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Biomedical subjects

W G Rainer

Publications and source records attributed to W G Rainer.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1983

Chitosan: a new hemostatic.

Chitosan is a deacetylated derivative of arthropod chitin. We found that it formed a coagulum in contact with defibrinated blood, heparinized blood, and washed red cells. When knitted DeBakey grafts were treated with chitosan, they were impermeable to blood. Examination of these grafts at 24 hours revealed no rebleeding. Examination at one, two, three, and four months showed the grafts to be encased in smooth muscle with a living endothelial lining and an abundant vasa vasorum. Control grafts showed the usual fibrous healing.

Animals↗
PubMed1982

Technique and value of operative arteriography in coronary artery bypass operations.

In an attempt to make evaluation of coronary artery bypass more meaningful, operative coronary arteriography has been used to aid in defining more precisely the technical aspects of the operation at a time when corrective measures can be carried out. Arteriography is performed following the completion of distal bypass graft anastomoses, whether saphenous vein or internal mammary artery (IMA) bypasses are used. Cut films are exposed at the rate of 2 to 4 frames per second and are evaluated for showing (1) status of anastomosis, (2) status of runoff, (3) lesions undetected preoperatively, and (4) any problems with the bypass conduit. A total of 934 vessels (including 107 IMA grafts) have been visualized in 535 patients. Some form of technical revision was necessary in nine instances. The use of this technique during intraoperative balloon dilatation, in conjunction with and to extend the benefits of conventional bypass, is currently being evaluated.

Angiography↗
PubMed1981

Aneurysm of the descending thoracic aorta: replacement with the use of a shunt or bypass.

The optimal method of protecting the spinal cord and viscera during the resection of aneurysms of the descending thoracic aorta is controversial, and some surgeons have recently abandoned shunting and bypass techniques. We are concerned that this may not be the safest approach in most surgeon's hands and have reviewed our experience with a consecutive series of these aneurysms, all of which were done with either bypass or a shunt. Between 1965 and 1976, we performed 23 aneurysm replacements with femorofemoral bypass. From 1976 to 1980, we used the Gott shunt in 12 aneurysm operations. Atherosclerotic, traumatic, and dissecting aneurysms were all presented. Nineteen operations were elective and 16 were urgent. Three patients died in the hospital, for an 8.6% operative mortality. There were no cases of paraplegia in the entire series of 35 operations. The actuarial 5 year survival rate (including operative deaths) is 79%. We conclude that when the appropriate surgical technique of aneurysm replacement is combined with a shunt or bypass, an acceptable operative mortality and a very low incidence of paraplegia can be obtained.

Aortic Dissection↗
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↗