than eight decades, should be discarded. The neoplasm arises indolently and usually in an area of pulmonary fibrosis. After lobectomy patients can now expect to follow one of four courses: (1) to be alive and well without recurrence; (2) after several years to have pulmonary recurrence or a new carcinoma; (3) with minute spread at the time of lobectomy to have metastasis develop in a short period; or (4) to die of unrelated conditions. The overall 5-year survival with this tumor is about 75%. Late recurrence or the development of another primary tumor, however, prompts the need for prolonged follow-up. Immunologically, patients have circulating antibodies when well and demonstrable circulating antigens with recurrence. The survival rate of selected patients with solitary bronchiolar carcinoma (eliminating those patients with microscopic spread from the primary neoplasm at the time of resection and those dying of other causes) was 100% after 5 years and 75% after 10 years.

Adenocarcinoma↗
PubMed1975

Effects of acid-base changes, hypoxia, and catecholamines on ventricular performance.

Extracellular pH changes were produced in dogs with tris (hydroxy-methyl)-aminomethane (Tris) or NaHCO3 in the presence or absence of hypoxemia and before and after beta-adrenergic blockade with propranolol. Ventricular performance (VP) was evaluated by measurement of maximum rate of rise of left ventricular pressure (dp/dt max) and left ventricular end-diastolic pressure in the canine right heart bypass preparation with aortic pressure, heart rate, and cardiac output held constant. Low pH diminished VP. Hypoxemia did not alter VP within the pH, suggesting that decreased V observed with acidosis before propranolol was due primarily to decreased myocardial response to catecholamines. Increase of pH with Tris increased VP significantly more than with NaHCO3. Beta blockade diminished the response of VP to Tris at a high pH;prior administration of reserpine abolished the inotropic effect of Tris. The data suggest that Tris can influence VP independent of its effect on pH. This effect is probably mediated by the interaction between endogenous catecholamines and myocardial beta receptors.

Acid-Base Equilibrium↗
PubMed1975

The echocardiogram of the anterior leaflet of the mitral valve. Correlation with hemodynamic and cineroentgenographic studies in dogs.

The echocardiogram of the anterior leaflet of the mitral valve (ECHO) was compared to hemodynamic and cineroentgenographic data to evaluate its accuracy in timing mitral valve (MV) opening and closure, and to validate it as an indicator of MV motion. The ECHO, high speed cineroentgenography at 250 frames/sec, and/or measurement of intracardiac pressures allowed accurate timing of the events of MV motion in dogs on right heart bypass. The intersection of left ventricular and left atrial pressures in early diastole preceded the onset of rapid anterior motion of ECHO (D' point) by 17 to 33 plus or minus 7.6 msec; r equals 0.98. The onset of left ventricular systole occurred before the termination of final rapid posterior motion of the ECHO in end diastole (Co point) by 25 plus or minus 10 msec; r equals 0.96. Radiopaque clips were attached to the free edges of both leaflets of the MV. Cineroentgenographically determined plots of clip distance from the ultrasound transducer were morphologically similar to the simultaneously recorded ECHO. A delay of 23 plus or minus 3 (0 to 40) msec was observed in the ECHO peaks of diastolic anterior excursion compared to clip motion. Contrast medium advances beyond the free edges of MV leaflets mixing with left ventricular blood 43 plus or minus 3 msec after initial separation. These cineroentgenographic studies elucidate nonuniformity of leaflet motion responsible for ECHO delays. Thus, ECHO D' and Co correlate well with hemodynamic indicators of MV opening and closure. However, ECHO motion, although qualitatively similar, is unpredictably delayed compared to cineroentgenography of clips on the MV free edge. Since the ECHO correlates well with hemodynamic indices of MV opening and closure, this noninvasive technique can be used as a reference in the timing of intracardiac events and in the determination of systolic and diastolic time intervals.

Angiocardiography↗
PubMedDate not supplied

Dysphagia lusoria: current surgical approach.

The presence of an anomalous right subclavian artery in a patient was a cause of dysphagia and ill-defined upper back pain. Her problem was ideally managed by the median sternotomy approach. With this exposure, the artery is divided and its origin from the aortic arch oversewn. Relocating the artery into the right upper mediastinum and anastomosis with or without a segmental graft to the aortic arch restores extremity circulation and eliminates the dysphagia.

Aorta, Thoracic↗