Robert M. O'Neal

An Electron Microscopic Study of Myocardial Ischemia in the Rat

Myocardial infarcts were produced in rats by ligating the anterior descending branch of the left coronary artery. After one hour, changes in the ultrastructure of myofibers in the infarcts were readily demonstrated by electron microscopy. These changes became progressively severe with time, and consisted primarily of swelling of mitochrondria and sarcoplasmic reticulum followed by increased lipid droplets and myolysis. Autolysis Atolysis of myocardium was also studied and the changes found to be similar to those of myocardial infarcts, but more uniform and slightly delayed in development. Perhaps the early ultrastructrural changes are related to hyperosmolarity of mitochondria and sarcoplasmic reticulum, especially after cell death. It is hoped that definition of ischemic ultrastructural change will be useful in defining electron microscopic lesions in other forms of myocardial damage.

The spreader flap in primary rhinoplasty.

Background: In a primary rhinoplasty that requires a humpectomy, the dorsal aspect of the upper lateral cartilages is commonly discarded. Many of these patients need spreader grafts to reconstruct the middle third of the nose. However, it is possible to reconstruct the upper lateral cartilages into “spreader flaps” that act much like spreader grafts. Methods: A tunnel is created on the underside of the upper lateral cartilage, which is released from the cartilaginous septum and also from its attachment to the nasal bone (medially). It is then rolled on itself to make a spreader flap, which is secured with sutures. Scoring along the dorsal edge of the upper lateral cartilage may be necessary. The flap is then secured to the dorsal edge of the reduced dorsal septum. Results: In 21 patients who underwent an open approach (and four patients who underwent the closed approach), the spreader flap almost always reconstructed the middle third of the nose. It was easy to execute in the open approach but difficult in the closed approach. At surgery, two patients undergoing the open approach and one patient undergoing the closed approach needed spreader grafts because the flaps were too narrow. Postoperatively, only one patient (operated on by the open approach) exhibited inadequate nasal width. Conclusions: Spreader grafts are the standard for reconstructing the middle third of the nose. However, the spreader flap avoids harvesting and carving cartilage for those grafts. In the open approach, the technique is easy to execute. Conclusions could not be drawn regarding the long-term success with the closed approach.

Incidence of myocardial infarction correlated with venous and pulmonary thrombosis and embolism∗: A geographic study based on autopsies in Uganda, East Africa and St. Louis, U. S. A.

Abstract Recent autopsy records at Washington University in St. Louis and Makerere College in Uganda, East Africa were reviewed to determine the incidences of venous thrombi and pulmonary thromboembolic phenomena, as well as the incidences of myocardial infarcts, in three groups of patients: (1) St. Louis white patients, (2) St. Louis Negroes, and (3) Uganda Negroes. The incidence of myocardial infarcts was high in St. Louis white patients, intermediate in St. Louis Negroes and practically nil in Uganda Negroes; the only infarct found in Uganda among 1,427 patients over forty years of age was a small healed one. The incidence of venous thrombi and pulmonary thromboembolic phenomena closely paralleled the incidence of myocardial infarcts in the three groups. The studies reported herein suggest that differences in the general tendency of the blood to clot and/or lyse account, at least in part, for the differences in the incidences of coronary thrombosis and myocardial infarction that exist between autopsied Ugandans and St. Louisans. Further investigation must be carried out utilizing many technics before the suggestion can be established as fact. Other studies will then be necessary to determine the precise nature of the difference and the reason for it, i.e., dietary, emotional or genetic. Probable, but as yet unestablished, differences in the degree of atherosclerosis present in the three groups may also contribute to the differences in incidences of myocardial infarction, but since the local factor of atherosclerosis is not present in veins, it could not account for the observed differences in evidences of venous thrombosis.

Myocardial Infarction in Patients Treated with Sippy and Other High-Milk Diets An Autopsy Study of Fifteen Hospitals in the U.S.A. and Great Britain

A study has been made of the incidence of myocardial infarcts among 3 groups of autopsied patients who were matched for age, sex, race, and place and period of death: (1) patients with peptic ulcers who had been treated with a Sippy diet or milk products, (2) patients with peptic ulcers who were not known to have been so treated, (3) a group consisting of non-ulcer patients matched with the other 2 groups. In the U.S.A. the incidence of myocardial infarcts was more than twice as high in the ulcer patients treated with Sippy diet than it was in either of the other 2 groups. The differences in each case were statistically highly significant. There was no significant difference in the incidence of myocardial infarcts between the ulcer patients not treated with the Sippy diet and the non-ulcer controls. Differences and similarities of the same degree were noted among corresponding groups from Great Britain. It is tempting to think that the high incidence of myocardial infarcts among the Sippy-treated patients was a result of the butter-fat content of their diets. Mere association, however, does not constitute proof and further study is needed before definitive conclusions are drawn.

Subperiosteal brow and midface lifts

The subperiosteal browlift and midface lift combination is a total mobilization of the composite full-thickness soft tissues from the bony skeleton with superior suspension. The object is to correct midfacial ptosis and the “tired” look of the lateral eyelids. It is done in conjunction with a browlift so that a composite correction of the upper and midface is achieved. When indicated, a modified lower cheeklift and the usual procedures for correcting neck deformities are utilized in combination. We believe the procedure is safe and the results reported are natural and long-lasting. This review of 130 cases also stresses technical aspects and the safety of the procedure.

Wide abdominal rectus plication abdominoplasty for the treatment of chronic intractable low back pain.

Background: A previous report demonstrated that the wide abdominal rectus plication abdominoplasty is an effective treatment modality in select patients with low back pain who failed to achieve relief with conservative therapy. Methods: The authors studied eight female patients who presented with chronic low back pain and marked lower abdominal wall muscular laxity. All had failed to respond to conservative management for their chronic back pain. They all underwent wide abdominal rectus plication abdominoplasty. Patient selection and details of the procedure are discussed. Results: There were no significant complications in this series, and all the patients had prompt and prolonged alleviation of their back pain. Length of follow-up ranged from 2 to 11 years. Conclusions: Changes in the biomechanics of the lower abdominal musculature as a result of the wide abdominal rectus plication abdominoplasty are discussed in the context of increasing spinal stability, leading to an alleviation of chronic low back pain. An argument is made that this abdominoplasty procedure produces a spine-stabilizing effect by (1) tightening the muscles of the lateral abdominal complex and thus increasing intraabdominal pressure and (2) increasing the efficiency of these muscles so that their effectiveness as spine stabilizers is increased. Even though this is a small series, the fact that all the patients sustained long-term alleviation of their preoperative chronic back pain suggests that the wide abdominal rectus plication abdominoplasty should be considered as an option for patients with weak lower abdominal muscles and intractable low back pain who have failed conservative management.

Dietary production of myocardial infarction in rats; anatomic features of the disease.

Abstract Arterial thromboses with myocardial and renal infarcts occur in a large percentage of rats fed a known atherogenic diet to which is added large amounts of saturated fats. Thromboses occur before the formation of significant local intimai lesions, indicating that some hematologie factor is involved. The mechanism of formation of the thrombi is unknown. The altered state produced in these animals is also characterized by marked accumulations of fat in the liver, spleen, lymph nodes and adrenal cortex as well as the presence of large fat globules lodged in the capillaries of the lungs and renal glomeruli.

Reduction mammoplasty with free-nipple transplantation: indications and technical refinements.

Multiple techniques for breast reduction have been proposed. For carefully selected women with macromastia, the technique of choice may be amputation mammoplasty with free nipple-areolar grafting. These select groups include the following: the poor-risk elderly, women with systemic disease that could affect the vascularity of the skin flaps or impair wound healing, women with previous operative procedures in the breast affecting skin flap or pedicle vascularity, and women with indications for removal of tissue in the region of the inferior pedicle. Our experience demonstrates that in these high-risk women, amputation mammoplasty with certain technical refinements provides an aesthetic safe result without significant perioperative surgical or medical complications. A clinical series is presented with an average follow-up of 2.75 years.

The Role of Pulmonary Hypertension and Thromboembolism in the Production of Pulmonary Arteriosclerosis

Thromboembolism and pulmonary hypertension have been assessed as factors in the production of pulmonary arteriosclerosis. A study was made of autopsy records and tissue sections from 59 cases of congenital heart disease with anomalies permitting shunting of blood from the systemic to the pulmonary circulation and 31 cases of pulmonary stenosis with septal defect. Pulmonary arteriosclerosis was found to be common and of equal frequency in the two groups of cases, indicating that hypertension is not a necessary factor. There was a close correlation between the presence of pulmonary arterial thrombi and pulmonary arteriosclerosis.

Anticoagulant therapy of acute myocardial infarction; an evaluation from autopsy data with special reference to myocardial rupture and thromboembolic complications.

Abstract The effects of anticoagulant therapy are evaluated from clinical and autopsy data on 500 patients with acute myocardial infarction. Intravascular thrombi were demonstrated at autopsy in a significantly greater percentage of inadequately treated patients than in treated patients. This difference is apparent only when patients who died within three days of clinical onset of infarction are omitted from the comparison. Our data indicate that therapy is not effective unless begun within three days of clinical onset of infarction. Myocardial rupture occurred five times as frequently among anticoagulant-treated patients as among untreated patients in the same period. However, no significant overall increase in myocardial rupture occurred during the years 1910 to 1954. The possibility exists that selection of patients receiving anticoagulant therapy accounts for the high incidence of rupture but no support for this explanation was found in the clinical histories. The incidence of myocardial rupture in untreated patients decreased slightly in the years 1910 to 1954. Hemopericardium without myocardial rupture was not significantly more frequent in patients treated with anticoagulants, and in no instance was the amount of blood considered sufficient to have caused death.