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Biomedical subjects

W S Coleman

Publications and source records attributed to W S Coleman.

11 recordsLinked to original sources
PubMed1995

Surgical intervention in acute myocardial infarction: an historical perspective.

Acute myocardial infarction is an evolving event that lends itself well to surgical intervention. An historical review of surgery of acute myocardial infarction, with specific emphasis on the Spokane data, shows that this can be done safely and efficiently with myocardial salvage. Those people who were operated on within 6 hours of the onset of symptoms of acute myocardial infarction had a clear reduction in hospital mortality incidence and a better long-term result. The conclusion of our review is that emergency coronary artery bypass grafting for acute evolving myocardial infarction should be considered as a therapeutic option in every patient. All other modalities of therapy should be compared with the results of acute bypass surgery.

Coronary Artery Bypass↗
PubMed1984

Surgical intervention in acute myocardial infarction.

The goal of surgical reperfusion during the first hours of acute evolving myocardial infarction is to limit the extent of the infarction. This should be reflected by improved ventricular function and low mortality. Over the past 10 years, 440 patients with transmural myocardial infarction and 261 patients with nontransmural myocardial infarction underwent coronary artery bypass graft surgery within 24 hours of peak symptoms. The in-hospital mortality was 5.2% in the transmural group and 3% in the non-transmural group. In a 10-year study period, the mortality in the transmural group rose to 12.5%, while the mortality in the nontransmural group, followed for an 8-year period, rose to a total of 6.5%. The transmural myocardial infarctions in patients revascularized within 6 hours, showed a significantly improved in-hospital mortality of 3.8% compared to an in-hospital mortality of 12% for reperfusion after 6 hours. Anterior transmural areas of myocardial infarctions were reperfused within 6 hours of symptom onset, and demonstrated improved global ejection fraction and regional wall motion. Little improvement was seen if revascularization was instituted later than 6 hours from symptoms except in patients with adequate collateral perfusion of non-total left anterior descending coronary occlusion. Long-term follow-up of patients revascularized for acute myocardial infarction shows a low rate of subsequent reinfarction, incapacitating angina and sudden death. Left ventricular function at the time of cardiac catheterization correlates well with subsequent long-term mortality.

Journal Article↗
PubMed1984

Acute evolving myocardial infarction. A surgical emergency.

This is a report of 342 cases of acute evolving myocardial infarction treated with prompt coronary artery bypass. Myocardial infarction results from a time-related sequence of ischemic pathophysiological changes. The first hours constitute a rapidly progressive event. Prompt surgical revascularization partially prevents impending myocardial necrosis; occasionally it may even prevent it completely. The results are limited infarct size, decreased mortality and morbidity, and a striking absence of the complications associated with conventional therapy (ventricular aneurysm or perforation and septal and papillary muscle rupture).

Adult↗
PubMed1981

The advantage of early operation for abdominal aortic aneurysm.

Factors affecting mortality in 493 consecutive patients undergoing operation for abdominal aortic aneurysms (AAAs) over a five-year period were analyzed. Cases were divided into three categories, based on clinical appearance: asymptomatic, symptomatic but unruptured, and ruptured. Patient age, relevant associated diseases, aneurysm size, conduct of the operation, mortality, and causes of death were reviewed and compared. Characteristics related to mortality were patient age and aneurysm size. In patients under 70 years of age, operated on electively, mortality was under 1% (two deaths in 242 patients). There were no deaths in 67 patients with aneurysms measuring 5 cm or less. Mortality increased as the aneurysms became larger and the patient older. We believe that elective operation for small asymptomatic aneurysms in younger patients will result in further reduction of morbidity and mortality associated with repair of AAAs.

Age Factors↗
PubMed1981

Clostridium septicum infection and malignancy.

Evidence mounts favoring the relationship, albeit unexplained, between Clostridium septicum infection and malignancy, particularly hematologic or intestinal malignancy. Seven patients with C. septicum gangrene or sepsis have been treated at the Massachusetts General Hospital in the years 1977-79. All of these patients have had associated malignant disease: four patients had colon adenocarcinomas, two patients had acute myeloblastic leukemias, and one patient had breast carcinoma. In six of the seven patients, the malignancy was in an advanced state; the breast carcinoma showed no evidence of recurrence after mastectomy, 17 years earlier. A bowel portal of entry is postulated in five patients. Despite prompt use of appropriate antibiotics, the only survivors were two of the four patients who underwent early extensive debridement. These results suggest that, in the patient with C. septicum infection, malignancy should be sought; that, in the septic patient with known malignancy, C. septicum should be considered; and that, in the absence of external source in the patient with clostridial myonecrosis or sepsis, the cecum or distal ileum should be considered a likely site of infection. Increased awareness of this association between C. septicum and malignancy, and aggressive surgical treatment, may result in improvement in the present 50-70% mortality rate.

Adult↗
PubMed1981

Myocardial temperature mapping. Improved intraoperative myocardial preservation.

An improved approach to intraoperative myocardial preservation technique to ensure uniform myocardial cooling past critically stenosed arteries was developed for patients undergoing aorta-coronary bypass grafting. Proximal anastomoses are done and then, after institution of cardiopulmonary bypass, a separate roller pump head is used to administer a specific controlled volume of cardioplegic solution (1 L) through a 4 degrees C coil to provide controlled pressure in the root of the cross-clamped aorta. Midmyocardial wall temperatures in the anterior, posterolateral, inferior, and septal walls of the left ventricle are measured. Distal anastomoses are then performed sequentially, beginning with the warmest region. After each distal anastomosis, 400 ml of cardioplegic solution are again administered into the aortic root. This approach has been used in 100 consecutive patients from July, 1979, through July 1980 (Group I). and these patients were compared to 97 consecutive patients undergoing aorta-coronary bypass grafting in the previous year (July, 1978, through June, 1979) (Group II) who had myocardial preservation with potassium cardioplegia administered by syringe injection and without regional temperature mapping. There were no perioperative myocardial infarctions in Group I: there were five (5.2%) in Group II (p less than 0.05). A significant reduction in cardiac deaths was also achieved, with two (2.0%) such deaths in Group I and eight (8.2%) in Group II (p less than 0.05). The data suggest that delivery of adequate volumes of cardioplegia solutions by a pressure-regulated system, in combination with myocardial temperature mapping to determine the sequence of bypass grafting, can improve myocardial preservation.

Body Temperature↗