James W. Mackenzie

PSYCHOLOGICAL ADJUSTMENT AND PSYCHIATRIC COMPLICATIONS FOLLOWING OPEN HEART SURGERY

A consecutive series of 110 adult open heart surgical patients were evaluated to assess postoperative psychiatric complications. This evaluation included psychological, social, and medical factors in the preoperative and postoperative periods. Psychological factors were assessed with the Minnesota Multiphasic Personality Inventory (MMPI). Many of the predisposing and precipitating factors studied were found to be differentially contributory among subgroups of male and female patients. This suggested certain hypotheses concerning the inter-relationships between psychological factors and the other factors which appear to play an important role in postoperative psychiatric complications. Male open heart surgery patients revealed a high rate of postoperative psychiatric complications. These were found to be related to age, type of surgical procedures, and a clinical picture characterized by depression, anxiety and physical complaints. Female open heart surgery patients revealed a lower incidence of postoperative psychiatric complications than male patients. Their complications were found to be significantly associated with a history of family or marital problems, or problems requiring psychiatric care, and with a significant incidence of brain damage following surgery. Correlated psychological data indicated symptoms and complaints of depression, anger, interpersonal discord, and unusual or bizarre feelings and experiences. It was hypothesized that good psychological adjustment prior to surgery may preclude a postoperative reaction and/or make it easier for a person to accept and effectively adjust to disturbing emotional experiences following surgery whatever their etiology. Some degree of psychological maladjustment would raise the probability for a postoperative reaction, but its ultimate occurrence would be dependent on other factors, such as age and/or type of operation, whose effects seem different in male and female patients. Some of the difficulties involved in the delineation of the role of psychological factors in open heart surgery were discussed, with specific attention called to the lack of clarity and consensus among the various definitions of postoperative psychiatric problems, and the lack of comparable methods used in quantifying psychological or behavioral factors. The importance of the assessment of preoperative psychiatric symptomatology was stressed in relation to both expectations of complications and to a basis for possible ameliorative preoperative procedures.

Psychological adjustment and acute response to open heart surgery.

Recent research has produced findings which indicate a significant role for psychological factors in determining the nature of a patients acute response to open heart surgery. In the present study a consecutive series of 68 adult open heart surgical patients were considered for psychological evaluation with the Minnesota Multiphasic Personality Inventory (MMPI) during the week preceding each operation. After determining that the 54 patients who were able to provide pre-operative psychological data were not a unique subsample of the originally referred patients, several parameters were analyzed in relation to survival of the surgical procedures. The factors of age, sex and pre-operative cardiac disability were not found to be significantly related to operative mortality in the present patient sample. Separate analysis of the MMPI scale scores for male and female patients revealed distinct group differences in personality characteristics, both with respect to each other and in relation to survival of the operation. Agitation was found to be more pronounced among male patients who did not survive the open heart operation than among those who did. This agitation was felt to be indicative of a basic vulnerability to stress without effective psychological coping mechanisms. Female patients who did not survive surgery were characterized by increased physical complaints and emotional overcontrol and appeared less accepting of any emotional component related to their physical disabilities than were the surviving female patients. These findings were also compared with previous reports based both on clinical interviews and on responses on standard psychological tests. Comparative analyses were also done between the groups of male and female open heart patients who survived the surgical procedures and matched groups of medical patients who did not have diagnoses directly involving the cardiac system or receive any operative procedures. These comparisons revealed high similarity between the groups for both male and female patients and were felt to further distinguish the personality features noted among the nonsurvivors of the open heart operation. The results were felt to indicate that attention to preoperative symptoms of severe psychiatric disturbance, symptoms of pronounced anxiety among male patients and symptoms of emotional overcontrol among female patients may help reduce mortality in open heart surgery.

Combined superior vena cavography and azygography in patients with suspected lung carcinoma.

Intraosseous costal or spinous process azygography has occasionally been used for visualization of the thoracic venous system in the preoperative assessment of carcinoma of the lung (2, 7). Obstruction of the superior vena cava or extrinsic compression or invasion of its lumen is a relatively frequent finding in the natural history of pulmonary carcinoma, especially when the lesion originates in the right lung (3). In 85 per cent of 33 cases coming to autopsy in one series, cancer was the etio-logic agent producing superior vena caval obstruction (1). To our knowledge, the combined use of superior vena cavography and azygography as part of the preoperative assessment of pulmonary carcinoma has not been previously reported. Our experience with 63 consecutive patients who have been evaluated for suspected primary lung carcinoma by the use of superior vena cavography and azygography forms the basis of this report. The roentgenographic patterns of abnormality are evaluated and presented. The importance of pro...

New surgical technique for studying placental transfer of drugs in vivo

Abstract A new surgical technique for studying placental transfer of drugs in vivo is outlined. The heart and the amniotic sac were catheterized for easy sampling.

Perforation of the Heart by a Permanent Transvenous Pacemaker

Excerpt Long-term cardiac pacing has unquestionably improved the prognosis for patients with complete heart block associated with Adams-Stokes syncope. However, problems may result from failure of ...

Energy transport through tissue by inductive coupling

Abstract There are several methods of supplying energy to a site within the body. Inductive coupling between a coil or coils external to the body and a coil within the body is an effective and efficient way. The theoretic aspects of inductive coupling are now well understood. On the basis of long-term experiments there has been no tissue damage from chronic exposure. Acceptance by the patient has been favorable. Inductive coupling should be actively considered for supplying energy to internal sites, particularly in situations in which the energy requirements are such that the use of implanted fuel sources would require frequent reoperation. Inductive coupling may prove to be an effective way to power the artificial heart.

Radio-frequency energy transport into the body☆

Abstract Inductive coupling and capacitive-conductive coupling are versatile methods of transporting energy into the body. Transport efficiencies and the distribution of thermal losses in the tissue are approximately calculable on the basis of classical electromagnetic theory. Limited studies in dogs and mice exposed, on a chronic basis, to fields appropriate to energy transport at the 50-watt level has elucidated no indications of adverse nonthermal effects. It is anticipated that inductive coupling and capacitive-conductive coupling will be increasingly utilized in both experimental and clinical situations as the advantages and limitations of these radio-frequency systems become more widely appreciated.

HEART PRESERVATION UTILIZING HYPERBARIC OXYGEN AND HYPOTHERMIA.

HE F E A S I B I L I T Y OF WHOLE ORGAN Ttransplanta t ion has awakened an interest in certain areas of investigation and crystalized attention to the magnitude of certain problems. Early transplantation work involved cells and small portions of tissues; however, the problems now have advanced to the stage of transplantation of whole organs. The problem areas are rather well defined: the surgical technique of whole organ transplantation, immune or rejection response and the organ availability or organ preservation. Of t h w problems, two are now receiving paramount attention and one is solved. The technical problems of whole organ tramplantation have been studied and overcome, and the s u c d u l surgical exercises are now a reality in many centers. The immune-rejection response is a formidable problem and is now under investigation but will require extensive research into cell metabolism and the transference of the immune mechanism. The yielding of the surgical technical problems to experimental solution has brought forth the paramount problem of having an organ suitable for implantation when needed. Since it is imposible to produce the organ for implantation, the organ must be obtained from another human subject at a given time when the subject has succumbed to either accidental death or disease, and the organ must be obtained in a viable oxygenated stage and pmSCrved until the recipient is prepared for implantation. This vital need s thus stimulating the search for means of maintaining the whole organ viable for a period of one or more days until the redpient can be hmpitalized, evaluated and

Low-Frequency Piezoelectric Energy Conversion for an Intrathoracic Artificial Heart

The present paper is concerned with an evaluation of a piezoelectric energy conversion system in which two columns of piezoelectric ceramic disks are excited axially by means of thin metallic shims stacked alternately with the disks. Mechanical energy output is extracted through the expansion and contraction of the Columns. The treatment is based upon the equivalent circuit approach first suggested by Mason. A lever system is used in making the mechanical impedance transformation between the very high force and small displacement of the piezoelectric columns and the low force and relatively large displacement required for an artificial heart. The role of mass loading in improving the power capability and efficiency of the energy converter is clearly indicated. It is concluded that the theoretical energy output per unit mass of material per cycle and the efficiency of conversion are such as to justify a continued developmental effort.