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Biomedical subjects

W G Rainer

Publications and source records attributed to W G Rainer.

At least 19 recordsLinked to original sources
PubMed1992

Carotid body tumor.

To better define the management and behavior of carotid body tumors, a 34-year surgical experience with 33 tumors in 30 patients was reviewed. There were 20 women and 10 men with an age range of 20 to 78 years. All but one presented with a neck mass. Arteriography was performed on 21 patients and was diagnostic in every case. There was no surgical mortality. Complications occurred in eight patients (27%), and one long-term neurologic deficit occurred. Three of 33 tumors were malignant, and aggressive resection of all approachable disease with radiotherapy for unresectable metastases led to prolonged survival in each case. Carotid body tumors present with neck mass. Arteriography is diagnostic and surgery is indicated. Even for malignant tumors and metastases, aggressive resection and radiotherapy are indicated.

Adult↗
PubMed1992

The Carpentier-Edwards pericardial aortic valve: intermediate results.

The Edwards pericardial aortic valve has unique design features that minimize cusp stress and reduce abrasion wear. Wear tests and in vivo fluid dynamic tests have shown superior performance compared with other bioprostheses. Between August 1981 and July 1985, 719 isolated aortic valves were implanted in 10 US centers. Patients were aged 18 to 90 years (mean, 64 years). Men were 63.3% of the patients. Aortic stenosis was present preoperatively in 63.4% of patients. New York Heart Association functional classes III and IV were assigned to 62% of the patients. Valve sizes were 21 mm or less in 49% of patients. Concomitant procedures (most often coronary artery bypass grafting) were performed in 48% of patients. Hospital mortality was 4.7%. There was one valve-related death due to anticoagulant hemorrhage. Late mortality yielded 23 valve-related deaths: endocarditis (13), anticoagulant hemorrhage (4), thromboembolism (3), structural (2), and pannus overgrowth (1). Freedom from valve-related death at 7 years was 95.5%. Regarding valve survival, cusp tears were not seen. There were 11 calcified valves and eight explants (57 to 107 months). Seven-year freedom from all valve reoperation was 95.5%, with 11% of the patients receiving warfarin sodium, freedom of the total series from hemorrhage at 7 years was 93.3%, and from major thromboembolism, 95.8%. Echocardiographic follow-up of hemodynamics at 7 years yielded the following calculated effective orifice areas: 19 mm, 1 cm2; 21 mm, 1.3 cm2; and 23 mm, 1.4 cm2. Average mean gradient for 19-mm valves was 15 mm Hg. New York Heart Association class improved in 78% of the patients. The Carpentier-Edwards pericardial valve, carefully studied by the Food and Drug Administration guidelines, is easy to use and has excellent hemodynamics.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Subendocardial arteriovenous malformation in a patient with unstable angina.

A variety of arteriovenous abnormalities of the heart have been previously described. Arteriovenous malformations are uncommon developmental abnormalities documented in almost every organ of the body. A subendocardial arteriovenous malformation in a patient with unstable angina is described which we believe to be the first reported case.

Angina, Unstable↗
PubMed1991

Cardiopulmonary bypass, profound hypothermia, and circulatory arrest for neurosurgery.

Six female and 4 male patients (age, 23 to 75 years) underwent operation for difficult intracranial lesions. Preoperative diagnoses included four giant intracranial aneurysms, three base of skull glomus jugulare tumors, two arteriovenous malformations, and one cerebellar hemangioblastoma. All lesions were inoperable or nearly so by standard neurosurgical techniques. All patients were placed on total bypass via groin cannulations. Bypass times ranged from 111 to 269 minutes (mean, 174 minutes) with cooling times of 26 to 83 minutes (mean, 48 minutes) and warming times of 68 to 110 minutes (mean, 83 minutes). Circulatory arrest times ranged from 1.25 to 60 minutes with 1 patient not requiring arrest. The lowest core temperatures recorded varied from 8.4 degrees to 13.7 degrees C. There was one postoperative death and one major complication, both in patients with arteriovenous malformations. Eight patients (80%) have achieved an excellent result. Profound hypothermia with the option of circulatory arrest and exsanguination has been an indispensable adjunct to the safe management of intracranial aneurysm, glomus jugulare tumor, and hemangioblastoma.

Adult↗
PubMed1990

Ethics in cardiovascular medicine. Task Force II: The relation of cardiovascular specialists to patients, other physicians and physician-owned organizations.

1. The American College of Cardiology acknowledges the continuum of changing societal, medical and economic perspectives affecting traditional medical ethics. Primacy of patient responsibility remains paramount to the cardiovascular specialist who at the same time should participate in the development of broader societal programs. 2. Medical decisions should be freely and jointly formulated by the patient and the cardiovascular specialist with appropriate sensitivity to such matters as mental competence, pertinent medical information and standards of care, sufficient time for contemplation, informed consent, patient right of refusal, physician right to refuse to provide inappropriate care and the right of patient, physician or third party payer to seek consultation or additional opinions. 3. The cardiovascular specialist should make a special effort to clarify and document patient preferences regarding end-of-life treatment through some form of advance directive. 4. The cardiovascular specialist bears a moral obligation to provide medical care to any patient who is HIV positive or has AIDS. 5. A conflict of interest occurs when a cardiovascular specialist places personal or financial interest ahead of the welfare and health of a patient. Professional accountability should be established through local or regional peer review. 6. The American College of Cardiology encourages and supports a renewed dedication to the principles of medical ethics, particularly in the field of cardiovascular disease. Cardiovascular specialists are encouraged to participate in the promulgation of medical ethics by teaching and by example, individually and with others.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Cardiovascular perfusion: evolution to allied health profession and status 1986.

The occupation of cardiovascular perfusion has evolved from a technical to a professional status during the past 25 years. The national thoracic surgical organizations, The American Association for Thoracic Surgery and the Society of Thoracic Surgeons, have supported this process of development through participation on various boards and committees of the perfusionist organizations. The rapid growth of cardiac surgical services in the past decade produced concern about the availability of perfusionist manpower. This concern was exacerbated by creation of formal processes for the certification of perfusionists and the accreditation of perfusion educational programs. Today, these issues are largely resolved and cardiovascular perfusion is recognized as an allied health profession.

Accreditation↗
PubMed1985

Upper dorsal sympathectomy.

Over a 20 year period, 60 patients underwent 76 procedures for upper dorsal sympathectomy, usually with a transaxillary approach but occasionally with an anterior approach. Procedures in male patients and in those that were carried out on the right side were most frequent. There were few simultaneous procedures. The extent of sympathectomy included resection of the lower half of the stellate ganglion through the fourth thoracic ganglion. The results were satisfying for patients with vasospastic disorders and hyperhidrosis and quite acceptable for those with causalgia and vaso-occlusive disorders. Complication rates and the incidence of postoperative Horner's syndrome were low. There were prominent differences in results among the various age groups. In addition, female patients and those with bilateral procedures had less favorable results. Factors that did not appear to affect results included technique of surgical approach, extent of sympathectomy, presence of Horner's syndrome, or the addition of other procedures. Current indications for upper dorsal sympathectomy include cases of Raynaud's and Buerger's diseases refractory to drug therapy, causalgia, vaso-occlusive disorders, and hyperhidrosis.

Adolescent↗
PubMed1979

Dynamic behavior of prosthetic aortic tissue valves as viewed by high-speed cinematography.

Using a valve testing apparatus of our own design and with a high-speed (600 to 800 frames per second) 16 mm movie camera, films were made of Hancock porcine, Carpentier-Edwards porcine, and Ionescu-Shiley bovine pericardial valves mounted in the aortic position and cycled under physiological conditions at 72 to 100 beats per minute. Fresh and explanted valves were observed using saline or 36.5% glycerol as the pumping solution. When fresh valves were studied using saline solution as the pumpint fluid, the Hancock and Carpentier-Edwards porcine valves showed high-frequency leaflet vibration, which increased in frequency with higher cycling rates. Abnormal leaflet motion was decreased when glycerol was used as the blood analogue. The Ionescu-Shiley bovine pericardial valve did not show abnormal leaflet motion under these conditions. Conclusions drawn from tissue valve testing studies that use excessively high pulsing rates and pressures (accelerated testing) and saline or water as pumping solutions cannot be transposed to predict the fate of tissue valves in a clinical setting.

Aortic Valve↗
PubMed1975

Thoracic outlet compression. Application of positional arteriographic and nerve conduction studies.

Positional arteriography has not proved to be of significant assistance in the evaluation of patients with thoracic outlet compression and should be reserved for those patients presenting with an obvious arterial problem such as aneurysm, obstruction, or embolic phenomena. Positional ulnar nerve conduction times were positive in 88 per cent of all patients operated on for thoracic outlet compression. Patients with normal neutral and elevated velocities through the outlet should be approached cautiously from a surgical standpoint. We believe that positional ulnar nerve conduction times are a desirable addition to the diagnostic armamentarium of the physician evaluating the patient presenting with symptoms and signs of the thoracic outlet compression syndrome.

Angiography↗
PubMed1975

In vivo strain measurements of a prosthetic aortic valve.

Up to the present, stress forces on prosthetic heart valves have been studied primarily in an in vitro state and have been derived with a fair amount of estimation. Because of the practical and clinical implications, such as forces that may cause fabric wear or material deterioration, we felt that in vivo determination would be worthy of investigation. A microminiature strain gauge was secured to each leg of a non-cloth-covered prosthetic aortic valve and connected to a dual-beam oscilloscope. Strain measurements were first determined in a pulse duplicator with a blood analogue solution and physiological pressures and flow. The valve was also implanted into a dog in the subcoronary position and strain again measured. In vivo strain was found to be approximately 57 per cent of strain on a prosthetic aortic valve, in vitro, under the conditions of this experiment. This represents the first time that strain and force on a prosthetic aortic valve have been determined directly in the intact animal.

Animals↗