Biomedical subjects
S J Phillips
Publications and source records attributed to S J Phillips.
Anoxic hypothermic cardioplegia compared to intermittent anoxic fibrillatory cardiac arrest. Clinical and metabolic experience with 1080 patients.
Appropriately applied, hypothermic cardioplegia allows an excellent surgical setting that can significantly reduce the myocardial ischemic injury resulting from anoxia. One thousand eighty adult and pediatric patients underwent a variety of corrective cardial surgical procedures utilizing cold potassium cardioplegic solution injected into the coronary arteries via the aortic root. Myocardial septal temperature was maintained at 18--20 degrees during arrested time. This group of patients was compared to a group of 220 patients that underwent intermittent normothermic ischemic arrest to perform cardiac surgical procedures. Significant reduction in morbidity, mortality, perioperative myocardial infarction was noted in favor of the cardioplegic group. Metabolic coronary sinus blood analysis in the group undergoing surgery with cardioplegia revealed favorable changes in myocardial lactate and oxygen extraction.
Emergency coronary artery revascularization: a possible therapy for acute myocardial infarction.
Cardiac muscle death caused by coronary artery occlusion is a dynamic process that often takes hours or days. Emergency revascularization (saphenous vein bypass graft (SVBG) during acute myocardial infarction (MI) can interrupt myocardial necrosis, salvage ischemic myocardium and revascularize vessels with obstructive lesions not involved in the MI. In this report we describe a preliminary experimental study of 75 patients in which emergency SVBG was the therapy for acute MI. Group 1, 16 patients, required vasoactive medications and/or intraaortic balloon pumping to maintain their blood pressure preoperatively. There was one operative death and two late deaths. Group 2 consisted of 59 hemodynamically stable patients. There were no deaths. The average preop CPK in group 1 was 892 vs 504 in group 2 (p greater than 0.05). Surgical techniques were routine. The average time from the onset of chest pain that continued to surgery was 6.5 hours. Forty patients were restudied. Post- vs presurgical hemodynamics revealed ejection fraction increased by 34% (p greater than 0.05), left ventricular end-diastolic pressure reduced by 40% (p greater than 0.01). End-systolic and end-diastolic volume reduced by 30% (p greater than 0.05), and 15% (p greater than 0.01), and stroke volume improved 25% (p greater than 0.05). Operative mortality was 1.3% and late mortality 2.8%. These results suggest that cautious continued trial of emergency SVBG in patients with evolving MI is warranted.
The preparation and immunosuppressive properties of equine antihuman thymocyte membrane immunoglobulin G.
Human thymocytes separated by a Ficoll gradient produced a cell population that was 99% pure thymocytes and free of platelets, leukocytes, and epithelial cells. These cells, disrupted by a nitrogen bomb, produced a membrane-ribosome antigen fraction confirmed by enzyme analysis. Equine antithymocyte membrane-immunoglobulin G (ATM-IgC) prepared against this antigen in four of five horses contained immunosuppressive properties capable of prolonging monkey skin allograft survival longer than 21 days. No adverse effects were noted by the intramuscular and intravenous administration of this antisera to primates, and autopsy examination showed marked depletion of paracortical lymphocytes in the spleen and mesenteric lymph nodes. A moderate thrombocytopenia occurred during a 4 hour intravenous administration of ATM-IgG to primates with a marked decrease in the peripheral lymphocyte count. The deposition of ATM-IgG upon monkey glomerular basement membrane could not be demonstrated by immunofluorescent techniques. The specificity of this globulin to contain anti-T-cell antibody was confirmed by an immunofluorescent assay in that ATM-IgG reacted with both human thymocytes and peripheral blood thymus-dependent cells, but was nonreactive when tested against a panel of human cells free of thymus-dependent antigens.
The adjunctive value of equine antithymocyte membrane globulin in a randomized study of patients undergoing cadaveric renal transplantation.
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Visualization of the coronary microvascular bed by light and scanning electron microscopy and x-ray in the mammalian heart.
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A new left ventricular assist device: clinical experience in two patients.
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Cardiogenic shock. Treatment by augmentation with a pulsatile assist device.
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Deceleration injuries of the great vessels.
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Combined valve procedures.
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A newly designed arterial monitoring/perfusion cannula for cardiac operations.
A newly designed arterial monitoring and perfusion cannula for cardiopulmonary bypass eliminates the need for cannulation of a peripheral artery for pressure monitoring. The double-lumen cannula is designed as follows: the large central lumen (12 to 26f) acts as the arterial inflow conduit from the pump oxygenator, while a second, smaller lumen (18 gauge)constructed in the wall of the first cannula acts as the pressure-monitoring port and the source for blood sampling and drug infusion. This monitoring/perfusion cannula has been used succesfully in more than 250 clinical patients in a variety of settings--total cardiopulmonary bypass, left heart bypass, and when multiple arterial inflow lines were necessary (as in aortic arch replacement). Use of this cannula is advantageous in the infant and pediatric patient or in the emergency setting, when insertion of a peripheral arterial line can be difficult. Used in conjunction with a Doppler system, the cannula provides accurate, dependable blood pressure monitoring.
Cardiac valve replacement with the glutaraldehyde preserved porcine heterograft.
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Secretin and vasoactive intestinal peptide inhibit fluid absorption and induce secretion in the isolated gall-bladder of the guinea-pig [proceedings].
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Cardiac hypothermia.
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Myocardial revascularization in patients with unstable angina.
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A temporary catheter-tip aortic valve: hemodynamic effects on experimental acute aortic insufficiency.
A catheter-mounted polyurethane cusp was designed to act as a temporary prosthetic aortic valve in the ascending aorta. Acute aortic insufficiency was created in 15 dogs by transventricular tearing of the two aortic valve leaflets with a wire hook. Hemodynamic variables were measured during aortic insufficiency and with the prosthetic valve in place. Comparison of the values showed that the prosthesis functioned as a competent aortic valve. Aortic diastolic pressure increased by 62 +/- 42%, pulse pressure was lowered by 44 +/- 9%, and left ventricular end-diastolic pressure decreased by 45 +/- 18%. Neither cardiac output, coronary blood flow, nor peak systolic pressure was significantly altered. The observed hemodynamic improvement and the simplicity of the design and application suggest that the prosthetic aortic valve may be applicable in the temporary treatment of decompensated aortic insufficiency.
Improvement in forward coronary blood flow by using a reversed saphenous vein with a competent valve.
Reversed segments of saphenous vein have been the grafts of choice for aortocoronary bypass (ACB). Internal mammary arteries and free radial autografts have recently been shown to have a higher ppatency rate, but flow is usually lower. Normally forward coronary blood flow ceases and retrograde flow occurs during cardiac systole. Prevention of retrograde flow with a rapidly acting valve proximal to the coronary artery anastomosis should improve forward coronary blood flow. Thirty-nine reversed saphenous veins containing a competent valve were implanted in 32 patients undergoing ACB. After accurate zero flow was determined and a resting state achieved, mean (22 veins) and pulsatile (17 veins) flows were measured distal to the valve with the valve competent and temporarily incompetent. A competent valve in 10 right coronary artery vein grafts increased mean flow by 29.7% (+41 ml/min; p less than 0.005) and pulsatile flow in 6 veins by 17.7% (p less than 0.001). A competent valve in 12 left coronary artery vein grafts increased mean flow by 31.3% (+34 ml/min; p less than 0.01) and pulsatile flow in 11 veins by 13.7% (p less than 0.001). This study suggests that a portion of reversed saphenous vein containing a competent valve provides greater coronary artery blood flow than veins without valves and may be the conduit of choice for coronary artery revascularization.