Frank Spencer, M.D.

Historical vignette: the introduction of arterial repair into the US Marine Corps, US Naval Hospital, in July-August 1952
Spencer, Frank C
2006 Apr;60(4):906-909, Journal of trauma
— id: 64169, year: 2006, vol: 60, page: 906, stat: Journal Article,

Sabiston & Spencer surgery of the chest
Sellke, Frank W; Del Nido, Pedro J; Swanson, Scott J; Sabiston, David C; Spencer, Frank Cole
Philadelphia : Elsevier Saunders, 2005,
— id: 975, year: 2005, vol: , page: , stat: ,

Evolving techniques for mitral valve reconstruction
Galloway, Aubrey C; Grossi, Eugene A; Bizekis, Costas S; Ribakove, Greg; Ursomanno, Patricia; Delianides, Julie; Baumann, F Gregory; Spencer, Frank C; Colvin, Stephen B
2002 Sep;236(3):288-293, Annals of surgery
OBJECTIVE: To analyze the effectiveness of new techniques of mitral valve reconstruction (MVR) that have evolved over the last decade, such as aggressive anterior leaflet repair and minimally invasive surgery using an endoaortic balloon occluder. SUMMARY BACKGROUND DATA: MVR via conventional sternotomy has been an established treatment for mitral insufficiency for over 20 years, primarily for the treatment of patients with posterior leaflet prolapse. METHODS: Between June 1980 and June 2001, 1,195 consecutive patients had MVR with ring annuloplasty. Conventional sternotomy was used in 843 patients, minimally invasive surgery in 352 (since June 1996). Anterior leaflet repair was performed in 374 patients, with increasing use over the last 10 years. Follow-up was 100% complete (mean 4.6 years, range 0.5-20.5). RESULTS: Hospital mortality was 4.7% overall and 1.4% for isolated MVR (1.1% for minimally invasive surgery vs. 1.6% for conventional sternotomy; =.4). Multivariate analysis showed the factors predictive of increased operative risk to be age, NYHA functional class, concomitant procedures, and previous cardiac surgery. The 5-year results for freedom from cardiac death, reoperation, and valve-related complications among the 782 patients with degenerative etiology are, respectively, as follows ( >.05 for all end points): for anterior leaflet repair, 93%, 94%, 90%; for no anterior leaflet repair, 91%, 92%, 91%; for minimally invasive surgery, 97%, 89%, 93%; and for conventional sternotomy, 93%, 94%, 90%. CONCLUSIONS: These findings indicate that late results of MVR after minimally invasive surgery and after anterior leaflet repair are equivalent to those achievable with conventional sternotomy and posterior leaflet repair. These options significantly expand the range of patients suitable for mitral valve repair surgery and give further evidence to support wider use of minimally invasive techniques
— id: 33332, year: 2002, vol: 236, page: 288, stat: Journal Article,

Principios de cirugia = [Principles of surgery]
Schwartz, Seymour I; Shires, G. Tom; Spencer, Frank Cole; Husser, Wendy Cowles; Samperio, Jorge Orizaga; Araiza M; Martha Elena; Gomez, Jose Perez
Mexico : McGraw-Hill Interamericana, 2000,
— id: 978, year: 2000, vol: , page: , stat: ,

Human error in hospitals and industrial accidents: current concepts
Spencer, F C
2000 Oct;191(4):410-418, Journal of the American College of Surgeons
Most data concerning errors and accidents are from industrial accidents and airline injuries. General Electric, Alcoa, and Motorola, among others, all have reported complex programs that resulted in a marked reduction in frequency of worker injuries. In the field of medicine, however, with the outstanding exception of anesthesiology, there is a paucity of information, most reports referring to the 1984 Harvard-New York State Study, more than 16 years ago. This scarcity of information indicates the complexity of the problem. It seems very unlikely that simple exhortation or additional regulations will help because the problem lies principally in the multiple human-machine interfaces that constitute modern medical care. The absence of success stories also indicates that the best methods have to be learned by experience. A liaison with industry should be helpful, although the varieties of human illness are far different from a standardized manufacturing process. Concurrent with the studies of industrial and nuclear accidents, cognitive psychologists have intensively studied how the brain stores and retrieves information. Several concepts have emerged. First, errors are not character defects to be treated by the classic approach of discipline and education, but are byproducts of normal thinking that occur frequently. Second, major accidents are rarely causedby a single error; instead, they are often a combination of chronic system errors, termed latent errors. Identifying and correcting these latent errors should be the principal focus for corrective planning rather than searching for an individual culprit. This nonpunitive concept of errors is a key basis for an effective reporting system, brilliantly demonstrated in aviation with the ASRS system developed more than 25 years ago. The ASRS currently receives more than 30,000 reports annually and is credited with the remarkable increase in safety of airplane travel. Adverse drug events constitute about 25% of hospital errors. In the future, the combination of new drugs and a vast amount of new information will additionally increase the possibilities for error. Two major advances in recent years have been computerization and active participation of the pharmacist with dispensing medications. Further investigation of hospital errors should concentrate primarily on latent system errors. Significant system changes will require broad staff participation throughout the hospital. This, in turn, should foster development of an institutional safety culture, rather than the popular attitude that patient safety responsibility is concentrated in the Quality Assurance-Risk Management division. Quality of service and patient safety are closely intertwined
— id: 107054, year: 2000, vol: 191, page: 410, stat: Journal Article,

The expert medical witness: concerns, limits, and remedies
Spencer, F C; Guice, K S
2000 Jun;85(6):22-23, Bulletin of the American College of Surgeons
The problems associated with inaccurate, misleading, or biased testimony from expert witnesses are well known. Expert witnesses are actively pursued for their views, their presentation style, and their willingness to tailor their testimony according to the particular needs of the case
— id: 107053, year: 2000, vol: 85, page: 22, stat: Journal Article,

Acquired heart disease
Galloway AC; Anderson RV; Grossi EA; Spencer FC; Colvin SB
Principles of surgery New York : McGraw-Hill, 1999,
— id: 3832, year: 1999, vol: , page: ?, stat: Chapter,

Thoracic aneurysms and aortic dissection
Galloway AC; Miller JS; Spencer FC; Colvin SB
Principles of surgery New York : McGraw-Hill, 1999,
— id: 3833, year: 1999, vol: , page: ?, stat: Chapter,

Principios de cirurgia : compendio
Schwartz, Seymour I; Shires, G. Tom; Spencer, Frank C; Daly, John M; Fischer, Josef E; Galloway, Aubrey C; Cosendey, Carlos Henrique; Vasconcelos, Marcio Moacyr; Pinho, Patricia Lydie Voeux; Azevedo, Maria de Fatima
Rio de Janeiro : McGraw-Hill, 1999,
— id: 1584, year: 1999, vol: , page: , stat: ,

Valve repair versus replacement for mitral insufficiency: when is a mechanical valve still indicated?
Grossi EA; Galloway AC; Miller JS; Ribakove GH; Culliford AT; Esposito R; Delianides J; Buttenheim PM; Baumann FG; Spencer FC; Colvin SB
1998 Feb;115(2):389-394, Journal of thoracic & cardiovascular surgery
OBJECTIVES: Although many advantages of mitral valve reconstruction have been demonstrated, whether specific subgroups of patients exist in whom mechanical valve replacement offers advantages over mitral reconstruction remains undetermined. METHODS: This study examined the late results of mitral valve surgery in patients with mitral insufficiency who received either a St. Jude Medical valve (n = 514) or a mitral valve reconstruction with ring annuloplasty (n = 725) between 1980 and 1996. RESULTS: Overall operative mortality was 7.2% in the patients receiving a St. Jude Medical mitral valve and 5.4% in those undergoing mitral valve reconstruction (no significant difference); isolated mortality was 2.5% in the St. Jude Medical group and 2.2% in the valve reconstruction group (no significant difference). The follow-up interval was more than 5 years for 340 patients with a mean of 39.8 months (98.5% complete). Overall 8-year freedom from late cardiac death, reoperation, and all valve-related complications was 72.8% for the St. Jude Medical group and 64.8% for valve reconstruction group (no significant difference). For patients with isolated, nonrheumatic mitral valve disease, 8-year freedom from late cardiac death and reoperation was better in the mitral valve reconstruction group (88.3%) than in the St. Jude Medical valve group (86.0%; p = 0.05). Furthermore, Cox proportional hazards regression revealed that mitral valve reconstruction was independently associated with a lesser incidence of late cardiac death (p = 0.04), irrespective of preoperative New York Heart Association class. However, the St. Jude Medical valve offered better 8-year freedom from late cardiac death, reoperation, and all valve-related complications than did mitral valve reconstruction in patients with multiple valve disease (77.0% vs 45.3%; p < 0.01). CONCLUSIONS: Therefore, mitral valve reconstruction appears to be the procedure of choice for isolated, nonrheumatic disease, whereas insertion of a St. Jude Medical valve should be preferred for patients with multiple valve disease
— id: 7585, year: 1998, vol: 115, page: 389, stat: Journal Article,

Choice of mitral prosthesis in the elderly. An analysis of actual outcome
Grossi EA; Galloway AC; Zakow PK; Miller JS; Buttenheim PM; Baumann FG; Culliford AT; Spencer FC; Colvin SB
1998 Nov 10;98(19 Suppl):II116-II119, Circulation
BACKGROUND: In younger patients requiring mitral valve replacement (MVR), mechanical prostheses (MPs) have been reported to give better freedom from all valve-related complications (VRCs) because of the high incidence of late valve degeneration (VD) associated with bioprostheses (BPs). In older patients, however, the risk of VD may be reduced because of the large competing risk of noncardiac death (NCD). Previous studies on VD in the elderly have used actuarial analysis, which overestimates the risk of VD in this population because it assumes that dead patients are still at risk. In contrast, cumulative incidence (actual) analysis acknowledges that patients who die have no risk of VD. This study compares the results of both 'actual' and 'actuarial' analyses of the freedom from VD in elderly patients undergoing MVR. METHODS AND RESULTS: From June 1976 through January 1996, 504 patients > or = 70 years of age underwent MVR at our institution. Isolated mitral operations were performed in 159 patients, and 169 had concomitant CABG. Hospital mortality was 59 of 374 (15.9%) for tissue prosthesis versus 24 of 130 (18.5%) for mechanical prosthesis (P = NS). For tissue versus mechanical prosthesis, 10-year freedom from noncardiac death was 75.0% versus 67.6% (P = NS); 10-year actuarial freedom from valve degeneration was 79.8% versus 93.4% (P = NS); 10-year actual freedom from valve degeneration was 92.6% versus 95.4% (P = NS); and 10-year actual freedom from all VRCs was 84.4% versus 92.3% (P = NS). CONCLUSIONS: In elderly patients undergoing MVR, actuarial analysis overestimates the 10-year risk of VD compared with actual analysis (20.2% versus 7.4% for BP, 6.6% versus 4.6% for MP). In these patients, the actual freedoms from VD and all VRCs do not differ significantly between BP and MP. Thus, in this age group, the necessity for anticoagulation or its avoidance may be the predominant factor in choosing a replacement mitral valve
— id: 7337, year: 1998, vol: 98, page: II116, stat: Journal Article,

Initial echocardiogram after mitral valve reconstruction predicts durability of repair
Grossi, EA; Applebaum, RM; Galloway, AC; Spencer, FC; Kronzon, I; Colvin, SB
1998 FEB ;31(2):399A-399A, Journal of the American College of Cardiology
— id: 33434, year: 1998, vol: 31, page: 399A, stat: Journal Article,

Changing patterns in the management of splenic trauma: the impact of nonoperative management
Pachter HL; Guth AA; Hofstetter SR; Spencer FC
1998 May;227(5):708-717, Annals of surgery
OBJECTIVE: The recognition that splenectomy renders patients susceptible to lifelong risks of septic complications has led to routine attempts at splenic conservation after trauma. In 1990, the authors reported that over an 11-year study period involving 193 patients, splenorrhaphy was the most common splenic salvage method (66% overall) noted, with nonoperative management employed in only 13% of blunt splenic injuries. This report describes changing patterns of therapy in 190 consecutive patients with splenic injuries seen during a subsequent 6-year period (1990 to 1996). An algorithmic approach for patient management and pitfalls to be avoided to ensure safe nonoperative management are detailed. METHODS: Nonoperative management criteria included hemodynamic stability and computed tomographic examination without shattered spleen or other injuries requiring celiotomy. RESULTS: Of 190 consecutive patients, 102 (54%) were managed nonoperatively: 96 (65%) of 147 patients with blunt splenic injuries, which included 15 patients with intrinsic splenic pathology, and 6 hemodynamically stable patients with isolated stab wounds (24% of all splenic stab wounds). Fifty-six patients underwent splenectomy (29%) and 32 splenorrhaphy (17%). The mean transfusion requirement was 6 units for splenectomy survivors and 0.8 units for nonoperative therapy (85% received no transfusions). Fifteen of the 16 major infectious complications that occurred followed splenectomy. Two patients failed nonoperative therapy (2%) and underwent splenectomy, and one patient required splenectomy after partial splenic resection. There no missed enteric injuries in patients managed nonoperatively. The overall mortality rate was 5.2%, with no deaths following nonoperative management. CONCLUSIONS: Nonoperative management of blunt splenic injuries has replaced splenorrhaphy as the most common method of splenic conservation. The criteria have been extended to include patients previously excluded from this form of therapy. As a result, 65% of all blunt splenic injuries and select stab wounds can be managed with minimal transfusions, morbidity, or mortality, with a success rate of 98%. Splenectomy, when necessary, continues to be associated with excessive transfusion and an inordinately high postoperative sepsis rate
— id: 7728, year: 1998, vol: 227, page: 708, stat: Journal Article,

Recent developments and evolving techniques of mitral valve reconstruction
Spencer FC; Galloway AC; Grossi EA; Ribakove GH; Delianides J; Baumann FG; Colvin SB
1998 Feb;65(2):307-313, Annals of thoracic surgery
Experiences with 1,000 patients undergoing mitral valve reconstruction at New York University over the past 18 years are summarized. A continuing follow-up (98% complete) demonstrated that 88% of patients are free from recurrent insufficiency 10 years after the operation. Reconstruction is feasible in nearly 90% of patients with mitral valve prolapse, with an operative mortality near 2%. Accordingly, operation is now recommended at an early stage with the first sign of left ventricular systolic dysfunction, while the patient is still in sinus rhythm. Most operations have been done with the Carpentier techniques of segmental resection with annuloplasty and insertion of a Carpentier ring. Recently, two other repair techniques and a minimally invasive operative approach have been evaluated. A triangular resection of a prolapsing anterior leaflet has been done in more than 100 patients with excellent results. Also, a posterior 'folding plasty' has been employed in more than 40 patients with a large redundant posterior leaflet, minimizing the need for annular plication. A minimally invasive approach to the mitral valve has now been employed in 130 patients over the past year, using a right mini-thoracotomy and the Port-Access (Heartport, Inc, Menlo Park, CA) approach. This technique employs catheters introduced through femoral vessels to institute cardiopulmonary bypass and cardioplegic arrest. The operative approach and techniques for mitral valve reconstructive operations continue to evolve, with excellent results and improved patient benefits
— id: 57261, year: 1998, vol: 65, page: 307, stat: Journal Article,

The American Surgical Association: past, present, and future
Spencer, F C
1998 Sep;228(3):273-283, Annals of surgery
— id: 107055, year: 1998, vol: 228, page: 273, stat: Journal Article,

Historical vignettes of arterial repair - Recollections of Korea 1951-1953 - Editorial comments
Spencer, FC
1998 NOV ;228(5):719-719, Annals of surgery
— id: 53671, year: 1998, vol: 228, page: 719, stat: Journal Article,

The development of valvular heart surgery over the past 50 years (1947-1997): personal recollections
Spencer FC
1997 Nov;64(5):1549-1554, Annals of thoracic surgery
The development of valvular heart surgery over the past 50 years has required the efforts and creative genius of many surgical pioneers. It has been filled with exhilarating short-term successes and some devastating failures. This article traces the 50 years of persistence and determination that have brought us to a time when the majority of patients with heart valve disease can be returned to a happy and fulfilling life by valvuloplasty or by valve replacement
— id: 12217, year: 1997, vol: 64, page: 1549, stat: Journal Article,

Managed care and medical ethics
Spencer, F C
1997 Oct;114(4):525-526, Journal of thoracic & cardiovascular surgery
— id: 107056, year: 1997, vol: 114, page: 525, stat: Journal Article,

Selective approach to descending thoracic aortic aneurysm repair: a ten-year experience
Galloway AC; Schwartz DS; Culliford AT; Ribakove GH; Grossi EA; Esposito RA; Baumann FG; Delianides J; Spencer FC; Colvin SB
1996 Oct;62(4):1152-1157, Annals of thoracic surgery
BACKGROUND: A variety of surgical techniques has been developed to attempt to minimize the risk of paraplegia after descending thoracic aortic aneurysm repair. This study reviews our institutional experience with several basic techniques over a period of 10 years. METHODS: Seventy-eight consecutive patients underwent repair of descending thoracic aortic aneurysm between 1983 and 1993. Two basic repair strategies were used: (1) distal perfusion with somatosensory evoked potential monitoring (n = 54) and (2) cross-clamping (n = 24), alone (n = 6) or with controlled distal exsanguination (n = 18). RESULTS: The operative mortality rate was 6.5% for elective repair (n = 62), 25.0% for emergent repair (n = 16), and 10.3% overall. Univariate predictors of increased operative risk were emergent operation, rupture, and shock. Neither death nor paraplegia was related to the operative technique used. The incidence of paraplegia was 3.7% in perfused patients and 4.2% in cross-clamping patients (p > 0.05). Paraplegia did not occur after any elective operation (zero of 62) but occurred in 18.6% of emergent cases (p < 0.01). In perfused patients, paraplegia did not occur when the distal pressure was maintained above 55 mm Hg and somatosensory evoked potentials remained intact. When somatosensory evoked potentials were lost (n = 7) in perfused patients, the operative technique was altered successfully in 5 patients, whereas in 2 patients (28.6%), paraplegia developed. CONCLUSIONS: The risks associated with elective descending thoracic aortic aneurysm repair were extremely low using an operative strategy that was flexible but skewed toward perfusion with somatosensory evoked potential monitoring. In perfused patients, paraplegia did not occur when distal pressure was greater than 55 mm Hg and somatosensory evoked potentials remained intact. However, the risks of death and paraplegia were primarily related to emergent presentation, not to technique, and the technique of cross clamping with controlled distal exsanguination was found to be valuable in unstable or in anatomically complicated subsets of patients
— id: 7071, year: 1996, vol: 62, page: 1152, stat: Journal Article,

Perioperative morbidity and mortality in combined vs. staged approaches to carotid and coronary revascularization
Giangola G; Migaly J; Riles TS; Lamparello PJ; Adelman MA; Grossi E; Colvin SB; Pasternak PF; Galloway A; Culliford AT; Esposito R; Ribacove G; Crawford BK; Glassman L; Baumann FG; Spencer FC
1996 Mar;10(2):138-142, Annals of vascular surgery
Between 1986 and 1994 we identified 57 patients who underwent carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) during the same hospitalization. Simultaneous CABG and CEA was performed in 28 patients (mean age 70.5 years, 58% male). Indications for CABG in these patients were myocardial infarction in two crescendo angina in 19, congestive heart failure in two and left main or triple-vessel coronary artery disease noted during carotid preoperative evaluation in five. Indications for CEA were transient ischemic attack (TIA) in 12, crescendo TIA in six, cerebrovascular accident (CVA) in five, and asymptomatic stenosis in five. There were no postoperative myocardial infarctions or perioperative deaths. Two patients developed atrial fibrillation, and four patients had CVAs (two were ipsilateral to the side of CEA). Twenty-nine patients underwent staged procedures (i.e., not performed concomitantly but during the same hospitalization). Indications for CABG and CEA were comparable to those in the group undergoing simultaneous procedures. In 17 patients CEA was performed before CABG. There was a single CVA, the result of an intracerebral hemorrhage. Five of the 17 patients had a myocardial infarction and two died; one patient had first-degree heart block requiring a pacemaker. Four additional patients developed atrial fibrillation, one of whom required cardioversion. The remaining 12 patients had CABG followed by CEA. There were no CVAs, myocardial infarctions, arrhythmias, or deaths in this subgroup. These data demonstrate that the performance of simultaneous CABG and CEA procedures is associated with increased neurologic morbidity (14.3%), both ipsilateral and contralateral to the side of carotid surgery in contrast to staged CABG and CEA (3.4%). In addition, when staged carotid surgery preceded coronary revascularization in those with severe coronary artery disease, the combined cardiac complication and mortality rate was significantly higher than when coronary revascularization preceded CEA. This evidence suggests that when CABG and CEA must be performed during the same hospitalization, the procedures should be staged with CABG preceding CEA
— id: 12638, year: 1996, vol: 10, page: 138, stat: Journal Article,

Principios de cirugia = [Principles of surgery]+
Schwartz, Seymour I; Shires, G. Tom; Spencer, Frank Cole
Rio de Janeiro : McGraw-Hill, 1996,
— id: 984, year: 1996, vol: , page: , stat: ,

Principios de cirugia = [Principles of surgery]
Schwartz, Seymour I; Shires, G. Tom; Spencer, Frank Cole; Husser, Wendy Cowles; Samperio, Jorge Orizaga
Mexico : McGraw-Hill Interamericana, 1996,
— id: 979, year: 1996, vol: , page: , stat: ,

Resuscitative retrograde blood cardioplegia. Are amino acids or continuous warm techniques necessary?
Asai T; Grossi EA; LeBoutillier M 3rd; Parish MA; Baumann FG; Spencer FC; Colvin SB; Galloway AC
1995 Feb;109(2):242-248, Journal of thoracic & cardiovascular surgery
This experiment was designed to determine the relative degree of cardiac functional recovery provided by various forms of resuscitative retrograde blood cardioplegia after global ischemic injury. Twenty-four dogs were subjected to 20 minutes of normothermic global myocardial ischemia followed by 60 minutes of cardioplegic arrest by one of three methods: group 1, standard cold blood cardioplegia with a cold terminal dose (n = 8); group 2, aspartate-glutamate-enhanced blood cardioplegia with warm induction and terminal enhancement (n = 8); and group 3, continuous warm blood cardioplegia (n = 8). Sonomicrometry was used to analyze left ventricular function for maximal elastance and preload recruitable stroke work area. Data were recorded at baseline and after 30 and 60 minutes of unloaded reperfusion. The results showed improved early recovery of preload recruitable stroke work area, but not of maximal elastance, after reperfusion of ischemic hearts with warm resuscitative blood cardioplegic solution enhanced with amino acids. The functional improvement provided by this technique was transient, however, and no significant differences were detectable among the groups after 60 minutes of unloaded reperfusion. Neither amino acid enhancement nor continuous warm cardioplegia offered a significant advantage in functional recovery over the standard method of cold blood cardioplegia reperfusion
— id: 6568, year: 1995, vol: 109, page: 242, stat: Journal Article,

Operative therapy for mitral insufficiency from coronary artery disease
Galloway AC; Grossi EA; Spencer FC; Colvin SB
1995 Oct;7(4):227-232, Seminars in thoracic & cardiovascular surgery
This report reviews the results of combined coronary bypass and Carpentier-type mitral valve reconstruction in 115 patients with ischemic mitral insufficiency. Overall operative mortality was 15.7%. Factors that increased operative risk in the overall valve repair population of 638 patients included ischemic etiology, previous cardiac surgery, NYHA functional classification, and age. Variables predicting increased risk of late cardiac death were ischemic etiology, concomitant procedures, and pulmonary hypertension. Late survival was diminished in ischemic patients, but 10-year freedom from reoperation was 93%, suggesting excellent durability after repair for ischemic mitral insufficiency. These results are compared with published reports of operative treatment for mitral insufficiency from coronary artery disease. Guidelines for use of coronary bypass alone versus coronary bypass in association with valve repair or replacement are developed. In most patients with moderate to severe mitral insufficiency secondary to coronary artery disease, the valvular pathology must be corrected, and valve repair with ring annuloplasty is the preferred method. Preoperative planning based on transesophageal echocardiography and cardiac catheterization data is essential for proper operative strategy, and attention to cardioplegia delivery and techniques to minimize reperfusion injury are necessary for optimal results. With these guidelines, late results are excellent after operative treatment for ischemic mitral insufficiency
— id: 56869, year: 1995, vol: 7, page: 227, stat: Journal Article,

Atrial spetal defects, atrioventricular canal defect and total anomalous pulmoarny venous return
Galloway AC; Spencer FC; Colvin SB
Surgery of the chest Philadelphia : Saunders, 1995,
— id: 3828, year: 1995, vol: , page: ?, stat: Chapter,

STATISTICAL APPROACH OF NEW-YORK CARDIAC REPORTING SYSTEM REQUIRES ADJUSTMENT
GREEN, J; WINTFELD, N; GROSSI, EA; BAUMANN, FG; RIBAKOVE, G; GALLOWAY, AC; COLVIN, SB; SPENCER, FC
1995 OCT 15 ;92(8):3089-3089, Circulation
— id: 33446, year: 1995, vol: 92, page: 3089, stat: Journal Article,

Endoventricular remodeling of left ventricular aneurysm. Functional, clinical, and electrophysiological results
Grossi EA; Chinitz LA; Galloway AC; Delianides J; Schwartz DS; McLoughlin DE; Keller N; Kronzon I; Spencer FC; Colvin SB
1995 Nov 1;92(9 Suppl):II98-I100, Circulation
BACKGROUND: Recent advances in surgical techniques for the repair of left ventricular aneurysms (LVAs) include the use of an endoventricular patch to exclude the aneurysm cavity. This technique has replaced conventional linear plication of the aneurysm. The endoventricular patch technique remodels the left ventricular cavity to a more physiological geometry that improves function. METHODS AND RESULTS: From December 1989 through November 1993, 45 patients underwent an LVA repair with an endoventricular patch. This procedure was performed in association with coronary artery bypass grafting in 40 patients. Twenty-eight patients (62.2%) also had nonguided encircling subendocardial incisions. Operative procedures included 7 emergency operations, 3 concomitant valve procedures, and a mean of 2.2 bypass grafts per patient. Eight patients had previous cardiac operations. Hospital mortality was 15.6% (7/45) for all patients and 9.1% (3/33) for nonemergent revascularization and LVA repairs. Ejection fraction improved from a mean of 25.8% preoperatively to 37.8% postoperatively; the mean New York Heart Association classification improved from 3.5 to 1.5. Of patients known to have preoperative arrhythmias (inducible or sudden death), 69% were not inducible postoperatively without antiarrhythmic medication. Survival from late cardiac death (including death of unknown origin) was 86.5% at 2 years. Freedom from documented ventricular arrhythmias was 94.3% at 2 years. CONCLUSIONS: These results indicate that the patch endoaneurysmorrhaphy technique can provide an excellent functional and physiological outcome in patients with LVAs and severely impaired ventricular function
— id: 56759, year: 1995, vol: 92, page: II98, stat: Journal Article,

Anterior leaflet procedures during mitral valve repair do not adversely influence long-term outcome
Grossi EA; Galloway AC; LeBoutillier M 3rd; Steinberg B; Baumann FG; Delianides J; Spencer FC; Colvin SB
1995 Jan;25(1):134-136, Journal of the American College of Cardiology
OBJECTIVES. This study was done to assess the impact of anterior mitral leaflet reconstructive procedures on initial and long-term results of mitral valve repair. BACKGROUND. It has been suggested that involvement of the anterior leaflet in mitral valve disease adversely affects the long-term outcome of mitral valve repair. Our policy has been to aggressively repair such anterior leaflets with procedures that include triangular resections in some cases. METHODS. From June 1979 through June 1993, 558 consecutive Carpentier-type mitral valve repairs were performed. The anterior mitral leaflet and chordae tendineae were repaired in 156 patients (mean age 58 years). The procedures included anterior chordal shortening in 78 patients (50%), anterior leaflet resections in 44 (28%), resuspension of the anterior leaflet to secondary chordae in 42 (27%) and anterior chordal transposition in 27 (17%). Concomitant cardiac surgical procedures were performed in 75 patients (48%). RESULTS. The operative mortality rate was 2.5% (2 of 81) for isolated mitral valve anterior leaflet repair and 3.8% (6 of 156) for all mitral valve anterior leaflet repair. Freedom from reoperation at 5 and 10 years was, respectively, 89.7% (n = 160) and 83.4% (n = 24) for the entire series of 558 patients, 91.9% (n = 51) and 81.2% (n = 10) for patients with anterior leaflet procedures, 88.8% (n = 109) and 84.4% (n = 14) for patients without anterior leaflet procedures and 91.7% (n = 118) and 88.9% (n = 18) for patients without rheumatic disease. Logistic regression showed that rheumatic origin of disease (odds ratio 2.99), but not anterior leaflet repair, increased the risk for reoperation. CONCLUSIONS. These results demonstrate that expansion of mitral valve techniques to include anterior leaflet disease yields immediate and long-term results equal to those seen in patients with posterior leaflet disease
— id: 6637, year: 1995, vol: 25, page: 134, stat: Journal Article,

MITRAL-VALVE REPAIR IN THE ELDERLY
GROSSI, EA; GALLOWAY, AC; LEBOUTILLIER, M; STEINBERG, B; RIBAKOVE, G; DELIANIDES, J; BAUMANN, FG; SPENCER, FC; COLVIN, SB
1995 AUG ;3(4):269-272, Cardiology in the elderly
Aim: To document the short- and long-term effects of mitral valve reconstruction in patients 70 years of age and older. Recent favorable experience with mitral-valve reconstructive techniques has led to an attempt to apply them to elderly patients with mitral-valve defects, in the hope of improving ventricular function and freedom from complications in this higher-risk group. Methods: Between lune 1980 and June 1993, 160 consecutive mitral-valve reconstructions were performed using Carpentier techniques on patients 70 years of age and older (n=140 for 70-79 years, n=20 for greater than or equal to 80 years). All procedures were for either pure mitral regurgitation or mixed stenosis/regurgitation and involved placement of an annuloplasty ring. Concomitant cardiac operative procedures were performed in 109 patients (68%), including coronary bypass grafting in 67 (42%) and other valve procedures in 27 (17%). Results: Hospital mortality was 5.9% (three out of 51) for isolated mitral-valve reconstruction and 11.9% (19 out of 160) overall. Before surgery, 89.4% of the patients were in New York Heart Association (NYHA) class III or IV. At follow-up, 89.1% were in NYHA class I or II. In patients who underwent an isolated mitral-valve operation, cumulative freedom from cardiac death and reoperation, including hospital death, was 85.9% at 5 years. Conclusions: These results demonstrate that the encouraging results seen to date in younger patients who have undergone mitral-valve reconstruction can also be achieved in elderly patients
— id: 33445, year: 1995, vol: 3, page: 269, stat: Journal Article,

Surgery of the chest
Sabiston, David C.; Spencer, Frank Cole
Philadelphia : W.B. Saunders, c1995,
— id: 521, year: 1995, vol: , page: , stat: ,

Principios de cirugia = [Principles of surgery]
Schwartz, Seymour I; Shires, G. Tom; Spencer, Frank Cole; Husser, Wendy Cowles; Samperio, Jorge Orizaga
Mexico : McGraw-Hill Interamericana, 1995,
— id: 980, year: 1995, vol: , page: , stat: ,

Acquired diseases of the mitral valve
Spencer FC; Galloway AC; Colvin SB
Surgery of the chest Philadelphia : Saunders, 1995,
— id: 3827, year: 1995, vol: , page: ?, stat: Chapter,

Heparin bonding of bypass circuits reduces cytokine release during cardiopulmonary bypass
Steinberg BM; Grossi EA; Schwartz DS; McLoughlin DE; Aguinaga M; Bizekis C; Greenwald J; Flisser A; Spencer FC; Galloway AC; et al.
1995 Sep;60(3):525-529, Annals of thoracic surgery
BACKGROUND. Heparin bonding of the cardiopulmonary bypass (CPB) pump circuit decreases complement activation and fibrinolysis. It is not known whether inflammatory cytokines produced during CPB can also be modulated by the more biocompatible heparin-coated circuit. METHODS. This initial study evaluated the impact of heparin-bonded CPB circuits on production of the cytokines interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-a), IL-6, and IL-8 in adults undergoing complex cardiac operations with prolonged CPB. Twenty patients had blood samples drawn immediately before and at hourly intervals after the start of CPB using either a conventional oxygenator and circuit (n = 14) or a covalently bonded heparin oxygenator and circuit (n = 6). Levels of IL-1, TNF-a, IL-6, and IL-8 were measured in all serum samples using a 'sandwich' enzyme-linked immunosorbent assay. RESULTS. The levels of IL-6 and IL-8 increased in a time-dependent fashion in both groups, but the response was significantly less over time in the heparin-bonded group (p < 0.05) for both IL-6 and IL-8. Levels of IL-1 and TNF-a were not significantly elevated with lengthening bypass interval in either group. CONCLUSIONS. These data indicate that the use of heparin-coated bypass pump circuits results in lower serum levels of the inflammatory cytokines IL-6 and IL-8 than standard circuits. Biocompatible materials that decrease the inflammatory response to CPB may ultimately reduce the morbidity associated with cardiac operations
— id: 56791, year: 1995, vol: 60, page: 525, stat: Journal Article,

Successful plication for postoperative diaphragmatic paralysis in an adult
Glassman LR; Spencer FC; Baumann FG; Adams FV; Colvin SB
1994 Dec;58(6):1754-1755, Annals of thoracic surgery
Diaphragmatic paralysis developed in an adult after a cardiac operation. The patient suffered from recurrent fevers and could not be weaned from mechanical ventilatory support. Diaphragmatic plication was performed and enabled rapid and sustained weaning from respiratory support
— id: 56641, year: 1994, vol: 58, page: 1754, stat: Journal Article,

Severe calcification does not affect long-term outcome of mitral valve repair
Grossi EA; Galloway AC; Steinberg BM; LeBoutillier M 3rd; Delianides J; Baumann FG; Spencer FC; Colvin SB
1994 Sep;58(3):685-687, Annals of thoracic surgery
Some surgeons have suggested that the presence of severe calcification in the mitral valve annulus or leaflets precludes successful repair. Our institution has attempted to repair these calcified valves when good annular and leaflet mobility could be achieved by annular debridement and leaflet resection. From June 1979 through June 1993 558 mitral valve repairs were performed using Carpentier's techniques. When calcified valves were encountered, these techniques were modified to include annular debridement and mechanical leaflet decalcification. Calcification was identified preoperatively in 49 patients (8.8%) by either left ventricular fluoroscopy or echocardiography and was debrided in 64 patients (11.5%). This included 24 annular debridements, 28 leaflet debridements, and 12 annular and leaflet debridements. Patient ages ranged from 13 to 83 years (mean age, 62.3 years), and 25 patients (39.1%, 25/64) had concomitant cardiac procedures. Operative mortality was 6.2% (4/64) overall and 2.6% (1/39) for isolated mitral valve repairs. Calcium debridement was performed in 19.3% (23/119) of patients with a rheumatic cause compared with 9.3% (41/439) of the nonrheumatic patients (p < 0.01). Long-term follow-up revealed the necessity for reoperation in 7.8% (5/64) in patients with calcium debridement as compared with 7.7% (38/494) with no debridement (p = not significant). Cumulative freedom from reoperation at 10 years was 83.3% for all patients, 88.1% for debrided patients, and 82.6% for nondebrided patients (p = not significant). Cox proportional hazards analysis revealed that the presence of rheumatic disease significantly increased the risk of reoperation (odds ratio = 3.28; p < 0.001), whereas calcium debridement had no significant effect. These results demonstrate that when good annulus and leaflet motion can be achieved in calcified mitral valves, calcium debridement allows durable repairs
— id: 56649, year: 1994, vol: 58, page: 685, stat: Journal Article,

Decreasing incidence of systolic anterior motion after mitral valve reconstruction
Grossi EA; Steinberg BM; LeBoutillier M 3rd; Ribacove G; Spencer FC; Galloway AC; Colvin SB
1994 Nov;90(5 Pt 2):II195-II197, Circulation
BACKGROUND: With the widespread application of mitral valve reconstructive techniques, systolic anterior motion (SAM) of the anterior mitral leaflet causing left ventricular outflow tract obstruction has been recognized by several groups. SAM occurred in 9.1% of the first 441 patients operated on for mitral valve reconstruction at our institution. Fortunately, SAM subsided with medical therapy within 1 year for a majority of patients as reported in May 1993. Some surgeons, however, have considered abandoning repair for prosthetic replacement after SAM was detected on intraoperative echocardiogram. METHODS AND RESULTS: Since June 1991, a triangular anterior leaflet resection has been cautiously evaluated in patients with extensive anterior leaflet tissue. This has been performed in 23 of 119 patients. CONCLUSIONS: The frequency of SAM in the 119 study patients has decreased from 9.1% to 3.4%
— id: 56650, year: 1994, vol: 90, page: II195, stat: Journal Article,

ENDOVENTRICULAR REMODELING FOR LV ANEURYSM - FUNCTIONAL AND ELECTROPHYSIOLOGICAL RESULTS
GROSSI, EA; CHINITZ, LA; GALLOWAY, AC; DELIANIDES, J; KRONZON, I; SPENCER, FC; COLVIN, SB
1994 OCT ;90(4):640-640, Circulation
— id: 33449, year: 1994, vol: 90, page: 640, stat: Journal Article,

ANTERIOR LEAFLET PROCEDURES DURING MITRAL REPAIR DO NOT ADVERSELY INFLUENCE LONG-TERM OUTCOME
GROSSI, EA; GALLOWAY, AC; LEBOUTILLIER, M; STEINBERG, B; DELIANIDES, J; SPENCER, FC; COLVIN, SB
1994 FEB ;90(5):A277-A277, Journal of the American College of Cardiology
— id: 33447, year: 1994, vol: 90, page: A277, stat: Journal Article,

MITRAL-VALVE REPAIR IN THE ELDERLY
GROSSI, EA; GALLOWAY, AC; LEBOUTILLIER, M; STEINBERG, B; ESPOSITO, R; CULLIFORD, AT; SPENCER, FC; COLVIN, SB
1994 FEB ;90(5):A465-A465, Journal of the American College of Cardiology
— id: 33448, year: 1994, vol: 90, page: A465, stat: Journal Article,

Effect of retrograde warm continuous cardioplegia on right ventricular function
LeBoutillier M 3rd; Grossi EA; Steinberg BM; Baumann FG; Colvin SB; Spencer FC; Galloway AC
1994 Nov;90(5 Pt 2):II306-II309, Circulation
BACKGROUND: Although retrograde warm continuous cardioplegia (RWCC) has been recently advocated as a method of myocardial preservation during cardiac surgery, scant data exist on the effects of RWCC on right ventricular function. However, previous data have clearly shown that retrograde cardioplegia is poorly distributed to the right ventricle and interventricular septum. This experiment was performed to analyze functional preservation of the right ventricle after RWCC. METHODS AND RESULTS: Fourteen mongrel dogs were instrumented with sonomicrometers and pressure transducers to determine left and right ventricular (LV, RV) pressure-volume relationships and placed on cardiopulmonary bypass. All dogs underwent 90 minutes of aortic cross-clamping with either (1) RWCC (n = 7) after antegrade warm arrest or (2) retrograde cold multidose cardioplegia (RCMC) (n = 7) with topical hypothermia after antegrade cold arrest. All dogs received identical blood cardioplegia solutions. Ventricular function was measured before arrest and 30 and 60 minutes after unclamping. The end-diastolic-work area relationship was calculated, and the slope is presented as percent of baseline (mean +/- SEM; repeated measures ANOVA). At 30 minutes after unclamping, RWCC provided 68.77 +/- 9.09 for the left ventricle and 41.03 +/- 7.49 (P < .05 for RWCC versus RCMC for RV function at 30 minutes) for the right ventricle, and RCMC provided 62.80 +/- 7.23 for the left ventricle and 79.40 +/- 13.82 for the right ventricle. At 60 minutes after unclamping, RWCC provided 58.24 +/- 12.35 for the left ventricle and 48.05 +/- 9.72 for the right ventricle, and RCMC provided 65.38 +/- 6.76 for the left ventricle and 61.95 +/- 8.70 for the right ventricle. (P = NS for RWCC versus RCMC for LV function at either 30 or 60 minutes). These results demonstrate depressed recovery of RV function after 90 minutes of RWCC (P < .05 at 30 minutes after reperfusion) compared with RCMC. No difference in recovery of LV function was detected. CONCLUSION: RWCC may be harmful to the right ventricle and should be used with caution, particularly in patients with preexisting RV hypertrophy
— id: 56671, year: 1994, vol: 90, page: II306, stat: Journal Article,

Principles of surgery
Schwartz, Seymour I; Shires, GT; Spencer, FC; Husser WC
New York : McGraw Hill, 1994,
— id: 971, year: 1994, vol: , page: , stat: ,

Principles of surgery : companion handbook
Schwartz, Seymour I; Shires, GT; Spencer, FC; Husser WC
New York : McGraw Hill, 1994,
— id: 972, year: 1994, vol: , page: , stat: ,

Role of amino acids and enhancement cardioplegia in routine myocardial protection. Experimental results
Crooke GA; Harris LJ; Grossi EA; Baumann FG; Esposito R; Spencer FC; Colvin SB; Galloway AC
1993 Sep;106(3):497-501, Journal of thoracic & cardiovascular surgery
The purpose of this study was to determine the effects of the addition of amino acids to blood cardioplegic solution and the value of terminal cardioplegia enhancement techniques in routine myocardial protection. Forty-five open-chest adult dogs were instrumented with sonomicrometry crystals to measure left ventricular long axis, midequatorial short axis, and wall thickness. The aorta was clamped for 120 minutes of cardiopulmonary bypass. Animals were randomly separated into four myocardial protection groups: (1) blood cardioplegic solution with amino acids and no terminal cardioplegia (n = 12); (2) blood cardioplegic solution with amino acids and warm amino acid terminal cardioplegia (n = 11); (3) blood cardioplegic solution with amino acids and cold amino acid terminal cardioplegia (n = 12); and (4) blood cardioplegic solution plus cold terminal cardioplegia (no amino acids, n = 10). Data for preload recruitable stroke work were obtained by inflow occlusion before bypass (baseline) and at 30 and 60 minutes after reperfusion and analyzed for changes in x-intercept and slope. A significant rightward shift in x-intercept did not occur in any group. When cardiac function was expressed as a percentage of baseline preload recruitable stroke work slope, improved functional recovery was seen at both 30 and 60 minutes in groups 2 (88.6% and 91.8%), 3 (85.8% and 86.9%), and 4 (88.6% and 92.6%) compared with group 1 (77.3% and 79.2%, p < 0.05). No significant difference was found in the degree of functional recovery among groups 2, 3, and 4. These results suggest that for myocardial protection of 2 hours in nonischemic hearts, a terminal dose of blood cardioplegic solution before unclamping is beneficial, but this positive effect is independent of amino acid supplementation and temperature
— id: 13079, year: 1993, vol: 106, page: 497, stat: Journal Article,

Acquired heart disease
Galloway AC; Colvin SB; Spencer FC
Principles of surgery New York : McGraw-Hill, 1993,
— id: 3825, year: 1993, vol: , page: ?, stat: Chapter,

Congenital heart disease
Galloway AC; Colvin SB; Spencer FC
Principles of surgery New York : McGraw-Hill, 1993,
— id: 3824, year: 1993, vol: , page: ?, stat: Chapter,

Diseases of great vessels
Galloway AC; Colvin SB; Spencer FC
Principles of surgery New York : McGraw-Hill, 1993,
— id: 3823, year: 1993, vol: , page: ?, stat: Chapter,

LONG-TERM FOLLOW-UP OF 516 PATIENTS WITH CARPENTIER-TYPE MITRAL CARPENTIER TECHNIQUES
GALLOWAY, AC; GROSSI, EA; ESPOSITO, R; RIBAKOVE, GH; SPENCER, FC; COLVIN, SB
1993 OCT ;88(4):539-539, Circulation
— id: 33452, year: 1993, vol: 88, page: 539, stat: Journal Article,

Differences in carotid shunt flow rates and implications for cerebral blood flow
Grossi EA; Giangola G; Parish MA; Baumann FG; Riles TS; Spencer FC
1993 Jan;7(1):39-43, Annals of vascular surgery
A wide variety of carotid shunts are available for use in extracranial carotid surgery. Since it is commonly assumed that when properly positioned all shunts are equal in ability to protect the brain from cerebral ischemia, the choice of shunt is usually based on handling characteristics. However, after an intraoperative stroke occurred in a patient, we compared shunt flow rates using a simple and reproducible method of measurement. A mock circuit was created using a saline-filled fluid reservoir connected to the particular shunt being tested via 1/2-inch tubing. Hydrostatic pressure across the shunt was varied by changing the height of the reservoir, and the flow was collected over 30-second intervals. Multiple flow rate measurements were performed for each shunt with pressure gradients varying from 25 to 150 cm H2O. The data show significant hemodynamic differences among commercially available carotid shunts. A pressure gradient of 75 cm H2O produced a 2.8-fold variation in the amount of fluid delivered by various shunts. Minimal cerebral blood flow requirements and the possibility of underperfusion require that the surgeon consider such data in choosing an appropriate carotid shunt
— id: 56538, year: 1993, vol: 7, page: 39, stat: Journal Article,

DECREASING INCIDENCE OF SYSTOLIC ANTERIOR MOTION AFTER MITRAL-VALVE REPAIR
GROSSI, E; LEBOUTILLIER, M; GALLOWAY, A; RIBAKOVE, G; STEINBERG, B; SPENCER, F; COLVIN, S
1993 OCT ;88(4):574-574, Circulation
— id: 52205, year: 1993, vol: 88, page: 574, stat: Journal Article,

Manual de principios de cirugia = [Principles of surgery : companion handbook]
Schwartz, Seymour I; Shires, G. Tom; Spencer, Frank Cole; Husser, Wendy Cowles; Blengio, Jose R; Valdepena, Hugo; Mendez, Jose Oropeza
Mexico : McGraw-Hill, 1993,
— id: 982, year: 1993, vol: , page: , stat: ,

Coronary artery bypass
Spencer FC; Galloway AC; Colvin SB
Principles of surgery New York : McGraw-Hill, 1993,
— id: 3826, year: 1993, vol: , page: ?, stat: Chapter,

Treatment of AIDS-related bronchopleural fistula by pleurectomy [see comments]
Crawford BK; Galloway AC; Boyd AD; Spencer FC
1992 Aug;54(2):212-214, Annals of thoracic surgery
Spontaneous pneumothorax in patients with acquired immunodeficiency syndrome (AIDS) may require prolonged therapy for treatment of a persistent bronchopleural fistula, and treatment by standard methods often fails. This pilot study was done to test the effectiveness of aggressive surgical therapy for definitive treatment of persistent bronchopleural fistula in patients with AIDS. Between March 1989 and September 1991, 44 patients with AIDS were treated for spontaneous pneumothorax with closed tube thoracostomy; 14 of these patients had development of persistent bronchopleural fistula for more than 10 days, and 2 patients had subsequent bronchopleural fistula on the opposite side. Operative therapy in 14 patients included 15 thoracotomies and one sternotomy. The bronchopleural fistula was closed directly with suture or staples in 15 procedures and resected by lobectomy in 1 patient. All 14 patients received adjuvant parietal pleurectomy. Operative mortality was 7% (1 of 14 patients). The fistula was closed in all survivors and 13 patients were discharged between 7 and 28 days postoperatively. Pathologic examination confirmed Pneumocystis carinii in 13 patients with a high incidence of diffuse involvement and subpleural necrosis, further demonstrating the need for pleurectomy. These data suggest that in selected patients bronchopleural fistulas associated with AIDS can be effectively controlled by surgical closure combined with pleurectomy
— id: 13482, year: 1992, vol: 54, page: 212, stat: Journal Article,

Multiple valve operation for advanced valvular heart disease: results and risk factors in 513 patients [published erratum appears in J Am Coll Cardiol 1992 Jun;19(7):1677-8]
Galloway AC; Grossi EA; Baumann FG; LaMendola CL; Crooke GA; Harris LJ; Colvin SB; Spencer FC
1992 Mar 15;19(4):725-732, Journal of the American College of Cardiology
To assess the results and incremental risk factors affecting outcome after multiple-valve operation in the early blood cardioplegia era of cardiac surgery, follow-up data (mean +/- SD 3.1 +/- 2 years) were obtained on 97% of 513 patients (mean age +/- SD 58.8 +/- 10.5 years) who underwent a multiple-valve procedure between June 1976 and August 1985. Preoperatively 41% of patients were in New York Heart Association functional class III and 54% in class IV. Three groups accounted for 98.6% of the patients: 57.7% had an aortic and mitral valve procedure, 29% had a mitral and tricuspid valve procedure and 11.9% had a triple-valve procedure. The overall hospital mortality rate was 12.5% and overall 5-year survival rate was 67.1%. Hazard function analysis for all deaths revealed systolic pulmonary artery pressure (p less than 0.0001), age (p = 0.005), triple valve procedure (p less than 0.005), concomitant coronary bypass operation (p less than 0.005) and prior cardiac surgery (p less than 0.002) as the significant incremental risk factors predicting decreased survival in the early hazard phase; diabetes (p less than 0.005) predicted decreased survival in the late hazard phase. Postoperatively the condition of 80% of the patients improved to functional class I or II; only 0.6% remained in functional class IV. The 5-year rate of freedom from late combined valve-related morbidity was 81.7% and that of freedom from late combined valve-related morbidity and mortality was 71.7%. These results demonstrate excellent clinical improvement and late survival after multiple valve operation in patients with advanced valvular heart disease, justifying aggressive surgical therapy in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 13657, year: 1992, vol: 19, page: 725, stat: Journal Article,

Experience with twenty-eight cases of systolic anterior motion after mitral valve reconstruction by the Carpentier technique
Grossi EA; Galloway AC; Parish MA; Asai T; Gindea AJ; Harty S; Kronzon I; Spencer FC; Colvin SB
1992 Mar;103(3):466-470, Journal of thoracic & cardiovascular surgery
Systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction after Carpentier-type mitral reconstruction with ring annuloplasty has led some surgeons to abandon an otherwise successful repair or to avoid use of a rigid ring. To assess the long-term significance of such motion, we studied 439 patients undergoing Carpenter mitral reconstruction at our institution between March 1981 and June 1990. The hospital mortality rate was 4.8% (21/439) overall and 3.7% (9/243) for isolated mitral reconstruction. Systolic anterior motion was found in 6.4% (28/438) after the operation, and 2.3% (10/438) had a coexisting left ventricular outflow tract gradient (mean 53 mm Hg). Of the 28 patients with systolic anterior motion, 27 (96.4%) had leaflet prolapse, 17 (60.7%) had undergone more than a 3 cm resection of the posterior leaflet, and two (7.1%) had preexisting idiopathic hypertrophic subaortic stenosis. All patients were treated medically, 14 with negative inotropic agents. Follow-up echocardiograms at a mean of 32 months demonstrated the disappearance of systolic anterior motion in 13 of 28 patients (46.4%) and resolution of the outflow tract gradient in 10 of 10 (100%). At follow-up only one patient was in New York Heart Association class III or IV and required reoperation for rheumatic mitral insufficiency. These data demonstrate that systolic anterior motion after Carpentier mitral reconstruction with ring annuloplasty is not prevalent and should be managed medically in most cases. Associated left ventricular outflow tract obstruction resolves with medical treatment
— id: 13676, year: 1992, vol: 103, page: 466, stat: Journal Article,

Protruding aortic atheromas predict stroke in elderly patients undergoing cardiopulmonary bypass: experience with intraoperative transesophageal echocardiography
Katz ES; Tunick PA; Rusinek H; Ribakove G; Spencer FC; Kronzon I
1992 Jul;20(1):70-77, Journal of the American College of Cardiology
Protruding atheromas of the aortic arch identified by transesophageal echocardiography have been implicated as a cause of stroke in elderly patients. One hundred thirty patients greater than or equal to 65 years of age were studied with intraoperative transesophageal echocardiography to detect aortic arch protruding atheromas and determine if these patients were at higher risk for perioperative stroke. Protruding atheromas were identified in 23 (18%) of 130 patients. In 19 (83%) of these 23 patients, palpation of the aortic arch at operation did not identify significant abnormalities. Five patients (4%) had perioperative stroke. Logistic regression identified aortic arch atheroma as the only historical or procedural variable that was predictive of stroke (odds ratio 5.8, 95% confidence interval 1.2 to 27.9, p less than 0.03). A history of peripheral or cerebrovascular disease, presence of aortic calcification, cardiac risk factors, age and duration of cardiopulmonary bypass did not predict stroke. In contrast, patients with protruding atheromas with mobile components were at highest risk. There were 3 (25%) of 12 patients with a mobile atheroma who had a stroke versus 2 (2%) of 118 patients without a mobile atheroma (chi-square = 10.3, p = 0.001). Displacement and detachment of the frail, protruding atherosclerotic material by aortic arch cannulation or by the high pressure jet emanating from the cannula tip may play an important role in the creation of embolization and stroke
— id: 13531, year: 1992, vol: 20, page: 70, stat: Journal Article,

Significant trends in the treatment of hepatic trauma. Experience with 411 injuries
Pachter HL; Spencer FC; Hofstetter SR; Liang HG; Coppa GF
1992 May;215(5):492-500, Annals of surgery
Several significant advances in the treatment of hepatic injuries have evolved over the past decade. These trends have been incorporated into the overall treatment strategy of hepatic injuries and are reflected in experiences with 411 consecutive patients. Two hundred fifty-eight patients (63%) with minor injuries (grades I to II) were treated by simple suture or hemostatic agents with a mortality rate of 6%. One hundred twenty-eight patients (31%) sustained complex hepatic injuries (grades III to V). One hundred seven patients (83.5%) with grades III or IV injury underwent portal triad occlusion and finger fracture of hepatic parenchyma alone. Seventy-three surviving patients (73%) required portal triad occlusion, with ischemia times varying from 10 to 75 minutes (mean, 30 minutes). The mortality rate in this group was 6.5% (seven patients) and was accompanied by a morbidity rate of 15%. Fourteen patients (11%) with grade V injury (retrohepatic cava or hepatic veins) were managed by prolonged protal triad occlusion (mean cross-clamp time, 46 minutes) and extensive finger fracture to the site of injury. In four of these patients an atrial caval shunt was additionally used. Two of these patients survived, whereas six of the 10 patients managed without a shunt survived, for an overall mortality rate of 43%. Over the past 4 years, six patients (4.7%) with ongoing coagulopathies were managed by packing and planned re-exploration, with four patients (67%) surviving and one (25%) developing an intra-abdominal abscess. One additional patient (0.8%) was managed by resectional debridement alone and survived. During the past 5 years, 25 hemodynamically stable and alert adult patients (6%) sustaining blunt trauma were evaluated by computed tomography scan and found to have grade I to III injuries. All were managed nonoperatively with uniform success. The combination of portal triad occlusion (up to 75 minutes), finger fracture technique, and the use of a viable omental pack is a safe, reliable, and effective method of managing complex hepatic injuries (grade III to IV). Juxtahepatic venous injuries continue to carry a prohibitive mortality rate, but nonshunting approaches seem to result in the lowest cumulative mortality rate. Packing and planned reexploration has a definitive life-saving role when used adjunctively in the presence of a coagulopathy. Nonoperative management of select hemodynamically stable adult patients, identified by serial computed tomography scans after sustaining blunt trauma is highly successful (95-97%)
— id: 13603, year: 1992, vol: 215, page: 492, stat: Journal Article,

The effects of different techniques of internal mammary artery harvesting on sternal blood flow
Parish MA; Asai T; Grossi EA; Esposito R; Galloway AC; Colvin SB; Spencer FC
1992 Nov;104(5):1303-1307, Journal of thoracic & cardiovascular surgery
We investigated chest wall blood flow in a canine model to determine if the technique used to harvest the mammary artery has a differential effect on residual chest wall blood flow. Eight dogs underwent bilateral internal mammary artery mobilization; one artery was harvested as a pedicle and the other was harvested as a skeletonized vessel. Residual blood flow to the chest wall distribution of each artery was measured with radioactive microspheres. Chest wall blood flow was significantly decreased from preharvest levels after internal mammary artery mobilization regardless of the technique used. Tissue blood flows decreased to 46.9%, 22.1%, and 41.2% of baseline values for the manubrium (p < 0.01), sternum (p < 0.001), and ribs (p < 0.05), respectively. Residual sternal blood flow on the side of the skeletonized vessel was significantly greater than on the side of the pedicle graft (2.60 +/- 0.68 versus 1.27 +/- 0.27 cm3/min/100 gm, p < 0.001). We conclude that minimization of tissue mobilization during internal mammary artery harvesting may reduce sternal devascularization. This finding may have clinical significance with respect to lowering the incidence of sternal wound complications in coronary bypass surgery using the internal mammary artery as a bypass conduit
— id: 13375, year: 1992, vol: 104, page: 1303, stat: Journal Article,

Surgical implications of transesophageal echocardiography to grade the atheromatous aortic arch
Ribakove GH; Katz ES; Galloway AC; Grossi EA; Esposito RA; Baumann FG; Kronzon I; Spencer FC
1992 May;53(5):758-761, Annals of thoracic surgery
Stroke is an especially serious complication of cardiopulmonary bypass with an incidence of 2% to 5%. This prospective study used transesophageal echocardiography (TEE) in 97 patients more than 65 years of age (mean age, 73 years) to identify those at high risk for aortic atheroemboli. The atheromatous disease of the aorta was graded by TEE: grade I = minimal intimal thickening (n = 29); II = extensive intimal thickening (n = 33); III = sessile atheroma (n = 15); IV = protruding atheroma (n = 10); V = mobile atheroma (n = 10). Clinical evaluation was also performed by intraoperative aortic palpation. Four patients who were graded as having normal aortas by palpation had intraoperative strokes. In contrast, 3 of these 4 patients were in grade V on TEE. The relationship of TEE to incidence of stroke was statistically significant (p less than 0.006), whereas there was no significant correlation between clinical grade and stroke incidence. Four of 10 TEE grade V patients were treated with hypothermic circulatory arrest and aortic arch debridement, and none suffered strokes. The other 6 patients were treated with standard techniques, and 3 had strokes. These results suggest that patients with mobile atheromatous disease are at high risk for embolic strokes that are not predicted by routine clinical evaluation. Selective use of circulatory arrest in the presence of TEE-detected mobile arch atheromas may reduce the risk of intraoperative stroke
— id: 13614, year: 1992, vol: 53, page: 758, stat: Journal Article,

Aortic valve replacement for aortic stenosis in persons aged 80 years and over
Culliford AT; Galloway AC; Colvin SB; Grossi EA; Baumann FG; Esposito R; Ribakove GH; Spencer FC
1991 Jun 1;67(15):1256-1260, American journal of cardiology
Seventy-one patients aged greater than or equal to 80 years (mean +/- standard deviation 82 +/- 2) with aortic stenosis or mixed stenosis and regurgitation underwent aortic valve replacement alone (n = 35, group 1) or in combination with a coronary artery bypass procedure without any other valve procedure (n = 36, group 2). Preoperatively, 91% had severe cardiac limitations (New York Heart Association class III or IV). Hospital mortality was 12.7% overall (9 of 71), 5.7% (2 of 35) for group 1 and 19.4% (7 of 36) for group 2. Perioperatively, 1 patient (1.4%) had a stroke. Survival from late cardiac death at 1 and 3 years was 98.2 and 95.5%, respectively, for all patients, 100% for patients who underwent isolated aortic valve replacement, and 96.3 and 91.2%, respectively, for patients who underwent aortic valve replacement plus coronary artery bypass. Eighty-three percent of surviving patients had marked symptomatic improvement. Freedom from all valve-related complications (thromboembolism, anticoagulant, endocarditis, reoperation or prosthetic failure) was 93.3 and 80.4% at 1 and 3 years, respectively. Thus, short- and long-term morbidity and mortality after aortic valve replacement for aortic stenosis in patients aged greater than or equal to 80 years are encouragingly low, although the addition of coronary artery bypass grafting increases short- and long-term mortality
— id: 14001, year: 1991, vol: 67, page: 1256, stat: Journal Article,

Repair of posterior left ventricular aneurysm in a six-year-old boy
Grossi EA; Colvin SB; Galloway AC; Rutkowski M; Doyle EF; Crooke GA; Spencer FC
1991 Mar;51(3):484-487, Annals of thoracic surgery
Left ventricular aneurysms and diverticula are rarely encountered in the pediatric age group. This paper reports a case of congestive heart failure and mitral regurgitation in a 6-year-old boy with a large posterolateral left ventricular aneurysm. Complete repair was successfully performed by excision of the aneurysm and Dacron patch reconstruction of the left ventricular free wall. The patch extended onto the posterior annulus of the mitral valve, thus restoring the mitral valve to normal geometry and correcting the mitral insufficiency. The surgical literature on congenital cardiac diverticula and acquired aneurysms in children is reviewed and summarized
— id: 14116, year: 1991, vol: 51, page: 484, stat: Journal Article,

Sternal wound infections and use of internal mammary artery grafts [see comments]
Grossi EA; Esposito R; Harris LJ; Crooke GA; Galloway AC; Colvin SB; Culliford AT; Baumann FG; Yao K; Spencer FC
1991 Sep;102(3):342-346, Journal of thoracic & cardiovascular surgery
Previous studies have provided conflicting evidence as to whether an increased risk of mediastinitis is associated with use of the internal mammary artery as a coronary bypass graft. In this study the effects of internal mammary artery grafts on wound complications were analyzed in a prospective, nonrandomized fashion. At New York University Medical Center from January 1985 through May 1988, 2356 patients underwent isolated coronary revascularization. Among these patients 1394 received one or more internal mammary artery grafts (group I) and 962 had vein grafts only (group II). Group I had a mean age of 59.5 years versus 67.7 years in group II; diabetes was equally present in both groups (22.7% versus 24.7%). Operative mortality rate was 1.3% in group I and 5.6% in group II. Sternal infection was significantly more prevalent in group I (2.2%, 31/1394) than in group II (0.8%, 8/962). Multivariate analysis revealed that aortic crossclamp time, use of a single internal mammary artery graft, use of a double mammary graft, and diabetes were associated with increased risk of sternal infection. The use of bilateral internal mammary artery grafting doubled the odds ratio of the risk compared with use of a single mammary graft, and the combination of diabetes and double internal mammary artery grafts increased the odds ratio 13.9-fold. Patients with an internal mammary artery graft who had sternal infection had a longer period of hospitalization than patients without a mammary artery graft who had sternal infection. We conclude that the risk of sternal infection is increased by the use of an internal mammary artery graft, especially use of double mammary grafts in the presence of diabetes
— id: 13918, year: 1991, vol: 102, page: 342, stat: Journal Article,

Anatomic distribution of preservation solutions during canine hepatic procurement
Harris LJ; Crooke GA; Grossi EA; Teperman LW; Halff GA; Galloway AC; Spencer FC; Weil R 3d
1991 Oct;23(5):2430-2431, Transplantation proceedings
— id: 13878, year: 1991, vol: 23, page: 2430, stat: Journal Article,

Principios de cirugia = [Principles of surgery]
Schwartz, Seymour I; Shires, G. Tom; Spencer, Frank Cole; Husser, Wendy Cowles; Margallanes, Jorge Blanco y Correa; Testelli, Mario R; Matarelli, Jose
Mexico : McGraw-Hill Interamericana, 1991,
— id: 981, year: 1991, vol: , page: , stat: ,

Principles of surgery : companion handbook
Schwartz, Seymour I; Shires, GT; Spencer, FC; Husser WC
New York : McGraw Hill, 1991,
— id: 973, year: 1991, vol: , page: , stat: ,

A surgical program. Director's view
Spencer FC
1991 Jul-Aug;67(4):344-350, Bulletin of the New York Academy of Medicine
In summary, the two major facts that have emerged from a year and a half of experience with 405 regulations are shown in Table VI. The increased staffing with the monies made available has greatly enhanced patient care and decreased the resident workload. I want to again compliment Dr. Axelrod for the foresight to make these funds available despite adverse criticism. He clearly understood that the changes needed were quite expensive because the problems are primarily economic in origin. What type of paramedical personnel are needed is yet uncertain. I mentioned briefly earlier that the 'data manager' combines an excellent administrative secretary and a nurse. The simple institution of electronic data processing can, surprisingly enough, worsen the problem rather than help. For example, institution of a beeper system, making it possible for anyone to 'beep' a house officer at any time, resulted in an astonishing increase in 'beeper frequency,' a house officer receiving seven or eight such messages per hour, 24 hours a day, rather than communicating by other methods. Such 'instant' communication can become a serious hazard rather than a help. Second, as repeatedly mentioned, the on-call time concept is crucial, permitting flexibility that avoids fatigue and yet maintains continuity of care. Otherwise there is a real danger with a rigid time-on/time-off schedule
— id: 13984, year: 1991, vol: 67, page: 344, stat: Journal Article,

THE BENEFICIAL-EFFECTS OF TERMINAL SUBSTRATE ENRICHED CARDIOPLEGIA ARE TEMPERATURE INDEPENDENT
Crooke, GA; Harris, LJ; Grossi, EA; Galloway, AC; Colvin, SB; Spencer, FC
1990 Oct;82(4):589-589, Circulation
— id: 31911, year: 1990, vol: 82, page: 589, stat: Journal Article,

Left ventricular unloading during reperfusion
Grossi EA; Axelrod HI; Baumann FG; Galloway AC; Spencer FC
1990 Oct;82(4):1543-1545, Circulation
— id: 33349, year: 1990, vol: 82, page: 1543, stat: Journal Article,

Experience with selective operative and nonoperative treatment of splenic injuries in 193 patients
Pachter HL; Spencer FC; Hofstetter SR; Liang HG; Hoballah J; Coppa GF
1990 May;211(5):583-589, Annals of surgery
During the past decade splenic salvage procedures rather than splenectomy have been considered the preferred treatment for traumatic splenic injuries. Splenic preservation has been most often accomplished by splenorrhaphy and more recently by a controversial nonoperative approach. This report delineates indications, contraindications, and results with splenectomy, splenorrhaphy, and nonoperative treatment based on an 11-year experience (1978 to 1989) in which 193 consecutive adult patients with splenic injuries were treated. One hundred sixty-seven patients (86.5%) underwent urgent operation. Of these, 111 (66%) were treated by splenorrhaphy or partial splenectomy and 56 (34%) were treated by splenectomy. During the last 4 years, 26 additional patients (13.5%) were managed without operation. Patients considered for nonoperative treatment were alert, hemodynamically stable with computed tomographic evidence of isolated grades I to III splenic injuries. Overall 24% of the injuries resulted from penetrating trauma, whereas 76% of the patients sustained blunt injuries. Complications were rare, with two patients in the splenorrhaphy group experiencing re-bleeding (1.8%) and one patient (4%) failing nonoperative treatment. The mortality rate for the entire group was 4%. This report documents that splenorrhaphy can safely be performed in 65% to 75% of splenic injuries. Splenectomy is indicated for more extensive injuries or when patients are hemodynamically unstable in the presence of life-threatening injuries. Nonoperative therapy can be accomplished safely in a small select group (15% to 20%), with a success rate of nearly 90% if strict criteria for selection are met
— id: 46464, year: 1990, vol: 211, page: 583, stat: Journal Article,

Surgery of the chest
Sabiston, David C.; Spencer, Frank Cole; Gibbon, John Heysham
Philadelphia : Saunders, 1990,
— id: 481, year: 1990, vol: , page: , stat: ,

The vital role in medicine of commitment to the patient
Spencer FC
1990 Nov;75(11):6-19, Bulletin of the American College of Surgeons
— id: 12034, year: 1990, vol: 75, page: 6, stat: Journal Article,

Mediastinitis after cardiac operations
Spencer FC; Grossi EA
1990 Mar;49(3):506-507, Annals of thoracic surgery
— id: 33352, year: 1990, vol: 49, page: 506, stat: Journal Article,

The harmful effects of the "bad doctor" myth
Spencer, F C; Halley, M M
1990 Jun;75(6):6-12, Bulletin of the American College of Surgeons
— id: 107057, year: 1990, vol: 75, page: 6, stat: Journal Article,

A comparison of mitral valve reconstruction with mitral valve replacement: intermediate-term results
Galloway AC; Colvin SB; Baumann FG; Grossi EA; Ribakove GH; Harty S; Spencer FC
1989 May;47(5):655-662, Annals of thoracic surgery
The continued good results after mitral valve reconstruction prompted this retrospective study to compare operative and late results from our institutional experience since 1976 with 975 porcine mitral valve replacements (MVRs) (1976 to December 1987), 169 mechanical MVRs (1976 to December 1987), and 280 Carpentier-type mitral valve reconstructions (CVRs) (1980 to mid-1988). The operative mortality was 2.0% for isolated CVR, 6.6% for isolated mechanical MVR, and 8.5% for isolated porcine MVR. The overall operative mortality was 5.0% for CVR, 16.6% for mechanical MVR, and 10.6% for porcine MVR. The overall 5-year survival including hospital deaths was 76% for CVR, 72% for mechanical MVR, and 69% for porcine MVR. By multivariate analysis, the predictors of increased operative risk and of decreased survival were age, New York Heart Association functional class IV status, previous cardiac operation, and performance of concomitant cardiac surgical procedures. The type of valvular procedure was not predictive of operative risk or overall survival. The 5-year freedom from reoperation was 94.4% for nonrheumatic patients having CVR, 77.4% for rheumatic patients having CVR, 96.4% for mechanical MVR, and 96.6% for porcine MVR (p less than 0.05, rheumatic patients with CVR versus both MVR groups). The 5-year freedom from all valve-related morbidity and mortality was significantly better for valve reconstruction compared with both types of valve replacement. Thus, the operative risk and late survival obtained after mitral valve reconstruction were at least equivalent to those obtained after MVR. In addition, patients receiving mitral valve reconstruction had less valve-related combined morbidity than patients receiving valve replacement, thus making mitral valve reconstruction preferable in some patients with mitral insufficiency
— id: 10632, year: 1989, vol: 47, page: 655, stat: Journal Article,

Ten-year operative experience with 165 aneurysms of the ascending aorta and aortic arch
Galloway AC; Colvin SB; LaMendola CL; Hurwitz JB; Baumann FG; Harris LJ; Culliford AT; Grossi EA; Spencer FC
1989 Sep;80(3 Pt 1):I249-I256, Circulation
Results of surgery in 165 patients with aneurysms of the ascending aorta and aortic arch during 1978-1988 were analyzed retrospectively. Etiology included 29% dissection, 22% atherosclerosis, 22% cystic-medial necrosis, and 27% other causes. Concomitant procedures on the aortic valve were performed in 65% of patients (valvular replacement in 37%, valve-conduit in 23%, and valvular resuspension in 5%), and 13% underwent concomitant coronary artery bypass surgery. Major changes in our operative technique for such aneurysms have been introduced during the last 5 years, especially use of a continuous suture-graft-inclusion technique in 99% of patients, use of circulatory arrest in 59%, and use of an open hemiarch repair in 32%. Hospital mortality dropped from 17.9% during the first 5 years of the study period to 12.3% in the last 5 years despite increasing complexity of the cases encountered. Operative mortality was 7.6% for ascending aortic aneurysmal repair; 5.3% for valve-conduit procedure; 8.8% for open hemiarch repair; and 30.8% for repair of extensive aneurysms involving the aortic arch and significant portions of the descending aorta. Multivariate analysis showed that, of the variables examined, significant predictors of increased operative risk were age (p less than 0.05) and extension of an ascending aortic aneurysm to the descending aorta or involvement of the aortic arch (p less than 0.001). The incidence of stroke was 2.4%, with only one stroke since 1983 despite more extensive use of circulatory arrest since that time. Follow-up was 94% complete, with a mean (+/- SD) follow-up interval of 28 +/- 24 months.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 10510, year: 1989, vol: 80, page: I249, stat: Journal Article,

Experience with the Grillo pleural wrap procedure in 18 patients with perforation of the thoracic esophagus [see comments]
Gouge TH; Depan HJ; Spencer FC
1989 May;209(5):612-617, Annals of surgery
Perforation of the thoracic esophagus may be fatal unless diagnosed promptly and treated with an effective operation. The wide mortality range in different reports reflects the importance of these two factors. This range spans from as low as 11%, if operation is within 24 hours, to greater than 50% after two to three days. The high mortality with delayed treatment is principally due to inability to surgically close the perforation. Eighteen patients (aged from 31 to 78 years) were treated four hours to 14 days after thoracic esophageal perforation (less than 24 hours: 7 patients; 24 to 72 hours: 7 patients; greater than 72 hours: 4 patients). In 14 patients the perforation was sutured, after which the suture line was buttressed with a circumferential wrap of parietal pleura, originally described by Grillo. Underlying esophageal pathology was corrected and wide mediastinal drainage was instituted. All 14 patients recovered and were discharged from the hospital after a median stay of 20 days. Two patients had minor leaks at the suture line that soon closed. Four patients had perforations too extensive to close. Of these, one was resected, the Urschel procedure was used in two, and the Abbott T-tube drainage was used in one. Three of the four patients died. It was quite significant that the pleural wrap was equally effective with both early (6 patients) and delayed perforations (8 patients). These data indicate that the pleural wrap should be used routinely. Extensive perforations that cannot be closed should probably be treated by resection and drainage, followed by esophageal reconstruction at a later time
— id: 10642, year: 1989, vol: 209, page: 612, stat: Journal Article,

Preservation of spinal cord function and prevention of paralysis during aortic occlusion via veno-arterial bypass
Grossi EA; Krieger KH; Cunningham JN Jr; Trehan NK; Culliford AT; Baumann FG; Spencer FC
1989 Jan-Feb;30(1):95-98, Journal of cardiovascular surgery
Paraplegia secondary to spinal cord ischemia is a too frequent devastating complication of thoracic aneurysm surgery. We examined the ability of veno-arterial bypass (VAB) to ensure adequate spinal cord blood flow during aortic cross-clamping by monitoring spinal cord function via somatosensory evoked potentials (SEP's) and postoperative motor function. Dogs were placed on VAB using a heparin-bonded roller pump circuit without systemic heparinization. SEP latency and amplitude were monitored continuously. The respirator FIO2 was set at 100% while the aorta was cross-clamped for one hour with the bypass adjusted to keep distal arterial pressure at greater than 60 mmHg. After one hour the aorta was unclamped, bypass discontinued, and the animals recovered. SEP's were always present during VAB as long as the distal pressure was kept at greater than 60 mmHg. There were several transient hypotensive episodes (less than 5 min) which were accompanied by reversible loss of SEP's. None of the animals displayed any gait abnormalities post-op. These findings using this simple bypass technique suggest the following conclusions: (1) SEP's degenerate (increased latency and decreased amplitude) in response to hypoxia; (2) spinal cord function can be maintained for up to one hour during hypoxic conditions; (3) SEP's can be used to monitor sensory spinal cord function under these conditions; and (4) heparinless VAB can provide spinal cord protection while also allowing monitoring of SEP's to ensure adequate spinal cord perfusion
— id: 10745, year: 1989, vol: 30, page: 95, stat: Journal Article,

Technique and results with a roller pump left and right heart assist device
Rose DM; Connolly M; Cunningham JN Jr; Spencer FC
1989 Jan;47(1):124-129, Annals of thoracic surgery
During the last 10 years we have inserted a roller pump-driven left heart assist device in 72 patients and a right heart assist device in 7 patients for profound heart failure after a variety of cardiac surgical procedures. In addition a percutaneous left heart assist device (transseptal insertion of left atrial cannula via a femoral vein) was employed in 5 patients with profound cardiogenic shock after acute myocardial infarction. Thirty patients (41.7%) were weaned from the left heart assist device and 21 (29.2%) were discharged from the hospital. Two patients (40.0%) were weaned from the right heart assist device, but both later died during the postoperative period. Of the 5 patients in whom a percutaneous left heart assist device was inserted, 4 underwent successful emergency percutaneous transluminal coronary angioplasty, but all 5 patients died. Causes of death included severe coagulopathy, irreversible extensive myocardial infarction and cardiac failure, refractory arrhythmias, severe 'shock' lung, and multisystem failure. In summary, satisfactory results can be achieved with a roller pump-driven left and right heart assist device for severe postoperative heart failure. Further experience should be obtained with the percutaneous technique to assess its efficacy in treating patients with acute myocardial infarction and cardiogenic shock
— id: 10752, year: 1989, vol: 47, page: 124, stat: Journal Article,

Principles of surgery
Schwartz, Seymour I.; Shires, G. Tom; Spencer, Frank Cole; Husser, Wendy Cowles
New York : McGraw-Hill, c1989,
— id: 71, year: 1989, vol: , page: , stat: ,

Acquired heart disease
Spencer F; Culliford A
Principles of surgery New York : McGraw-Hill, 1989,
— id: 3810, year: 1989, vol: , page: 843, stat: Chapter,

A critique of emergency and urgent operations for complications of coronary artery disease
Spencer, F C
1989 Jun;79(6 Pt 2):I160-I162, Circulation
— id: 107058, year: 1989, vol: 79, page: I160, stat: Journal Article,

Basic considerations concerning regulation of house staff working hours
Spencer, F C
1989 Jun;74(6):8-12, Bulletin of the American College of Surgeons
— id: 107059, year: 1989, vol: 74, page: 8, stat: Journal Article,

INTRATHORACIC MUSCLE FLAPS - A 10-YEAR EXPERIENCE IN THE MANAGEMENT OF LIFE-THREATENING INFECTIONS - DISCUSSION
Spencer, FC
1989 Jul;84(1):99-99, Plastic & reconstructive surgery
— id: 31687, year: 1989, vol: 84, page: 99, stat: Journal Article,

Percutaneous cardiopulmonary bypass limits myocardial injury from ischemic fibrillation and reperfusion
Axelrod HI; Murphy MS; Galloway AC; Baumann FG; Laschinger JC; Colvin SB; Spencer FC
1988 Nov;78(5 Pt 2):III148-III152, Circulation
Percutaneous implementation of cardiopulmonary bypass (PCPB) with a synchronous pulsatile pump has been shown to be an efficient means of unloading the heart. Therefore, this technique may provide a practical and effective method for treating patients undergoing a major cardiac catastrophe who are unresponsive to the usual resuscitative efforts. We tested whether PCPB could effectively unload the heart and provide myocardial salvage during left anterior descending (LAD) coronary artery occlusion complicated by ventricular fibrillation in the canine model (n = 13). All 13 dogs fibrillated within 20 minutes of LAD occlusion, and none could be successfully resuscitated by manual cardiac compression, sodium bicarbonate administration, antiarrhythmic agent administration, and electrical defibrillation. All 13 dogs were then placed on PCPB by way of the right jugular vein and right femoral artery; in seven, we used a synchronous pulsatile pump and in six a standard roller pump. No vent was placed in the left ventricle. All animals returned to normal sinus rhythm within 20 minutes of institution of PCPB. The LAD snare was released after 2 hours, and all animals were maintained on PCPB during 3 hours of reperfusion. At sacrifice, the area of infarction was determined by staining with triphenyltetrazolium chloride and was expressed as a percentage of the left ventricular area-at-risk for infarction. The tension time index was also measured and expressed as percent change from baseline. The left ventricular area-at-risk for infarction was similar in both groups (31.5% for roller pump vs. 29.2% for pulsatile pump; p greater than 0.05), but the area of infarction as a percentage of the area at risk was significantly smaller in the pulsatile-pump group (22.0%) than in the roller-pump group (35.4%; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 10905, year: 1988, vol: 78, page: III148, stat: Journal Article,

Surgical treatment for aneurysm of aberrant subclavian artery based on a case report and a review of the literature [see comments]
Esposito RA; Khalil I; Galloway AC; Spencer FC
1988 May;95(5):888-891, Journal of thoracic & cardiovascular surgery
Experiences with the recent successful treatment of a patient with an aneurysm arising from an aberrant subclavian artery are described. The reported experiences with surgical treatment by others were reviewed in detail: Only 16 such patients were found, with a surprising frequency of serious complications. These data led to the conclusion that a two-stage approach, through right cervical and left thoracotomy incisions, seems to offer the ideal method of treatment for this unusual problem
— id: 11113, year: 1988, vol: 95, page: 888, stat: Journal Article,

Long-term results of mitral valve reconstruction with Carpentier techniques in 148 patients with mitral insufficiency
Galloway AC; Colvin SB; Baumann FG; Esposito R; Vohra R; Harty S; Freeberg R; Kronzon I; Spencer FC
1988 Sep;78(3 Pt 2):I97-105, Circulation
There have been few relatively complete follow-up studies of long-term mitral valve function after Carpentier-type surgical reconstruction. Between January 1980 and May 1986, 148 patients underwent Carpentier reconstruction for mitral valve disease (43% degenerative and 30% rheumatic). Operative mortality was 5.4% overall (1.2% for isolated mitral reconstruction), and follow-up (mean, 26 months) was completed for all survivors. Five-year survival from late cardiac death was 90.0%, as was 5-year freedom from postreconstruction mitral valve replacement. Postreconstruction mitral replacement was needed in eight patients, in only five for failure of repair. Follow-up echocardiographic studies on 83.2% (104 of 125) of eligible patients showed 92.3% were free of significant (3+ or 4+) mitral regurgitation. Freedom from mitral valve replacement or recurrent severe (4+) insufficiency was 84.4% at 5 years overall, but was lower for the rheumatic type of mitral disease than for the degenerative type (71.6% vs. 88.3%). At 5 years, 95.2% of patients were free from thromboembolism without the necessity for long-term warfarin (Coumadin) therapy. At follow-up, 95.3% of survivors had improved to New York Heart Association Class I or II. The functional durability of mitral reconstruction and consistently high level of freedom from late endocarditis and thromboembolic and anticoagulant complications support the value of the Carpentier method of mitral reconstruction for mitral insufficiency, especially insufficiency due to degenerative disease
— id: 10965, year: 1988, vol: 78, page: I97, stat: Journal Article,

Current concepts of mitral valve reconstruction for mitral insufficiency
Galloway AC; Colvin SB; Baumann FG; Harty S; Spencer FC
1988 Nov;78(5 Pt 1):1087-1098, Circulation
In recent years, there has been a renewed interest in surgical reconstruction of the insufficient mitral valve because of reconfirmation of the limitations of existing prosthetic and bioprosthetic valves. A follow-up study, including late functional data, of 148 patients who underwent mitral valve reconstruction at our institution was combined with a review of the literature to assess the current status of mitral reconstruction. The results indicate that mitral reconstruction by Carpentier techniques is widely applicable, durable, and relatively free of complication. Freedom from late thromboembolic and anticoagulant complications is particularly notable. These factors could prove to justify earlier operative intervention in patients with mitral insufficiency before permanent myocardial damage evolves. As mitral valve reconstruction techniques become more familiar and widely used, mitral reconstruction may become the operative procedure of choice for mitral insufficiency, especially insufficiency due to degenerative disease
— id: 10918, year: 1988, vol: 78, page: 1087, stat: Journal Article,

Results in closed mitral valvotomy
Spencer, F C
1988 Apr;45(4):355-355, Annals of thoracic surgery
— id: 107061, year: 1988, vol: 45, page: 355, stat: Journal Article,

The expert witness: one surgeon's opinion
Spencer, F C
1988 May;73(5):11-4, 43, Bulletin of the American College of Surgeons
— id: 107060, year: 1988, vol: 73, page: 11, stat: Journal Article,

PROFESSIONAL LIABILITY REFORM - REPLY
Spencer, FC
1988 Jul;46(1):119-119, Annals of thoracic surgery
— id: 31470, year: 1988, vol: 46, page: 119, stat: Journal Article,

RESULTS IN CLOSED MITRAL VALVOTOMY
Spencer, FC
1988 Apr;45(4):355-355, Annals of thoracic surgery
— id: 31526, year: 1988, vol: 45, page: 355, stat: Journal Article,

Percutaneous cardiopulmonary bypass with a synchronous pulsatile pump combines effective unloading with ease of application
Axelrod HI; Galloway AC; Murphy MS; Laschinger JC; Baumann FG; Grossi EA; Glassman E; Spencer FC
1987 Mar;93(3):358-365, Journal of thoracic & cardiovascular surgery
Percutaneous total cardiopulmonary bypass offers the advantage of rapid, simple implementation without the need for thoracic incision and provides the ability to support both left and right ventricular failure as well as pulmonary insufficiency. Previous studies using roller pump percutaneous bypass were only partially successful because of the inability to effectively unload the left ventricle. In the present experiment we attempted to determine in a normal canine model whether use of synchronous pulsatile pumping for percutaneous bypass could overcome this problem. Fourteen dogs were placed on percutaneous bypass for 1 hour. A roller pump was used in seven and a synchronous pulsatile pump with an electrocardiogram triggering mechanism in the other seven. All animals were maintained on percutaneous bypass for 1 hour. In the pulsatile pump group there was a significantly greater percent decrease from baseline in tension-time index (-56.3% versus -19.1%, p less than 0.01) and in myocardial oxygen consumption (-45.8% versus +2.1%, p less than 0.05) and a significantly greater percent increase in the endocardial/epicardial blood flow ratio (27.6% versus -6.5%, p less than 0.01) than in the roller pump group. These results show that superior unloading can be achieved by percutaneous pulsatile bypass compared with percutaneous roller pump bypass. The findings suggest that percutaneous total cardiopulmonary bypass with a synchronous pulsatile pump offers a relatively simple but effective method for providing appropriate patients with temporary hemodynamic stability before cardiac catheterization or medical or surgical revascularization
— id: 33353, year: 1987, vol: 93, page: 358, stat: Journal Article,

A comparison of methods for limiting myocardial infarct expansion during acute reperfusion--primary role of unloading
Axelrod HI; Galloway AC; Murphy MS; Laschinger JC; Grossi EA; Baumann FG; Colvin SB; Hunter CE; Glassman E; Spencer FC
1987 Nov;76(5 Pt 2):V28-V32, Circulation
Current use of angioplasty, thrombolysis, and surgical techniques for prompt reperfusion of an acute myocardial infarction raises questions concerning the optimum reperfusion technique for maximum myocardial salvage. Alterations in the conditions of reperfusion and/or the composition of the initial reperfusate can exert a significant effect on the extent of myocardial salvage. In an effort to define an optimum reperfusion technique, we used 40 dogs in a series of experiments in which the left anterior descending coronary artery (LAD) was snared for 2 hr followed by reperfusion by one of five methods for 4 hr. In addition, in a control group(group I, n = 6) the LAD was occluded for 6 hr without any reperfusion. In group 2 (n = 12), simulating medical reperfusion, reperfusion was achieved by simply releasing the snare for 4 hr. Group 3 dogs (n = 6) were placed on pulsatile left atrial-femoral bypass throughout 4 hr of reperfusion. Group 4 dogs (n = 9) were placed on percutaneous, synchronized pulsatile cardiopulmonary bypass during reperfusion. The procedure in group 5 (n = 7) dogs simulated coronary artery bypass grafting with cardiopulmonary bypass and cold blood, low-Ca++ cardioplegia during reperfusion. Group 6 (n = 6) was treated similarly except that during reperfusion amino acid-enriched cardioplegia was administered by warm induction techniques. At the end of 4 hr of reperfusion, the left ventricular area of infarction was determined by triphenyltetrazolium chloride staining and expressed as a percentage of the left ventricular area at risk for infarction (area of infarction [AI]/area at risk [AR]).(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 11327, year: 1987, vol: 76, page: V28, stat: Journal Article,

PERCUTANEOUS CARDIOPULMONARY BYPASS LIMITS MYOCARDIAL FIBRILLATION INJURY
Axelrod, HI; Murphy, MS; Galloway, AC; Baumann, FG; Laschinger, JC; Colvin, SB; Spencer, FC
1987 Oct;76(4):164-164, Circulation
— id: 31115, year: 1987, vol: 76, page: 164, stat: Journal Article,

Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. IV. Clinical observations and results
Cunningham, J N Jr; Laschinger, J C; Spencer, F C
1987 Aug;94(2):275-285, Journal of thoracic & cardiovascular surgery
Thirty-three patients undergoing operations on the descending thoracic or thoracoabdominal aorta were monitored to evaluate causes and effects of spinal cord ischemia as manifested by changes in somatosensory evoked potentials. Maintenance of distal aortic perfusion pressure (greater than 60 mm Hg) by either shunt or bypass techniques in 17 patients resulted in preservation of somatosensory evoked potentials and a normal postoperative neurologic status, irrespective of the interval of thoracic cross-clamping (range 23 to 105 minutes). In 16 other patients in whom cross-clamp time ranged from 16 to 124 minutes, evoked potential loss was observed because of failure to provide distal perfusion (n = 8), inadequate maintenance of distal perfusion pressure (less than 60 mm Hg) despite shunt/bypass (n = 6), or interruption of critical intercostal arteries (n = 2). Incidence of paraplegia in the entire group was 15.1% (5/33) and was limited to only those patients in whom evoked potential loss occurred (5/16, 31.2%) (p = 0.02). Loss of somatosensory evoked potentials for more than 30 minutes resulted in a 71.2% (5/7) incidence of paraplegia, whereas no neurologic deficit was noted in patients (0/26) in whom evoked potential loss was either prevented or limited in duration to 30 minutes (p less than 0.001 versus loss for more than 30 minutes). Intraoperative monitoring of somatosensory evoked potentials is a sensitive indicator of spinal cord ischemia. Simple aortic cross-clamping, failure to maintain distal perfusion pressure above 60 mm Hg, and inability to reimplant critical intercostals in a timely fashion result in a high rate of paraplegia if duration of spinal cord ischemia as measured by somatosensory evoked potentials exceeds 30 minutes. Routine evoked potential monitoring during thoracoabdominal procedures appears useful in assessing the adequacy of spinal cord perfusion. Furthermore, it can alert the surgeon to the necessity for critical intercostal artery reimplantation as well as the need for adjustment or regulation of distal aortic perfusion
— id: 107062, year: 1987, vol: 94, page: 275, stat: Journal Article,

The effect of pericardial insulation on hypothermic phrenic nerve injury during open-heart surgery
Esposito, R A; Spencer, F C
1987 Mar;43(3):303-308, Annals of thoracic surgery
Phrenic nerve injury was evaluated prospectively in 133 patients undergoing open-heart surgery using iced saline slush for topical hypothermia. In the control group of 70 patients no attempt was made to shield the phrenic nerves from direct exposure to ice. Phrenic nerve damage occurred in 73% of these patients, as assessed by persistent diaphragm paralysis evident on inspiratory chest roentgenogram. In 2 patients the paralysis was bilateral. In the second group of 63 patients a pericardial insulation pad was used to prevent contact of the iced slush to the phrenic nerve. Diaphragm paralysis was observed in 17% of these patients. This difference was highly significant (p less than .001). Diaphragm paralysis in the control group was clinically significant; life-threatening respiratory complications developed in 7 patients (14%), frequently resulting in multiple reintubations, tracheostomy, and prolonged mechanical ventilation. In addition, 4 patients with phrenic nerve injury exhibited a clinical syndrome consistent with gastric ileus, which may possibly represent hypothermic injury to the thoracic vagi. The likelihood of phrenic nerve injury when iced saline slush is used for topical myocardial cooling and the possibility of developing serious respiratory disability would support the routine use of pericardial insulation when this method of hypothermia is used
— id: 107063, year: 1987, vol: 43, page: 303, stat: Journal Article,

LATE RESULTS OF CARPENTIER TECHNIQUE FOR MITRAL-VALVE RECONSTRUCTION IN 148 PATIENTS WITH MITRAL-INSUFFICIENCY
Galloway, AC; Colvin, SB; Baumann, FG; Esposito, R; Vohra, R; Harty, S; Freedberg, R; Kronzon, I; Spencer, FC
1987 Oct;76(4):445-445, Circulation
— id: 31117, year: 1987, vol: 76, page: 445, stat: Journal Article,

Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. III. Intraoperative identification of vessels critical to spinal cord blood supply
Laschinger, J C; Cunningham, J N Jr; Baumann, F G; Cooper, M M; Krieger, K H; Spencer, F C
1987 Aug;94(2):271-274, Journal of thoracic & cardiovascular surgery
Somatosensory evoked potentials were used to locate intercostal arteries critical to spinal cord blood flow in nine dogs. To mimic a clinical situation, the proximal descending thoracic aorta (left subclavian artery to T7) was excluded with cross-clamps, and partial pulsatile left atrial-femoral artery bypass was instituted to maintain distal aortic pressure at 100 mm Hg. Progressively lower aortic segments were excluded (T7-10, T10-L1, L1-3, L3-6, L6-7) until loss of somatosensory evolved potentials occurred. Spinal cord blood flow measurements at the time of evoked potential loss revealed significant ischemia (p less than 0.02 versus baseline) in the excluded segment in seven animals but normal spinal cord blood flow in the remainder of the cord. Upon reperfusion, significant reactive hyperemia (p less than 0.02) was noted only in previously ischemic cord segments. Two animals exhibited no change in somatosensory evoked potentials or spinal cord blood flow despite exclusion of the entire thoracoabdominal aorta, presumably as a result of spinal collaterals. Loss of somatosensory evoked potentials despite adequate distal perfusion indicates that critical intercostal vessels have been excluded from systemic and bypass circulations. Use of evoked potential measurements in both experimental and clinical situations provides a means for assessing adequacy of spinal cord blood flow during cross-clamping and can alert the surgeon to the need for reimplantation of critical intercostal arteries during surgical resection of the thoracoabdominal aorta
— id: 106529, year: 1987, vol: 94, page: 271, stat: Journal Article,

Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. II. Use of somatosensory evoked potentials to assess adequacy of distal aortic bypass and perfusion after thoracic aortic cross-clamping
Laschinger, J C; Cunningham, J N Jr; Baumann, F G; Isom, O W; Spencer, F C
1987 Aug;94(2):266-270, Journal of thoracic & cardiovascular surgery
Pulsatile left atrial-femoral artery bypass was instituted after aortic cross-clamping distal to the left subclavian artery in a canine experimental model to determine the relationship of distal aortic perfusion pressure with spinal cord blood flow and somatosensory evoked potentials. In six animals (Group I) distal aortic perfusion pressure was maintained at 100 mm Hg throughout a 1 hour interval of aortic cross-clamping. During this period, somatosensory evoked potentials and spinal cord blood flow (radioactive microspheres) showed no significant change from baseline. In six other dogs (Group II) distal aortic perfusion pressure was initially maintained at 100 mm Hg after aortic cross-clamping and then progressively decreased to 70, 40, and 25 mm Hg. Somatosensory evoked potentials and spinal cord blood flow were preserved at baseline levels for all distal perfusion pressures greater than 70 mm Hg. At 40 mm Hg, abnormalities in amplitude of the somatosensory evoked potentials were noted in all animals with progression to complete loss of evoked potential activity at lower perfusion pressures. Maintenance of adequate somatosensory spinal cord conduction after thoracic aortic cross-clamping is dependent on a critical level of distal aortic perfusion that can be accomplished by use of an adjunct such as pulsatile left atrial-femoral artery bypass. The critical level of distal aortic perfusion pressure to maintain normal somatosensory evoked potentials and spinal cord blood flow in this canine experimental study was 70 mm Hg or greater. Because inadequate distal aortic perfusion can be easily detected by monitoring of somatosensory evoked potentials, these techniques should prove helpful in evaluating the effectiveness of distal perfusion techniques during clinical aortic cross-clamping for procedures on the thoracoabdominal aorta
— id: 106530, year: 1987, vol: 94, page: 266, stat: Journal Article,

Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. I. Relationship of aortic cross-clamp duration, changes in somatosensory evoked potentials, and incidence of neurologic dysfunction
Laschinger, J C; Cunningham, J N Jr; Cooper, M M; Baumann, F G; Spencer, F C
1987 Aug;94(2):260-265, Journal of thoracic & cardiovascular surgery
To determine if intraoperative monitoring of somatosensory evoked potentials detects spinal cord ischemia, we subjected 21 dogs to aortic cross-clamping distal to the left subclavian artery. Group I animals (short-term studies, n = 6) demonstrated decay and loss of somatosensory evoked potentials at 8.5 +/- 1.1 minutes after aortic cross-clamping. During loss of somatosensory evoked potentials, significant decreases in spinal cord blood flow occurred in cord segments below T6. Significant reactive hyperemia occurred without normalization of somatosensory evoked potentials after reperfusion. Fifteen Group II animals (long-term studies) were studied to determine the relationship between duration of spinal cord ischemia (evoked potential loss) and subsequent incidence of paraplegia. Extension of aortic cross-clamping for 5 minutes after loss of somatosensory evoked potentials in six dogs resulted in no paraplegia (mean cross-clamp time 12.7 +/- 0.6 minutes). Prolongation of aortic cross-clamping for 10 minutes after evoked potential loss in nine dogs (mean cross-clamp time 17.6 +/- 0.6 minutes) resulted in a 67% (6/9) incidence of paraplegia 7 days postoperatively (p = 0.02 versus 10 minutes of aortic cross-clamping). These findings demonstrate that simple aortic cross-clamping uniformly results in spinal cord ischemia and that such ischemia is detectable by monitoring of somatosensory evoked potentials. Duration of ischemia, as measured by the time of evoked potential loss during the cross-clamp interval, is related to the incidence of postoperative neurologic injury
— id: 106531, year: 1987, vol: 94, page: 260, stat: Journal Article,

The urgent need for major reform of the professional liability system
Spencer FC
1987 Oct;44(4):335-337, Annals of thoracic surgery
— id: 11349, year: 1987, vol: 44, page: 335, stat: Journal Article,

Improved results from a standardized approach in treating patients with necrotizing fasciitis
Sudarsky LA; Laschinger JC; Coppa GF; Spencer FC
1987 Nov;206(5):661-665, Annals of surgery
Necrotizing fasciitis has been associated with significant morbidity and mortality. Thirty-three patients were studied over a 3-year period. Predisposing factors included intravenous drug abuse (30%), diabetes (21%), and obesity (18%). Severe pain (94%) and abnormal temperature (88%) were present, whereas laboratory data and x-ray were nonspecific. Gram-positive organisms were most frequently recovered (B-hemolytic streptococcus 45%). Treatment consisted of antibiotics, surgical debridement, re-exploration 24 hours before surgery, nutritional support, and early soft tissue coverage as needed. Mean duration from admission to operation was 43 hours. The average number of operative debridements was three and the average length of hospitalization was 47 days. Patients operated on less than 12 hours from admission or greater than 48 hours had shorter hospital stays (36 and 38 days). The critical time period was 12-48 hours after admission; all deaths and amputations were in this group and the average hospital stay was 62 days (p less than 0.05). The number of operations did not correlate to hospital stay. Despite antibiotics and aggressive debridement, significant morbidity exists if operation is delayed more than 12 hours. Methods of early detection such as local bedside diagnostic incision and fascial inspection may be needed in high risk patients to further reduce the morbidity and mortality
— id: 11332, year: 1987, vol: 206, page: 661, stat: Journal Article,

"EXPERIMENTAL COMPARISON OF SURGICAL MEDICAL, AND ASSISTED REPERFUSION OF ACUTE MI"
AXELROD, HI; GALLOWAY, AC; MURPHY, MS; LASCHINGER, JC; GLASSMAN, E; BAUMANN, FG; SPENCER, FC
1986 OCT ;74(4):134-134, Circulation
— id: 41339, year: 1986, vol: 74, page: 134, stat: Journal Article,

The atherosclerotic ascending aorta and transverse arch: a new technique to prevent cerebral injury during bypass: experience with 13 patients
Culliford AT; Colvin SB; Rohrer K; Baumann FG; Spencer FC
1986 Jan;41(1):27-35, Annals of thoracic surgery
Calcification of the ascending aorta and transverse arch significantly increases morbidity and may compromise the completeness of cardiac surgical procedures. Several stratagems have been suggested to reduce the risk, but for some patients this finding is still associated with a devastating outcome, irrespective of the technique employed. Thirteen patients (7 men and 6 women with a mean age of 66 years) with extensive calcification in the ascending aorta and transverse arch underwent cardiopulmonary bypass (CPB). The presence of calcification was known prior to CPB in 12 patients and noted after cross-clamping of the aorta in 1 patient. Special techniques for cannulation of the ascending aorta or arch were undertaken in 12 patients; 1 patient required groin cannulation. In 12 patients CPB with gradual core cooling to 18 degrees C was done, during which time no manipulation of the aorta was allowed. Circulatory arrest was then initiated for 3.5 to 12 minutes. The aorta was opened widely during this time to remove ulcerated plaques and friable debris, and to locate a safe place for aortic occlusion. All patients recovered without neurological complications. In 1 patient, in whom occipital lobe infarcts developed, calcification was discovered after the aorta had been cross-clamped and necessitated subsequent endarterectomy of the ascending aorta and transverse arch.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 28927, year: 1986, vol: 41, page: 27, stat: Journal Article,

The value of computed tomography in postoperative pneumothorax following open-heart surgery
Esposito, R A; Boyd, A; Spencer, F C
1986 Dec;42(6):699-701, Annals of thoracic surgery
Two patients with postoperative pneumothorax following open-heart surgery are described. The diagnostic usefulness of computed tomography and chest roentgenogram in this complication is discussed
— id: 107040, year: 1986, vol: 42, page: 699, stat: Journal Article,

Long-term follow-up after mitral valve reconstruction: incidence of postoperative left ventricular outflow obstruction
Galler, M; Kronzon, I; Slater, J; Lighty, G W Jr; Politzer, F; Colvin, S; Spencer, F
1986 Sep;74(3 Pt 2):I99-103, Circulation
Reconstructive surgery of the mitral valve has been an alternative to mitral valve replacement in patients with mitral regurgitation. Previously, we reported on postoperative left ventricular outflow tract obstruction associated with systolic anterior motion of the anterior mitral leaflet. The current study was designed to evaluate the incidence of this complication and the long-term results of mitral valve reconstructive surgery. Sixty-five patients, aged 19 to 78 years, had mitral valve reconstructive surgery. Two patients died perioperatively, and three died late after surgery. The 60 surviving patients were studied by M mode, two-dimensional, and Doppler echocardiography 1 to 55 months postoperatively (mean 21). Fifty patients had no evidence of postoperative mitral regurgitation, two patients had moderate mitral regurgitation, three patients had mild mitral regurgitation, and five patients had trace mitral regurgitation. No significant mitral stenosis was detected in any patient postoperatively. After surgery, the diameter of the left ventricular outflow tract was significantly smaller than that before surgery. The echocardiograms of six patients showed abnormal systolic anterior motion of the anterior mitral leaflet that was not observed preoperatively. Doppler echocardiography demonstrated pressure gradients across the left ventricular outflow tract between 10 and 64 mm Hg. Inhalation of amyl nitrite increased these gradients. An additional patient who had systolic anterior motion but no gradient developed a 36 mm Hg gradient after inhalation of amyl nitrite. The remaining patients had no gradient induced by amyl nitrite. Abnormal systolic anterior motion of the anterior mitral leaflet may be surgically induced by changes in left ventricular geometry and the size of the left ventricular outflow tract during systole.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 100115, year: 1986, vol: 74, page: I99, stat: Journal Article,

Time course of effective interventional left heart assist for limitation of evolving myocardial infarction
Grossi EA; Krieger KH; Cunningham JN Jr; Laschinger JC; Weiss MR; Nathan IM; Hunter CE; Spencer FC
1986 Apr;91(4):624-629, Journal of thoracic & cardiovascular surgery
Previous work has shown that if pulsatile left atrial-femoral artery bypass is instituted after occlusion of the left anterior descending coronary artery for from 15 minutes to 2 hours, it can significantly limit the size of the infarct resulting 4 hours later. This study investigated whether pulsatile left atrial-femoral artery bypass begun after more clinically pertinent periods of initial ischemia can still significantly limit infarct expansion. After baseline measurements of hemodynamics, tension-time index, and regional myocardial blood flow in 73 open-chest, adult dogs, the left anterior descending coronary artery was ligated for 15 minutes or 1, 2, 4, or 6 hours of unprotected ischemia. In the five control groups, the initial ischemic period was merely extended for another 4 hours. In the five experimental groups, the animals were placed on pulsatile left atrial-femoral artery bypass for another 4 hours after the initial ischemic period. At the end of each procedure, gentian violet was used to identify the area at risk of infarction, and triphenyltetrazolium chloride was used to delineate the area of infarct. The results showed a significant reduction in the area of infarct as a percentage of the area at risk in each bypass group compared with its control group for all ischemic periods of less than 6 hours. These findings suggest that the maximum permissible ischemic time delay for myocardial salvage by pulsatile left atrial-femoral artery bypass is one which is pertinent in a clinical setting. The results justify continued attempts to develop appropriate techniques for percutaneous application of this modality to patients with an evolving myocardial infarction
— id: 33355, year: 1986, vol: 91, page: 624, stat: Journal Article,

The management of juxtahepatic venous injuries without an atriocaval shunt: preliminary clinical observations
Pachter HL; Spencer FC; Hofstetter SR; Liang HC; Coppa GF
1986 May;99(5):569-575, Surgery
Juxtahepatic venous injuries are usually fatal. The optimal method of dealing with these injuries remains controversial, but most experience has been with the insertion of an atriocaval shunt. However, the mortality rate with atriocaval shunting remains prohibitively high (60% to 100%). The experience at the Bellevue Hospital Trauma and Shock Unit during a 9-year period revealed a 50% mortality rate in four consecutive patients who underwent atriocaval shunting. As such, a different approach was used in the following five patients, all of whom survived. One additional patient died in the operating room before any definitive repair could be undertaken. Four steps are considered essential to the successful management of these patients: (1) compression of the injury site until adequate resuscitation has been achieved; (2) early recognition that a juxtahepatic venous injury exists, as indicated by failure of the Pringle maneuver to adequately arrest hemorrhage; (3) prolonged portal triad occlusion with hepatocyte protection by means of large doses of steroids and topical hypothermia (portal triad occlusion time in the nonshunted group ranged from 20 to 64 minutes with a mean occlusion time of 46 minutes; although a transient rise in liver function test results seemed to correlate with the length of ischemia time, neither hepatic dysfunction nor hepatic necrosis occurred; and (4) extensive finger fracture of the liver to the site of vascular injury for primary repair or ligation; the extent of the finger fracture varied from 15 to 30 cm in length and from 5 to 15 cm in depth. The successful results achieved in five consecutive patients who sustained juxtahepatic venous injuries treated without a shunt serve as a basis for recommending this operative approach
— id: 59995, year: 1986, vol: 99, page: 569, stat: Journal Article,

Patologia quirurgica = [Principles of surgery]
Schwartz, Seymour I; Shires, G. Tom; Spencer, Frank C; Storer, Edward H
Mexico : La Prensa Medica Mexicana, 1986,
— id: 985, year: 1986, vol: , page: , stat: ,

Experiences with 1643 porcine prosthetic valves in 1492 patients
Spencer FC; Baumann FG; Grossi EA; Culliford AT; Galloway AC
1986 Jun;203(6):691-700, Annals of surgery
Sixteen hundred and forty-three porcine prosthetic values (1102 Carpentier-Edwards, 541 Hancock) were implanted in 1492 patients at New York University Medical Center between January 1976 and June 1983. The aortic valve alone was replaced in 786 patients (53%), mitral valve alone in 556 (37%), and multiple valves in 143 patients (9.6%). Concomitant coronary artery bypass was performed in 326 patients (22%). There were 116 deaths within 30 days of operation (7.8%). Follow-up (mean: 42 months) was completed in 94% of survivors and revealed that late survival from cardiac-related death was 87% at 5 years and 81% at 7 years, with no significant difference between the Carpentier-Edwards and Hancock patients. Late thromboembolic complications, however, were significantly more frequent in Hancock patients at all intervals from 1-7 years (p less than 0.05), whether in the aortic or mitral position. Patients with coronary artery disease who had concomitant coronary bypass showed a survival from late cardiac death that did not differ significantly from that of patients undergoing valve replacement alone. Before operation, 87% of patients were in New York Heart Association Class III or IV, but after operation 80% were in Class I or II. Late anticoagulant complications, endocarditis, and valve dysfunction were relatively rare. These results from a series of such size, duration, and representative numbers of two types of porcine bioprosthesis confirm excellent results with porcine prostheses in the first 4-5 years following operation
— id: 28925, year: 1986, vol: 203, page: 691, stat: Journal Article,

The impact of fragmentation on surgical practice patterns
Spencer, F C
1986 Feb;71(2):14-15, Bulletin of the American College of Surgeons
— id: 107064, year: 1986, vol: 71, page: 14, stat: Journal Article,

The internal mammary artery: the ideal coronary bypass graft?
Spencer, F C
1986 Jan 2;314(1):50-51, New England journal of medicine
— id: 107065, year: 1986, vol: 314, page: 50, stat: Journal Article,

STERNAL INFECTIONS AFTER HEART OPERATIONS - REPLY
SPENCER, FC
1986 AUG ;42(2):229-229, Annals of thoracic surgery
— id: 41373, year: 1986, vol: 42, page: 229, stat: Journal Article,

Intrathoracic extramedullary hematopoiesis simulating anterior mediastinal tumor
Catinella, F P; Boyd, A D; Spencer, F C
1985 Apr;89(4):580-584, Journal of thoracic & cardiovascular surgery
Intrathoracic extramedullary hematopoiesis is a rare tumor occurring predominantly in the posterior mediastinum, most commonly in patients with congenital hemolytic anemias. The first reported case of this entity's occurring in the anterior mediastinum is described in a 68-year-old man with an incompletely characterized anemia. Definitive diagnosis was established only after median sternotomy and removal of the tumor
— id: 107041, year: 1985, vol: 89, page: 580, stat: Journal Article,

EARLY PROGNOSTIC HEMODYNAMIC INDICES FOR SURVIVAL WITH USE OF POSTOPERATIVE PARTIAL LEFT HEART BYPASS
Connolly, MW; Grossi, EA; Rose, DM; Colvin, SB; Cunningham, JN; Spencer, FC
1985 ;72(4):393-393, Circulation
— id: 30841, year: 1985, vol: 72, page: 393, stat: Journal Article,

Aortopulmonary fistula in a post-coarctation mycotic aneurysm
DaValle, M J; Krieger, K H; Spencer, F C
1985 Jan;97(1):93-96, Surgery
A 21-year-old man presented with fever and septicemia resistant to antibiotic therapy. An unusual post-coarctation mycotic aortic aneurysm that had eroded into the left main stem bronchus was identified and replaced with a Dacron graft. A critical factor in achieving the satisfactory result was preparation of the femoral vessels for autotransfusion and possible cardiopulmonary bypass
— id: 107068, year: 1985, vol: 97, page: 93, stat: Journal Article,

LONG-TERM FOLLOW UP AFTER MITRAL-VALVE RECONSTRUCTION - INCIDENCE OF POSTOPERATIVE LEFT-VENTRICULAR OUTFLOW OBSTRUCTION
Galler, M; Kronzon, I; Lighty, GW; Colvin, S; Spencer, FC
1985 ;72(4):210-210, Circulation
— id: 30840, year: 1985, vol: 72, page: 210, stat: Journal Article,

Quantification of pulsatile flow during cardiopulmonary bypass to permit direct comparison of the effectiveness of various types of "pulsatile" and "nonpulsatile" flow
Grossi EA; Connolly MW; Krieger KH; Nathan IM; Hunter CE; Colvin SB; Baumann FG; Spencer FC
1985 Sep;98(3):547-554, Surgery
The relative merits of adding a 'pulsatile' component to flow during cardiopulmonary bypass (CPB) has long generated controversy, the resolution of which has been hampered by lack of quantification of the 'pulsatility' delivered by different devices. The present experimental series had two goals: to quantify the 'pulsatility' of blood flow during CPB in terms of pulse rate and pulsatility index (PI) and to examine which aspects of a 'pulsed flow' provide clinical benefits. A flow waveform can be expressed in terms of its baseline rate and its PI, the sum of the square of its harmonics components divided by the square of the mean flow. We used PI to quantify the pulsatility of blood flow in the descending thoracic aorta and used changes in the serum lactate level as an indication of end organ flow. In one experimental series seven adult mongrel dogs were placed on roller pump CPB at a constant flow of 100 ml/kg/min. After a 20-minute stabilization period a roller pump wave and three different pulse shapes (generated by a computer-controlled hydraulic pump) were evaluated for 15 minutes each. The pulse wave shapes were graded, with C being the sharpest and A the least sharp. In a second series six other dogs were placed on CPB and were subjected to roller pump perfusion and three pulse waves of identical shape but at different rates. The results indicated that a combination of a minimum PI of 1.88 and a minimum rate of 80 bpm were necessary to significantly reduce lactate production as compared with roller pump perfusion. Thus the same mean flow can have very different physiologic effects depending on how it is delivered. This quantification method permits direct comparison of different 'pulsatile waveforms' and provides a means for identification of optimal pulsatile flow
— id: 33358, year: 1985, vol: 98, page: 547, stat: Journal Article,

A survey of 77 major infectious complications of median sternotomy: a review of 7,949 consecutive operative procedures
Grossi EA; Culliford AT; Krieger KH; Kloth D; Press R; Baumann FG; Spencer FC
1985 Sep;40(3):214-223, Annals of thoracic surgery
Sternal wound infections developed following 77 (0.97%) of 7,949 operative procedures involving median sternotomy at New York University Medical Center from 1976 to 1984. Risk factors associated with the development of a sternal wound infection included combined revascularization and valve replacement, early reexploration for bleeding, prolonged low cardiac output syndrome, and prolonged ventilatory support (greater than 24 hours). Concomitant infection at other sites with the same organism as cultured from the sternum was present in 42% of the patients. Thirty-seven patients (48%) were treated with radical debridement followed by closed antibiotic irrigation. In 31 other patients (40%), the wounds were debrided and left to heal by open granulation. Both initial treatments had equally high success rates (78.4% and 74.2%, respectively). However, the open granulation method resulted in a hospital stay that was an average of 10 days longer than the closed antibiotic irrigation method. Muscle flaps were used to expedite healing of open granulation in 9 patients. Analysis of the results of different treatment strategies revealed that if debridement was accomplished within 20 days of the initial cardiac procedure, 76% of the patients could be successfully treated with closed antibiotic irrigation. Conversely, if treatment was delayed for longer than 20 days, 81% of the patients were treated with open granulation (p less than 0.001). Also noted was an inverse relationship between the serum blood urea nitrogen (BUN) level and the success rate of initial treatment with closed antibiotic irrigation. Patients with a serum BUN level of less than 40 mg/dl at the time of debridement had a 90% success rate as opposed to a success rate of 38% when the BUN level was 40 mg/dl or greater. The data presented suggest the following conclusions. Early diagnosis is crucial to successful treatment of sternal wound infection. When diagnosis can be established within 20 days, 80% of infections can be eradicated by the simple approach of debridement and closed antibiotic irrigation. When diagnosis is delayed, however, prompt debridement followed by muscle flaps is the procedure of choice. Open granulation alone, while successful, unnecessarily prolongs the hospital course
— id: 28928, year: 1985, vol: 40, page: 214, stat: Journal Article,

Venoarterial bypass: a technique for spinal cord protection
Grossi EA; Krieger KH; Cunningham JN Jr; Culliford AT; Nathan IM; Spencer FC
1985 Feb;89(2):228-234, Journal of thoracic & cardiovascular surgery
In the present study, we examined the effects of various levels of oxygen tension on spinal cord blood flow while using somatosensory evoked potentials to monitor spinal cord sensory function during hypoxia. In this experiment, six adult, mongrel dogs were heparinized and placed on right atrial-femoral artery bypass with an oxygenator in the bypass circuit. The aorta was cross-clamped proximal to the left subclavian artery, and bypass flow and fluid balance were adjusted so as to maintain a distal aortic perfusion pressure of greater than 80 mm Hg. Oxygen flow to the oxygenator was lowered by graded decrements to provide decreasing levels of oxygen tension, which ultimately approached pure venoarterial bypass. Each successive oxygen level was maintained for 30 minutes. Spinal cord blood flow was measured with radioactive microspheres, and latency and amplitude of somatosomatic evolved potentials were continuously monitored. The somatosensory evolved potential signal was invariably present as long as the distal aortic pressure was greater than 80 mm Hg; there were several transient hypotensive episodes (less than 5 minutes), which were accompanied by reversible loss of somatosensory evolved potentials. The spinal cord blood flow increased from 13.6 to 119.7 ml/100 gm/min as the distal oxygen tension fell to a mean value of 30 mm Hg, while latency of somatosensory evolved potentials increased 19.3% and amplitude decreased 43.3%. These results suggest the following conclusions: (1) In response to hypoxia, spinal cord blood flow dramatically increases and somatosensory evolved potentials deteriorate (increase in latency and decrease in amplitude). (2) However, during prolonged hypoxia, spinal cord sensory function can be maintained by sufficiently high flow rates and perfusion pressures. (3) Somatosensory evolved potentials can be used to monitor continuously spinal cord sensory function under these conditions
— id: 28930, year: 1985, vol: 89, page: 228, stat: Journal Article,

Pulsatile left atrial-femoral artery bypass aids in limiting myocardial infarct size following reperfusion
Grossi EA; Laschinger JC; Cunningham JN; Krieger KH; Weiss MR; Nathan IM; Trehan NK; Spencer FC
1985 May-Jun;42(3):211-213, Current surgery
— id: 18163, year: 1985, vol: 42, page: 211, stat: Journal Article,

USE OF PERCUTANEOUS LEFT-VENTRICULAR ASSIST DEVICE PROVIDES A SIMPLE MEANS FOR REDUCTION OF INFARCT SIZE DURING REPERFUSION OF EVOLVING MI
Grossi, EA; Baumann, FG; Spencer, FC
1985 ;72(4):62-62, Circulation
— id: 30839, year: 1985, vol: 72, page: 62, stat: Journal Article,

ABSOLUTE QUANTIFICATION OF PULSATILE FLOW DURING CARDIOPULMONARY BYPASS CORRELATES PULSATILITY WITH ENHANCED RENAL PERFUSION
Grossi, EA; Connolly, MW; Krieger, KH; Baumann, FG; Colvin, SB; Spencer, FC
1985 ;88(2):S35-S35, Chest
— id: 30864, year: 1985, vol: 88, page: S35, stat: Journal Article,

PERCUTANEOUS ASSIST DEVICE PROVIDES SIMPLE TECHNIQUE FOR TOTAL LEFT-VENTRICULAR SUPPORT
GROSSI, EA; HUNTER, CE; CULLIFORD, AT; COLVIN, SB; BAUMANN, FG; SPENCER, FC
1985 FEB ;36(6):208-210, Surgical forum
— id: 33456, year: 1985, vol: 36, page: 208, stat: Journal Article,

PERCUTANEOUS LEFT-VENTRICULAR ASSIST DEVICE PROVIDES SIGNIFICANTLY REDUCED MYOCARDIAL O-2 CONSUMPTION AND SUPERIOR LEFT HEART UNLOADING COMPARED TO INTRA-AORTIC BALLOON PUMP
Grossi, EA; Krieger, KH; Baumann, FG; Spencer, FC
1985 ;72(4):406-406, Circulation
— id: 30842, year: 1985, vol: 72, page: 406, stat: Journal Article,

PERCUTANEOUS LVAD PROVIDES SIGNIFICANTLY REDUCED MYOCARDIAL O-2 CONSUM
Grossi, EA; Krieger, KH; Colvin, SB; Culliford, AT; Baumann, FG; Spencer, FC
1985 ;88(2):S36-S36, Chest
— id: 30865, year: 1985, vol: 88, page: S36, stat: Journal Article,

PULSATILE LEFT ATRIAL-FEMORAL ARTERY BYPASS PLUS REPERFUSION AFTER ACUTE MYOCARDIAL ISCHEMIA PERMANENTLY LESSENS INFARCT SIZE AND REPERFUSION INJURY
Grossi, EA; Krieger, KH; Cunningham, JN; Baumann, FG; Weiss, MR; Colvin, SB; Spencer, FC
1985 ;5(2):440-440, Journal of the American College of Cardiology
— id: 30991, year: 1985, vol: 5, page: 440, stat: Journal Article,

MULTIPLE VALVE SURGERY IN THE ELDERLY - A FOLLOW-UP-STUDY OF 49 PATIENTS
Ing, AF; Baumann, FG; Grossi, EA; Colvin, SB; Hunter, CE; Spencer, FC
1985 ;88(2):S48-S48, Chest
— id: 30866, year: 1985, vol: 88, page: S48, stat: Journal Article,

Is paraplegia after repair of coarctation of the aorta due principally to distal hypotension during aortic cross-clamping?
Krieger, K H; Spencer, F C
1985 Jan;97(1):2-7, Surgery
The hypothesis is presented that paraplegia after coarctation of the aorta is principally due to hypotension of sufficient severity and duration. In a group of 103 patients who underwent surgery during a 10-year period, the distal aortic pressure was maintained above 60 mm Hg while the aorta was cross-clamped or the period of cross-clamping was limited to less than 20 minutes. No neurologic problems occurred. In 17 of the 103 cases aortic pressure decreased below 60 mm Hg, occurring in 8% of patients with the aorta occluded below the left subclavian artery but in 30% of those occluded above. Therapeutic measures used in the 17 patients included infusion of metaraminol in five and limiting cross-clamp time to less than 20 minutes in 11. The theory is proposed that ligation of intercostal arteries in a patient with coarctation cannot injure the spinal cord because the normal direction of blood flow is reversed. Certainly, in patients without a coarctation, such as thoracic aneurysms, ligation of a critical intercostal artery may injure the spinal cord. However, in patients with coarctation the direction of blood flow is reversed, blood flowing from the intercostals into the distal aorta. The vague relationship long noted between development of collateral circulation, including rib notching, and the frequency of paraplegia probably depends not on the presence of enlarged intercostal arteries but on whether their temporary occlusion at the time of aortic cross-clamping results in distal hypotension. Data with somatosensory-evoked potentials measured during operations on the thoracic aorta in 25 patients found no changes in sensory potentials as long as the distal aortic pressure remained above 60 mm Hg, but a gradual disappearance was found at lower pressures. In five of six patients with large thoracicoabdominal aneurysms in whom sensory potentials were absent for longer than 30 minutes, paraplegia resulted. Use of somatosensory potentials provides a significant method for evaluating methods to protect from paraplegia. This method should be far more productive than are simple clinical experiences because the fortunate rare occurrence of paraplegia, one in 200, greatly limits available data
— id: 107067, year: 1985, vol: 97, page: 2, stat: Journal Article,

Adjunctive left ventricular unloading during myocardial reperfusion plays a major role in minimizing myocardial infarct size
Laschinger JC; Grossi EA; Cunningham JN Jr; Krieger KH; Baumann FG; Colvin SB; Spencer FC
1985 Jul;90(1):80-85, Journal of thoracic & cardiovascular surgery
Although prompt institution of reperfusion following coronary artery occlusion has been shown to limit myocardial infarct size, significant 'reperfusion injury' may result. We investigated in a canine model whether maintenance of the left ventricle in an unloaded state during the initial reperfusion period following acute myocardial ischemia would result in greater limitation of infarct size or modify the development of reperfusion injury. Group I (control, n = 6) underwent 6 hours of occlusion of the left anterior descending coronary artery without further intervention. In both Group II (n = 6) and Group III (n = 6), the snare was released after 2 hours and hearts were reperfused for 4 hours. In Group III only, the left ventricle was maintained in an unloaded state throughout the entire reperfusion interval via pulsatile left atrial-femoral artery bypass. The results showed that reperfusion of the left ventricle in an unloaded state resulted in significantly improved limitation of both infarct size (area of infarct/area at risk = 16.6% for Group III versus 72.0% for Group I and 55.4% for Group II, p less than 0.001) and area of microvascular damage (area of microvascular damage/area at risk = 4.8% for Group III versus 30.6% for Group II, p less than 0.001). These results indicate that although myocardial reperfusion of the type provided by thrombolysis and/or angioplasty techniques does result in limitation of infarct size when compared to no reperfusion, this limitation is not optimal unless the left ventricle is unloaded during the initial reperfusion period
— id: 33359, year: 1985, vol: 90, page: 80, stat: Journal Article,

Experimental and clinical results with a simplified left heart assist device for treatment of profound left ventricular dysfunction
Rose, D M; Laschinger, J; Grossi, E; Krieger, K H; Cunningham, J N Jr; Spencer, F C
1985 Feb;9(1):11-17, World journal of surgery
— id: 107066, year: 1985, vol: 9, page: 11, stat: Journal Article,

Experiences with the Carpentier techniques of mitral valve reconstruction in 103 patients (1980-1985)
Spencer FC; Colvin SB; Culliford AT; Isom OW
1985 Sep;90(3):341-350, Journal of thoracic & cardiovascular surgery
A total of 103 patients, age range 2 to 77 years, had some type of Carpentier reconstruction for mitral insufficiency. The mitral insufficiency resulted from ruptured chordae in 52, prolapse in 13, rheumatic fever in 16, coronary disease in eight, congenital disease in nine, and endocarditis in five. Multiple abnormalities were usually present. Four patients had severe calcification of the anulus. A reconstruction was accomplished in almost all patients. A ring annuloplasty was performed in all but two small children, but annuloplasty alone was adequate in only 17 patients. Fifty-eight had resection of 1 to 4 cm of diseased mitral leaflet. In 23 patients, chordal transposition or shortening was employed. Aortic leaflet repair was done in 28. Shortened, fused chordae (one to eight) were divided in 13 patients. Additional procedures performed in 28 patients included coronary bypass in 14. A successful repair was accomplished in all but one patient (moderate residual insufficiency). Two late hospital deaths were unrelated to the mitral repair. Following hospital discharge, ring dehiscence necessitated repeat operation in one patient. Thromboembolism produced a permanent minor neurological deficit in only one patient. There have been no late recurrences of insufficiency. Recurrent endocarditis necessitated valve replacement in three patients. A late Doppler evaluation of 95 patients for mitral insufficiency revealed none in 82, a trace in 12, and moderate insufficiency in one. Late catheterization in 16 patients revealed no insufficiency. The data suggest that reconstruction, rather than prosthetic valve replacement, can be successfully performed in over 90% of patients with nonrheumatic, noncalcified mitral valves. A much wider use of the technique seems strongly indicated
— id: 28929, year: 1985, vol: 90, page: 341, stat: Journal Article,

A clinical evaluation of the hypothesis that rupture of the left ventricle following mitral valve replacement can be prevented by preservation of the chordae of the mural leaflet
Spencer FC; Galloway AC; Colvin SB
1985 Dec;202(6):673-680, Annals of surgery
Experiences with 14 patients undergoing rupture of the left ventricle following mitral valve replacement over a period of 9 years have been described. Three different types have been recognized. Before 1978, most injuries occurred in the atrioventricular groove, apparently resulting from traction that insidiously avulsed the mitral annulus from the underlying left ventricular muscle. Several changes in operative technique, described in the text, were made to prevent this traction avulsion. Following the adoption of these principles, rupture in the atrioventricular groove virtually disappeared. A second type of injury, strut perforation, has been recognized in only one patient, a small 81-year-old female in whom the prosthesis inserted was too large for the ventricular cavity. Translucent obturators were subsequently developed not only to size the left ventricle but also to note the location of the post of the porcine prosthesis before insertion. Further problems of this type have not been seen. The most puzzling, and currently the most significant, problem is a third type of rupture, the mid-ventricular rupture, suggested as Type III by Miller in 1978 and described in detail by Cobbs in 1977 and 1980. The phenomenon seems to be a true spontaneous rupture of a thin left ventricle, usually occurring in small elderly women with mitral valve disease. If the friability of the left ventricle is transiently increased with potassium cardioplegia, such ventricles may spontaneously rupture following division of the chordae to the annulus of the mural leaflet. If this concept is correct, a rupture in some patients can best be prevented by preserving these chordae. It is well realized, of course, that a fortunate narrative experience of 3 1/2 years does not have any statistical value concerning a complication that occurs in 1 to 2% of operations. The experiences are reported, however, because to our knowledge, the untethered loop hypothesis has not been previously evaluated in a large number of consecutive patients operated on. Future comparison of experiences reported by others should make it possible to determine whether or not this concept is correct
— id: 36732, year: 1985, vol: 202, page: 673, stat: Journal Article,

Myocardial protection during prolonged aortic cross-clamping. Comparison of blood and crystalloid cardioplegia
Catinella, F P; Cunningham, J N Jr; Spencer, F C
1984 Sep;88(3):411-423, Journal of thoracic & cardiovascular surgery
We compared the ability of blood and crystalloid cardioplegia to protect the myocardium during prolonged arrest. Twelve dogs underwent 180 minutes of continuous arrest. Group I (six dogs) received 750 ml of blood cardioplegic solution (potassium chloride 30 mEq/L) initially and every 30 minutes. Group II (six dogs) received an identical amount of crystalloid cardioplegic solution (potassium chloride 30 mEq, methylprednisolone 1 gm, and 50% dextrose in water 16 ml/L of electrolyte solution). Temperature was 10 degrees C and pH 8.0 in both groups. Studies of myocardial biochemistry, physiology, and ultrastructure were completed before arrest and 30 minutes after normothermic reperfusion. Biopsy specimens for determination of adenosine triphosphate were obtained before, during, and after the arrest interval. Regional myocardial blood flow, total coronary blood flow, and myocardial oxygen consumption were statistically unchanged in Group I (p greater than 0.05). Total coronary blood flow rose 196% +/- 49% in Group II (p less than 0.005), and left ventricular endocardial/epicardial flow ratio fell significantly in this group from 1.51 +/- 0.18 to 0.8 +/- 0.09, p less than 0.01 (mean +/- standard error of the mean. The rise in myocardial oxygen consumption was not significant in this group (34% +/- 36%, p greater than 0.05). Ventricular function and compliance were statistically unchanged in both groups. In Group II, adenosine triphosphate fell 18% +/- 3.4% (p less than 0.005) after 30 minutes of reperfusion; it was unchanged in Group I. Ultrastructural appearance in both groups correlated with these changes. We conclude that blood cardioplegia offers several distinct advantages over crystalloid cardioplegia during prolonged arrest
— id: 107071, year: 1984, vol: 88, page: 411, stat: Journal Article,

PULSATILE LEFT ATRIAL-FEMORAL ARTERY BYPASS LIMITS MYOCARDIAL INFARCT EXPANSION EVEN AFTER PROLONGED ISCHEMIA
GROSSI, EA; KRIEGER, KH; CUNNINGHAM, JN; WEISS, MR; NATHAN, IM; LASCHINGER, JC; HUNTER, CE; SPENCER, FC
1984 FEB ;3(2):593-593, Journal of the American College of Cardiology
— id: 33460, year: 1984, vol: 3, page: 593, stat: Journal Article,

TIME COURSE OF MYOCARDIAL SALVAGE WITH LEFT HEART ASSIST IN EVOLVING MYOCARDIAL-INFARCTION
GROSSI, EA; LASCHINGER, JC; CUNNINGHAM, JN; KRIEGER, KH; NATHAN, IM; WEISS, R; SPENCER, FC
1984 FEB ;35(2):322-324, Surgical forum
— id: 33458, year: 1984, vol: 35, page: 322, stat: Journal Article,

EPIDURAL EVOKED-POTENTIALS PROVIDE A MORE SPECIFIC INDICATION OF SPINAL-CORD ISCHEMIA
GROSSI, EA; LASCHINGER, JC; KRIEGER, KH; NATHAN, IM; COLVIN, SB; WEISS, MR; SPENCER, FC
1984 FEB ;86(2):314-314, Chest
— id: 33459, year: 1984, vol: 86, page: 314, stat: Journal Article,

Demonstration of sustained increases in myocardial ATP following preischemic enhancement
Laschinger JC; Cunningham JN Jr; Krieger K; Knopp E; Culliford AT; Colvin S; Spencer FC
1984 Mar-Apr;41(2):104-106, Current surgery
— id: 28931, year: 1984, vol: 41, page: 104, stat: Journal Article,

Prevention of ischemic spinal cord injury following aortic cross-clamping: use of corticosteroids
Laschinger, J C; Cunningham, J N Jr; Cooper, M M; Krieger, K; Nathan, I M; Spencer, F C
1984 Nov;38(5):500-507, Annals of thoracic surgery
Prior to proximal aortic cross-clamping, baseline measurements of spinal cord blood flow and function were done. Blood flow was evaluated with radioactive microspheres and function determined by assessment of somatosensory evoked potential (SEP). Group 1 (N = 6) animals had aortic cross-clamping for 5 minutes after ischemic spinal cord dysfunction (SEP loss) was documented. Group 2 (N = 9) underwent aortic cross-clamping for 10 minutes after loss of SEP. Group 3 (N = 6) also underwent 10 minutes of cross-clamping after initial SEP loss, but were treated intravenously with methylprednisolone (30 mg per kilogram of body weight) 10 minutes prior to cross-clamping and again 4 hours postoperatively. After release of the cross-clamp, the animals were allowed to recover and serial evaluations of spinal cord blood flow and neurological status were carried out for seven days. Group 1 animals recovered uneventfully without evidence of neurological injury. Group 2 animals sustained a 67% incidence of permanent spastic paraplegia (p = 0.02 versus Group 1). In contrast, methylprednisolone-treated animals sustained no clinically detectable neurological injury (p = 0.02 versus Group 2). Measurements of spinal cord blood flow at the time of SEP loss revealed similar degrees of spinal cord ischemia in all groups. No significant differences were observed in the duration of aortic cross-clamping prior to SEP loss among the three groups. The data indicate that short periods of cross-clamping (5 minutes) following SEP loss are well tolerated, whereas longer periods (10 minutes) are associated with a high incidence of paraplegia.(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 107069, year: 1984, vol: 38, page: 500, stat: Journal Article,

Intraoperative identification of vessels critical to spinal cord blood supply--use of somatosensory evoked potentials
Laschinger, J C; Cunningham, J N Jr; Nathan, I M; Krieger, K; Isom, O W; Spencer, F C
1984 Mar-Apr;41(2):107-109, Current surgery
— id: 107073, year: 1984, vol: 41, page: 107, stat: Journal Article,

MINIMIZATION OF MYOCARDIAL INFARCT SIZE BY COMBINED LEFT- VENTRICULAR UNLOADING AND REPERFUSION
LASCHINGER, JC; GROSSI, EA; CUNNINGHAM, JN; KRIEGER, KH; BAUMANN, FG; WEISS, MR; SPENCER, FC
1984 FEB ;35(2):306-308, Surgical forum
— id: 33457, year: 1984, vol: 35, page: 306, stat: Journal Article,

Patterns of severe pancreatic injury following cardiopulmonary bypass
Rose, D M; Ranson, J H; Cunningham, J N Jr; Spencer, F C
1984 Feb;199(2):168-172, Annals of surgery
Severe pancreatic complications following cardiac surgery are rare, but 14 patients with severe pancreatitis have been encountered since 1971. Six of these developed acute fulminating pancreatitis following cardiac surgery and each of these died within 21 days following operation. Seven patients had less severe pancreatitis, resulting in pancreatic abscess formation and five in this group expired. One patient developed a pancreatic pseudocyst following mild acute pancreatitis and expired 4 months later. Although the etiologic mechanisms are unclear, possible factors include: prolonged cardiopulmonary bypass, 'the low cardiac output syndrome,' and inadequately treated or unrecognized postoperative pancreatitis. The diagnosis is based on physical examination, upper gastrointestinal series, and the abdominal CT scan. Despite aggressive surgical therapy, pancreatitis following cardiopulmonary bypass is an extremely serious condition
— id: 92878, year: 1984, vol: 199, page: 168, stat: Journal Article,

RIGHT AND LEFT HEART FUNCTION IN SURVIVING AND NON-SURVIVING PATIENTS REQUIRING INSERTION OF A LEFT HEART ASSIST DEVICE FOLLOWING CARDIAC-SURGERY
ROSE, DM; COLVIN, SB; CUNNINGHAM, JN; ISOM, OW; KRIEGER, KH; GLASSMAN, E; SPENCER, FC
1984 ;3(2):508-508, Journal of the American College of Cardiology
— id: 41025, year: 1984, vol: 3, page: 508, stat: Journal Article,

Principles of surgery
Schwartz, Seymour I.; Shires, G. Tom; Spencer, Frank Cole; Storer, Edward H
New York : McGraw-Hill, c1984,
— id: 227, year: 1984, vol: , page: , stat: ,

The role of the surgeon in the intensive care unit
Spencer, F C; Skinner, D B
1984 Oct;88(4):483-485, Journal of thoracic & cardiovascular surgery
— id: 107070, year: 1984, vol: 88, page: 483, stat: Journal Article,

Prophylactic replacement of a Starr-Edwards model 1000 aortic valve prosthesis in place for 20 years
Vlay, S C; Spencer, F C
1984 Mar 15;53(7):969-969, American journal of cardiology
— id: 107072, year: 1984, vol: 53, page: 969, stat: Journal Article,

The incidence and natural history of pericardial effusion after cardiac surgery--an echocardiographic study
Weitzman, L B; Tinker, W P; Kronzon, I; Cohen, M L; Glassman, E; Spencer, F C
1984 Mar;69(3):506-511, Circulation
One hundred twenty-two consecutive patients (104 men; 18 women) were studied to determine the incidence and natural history of pericardial effusion occurring 2, 5, 10, and 20 to 50 days after cardiac surgery. Three patients had pericardial effusions before and 103 patients (91 men; three women) had effusions after surgery. Effusions were first recorded on the second postoperative day in 72 patients, on the fifth postoperative day in 29 patients, and on the tenth postoperative day in two patients. In 96 of these patients, effusions reached their maximum size by postoperative day 10. Of the 103 patients with effusions, 66 (64%) were followed to complete resolution. A specific pattern was observed in most resolving effusions. The echo-free space diagnostic of pericardial effusion became progressively more echo-dense as the effusion diminished in size. As the effusion became echo-dense, the posterior pericardium, which had been motionless, resumed its normal systolic anterior motion. One patient developed cardiac tamponade on postoperative day 3. We conclude that pericardial effusion occurs frequently after cardiac surgery, but that associated complications are rare
— id: 100124, year: 1984, vol: 69, page: 506, stat: Journal Article,

INCIDENCE AND NATURAL-HISTORY OF PERICARDIAL-EFFUSION AFTER CARDIAC-SURGERY
WEITZMAN, L; TINKER, P; KRONZON, I; GLASSMAN, E; SPENCER, FC
1984 ;3(2):488-488, Journal of the American College of Cardiology
— id: 41024, year: 1984, vol: 3, page: 488, stat: Journal Article,

Mechanical ventilation : airway pressure therapy
Boyd AD; Bernhard WN; Spencer FC
Gibbon's surgery of the chest Philadelphia : Saunders, 1983,
— id: 3478, year: 1983, vol: , page: 196, stat: Chapter,

Tracheal intubation and mechanical ventilation
Boyd AD; Bernhard WN; Spencer FC
Gibbon's surgery of the chest Philadelphia : Saunders, 1983,
— id: 3479, year: 1983, vol: , page: 182, stat: Chapter,

Left atrium-to-femoral artery bypass: effectiveness in reduction of acute experimental myocardial infarction
Catinella, F P; Cunningham, J N Jr; Glassman, E; Laschinger, J C; Baumann, F G; Spencer, F C
1983 Dec;86(6):887-896, Journal of thoracic & cardiovascular surgery
The effects of prompt institution of left atrium-to-femoral artery (LA-FA) bypass on myocardial infarct area (AI) as a percentage of myocardial area at risk for infarction (AR) during a 4 hour period following ligation of the left anterior descending coronary artery (LAD) were studied in 26 dogs. Following LAD ligation, baseline measurements of myocardial tension-time index (TTI) and regional myocardial blood flow (RMBF) were obtained. Group I (controls, n = 16) received no further support. Group II (LA-FA bypass, n = 10) underwent left ventricular unloading via LA-FA bypass beginning 15 minutes after coronary occlusion. Four hours after LAD occlusion, measurements of TTI and RMBF were repeated in both groups. Just before sacrifice, gentian violet was injected into the aortic root to delineate the AR. The hearts were then removed and sectioned transversely through the left ventricle (LV) and septum. The AR (that ventricular area not perfused by gentian violet) was measured by planimetry and compared to the AI as identified by incubation of heart slices in triphenyltetrazolium chloride dye. In comparisons of control versus LA-FA bypass groups, both AI/LV (21.6% versus 10.4%) and AI/AR ratios (73.7% versus 21.8%) were significantly reduced in the bypass group (p less than 0.005). Mortality in the control group (5/16, 31.2%) was significantly greater (p less than 0.005) than in the bypass group (0/10, 0%). Mean TTI over the 4 hour ischemic period was essentially unchanged in the control group as compared to a reduction of 62.8% in the bypass group (p less than 0.005). Furthermore, RMBF at 4 hours was significantly improved in all regions of the LV in hearts undergoing LA-FA bypass when compared with control hearts (p = 0.025). These results demonstrate by a consistent method that prompt institution of LA-FA bypass significantly reduces the mortality associated with acute coronary artery occlusion, as well as the total AI and AI/AR. The protective mechanisms provided by LA-FA bypass probably include the highly significant reduction of LV work and the opening of new bridge collateral blood vessels with redistribution of blood flow to the ischemic region
— id: 106532, year: 1983, vol: 86, page: 887, stat: Journal Article,

Preservation of myocardial ATP. Comparison of blood vs crystalloid cardioplegia
Catinella, F P; Cunningham, J N Jr; Knopp, E A; Laschinger, J C; Spencer, F C
1983 Apr;83(4):650-654, Chest
Preservation of myocardial high-energy phosphates correlates with the heart's ability to resume normal function following aortic crossclamping (AXC). The ability of the canine myocardium to synthesize and maintain ATP during 180 minutes of AXC was evaluated in 12 hearts subjected to either blood or crystalloid cardioplegic arrest. Group 1 hearts were arrested by infusion of 750 ml of blood potassium cardioplegia (BKC) solution into the aortic root initially and every 30 minutes, as were group 2 (six) hearts but with a crystalloid cardioplegia (CC) solution. Transmural left ventricular biopsy specimens were obtained for ATP analysis prior to AXC (control), before and after cardioplegia injections 2, 4, and 6, prior to unclamping (180 minutes of AXC), and 30 minutes following reperfusion. ATP levels increased significantly above control (p less than 0.005) during the 180 minutes of AXC immediately following infusion of BKC. At the end of 180 minutes of AXC and following 30 minutes of reperfusion, ATP was noted to be normal in this group (p = NS). In contrast, ATP levels fell significantly (p less than 0.005) during the period of aortic cross-clamping in the crystalloid cardioplegia group and did not return to normal even after 30 minutes of reperfusion (p less than 0.005). We concluded that BKC, by presenting the arrested myocyte with adequate oxygen and substrate, allows for synthesis and preservation of myocardial ATP during periods of AXC as long as three hours. In this respect, it should be regarded as superior to CC, which permits a statistically significant depletion of ATP (p less than 0.005) uncorrected, even after 30 minutes of reperfusion in the beating, nonworking state
— id: 107080, year: 1983, vol: 83, page: 650, stat: Journal Article,

Significant reduction of infarct size with left atrial to femoral artery bypass
Catinella, F P; Cunningham, J N Jr; Laschinger, J C; Nathan, I M; Glassman, E; Spencer, F C
1983 Jan-Feb;40(1):27-29, Current surgery
— id: 107081, year: 1983, vol: 40, page: 27, stat: Journal Article,

Variations in total and ionized calcium during cardiac surgery
Catinella, F P; Cunningham, J N Jr; Strauss, E D; Adams, P X; Laschinger, J C; Spencer, F C
1983 Nov-Dec;24(6):593-602, Journal of cardiovascular surgery
Twenty patients undergoing cardiac surgery were studied to examine variations in total and ionized serum calcium and urine calcium during cardiopulmonary bypass. Serial samples of blood and urine were analyzed during bypass using a highly specific calcium electrode to determine the effects of hemodilution, various pharmacologic agents, and transfusions of citrated blood. Calcium chloride was routinely added to the crystalloid pump prime (400 mgs/L) and also administered when additional blood or crystalloid were infused. An average of 4.8 +/- .50 grams of calcium chloride was given per procedure. After induction of general anesthesia with nitrous oxide and Halothane, total serum calcium decreased from 10.0 +/- 0.3 to 8.5 +/- 0.8 mg% (p less than 0.05). Following heparinization, ionized calcium decreased from 4.2 +/- .08 to 3.9 +/- 12 mg% (p less than 0.05). Ionized calcium was not affected by reversal of heparin with Protamine. Following institution of cardiopulmonary bypass the ratio of ionized to total calcium declined about 13.4% (0.49 vs. 0.43). This ratio did not change during bypass but returned to normal immediately post-perfusion. Urinary calcium excretion averaged 1.9 +/- 0.6 mg/min and could not be implicated as a cause of hypocalcemia during bypass. Post-perfusion, ionized serum calcium rose 1.3 +/- .01 mg% for each gram of exogenously administered calcium chloride (p less than 0.05). From these observations, we conclude: (1) ionized and total serum calcium levels decreased significantly following institution of cardiopulmonary bypass alone, presumably as a result of hemodilution from the crystalloid pump prime and addition of citrated blood products; (2) induction of general anesthesia alone with nitrous oxide and Halothane is associated with a significant decrease in total serum calcium; (3) ionized calcium declined following heparinization but is unchanged by Protamine administration; (4) changes in total and ionized serum calcium are unaffected by urinary excretion during bypass; (5) exogenously administered calcium chloride significantly increases serum ionized calcium and these changes are inversely related to the circulating pool of calcium; (6) current protocols for administration of exogenous calcium chloride during bypass may result in insufficient levels of ionized calcium and we have adopted measures to correct these deficiencies, when indicated
— id: 107074, year: 1983, vol: 24, page: 593, stat: Journal Article,

PRESERVATION OF MYOCARDIAL ATP - COMPARISON OF BLOOD VS CRYSTALLOID CARDIOPLEGIA
Catinella, FP; Cunningham, JN; Knopp, EA; Laschinger, JC; Spencer, FC
1983 ;83(4):650-654, Chest
— id: 30662, year: 1983, vol: 83, page: 650, stat: Journal Article,

Aneurysms of the descending aorta. Surgical experience in 48 patients
Culliford AT; Ayvaliotis B; Shemin R; Colvin SB; Isom OW; Spencer FC
1983 Jan;85(1):98-104, Journal of thoracic & cardiovascular surgery
Uniformity of opinion does not exist concerning an optimal surgical strategy for descending aortic aneurysms. In order to assess the impact of surgical technique on operative mortality, morbidity, late outcome, we reviewed 48 consecutive patients operated upon from 1976 to 1980. Average age was 61 years, and 37 patients (77%) were men. The average interval of aortic occlusion in the Gott shunt group was 48 minutes, which was significantly longer than that of patients operated upon without shunts (30 minutes). No patient in the Gott shunt group had postoperative paraplegia, but it was noted in two patients (18%) treated without a shunt. Operative deaths in patients with Gott shunts were caused by cardiac (two patients), neurologic (one patient), pulmonary (one patient), and abdominal (two patients) factors. A pulmonary embolus caused the single postoperative death in the 'no shunt' group, and another patient died intraoperatively. A group of seven patients were treated by temporary femoral vein--femoral artery bypass because of extensive aneurysmal disease, advanced associated major systemic disorders, or anticipated excessive hemorrhage when the aneurysm was opened. All patients survived free of neurologic sequela, but one developed a reversible intraoperative coagulopathy. This study underscores the safety and usefulness of the femoral vein--femoral artery bypass in treating certain descending thoracic aneurysms and reinforces the importance of several technical guidelines concerning the proper insertion and use of the Gott shunt. These guidelines would have significantly reduced the observed operative morbidity and mortality
— id: 28935, year: 1983, vol: 85, page: 98, stat: Journal Article,

CLINICAL USE OF PREISCHEMIC ENHANCEMENT - REPLENISHMENT OF MYOCARDIAL ADENOSINE-TRIPHOSPHATE STORES IN HYPERTROPHIED RIGHT VENTRICLES
CUNNINGHAM, JN; LASCHINGER, JC; KRIEGER, KH; KNOPP, EA; ISOM, OW; SPENCER, FC
1983 ;34(12):279-282, Surgical forum
— id: 41123, year: 1983, vol: 34, page: 279, stat: Journal Article,

Heparin resistance during cardiopulmonary bypass. The role of heparin pretreatment
Esposito RA; Culliford AT; Colvin SB; Thomas SJ; Lackner H; Spencer FC
1983 Mar;85(3):346-353, Journal of thoracic & cardiovascular surgery
— id: 28933, year: 1983, vol: 85, page: 346, stat: Journal Article,

The role of the activated clotting time in heparin administration and neutralization for cardiopulmonary bypass
Esposito RA; Culliford AT; Colvin SB; Thomas SJ; Lackner H; Spencer FC
1983 Feb;85(2):174-185, Journal of thoracic & cardiovascular surgery
Precise guidelines for heparin administration and neutralization during cardiopulmonary bypass (CPB) are not established. To a large extent, the uncertainty originates from a disparity between the heparin dosage, the plasma heparin concentration, and the clinical heparin effect. We investigated these relationships in 44 consecutive patients at New York University Medical Center. Following serial loading doses of heparin (2 and 4 mg/kg) there was a wide variation in both the measured clinical heparin effect (activated clotting time--ACT) and the plasma heparin concentration. When the Act was compared to the heparin concentration, there was no linear relationship noted after heparin does commonly employed for CPB. The calculated heparin sensitivity varied over a fourfold range and was not related to the baseline antithrombin III activity. At the completion of CPB, heparin was neutralized with a 2 mg/kg protamine dose regardless of the total heparin dose. Heparin levels fell from 4.17 +/- 1.29 to 0.19 +/- 0.20 units/ml. Additional protamine was given to 49% of the patients as the ACT had not returned to pre-heparin levels. The total protamine dose rarely exceeded 3 mg/kg. This technique resulted in the administration of 30% to 50% less protamine than predicted by other commonly used protocols. In the subsequent 4 hours after protamine administration, heparin levels remained insignificant. Mild heparin rebound was found in two patients (4.5%) but was not associated with excessive bleeding. Following bypass a comparison of heparin levels and ACTs demonstrated the ACT to be a poor indicator of residual circulating heparin. These data show: (1) that neither the heparin dosage nor the plasma heparin concentration can accurately predict the magnitude of the clinical heparin effect in patients undergoing CPB and emphasize the importance of the ACT as the best available measurement of safe anticoagulation, (2) heparin 'rebound' was not clinically significant, and (3) heparin was neutralized with 2 to 3 mg/kg protamine in virtually all patients, regardless of the total heparin dose
— id: 28934, year: 1983, vol: 85, page: 174, stat: Journal Article,

Chirugia toracica di Gibbon
Gibbon JH; Sabiston DC; Spencer FC; Cariati E
Padova : Piccin, 1983,
— id: 983, year: 1983, vol: , page: , stat: ,

Gibbon's Surgery of the chest
Gibbon, John Heysham.; Sabiston, David C.; Spencer, Frank Cole
Philadelphia : Saunders, 1983,
— id: 94, year: 1983, vol: , page: , stat: ,

'Pulsatile' left atrial-femoral artery bypass. A new method of preventing extension of myocardial infarction
Laschinger, J C; Cunningham, J N Jr; Catinella, F P; Knopp, E A; Glassman, E; Spencer, F C
1983 Aug;118(8):965-969, Archives of Surgery (Chicago)
A left atrial-femoral artery (LA-FA) bypass system was designed to deliver synchronous pulsatile blood flow. We compared it with nonpulsatile LA-FA bypass in its effectiveness to limit infarct extension after ligation of the left anterior descending coronary artery at its origin in 35 dogs. Nonpulsatile LA-FA bypass resulted in a 70% reduction in the size of infarct. The addition of synchronous diastolic counterpulsation (P-LA-FA) further reduced the size of infarct, when compared with that in controls (95%) or animals that underwent LA-FA bypass (83%). Both LA-FA and P-LA-FA bypasses limited infarct extension and reduced mortality after acute coronary occlusion through effective unloading of the left ventricle. The addition of diastolic counterpulsation to LA-FA bypass led to further significant infarct reduction, when compared with LA-FA bypass alone. These effects were most likely secondary to improvements in myocardial blood flow distribution
— id: 107078, year: 1983, vol: 118, page: 965, stat: Journal Article,

Definition of the safe lower limits of aortic resection during surgical procedures on the thoracoabdominal aorta: use of somatosensory evoked potentials
Laschinger, J C; Cunningham, J N Jr; Isom, O W; Nathan, I M; Spencer, F C
1983 Nov;2(5):959-965, Journal of the American College of Cardiology
The technique of intraoperative monitoring of somatosensory evoked potentials was applied to a canine model of spinal cord ischemia in an attempt to determine the safe lower limits of aortic resection during thoracic aortic surgery. Fifteen animals underwent left thoracotomy with institution of partial left atrial/femoral artery bypass for maintenance of distal aortic perfusion after proximal descending thoracic aortic exclusion. In Group I animals (n = 6, control), no further interventions were performed so that the effect of exclusion of vessels noncritical to spinal cord blood supply could be assessed by measurements of spinal cord blood flow and somatosensory evoked potentials. In Group II animals (n = 8), the level of distal aortic exclusion was progressively lowered until loss of somatosensory evoked potential (critical vessel exclusion) occurred. The effect of critical vessel exclusion on spinal cord blood flow was then assessed. Exclusion of multiple vessels noncritical to spinal cord blood supply (Group I) had no effect on spinal cord blood flow or function (somatosensory evoked potentials). Exclusion of vessels critical to spinal cord blood supply resulted in significant spinal cord ischemia (83.4% flow reduction, probability [p] less than 0.05 versus baseline) and ischemic spinal cord dysfunction (loss of somatosensory evoked potential).(ABSTRACT TRUNCATED AT 250 WORDS)
— id: 107075, year: 1983, vol: 2, page: 959, stat: Journal Article,

Experimental and clinical assessment of the adequacy of partial bypass in maintenance of spinal cord blood flow during operations on the thoracic aorta
Laschinger, J C; Cunningham, J N Jr; Nathan, I M; Knopp, E A; Cooper, M M; Spencer, F C
1983 Oct;36(4):417-426, Annals of thoracic surgery
We studied both experimentally and clinically the efficacy of partial bypass techniques in maintaining spinal cord blood flow and physiological function during surgical procedures on the thoracoabdominal aorta. We attempted to define the level of distal aortic pressure required to safely ensure normal neurological function in the absence of critical intercostal occlusion. Six dogs underwent left thoracotomy with baseline measurements of spinal cord blood flow and spinal cord impulse conduction (somatosensory evoked potentials). Following exclusion of the entire descending thoracic aorta from the left subclavian artery to the T-13 level, partial left atrium-femoral artery bypass was instituted, and baseline levels of proximal and distal aortic pressure were maintained during a 30-minute stabilization period. Mean distal aortic pressure then was progressively altered at 30-minute intervals to 100, 70, and 40 mm Hg. Measurements of spinal cord blood flow and somatosensory evoked potential were repeated at the end of each interval for comparison with baseline. No significant changes in spinal cord blood flow or somatosensory evoked potential were observed in any animal with a distal aortic pressure greater than or equal to 70 mm Hg. With a pressure of 40 mm Hg, normal flow and somatosensory evoked potentials were maintained in 5 of the 6 dogs. Loss of somatosensory evoked potential, with simultaneous loss of spinal cord blood flow at the T-6 level, occurred in 1 dog. Restoration of distal aortic pressure to 70 mm Hg in all animals resulted in immediate return of somatosensory evoked potential. Loss of somatosensory evoked potential routinely occurred in animals with a distal aortic pressure less than 40 mm Hg. Clinically, 9 patients have undergone operation for lesions of the thoracoabdominal aorta using shunt or bypass techniques. Normal somatosensory evoked potentials were preserved in 7 patients with maintenance of adequate distal aortic pressure (greater than or equal to 60 mm Hg) without evidence of postoperative neurological deficit. Two patients showed hypotensive somatosensory evoked potential loss (distal aortic pressure less than 40 mm Hg). Prolonged distal hypotension (85 minutes of aortic cross-clamping) in the latter resulted in paraplegia. We conclude that maintenance of a distal aortic pressure greater than 60 to 70 mm Hg will uniformly preserve spinal cord blood flow in the absence of critical intercostal exclusion. Should distal aortic pressure be inadequate, early reversible changes in the somatosensory evoked potential will alert the surgeon. Failure to institute measures to reverse these changes may result in paraplegia
— id: 107076, year: 1983, vol: 36, page: 417, stat: Journal Article,

PREVENTION OF ISCHEMIC SPINAL-CORD INJURY FOLLOWING AORTIC CROSSCLAMPING - USE OF CORTICOSTEROIDS
LASCHINGER, JC; CUNNINGHAM, JN; COOPER, MM; KRIEGER, K; NATHAN, IM; SPENCER, FC
1983 ;84(3):357-357, Chest
— id: 40633, year: 1983, vol: 84, page: 357, stat: Journal Article,

IMMEDIATE VS DELAYED INSTITUTION OF PULSATILE LEFT ATRIAL-FEMORAL ARTERY BYPASS - EFFECTS ON LIMITATION OF ACUTE INFARCT SIZE
LASCHINGER, JC; CUNNINGHAM, JN; GLASSMAN, E; KRIEGER, KH; NATHAN, IM; SPENCER, FC
1983 ;68(4):261-261, Circulation
— id: 40626, year: 1983, vol: 68, page: 261, stat: Journal Article,

DEFINITION OF THE SAFE LOWER LIMITS OF AORTIC RESECTION DURING SURGICAL-PROCEDURES ON THE THORACOABDOMINAL AORTA USE OF SOMATOSENSORY EVOKED-POTENTIALS
LASCHINGER, JC; CUNNINGHAM, JN; ISOM, OW; NATHAN, IM; SPENCER, FC
1983 ;1(2):697-697, Journal of the American College of Cardiology
— id: 40720, year: 1983, vol: 1, page: 697, stat: Journal Article,

INTERRUPTION OF VESSELS CRITICAL TO SPINAL-CORD BLOOD-SUPPLY - A CAUSE OF SPINAL-CORD ISCHEMIA DURING SURGERY ON THE THORACOABDOMINAL AORTA
LASCHINGER, JC; CUNNINGHAM, JN; KRIEGER, K; ISOM, OW; CULLIFORD, AT; SPENCER, FC
1983 ;84(3):363-363, Chest
— id: 40635, year: 1983, vol: 84, page: 363, stat: Journal Article,

DELAYED INSTITUTION OF PULSTILE LEFT ATRIAL-FEMORAL ARTERY BYPASS - EFFECTS ON REDUCTION OF MYOCARDIAL INFARCT SIZE
LASCHINGER, JC; CUNNINGHAM, JN; KRIEGER, KH; BAUMANN, FG; COOPER, MM; NATHAN, IM; SPENCER, FC
1983 ;34(1):258-261, Surgical forum
— id: 40866, year: 1983, vol: 34, page: 258, stat: Journal Article,

EXPERIMENTAL AND CLINICAL-ASSESSMENT OF THE ADEQUACY OF PARTIAL BYPASS IN MAINTENANCE OF SPINAL-CORD BLOOD-FLOW DURING OPERATIONS ON THE THORACIC AORTA
Laschinger, JC; Cunningham, JN; Nathan, IM; Knopp, EA; Cooper, MM; Spencer, FC
1983 ;36(4):417-426, Annals of thoracic surgery
— id: 30606, year: 1983, vol: 36, page: 417, stat: Journal Article,

Experience with the finger fracture technique to achieve intra-hepatic hemostasis in 75 patients with severe injuries of the liver
Pachter HL; Spencer FC; Hofstetter SR; Coppa GF
1983 Jun;197(6):771-778, Annals of surgery
The most important concept emerging from the management of complex hepatic trauma is that direct suture ligation of severed blood vessels and bile ducts is the most effective treatment. Three essential maneuvers are necessary: (1) the use of the finger fracture technique to expose the laceration widely, so that individual ligation of severed blood vessels and bile ducts can be accomplished under direct vision; (2) occluding the portal triad for 20 to 60 minutes; (3) closure of the hepatic incision over a viable omental pedicle. Two hundred consecutive patients with hepatic injuries were treated at the Trauma and Shock Unit of Bellevue Hospital between July 1976 and January 1982. One hundred and twenty-five injuries (63%) could be managed by superficial suture and drainage alone; 75 (37%) more extensive injuries required additional therapy; 47 of the 75 injuries required inflow occlusion for periods of up to 60 minutes, with the mean occlusion time of 30 minutes. All patients were pretreated with 30 to 40 mg/kg of Solu-Medrol prior to cross-clamping the portal triad. In addition, the liver was cooled to 27-32 degrees C topically by pouring 1 liter of iced Ringer's lactate directly on the liver surface, monitoring the temperature with an intra-hepatic probe. Ischemia time exceeded 20 minutes in 70%, 30 minutes in 40% and 60 minutes in 7% of patients. This approach, with complex hepatic trauma, has been dramatically effective. There were only four deaths (5.3%). One (1.3%) patient required reoperation for bleeding; three patients (4%) developed perihepatic abscesses; and two patients (3%) developed biliary fistulae that spontaneously closed. An extended right hepatectomy was necessary in the one patient who required reoperation for bleeding. This represents the only case of a formal hepatic resection in this series. Hepatic artery ligation was not employed in any case. These experiences strongly endorse the direct approach to the treatment of major hepatic lacerations by opening a lacerated liver sufficiently to ligate lacerated blood vessels and bile ducts, followed by closure over an omental pedicle. The wide-spread adoption of this technique will probably lower the mortality from massive liver injuries to 5-10%
— id: 59998, year: 1983, vol: 197, page: 771, stat: Journal Article,

Late functional and hemodynamic status of surviving patients following insertion of the left heart assist device
Rose DM; Colvin SB; Culliford AT; Isom OW; Cunningham JN Jr; Glassman E; Spencer FC
1983 Nov;86(5):639-645, Journal of thoracic & cardiovascular surgery
Since July, 1978, we have inserted a roller pump type of left heart assist device between the left atrium and ascending aorta in 35 patients. There were no significant complications related to use of the device. Seventeen patients recovered sufficiently to have the device removed. There were four early deaths, 60 to 120 days following removal of the device. Three of these patients died of septic complications and one patient died as a result of a cardiac arrest. Of the 13 long-term survivors, seven are working and six are retired. Five patients have mild to moderate cardiac symptoms, whereas eight others are completely asymptomatic. In three patients the ejection fraction was significantly lower than preoperatively; however, in all other patients the ejection fraction either stayed the same or improved postoperatively. We conclude that this type of left heart assist device can provide adequate cardiac support in patients with profound left ventricular dysfunction following cardiac operations. Furthermore, surviving patients generally have satisfactory long-term cardiac function and are leading productive lives
— id: 28932, year: 1983, vol: 86, page: 639, stat: Journal Article,

Emergency coronary bypass for acute infarction: an unproved clinical experiment
Spencer, F C
1983 Sep;68(3 Pt 2):II17-II19, Circulation
— id: 107077, year: 1983, vol: 68, page: II17, stat: Journal Article,

Presidential address. Intellectual creativity in thoracic surgeons
Spencer, F C
1983 Aug;86(2):163-179, Journal of thoracic & cardiovascular surgery
— id: 107079, year: 1983, vol: 86, page: 163, stat: Journal Article,

SYMPOSIUM ON ASSISTED CIRCULATION AND EMERGENCY CORONARY REVASCULARIZATION - INTRODUCTION
SPENCER, FC
1983 ;118(8):956-956, Archives of Surgery (Chicago)
— id: 40658, year: 1983, vol: 118, page: 956, stat: Journal Article,

Myocardial protection with cold blood potassium cardioplegia during prolonged aortic cross-clamping
Catinella, F P; Cunningham, J N Jr; Adams, P X; Snively, S L; Gross, R I; Spencer, F C
1982 Mar;33(3):228-233, Annals of thoracic surgery
The efficacy of cold blood potassium cardioplegia during periods of aortic cross-clamping (greater than 100 minutes) was assessed in 127 patients undergoing a variety of open-heart surgical procedures at New York University Medical Center from january, 1978, to April, 1979. Ischemic intervals ranged from 100 to 267 minutes (mean, 128 minutes). Cardiac-related deaths occurred in only 3 patients (2.4%), and overall operative mortality was 8.7% (11 patients). The rate of perioperative infarction was 10%. Fourteen patients (11%) required vasopressor support or balloon counterpulsation after cardiopulmonary bypass despite the lengthy cross-clamp intervals. Multivariate analysis revealed no significant relationship between the length of cross-clamp time and operative mortality (p = 0.29), incidence of perioperative infarction (p = 0.54), or the occurrence of low-output syndrome postoperatively (p = 0.68). These findings suggest that cold blood potassium cardioplegia provides adequate myocardial protection when periods of arrest as long as 3 to 4 hours are required for complex cardiac surgical procedures
— id: 107085, year: 1982, vol: 33, page: 228, stat: Journal Article,

The factors influencing early patency of coronary artery bypass vein grafts: correlation of angiographic and ultrastructural findings
Catinella, F P; Cunningham, J N Jr; Srungaram, R K; Baumann, F G; Nathan, I M; Glassman, E A; Knopp, E A; Spencer, F C
1982 May;83(5):686-700, Journal of thoracic & cardiovascular surgery
To test the hypothesis that suboptimal preparation of saphenous veins may adversely affect early patency of aorta-coronary artery bypass grafts, a nonrandomized prospective study was undertaken comparing two methods of saphenous vein preparation prior to grafting. Forty recatheterizations were performed during the postoperative hospital stay (approximately 10 days) in two groups of asymptomatic patients who had undergone isolated coronary artery bypass grafting. Veins from patients in Group I were bathed in autologous, heparinized blood at 20 degrees C and distended to 80 mm Hg, prior to grafting. The veins from Group II patients were prepared in an identical manner, except that the bathing solution consisted of heparinized electrolyte solution with added papaverine (0.6 mg/lg). Segments of vein from each group were obtained prior to grafting and preserved in 3% glutaraldehyde for subsequent electron microscopic studies. Operative technique in both groups of patients was identical and all procedures were performed by the same surgeons. Comparison of patients in Group I and II revealed no significant difference in the number of diseased vessels per patient (3.1 versus 3.4), number of grafts per patient (2.9 versus 2.9), native vessel diameter (1.9 versus 1.7 mm), and postoperative graft flows (65 versus 68 cc/min). However, early postoperative graft patency in Group II patients was 93% versus 80% in patients in Group I (p less thn 0.01). Electron microscopic analysis revealed severe spasm of venous smooth muscle in the blood-stored veins causing intraluminal smooth muscle cell cytoplasmic protrusions with resultant endothelial separation and desquamation. Formation of fibrin-platelet microaggregates was common. These findings were not present in the solution-treated veins. In view of these ultrastructural findings, and the highly significant difference in patency rates, we have abandoned all blood storage techniques and now prepare saphenous veins by soaking them in a clear bathing medium with added heparin and papaverine. Long-term follow-up of these patients is currently in progress and may reveal even more dramatic results than we have heretofore observed
— id: 106536, year: 1982, vol: 83, page: 686, stat: Journal Article,

SHORT-TERM EFFECTS OF HIGH FLOW-RATES ON ENDOTHELIAL-LINING OF VARIOUSLY PRESERVED VEIN GRAFTS
Catinella, FP; Baumann, FG; Cunningham, JN; Laschinger, JC; Spencer, FC
1982 ;66(4):135-135, Circulation
— id: 30370, year: 1982, vol: 66, page: 135, stat: Journal Article,

AN ULTRASTRUCTURAL COMPARISON OF ENDOTHELIAL PRESERVATION IN VEIN GRAFTS PREPARED BY VARIOUS TECHNIQUES
Catinella, FP; Cunningham, JN; Baumann, FG; Laschinger, JC; Spencer, FC
1982 ;1(6):393-402, Journal of clinical surgery
— id: 30642, year: 1982, vol: 1, page: 393, stat: Journal Article,

The third manpower study of thoracic surgery: 1980 report of the Ad Hoc Committee on Manpower of The American Association for Thoracic Surgery and The Society of Thoracic Surgeons
Cleveland, R J; Orthner, H F; Bahnson, H T; Ferguson, T B; Spencer, F C; Bonchek, L I; Kirsh, M M; Loop, F D
1982 Dec;84(6):921-932, Journal of thoracic & cardiovascular surgery
An ad hoc committee was appointed by The Society of Thoracic Surgeons (STS) in 1977 in order to determine the available manpower and workload of thoracic surgeons in 1976. This committee conducted a survey of the professional activities and geographic location of all known surgeons certified by the American Board of Thoracic Surgery (ABTS) at that time. A summary of this study indicated the available and projected thoracic surgery manpower. The report also determined the present and projected health care needs of the population of the United States through 1993. Because thoracic surgery needs to continue to meet the health care needs of the United States in an appropriate yet economical fashion, the STS and The American Association for Thoracic Surgery (AATS) undertook a joint review to determine again the available manpower and its workload in calendar year 1980. In addition, this study compared its findings with the 1976 report in order to detect changes in the workload and need for thoracic surgical services. A questionnaire was mailed to 3,584 certified thoracic surgeons. There were 2,675 responses. The material was sent to the Academic Computer Services at George Washington University Medical Center for tabulation and data processing. This report summarizes the results of this survey. It also compares these data with those obtained in the 1976 study and, based on this information, attempts to project the thoracic surgery manpower needs in the next decade by using several hypothetical models
— id: 107083, year: 1982, vol: 84, page: 921, stat: Journal Article,

The operative management of acute post-pneumonectomy bronchopleural fistula after flush bronchial amputation
Conlan, A A; Boyd, A D; Spencer, F C
1982 May 22;61(21):792-794, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde
Acute disruption of the bronchial closure after pneumonectomy causes severe problems in patient management. Radical attempts at closure of the fistula and space obliteration (thoracoplasty) carry a high mortality. The management of this condition by a series of staged operative procedures is described. Pneumonectomy has usually been performed for bronchogenic carcinoma and prognosis is therefore guarded. Several low-risk operative interventions, with discharge from hospital between procedures, provide a safe and effective management method in the case described
— id: 107042, year: 1982, vol: 61, page: 792, stat: Journal Article,

Aneurysms of the ascending aorta and transverse arch: surgical experience in 80 patients
Culliford AT; Ayvaliotis B; Shemin R; Colvin SB; Isom OW; Spencer FC
1982 May;83(5):701-710, Journal of thoracic & cardiovascular surgery
Aneurysms of the ascending aorta and transverse arch constitute formidable surgical challenges. To assess the impact of surgical techniques on operative morbidity and mortality and late results, we reviewed 80 consecutive patients operated from 1976 through 1980. Average age was 52 years and 81% were male. The operative mortality was 17.5% (14 deaths). In patients with aneurysm of the ascending aorta, operative deaths were due to cardiac factors (three patients), neurologic factors (three patients), cardiac factors (two patients), and exsanguination (one patient) accounted for the six operative deaths in patients with transverse arch aneurysms. Two late neurologic deaths occurred in this group. The following conclusions were reached when the surgical techniques were reviewed: Annuloaortic ectasia is best treated by insertion of a conduit with reimplantation of coronary ostia. Dissections are optimally managed by Dacron graft insertion in the ascending aorta and valve replacement. Aortic valve resuspension was done in six patients, with three undergoing subsequent aortic valve replacement for insufficiency. Aneurysms of the transverse arch treated with profound hypothermia and circulatory arrest were associated with fewer neurologic complications, and the operations were more expeditiously completed. Eleven of 80 patients (14%) had or subsequently needed additional surgical procedures on the aortic valve (insufficiency) or the distal aorta
— id: 28937, year: 1982, vol: 83, page: 701, stat: Journal Article,

Measurement of spinal cord ischemia during operations upon the thoracic aorta: initial clinical experience
Cunningham, J N Jr; Laschinger, J C; Merkin, H A; Nathan, I M; Colvin, S; Ransohoff, J; Spencer, F C
1982 Sep;196(3):285-296, Annals of surgery
Paraplegia has been an unpredictable, devasting complication following operations upon the thoracoabdominal aorta for over 30 years. The frequency ranges from 0.5% with operations for coarctation to as high as 15% following surgery for thoracoabdominal aneurysms. Both uncertainty and controversy exist about the value of different protective methods during aortic crossclamping (AXC): heparinized shunts, partial bypass, and reimplantation of intercostal arteries. This report describes the authors' initial clinical experience with a highly sensitive indicator of spinal cord ischemia, somatosensory evoked potentials (SEP) in an attempt to prevent paraplegia associated with surgical procedures on the thoracoabdominal aorta. Seven consecutive patients (one coarctation, five thoracic aneurysms, one thoracoabdominal aneurysm) underwent continuous operative monitoring of SEP. Cortical response to simultaneous electrical stimulation (20 mAmps, 0.6 mSec., 2.3 cps) of both the right and left posterior tibial nerves was recorded before, during, and after AXC, and following operation. When ischemic changes were detected by SEP, increasing distal circulation by different maneuvers (heparinized shunt, femoral-femoral bypass, reimplantation of intercostal arteries) reversed these changes. In two patients with thoracic aneurysms, ischemic changes appeared within three minutes after AXC and all potentials disappeared in nine minutes. Rapid insertion of a graft (AXC 28 and 37 minutes) resulted in SEP return 40 minutes following restoration of flow. These changes were prevented by a heparinized shunt in two patients, femoral/femoral bypass in one, and T8-T9 intercostal reimplantation in one. No SEP changes occurred in the patient with coarctation. No postoperative neurologic complications occurred. Continuous operative monitoring of SEP has exciting possibilities for preventing paraplegia. It is simple, highly sensitive, and seems to provide a precise measurement of adequacy of circulation to the spinal cord
— id: 67649, year: 1982, vol: 196, page: 285, stat: Journal Article,

PREVENTION OF INFARCT EXTENSION BY PULSATILE LEFT ATRIAL- FEMORAL ARTERY BYPASS
Cunningham, JN; Laschinger, JC; Catinella, FP; Glassman, E; Nathan, IM; Spencer, FC
1982 ;33(1):328-331, Surgical forum
— id: 30670, year: 1982, vol: 33, page: 328, stat: Journal Article,

Release of particulate matter from extracorporeal tubing: ineffectiveness of standard arterial line filters during bypass
Knopp, E A; Baumann, F G; Pratt, D; Faden, R; Catinella, F P; Nathan, I M; Adams, P X; Cunningham, J N Jr; Spencer, F C
1982 Nov-Dec;23(6):470-476, Journal of cardiovascular surgery
Microemboli resulting from extracorporeal circulation have been considered to be a cause of organ dysfunction after cardiopulmonary bypass. A scanning electron microscopic study was carried out to quantitate the number of nonbiological particles which escape capture by the arterial line filter in a standard extracorporeal circulation circuit. Five different lots of polyvinylchloride (PVC) tubing from the same manufacturer were used in closed circuit extracorporeal pump set-ups consisting of a typical length of PVC tubing, a cardiotomy reservoir, and an arterial line filter (Pall 40 microns (mu)). A liter of Plasmalyte was circulated through this set-up for 15 minutes at 2 liters/minute with the pump head set at almost total occlusion. The circulated Plasmalyte from each pump line was then collected and passed through a 0.22 mu Millipore filter. Numerous particles ranging from 5-40 mu in diameter were observed on the surface of the filters. A mean of 51.2 particles/mm2 of filter was found after the first recirculation period. By extrapolation the mean total number of particles contained in the Plasmalyte was calculated to be 70,943. A second similar 15 minute rinse on the same pump set-ups revealed the release of a mean of 51.0 particles/mm2, or a mean total number of 70,665 particles. Analysis of variance showed no significant difference in the number of particles produced by the first compared with the second recirculation period but there were significant differences (P less than .05) between the numbers of particles produced by the different lots of tubing. This study demonstrates that commonly employed tubing packs and standard roller pump designs for extracorporeal circulation are associated with continuous release of particulate matter (5-40 mu) which is not removed by the arterial line filters most often employed. These particles seem to be released at a constant rate which makes an initial pre-bypass filtration run ineffective. Such particles can only be removed by continuous use of lower porosity filters in the pump circuit. The clinical significance of these large numbers of small particles is unknown, but they may contribute to the multi-organ failure often seen in prolonged (greater than 2 hour) periods of cardiopulmonary bypass
— id: 106533, year: 1982, vol: 23, page: 470, stat: Journal Article,

Management of the calcified aorta during myocardial revascularization
Landymore R; Spencer F; Colvin S; Culliford A; Trehan N; Cartier P; Floten S
1982 Oct;84(3):455-456, Journal of thoracic & cardiovascular surgery
— id: 45693, year: 1982, vol: 84, page: 455, stat: Journal Article,

Myocardial cooling: beneficial effects of topical hypothermia
Laschinger, J C; Catinella, F P; Cunningham, J N Jr; Knopp, E A; Nathan, I M; Spencer, F C
1982 Dec;84(6):807-814, Journal of thoracic & cardiovascular surgery
— id: 107084, year: 1982, vol: 84, page: 807, stat: Journal Article,

Early open radical commissurotomy: surgical treatment of choice for mitral stenosis
Laschinger, J C; Cunningham, J N Jr; Baumann, F G; Isom, O W; Catinella, F P; Mendelsohn, A; Adams, P X; Spencer, F C
1982 Sep;34(3):287-298, Annals of thoracic surgery
Between 1967 and 1979, 411 patients underwent surgical treatment of isolated mitral stenosis at our institution. Open radical mitral commissurotomy was performed in 150 patients (1967-1978; mean follow-up, 46 months; range, 4 to 116 months). Mitral valve replacement using a porcine prosthesis was performed in 74 patients (1976-1979; mean follow-up, 23 months; range, 2 to 48 months). Mitral valve replacement with a cloth-covered Starr-Edwards prosthesis was performed in 187 patients (1967-1975; mean follow-up, 45 months; range, 2 to 106 months). Preoperative characteristics were similar in the three groups. The open commissurotomy and Starr-Edwards groups were followed up to 9 years and the porcine valve group up to 4 years, with 97% follow-up in each group. Life-table analysis (6-month intervals) of all postoperative complications revealed significantly greater complication-free survival for patients who had open radical commissurotomy compared with Starr-Edwards (p less than 0.05) valve replacement. Similar analysis of thromboembolic and warfarin-related complications revealed significantly fewer complications in commissurotomy patients. No significant differences were found (p greater than 0.05) when comparing the need for subsequent reoperation in each group. Operative mortality following open radical mitral commissurotomy (0%; 0 out of 150) was significantly less (p less than 0.05) than after mitral valve replacement in both porcine (8.1%; 6 out of 74) and Starr-Edwards (11.2%; 21 out out 187) groups. Life-table analysis of late cardiac-related mortality revealed a significantly greater cumulative survival rate for the commissurotomy versus the Starr-Edwards groups at all intervals from 12 to 108 months (100 versus 84 +/- 5%, p less than 0.05). No significant differences were noted between commissurotomy and porcine valve groups during the 4-year follow-up period (100 +/- 0% versus 96 +/- 3%, p greater than 0.05). Based on these findings, we conclude that when the anatomy is favorable, the surgical treatment of choice for isolated mitral stenosis is open radical mitral commissurotomy
— id: 106535, year: 1982, vol: 34, page: 287, stat: Journal Article,

Protection of regional myocardium with blood cardioplegia following chronic coronary occlusion
Laschinger, J C; Cunningham, J N Jr; Catinella, F P; Baumann, F G; Nathan, I M; Spencer, F C
1982 Sep-Oct;39(5):323-326, Current surgery
— id: 106534, year: 1982, vol: 39, page: 323, stat: Journal Article,

Detection and prevention of intraoperative spinal cord ischemia after cross-clamping of the thoracic aorta: use of somatosensory evoked potentials
Laschinger, J C; Cunningham, J N Jr; Catinella, F P; Nathan, I M; Knopp, E A; Spencer, F C
1982 Dec;92(6):1109-1117, Surgery
— id: 107082, year: 1982, vol: 92, page: 1109, stat: Journal Article,

DETECTION AND PREVENTION OF INTRA-OPERATIVE SPINAL-CORD ISCHEMIA AFTER CROSS-CLAMPING OF THE THORACIC AORTA - USE OF SOMATOSENSORY EVOKED-POTENTIALS
LASCHINGER, JC; CUNNINGHAM, JN; CATINELLA, FP; NATHAN, IM; KNOPP, EA; SPENCER, FC
1982 ;92(6):1109-1117, Surgery
— id: 40367, year: 1982, vol: 92, page: 1109, stat: Journal Article,

Long-term survival with partial left heart bypass following perioperative myocardial infarction and shock
Rose DM; Colvin SB; Culliford AT; Cunningham JN; Adams PX; Glassman E; Isom OW; Spencer FC
1982 Apr;83(4):483-492, Journal of thoracic & cardiovascular surgery
During the period from July 1, 1978 to Dec. 31, 1980, we employed a partial left heart bypass (left atrium to ascending aorta) in 16 patients who could not be weaned from cardiopulmonary bypass with inotropic agents and the intra-aortic balloon pump. Flow rates up to 3,500 ml/min could be obtained with this device. Eight of the 16 patients survived and left the hospital. One patient died of a cardiac arrest 4 months postoperatively and one has recurrent angina and moderate congestive heart failure 24 months postoperatively. Six patients are well 5 to 17 months after discharge. Seven of the eight deaths were characterized by progressive myocardial failure. One patient died of ventricular fibrillation 18 hours after discontinuation of the left heart bypass. All survivors had significant improvement in ventricular function 12 to 24 hours afer institution of the left heart bypass, which was continued for 16 to 68 hours. These results indicate that early institution of left heart bypass in seriously ill patients can provide satisfactory long-term results
— id: 28938, year: 1982, vol: 83, page: 483, stat: Journal Article,

Thoracic surgeons and vascular surgery
Spencer, F C
1982 Feb;33(2):107-113, Annals of thoracic surgery
— id: 107086, year: 1982, vol: 33, page: 107, stat: Journal Article,

THORACIC SURGEONS AND VASCULAR-SURGERY
Spencer, FC
1982 ;33(2):107-113, Annals of thoracic surgery
— id: 30491, year: 1982, vol: 33, page: 107, stat: Journal Article,

Scanning electron microscopic study of endothelial damage resulting from vein graft contraction during preparation
Yoder, M J; Baumann, F G; Castro, G H; Catinella, F P; Cunningham, J N Jr; Laschinger, J C; Spencer, F C
1982 ;(Pt 3):1221-1228, Scanning electron microscopy
Preservation of the endothelial lining of veins during preparation as grafts appears likely to play a critical role in subsequent early graft patency rates. 82 cephalic veins from 41 dogs were divided into 6 major groups by the type of heparinized vein preservation solution used. Veins were soaked for 5 min. or 1 hr. at either 10 degrees C or 20 degrees C in one of the following solutions with or without 60mg/100 ml of papaverine added: Plasma-Lyte 148 autologous blood, or Fluosol DA (an oxygenated perfluorocarbon emulsion). A segment was removed from each vein as soon as it was dissected free and perfused with fixative at 30 mm Hg as a control. In 4 additional dogs both cephalic veins were perfusion fixed in situ as further controls. SEM examination of the vein grafts' luminal surface after storage in the various preservation solutions showed that the greatest single cause of endothelial cell damage or loss was the extent to which the vein was permitted to undergo vigorous contraction during preparation and storage prior to use as an arterial graft. Preparation solutions which contained the smooth muscle cell relaxant papaverine, therefore, minimized endothelial protrusion and loss. In this regard Plasma-Lyte plus papaverine maintained at 20 degrees C was the most satisfactory of the solutions tested
— id: 106538, year: 1982, vol: , page: 1221, stat: Journal Article,

SCANNING ELECTRON-MICROSCOPIC STUDY OF ENDOTHELIAL DAMAGE RESULTING FROM VEIN GRAFT CONTRACTION DURING PREPARATION
Yoder, MJ; Baumann, FG; Castro, GH; Catinella, FP; Cunningham, JN; Laschinger, JC; Spencer, FC
1982 ;9(4):1221-1228, Scanning microscopy
— id: 30659, year: 1982, vol: 9, page: 1221, stat: Journal Article,

Vein contraction and smooth muscle cell extensions as causes of endothelial damage during graft preparation
Baumann, F G; Catinella, F P; Cunningham, J N Jr; Spencer, F C
1981 Aug;194(2):199-211, Annals of surgery
Meticulous preservation of the endothelial lining of vein grafts harvested during vascular operations is undoubtedly an important factor in determining patency rates following bypass procedures. Destruction of the vein graft's endothelial lining prior to graft implantation results in a more thrombogenic graft which is essentially a collagen-lined tube. This study used light, transmission, and scanning electron microscopy to investigate effects of various methods of vein graft preparation on endothelial and smooth muscle cells of the dog cephalic vein. Veins were removed and stored in one of three heparinized solutions at 10 C for either five minutes or one hour: autologous blood, Plasmalyte((R)) or Plasmalyte((R)) with 0.6 mg/ml papaverine HCI added. The vein wall was extremely sensitive to dissection, manipulation, or introduction of fixative solutions and reacted to such stimuli with severe contraction which not only diminished the luminal diameter but also resulted in protrusion of endothelial cells into the lumen and formation of cytoplasmic extensions of medial smooth muscle cells. Such cytoplasmic extensions were particularly frequent in the immediate subendothelial area and appeared to be instrumental in elevating, separating, or desquamating the endothelial cell lining. Veins stored in blood alone demonstrated the greatest vessel wall contraction and endothelial cell loss. Veins soaked in Plasmalyte((R))-papaverine solution had the most relaxed and normal appearance with minimal endothelial cell loss. Papaverine-treated veins which were subjected to brief periods of distension at pressures of 100 mmHg or greater demonstrated large gaps between the endothelial lining cells. The results suggest pretreatment with papaverine greatly reduces vein graft endothelial cell loss due to contraction, although such relaxation may be detrimental if vein grafts are subjected to excessive pressure prior to reversal of relaxation
— id: 106540, year: 1981, vol: 194, page: 199, stat: Journal Article,

VEIN CONTRACTION AND SMOOTH-MUSCLE CELL EXTENSIONS AS CAUSES OF ENDOTHELIAL SLOUGHING DURING GRAFT PREPARATION
BAUMANN, FG; CATINELLA, FP; CUNNINGHAM, JN; SPENCER, FC
1981 ;46(1):222-222, Thrombosis & haemostasis
— id: 40163, year: 1981, vol: 46, page: 222, stat: Journal Article,

Immediate reconstruction of full-thickness chest wall defects
Boyd AD; Shaw WW; McCarthy JG; Baker DC; Trehan NK; Acinapura AJ; Spencer FC
1981 Oct;32(4):337-346, Annals of thoracic surgery
Twenty-one patients had full-thickness chest wall defects reconstructed at the New York University Medical Center in the last ten years. Marlex mesh provided chest wall stability in 5 patients. In 9 patients with radiation ulcers Marlex mesh was not required; a severe fibrotic reaction had obliterated the pleural space and prevented paradoxical motion. Partial sternal resections did not require Marlex stabilization, while a total sternectomy resulted in marked ventilatory insufficiency in a patient who would have benefited from the use of a stabilizing material. Random pattern flaps were used initially; more recently, axial pattern, myocutaneous, and myocutaneous free flaps were employed. Necrosis developed in 4 (36%) of the 11 patients with random pattern flaps, but was not seen with the newer flap techniques. Myocutaneous free flaps provided uncomplicated coverage of and stability to three large, potentially contaminated defects. It seems that with the currently available flap techniques and the methods of chest wall stabilization, immediate repair of all full-thickness chest wall defects is possible
— id: 18164, year: 1981, vol: 32, page: 337, stat: Journal Article,

Blood potassium cardioplegia preserves ATP and ventricular function for three hours of aortic crossclamping
Catinella, F P; Cunningham, J N Jr; Paone, G; Knopp, E A; Nathan, I M; Spencer, F C
1981 Nov-Dec;38(6):387-391, Current surgery
— id: 107087, year: 1981, vol: 38, page: 387, stat: Journal Article,

Blood potassium cardioplegia administration. Comparison of myocardial protection offered by three techniques
Catinella, F P; Cunningham, J N Jr; Srungaram, R K; Nathan, I M; Knopp, E A; Paone, G; Baumann, F G; Adams, P X; Spencer, F C
1981 Dec;116(12):1509-1516, Archives of Surgery (Chicago)
To investigate the best method of administration of blood potassium cardioplegia, 19 dogs were studied while undergoing 120 minutes each of aortic crossclamping (myocardial temperature, less than 15 degrees C). Group 1 (six dogs) underwent a single 120-minute period of aortic crossclamping with the heart protected by multiple reinjections (1,000 mL every 30 minutes) of blood potassium cardioplegia solution (potassium chloride, 30 mEq/L; pH, 8; temperature, less than 15 degrees C). Group 2 (six dogs) underwent four separate 30-minute periods of aortic crossclamping, but allowing hearts to beat in a nonworking state for 20 minutes at 35 degrees C between each arrest interval. Hearts in group 3 (seven dogs) were initially arrested as described above, following which a continuous infusion (75 mL/min; KCl, 10 mEq/L) of blood potassium cardioplegia solution was maintained throughout the arrest period. Measurements of myocardial metabolism, ventricular function, regional blood flow, and ultrastructure were carried out before arrest and 30 minutes after final unclamping. Analysis of the data revealed no significant benefit of one method over another, with the exception that adenosine triphosphate level was least preserved with intermittent unclamping and reperfusion. Because continuous perfusion techniques are more cumbersome than multidose reinjection, and intermittent aortic crossclamping lengthens total cardiopulmonary bypass time, we favor the simplest approach, multidose reinjection during a single uninterrupted period of aortic crossclamping
— id: 106539, year: 1981, vol: 116, page: 1509, stat: Journal Article,

SYNTHESIS AND PRESERVATION OF MYOCARDIAL ATP - BLOOD CARDIOPLEGIA IS SUPERIOR TO CRYSTALLOID CARDIOPLEGIA
CATINELLA, FP; CUNNINGHAM, JN; SRUNGARAM, R; NATHAN, IM; KNOPP, EA; SPENCER, FC
1981 ;80(3):368-368, Chest
— id: 40192, year: 1981, vol: 80, page: 368, stat: Journal Article,

Lack of correlation between activated clotting time and plasma heparin during cardiopulmonary bypass
Culliford AT; Gitel SN; Starr N; Thomas ST; Baumann FG; Wessler S; Spencer FC
1981 Jan;193(1):105-111, Annals of surgery
The activated clotting time (ACT) with a Hemochron system for determining heparin requirements during cardiopulmonary bypass surgery, (CPB) accompanied by hemodilution and hypothermia was evaluated using plasma heparin levels as a standard. In 28 patients who were administered a standard heparin regimen (300 units/kg prebypass, 8000 units in the pump prime and 100 units/kg hourly during CPB) mean prebypass plasma heparin was 4 units/ml, and ACT was 493 seconds. During CPB mean plasma heparin decreased significantly (p < 0.001) to 3.1 units/ml, whereas mean ACT increased significantly (p < 0.001) to 674 seconds. The mean protamine requirement predicted from ACT was significantly higher (43%) than predicted from plasma heparin levels or actual protamine administered. The ACT neither accurately reflected plasma heparin during CPB nor predicted protamine requirements. The fixed-dose regimen employed, however, prevented both intraoperative thrombosis, assessed clinically in all patients, and clotting on six arterial line filters, as determined by scanning EM, despite wide variations in ACT and plasma heparin levels during surgery
— id: 28939, year: 1981, vol: 193, page: 105, stat: Journal Article,

PROPOSED MECHANISM FOR EARLY VEIN GRAFT THROMBOSIS
Cunningham, JN; Catinella, FP; Baumann, FG; Nathan, IM; Adams, PX; Spencer, FC
1981 ;32(1):239-241, Surgical forum
— id: 30335, year: 1981, vol: 32, page: 239, stat: Journal Article,

Gibbon cirugia toracica = [Gibbon's surgery of the chest]
Gibbon, John Heysham; Sabiston, David C; Spencer, Frank Cole
Barcelona : Salvat, 1981,
— id: 986, year: 1981, vol: , page: , stat: ,

Long-term results of open radical mitral commissurotomy: ten year follow-up study of 202 patients
Gross, R I; Cunningham, J N Jr; Snively, S L; Catinella, F P; Nathan, I M; Adams, P X; Spencer, F C
1981 Apr;47(4):821-825, American journal of cardiology
— id: 107088, year: 1981, vol: 47, page: 821, stat: Journal Article,

IMPORTANCE OF TOPICAL HYPOTHERMIA TO ENSURE UNIFORM MYOCARDIAL COOLING DURING CORONARY-ARTERY BYPASS
LANDYMORE, RW; TICE, D; TREHAN, N; SPENCER, F
1981 ;82(6):832-836, Journal of thoracic & cardiovascular surgery
— id: 40299, year: 1981, vol: 82, page: 832, stat: Journal Article,

Evolving concepts in splenic surgery: splenorrhaphy versus splenectomy and postsplenectomy drainage: experience in 105 patients
Pachter HL; Hofstetter SR; Spencer FC
1981 Sep;194(3):262-269, Annals of surgery
— id: 60001, year: 1981, vol: 194, page: 262, stat: Journal Article,

ACUTE HEMODYNAMIC-EFFECTS OF A LEFT HEART ASSIST DEVICE IN PATIENTS WITH PROFOUND CARDIAC-FAILURE FOLLOWING CARDIAC-SURGERY
ROSE, DM; COLVIN, SB; CULLIFORD, AT; ADAMS, PX; CUNNINGHAM, JN; ISOM, OW; GLASSMAN, E; SPENCER, FC
1981 ;64(4):201-201, Circulation
— id: 50322, year: 1981, vol: 64, page: 201, stat: Journal Article,

Principios de cirurgia
Schwartz, Seymour I.; Shires, G. Tom; Spencer, Frank Cole; Storer, Edward H
Rio de Janeiro : Editora Guanabara Koogan S.A., c1981,
— id: 26, year: 1981, vol: , page: , stat: ,

BLOOD VERSUS CRYSTALLOID CARDIOPLEGIA - WHICH IS SUPERIOR FOR PROLONGED AORTIC CROSS-CLAMPING
Srungaram, RK; Cunningham, JN; Catinella, FP; Knopp, EA; Nathan, IM; Spencer, FC
1981 ;32(1):288-290, Surgical forum
— id: 30336, year: 1981, vol: 32, page: 288, stat: Journal Article,

IMPORTANCE OF IONIZED CALCIUM CONCENTRATIONS IN SECONDARY BLOOD CARDIOPLEGIA SOLUTIONS
STRAUSS, ED; CUNNINGHAM, JN; SCHNEINERMAN, SJ; CATINELLA, FP; KNOPP, EA; ADAMS, PX; SPENCER, FC
1981 ;80(3):368-368, Chest
— id: 40193, year: 1981, vol: 80, page: 368, stat: Journal Article,

Clinical experience with potassium cold blood cardioplegia [at] New York University Medical Center
Culliford A; Cunningham J; Adams P; Spencer F
Surgery for the complications of myocardial infarction New York : Grune & Stratton, 1980,
— id: 3807, year: 1980, vol: , page: 119, stat: Chapter,

Operation for chronic constrictive pericarditis: Do the surgical approach and degree of pericardial resection influence the outcome significantly?
Culliford AT; Lipton M; Spencer FC
1980 Feb;29(2):146-152, Annals of thoracic surgery
Our experience with 27 patients undergoing pericardiectomy at New York University Medical Center over the past 13 years has evolved a radical pericardiectomy operation suggesting that two traditional concepts are erroneous: (1) pericardiectomy limited to the anterior and lateral surfaces of the ventricles is an adequate operation and (2) delayed recovery is due to myocardial 'atrophy' and not to inadequate operation. Radical pericardiectomy entails removal of virtually the entire parietal pericardium from all cardiac surfaces including that of both ventricles, the right atrium, and the venae cavae. Performed in 22 patients by dissecting a cleavage plane between the thickened parietal pericardium and underlying epicardium, all procedures were done through a sternotomy. Intraoperative monitoring of arterial pressure, cardiac output, and wedge pressure is essential because of displacement of the left ventricle. The left ventricle can be completely mobilized so that at the end of the operation the entire heart can be lifted upward and the course of the coronary sinus fully visualized. Intraoperative pressure measurements demonstrate that this radical resection immediately corrects hemodynamic abnormalities (elevated right atrial and ventricular end-diastolic pressures), as demonstrated in 10 patients. Most patients undergo massive diuresis (7 to 16 kg) within two weeks, with an uneventful recovery. These findings contrast markedly with early experiences using a conventional limited pericardiectomy
— id: 28941, year: 1980, vol: 29, page: 146, stat: Journal Article,

Fulminating noncardiogenic pulmonary edema. A newly recognized hazard during cardiac operations
Culliford AT; Thomas S; Spencer FC
1980 Dec;80(6):868-875, Journal of thoracic & cardiovascular surgery
At New York University Medical Center over the past 18 months, a distinctive and potentially lethal syndrome of fulminating noncardiogenic pulmonary edema has been observed in three patients following cardiopulmonary bypass. The clinical appearance is virtually identical to that produced by acute left ventricular failure, and the condition could have been diagnosed incorrectly in the past as myocardial infarction with left ventricular failure and pulmonary edema. Thus it is uncertain whether this is a new syndrome or whether it has long been present. Fulminating noncardiogenic pulmonary edema can be diagnosed by finding a low left atrial or pulmonary artery wedge pressure combined with a high protein content in the pulmonary edema fluid when compared to simultaneous measurements of the plasma protein level. As no other etiologic agent could be identified in our three patients, the probable cause seems to be an unknown type of allergic reaction to blood or blood products, manifested by acute pulmonary edema--the pulmonary capillary membranes being the first to be exposed to fluids administered intravenously. The significant point is that a nearly fatal degree of pulmonary congestion can be managed safely and effectively with corticosteroids, antihistamines, positive-pressure ventilation, diuretics, and albumin. Presently, two important questions remain: (1) Should fluids be restricted and balloon pump counterpulsation and vasopressors utilized to maintain systemic pressure? (2) How long after administration of steroids is it safe to give intravenous albumin? Meanwhile, both the mechanism and frequency of this syndrome remain unknown
— id: 28940, year: 1980, vol: 80, page: 868, stat: Journal Article,

PORCINE VALVES - IS THERE A DIFFERENCE
Isom, OW; Culliford, A; Colvin, S; Cunningham, J; Adams, P; Trehan, N; Leist, A; Cordone, R; Spencer, F
1980 ;62(4):156-156, Circulation
— id: 27963, year: 1980, vol: 62, page: 156, stat: Journal Article,

Unilateral sudden loss of hearing: an unusual complication of cardiac operation
Plasse HM; Spencer FC; Mittleman M; Frost JO
1980 Jun;79(6):822-826, Journal of thoracic & cardiovascular surgery
Between 1969 and 1978 7,000 patients underwent cardiopulmonary bypass at Bellevue and University Hospitals. In seven of these patients, sudden loss of hearing in one ear developed immediately after the operation. Four of the seven patients showed improvement in hearing after the initial loss, although in no case did the hearing return completely to normal. None of the patients had vertigo but two were listless postoperatively. Two of the operations were for congenital heart disease; the remainder were coronary artery bypass procedures. All of the affected patients were male. There was no predilection as to which ear was affected. The most likely cause is particulate emboli generated by cardiopulmonary bypass. Other possible sources of emboli include air, antifoam, fat, and particulate matter from calcified valves and the aorta. Improvement in the kind of pump and the addition of various filters in the period between 1969 and 1978 did not eliminate unilateral hearing loss. The relationship between cerebral emboli and decreased consciousness after operations is also discussed
— id: 26401, year: 1980, vol: 79, page: 822, stat: Journal Article,

A clinical evaluation of cricothyroidotomy
Boyd AD; Romita MC; Conlan AA; Fink SD; Spencer FC
1979 Sep;149(3):365-368, Surgery, gynecology & obstetrics
Cricothyroidotomies were performed upon 147 patients at the New York University Medical Center and Booth Memorial Center from March 1976 through February 1978. Cricothyroidotomy was demonstrated to be a rapid and technically simple and precise procedure. The incidence of complications was 8.6 per cent. Catastrophic complications occurred in two patients who had severe laryngeal stenosis. Cricothyroidotomy was performed following prolonged endotracheal intubation in these two patients who had airway obstruction immediately following endotracheal extubation. In both patients, there was a glottic and subglottic component to the laryngeal stenosis suggesting that endotracheal intubation as well cricothyroidotomy played a critical part in the development of laryngeal stenosis. In view of these observations, we believe that cricothyroidotomy is useful, particularly in emergency situations and in patients with median sternotomy incisions but is contraindicated in patients having endotracheal intubation of more than seven days' duration or in patients having airway obstruction develop following removal of an endotracheal tube except as a temporary lifesaving procedure
— id: 19515, year: 1979, vol: 149, page: 365, stat: Journal Article,

A special rongeur for removal of extensively calcified mitral valves
Culliford AT; Boyd AD; Spencer FC
1979 Dec;28(6):605-606, Annals of thoracic surgery
A rare complication of advanced mitral valve disease occurs when calcium extends from the valve downward along the wall of the left ventricle into the ventricular cavity. This unusual condition can be recognized on fluoroscopy because the calcium is visible at right angles to the calcium in the valve. The surgeon faces a very difficult technical problem because it is hard to obtain adequate exposure and to remove the calcium without injury to adjacent tissues or loss of calcific fragments, with resulting embolization. Such difficulties were encountered a year ago in a patient undergoing mitral and aortic valve replacement and ultimately resulted in the patient's death. After this event, the special rongeurs described here were designed
— id: 28942, year: 1979, vol: 28, page: 605, stat: Journal Article,

Angina following myocardial revascularization. Does time of recurrence predict etiology and influence results of operation?
Culliford AT; Girdwood RW; Isom OW; Krauss KR; Spencer FC
1979 Jun;77(6):889-895, Journal of thoracic & cardiovascular surgery
To assess the operative mortality and long-term results in patients undergoing repeat revascularization for recurrent angina, we analyzed 48 consecutive patients operated upon at New York University Medical Center between 1970 and 1978. Between January, 1970, and July, 1973, 15 patients underwent repeat revascularization with five operative deaths (33 percent). Thirty-three patients underwent similar operations from July, 1973, to July, 1978, with only one operative death (3 percent). Technical factors and improved methods of myocardial protection during the operation directly influence this decrease in operative mortality rate. The indication for reoperation was incapacitating angina developing within 2 months of the inital operation in 18 patients (early failures) and after more than 2 months in 30 patients (late failures). The early failures were most commonly attributed to technical factors (33 percent) and graft occlusion by exuberant pericardial scarring (33 percent). The late failures were commonly related to the development of new native coronary lesions (47 percent) and selection of an incorrect site for distal anastomoses (23 percent). The prognostic and therapeutic implications of these findings will be discussed in detail. Angina was abolished or significantly decreased in 90 percent of the survivors, and there were only two late deaths occuring 18 and 20 months postoperatively. These data indicate that patients undergoing repeat myocardial revascularization can be operated upon with low operative mortality rates and symptomatic improvement comparable to that of patients undergoing coronary artery bypass for the first time
— id: 28944, year: 1979, vol: 77, page: 889, stat: Journal Article,

Guidelines for safely opening a previous sternotomy incision
Culliford AT; Spencer FC
1979 Oct;78(4):633-638, Journal of thoracic & cardiovascular surgery
Operations through a previous sternotomy incision are associated with significant hazards, including cardiac injury, excessive hemorrhage during and after cardiopulmonary bypass, and postoperative sternal instability. A technique for safely opening previous sternotomy incisions has been developed at New York University Medical Center which has proved satisfactory in over 150 patients. It has been demonstrated repeatedly to be free of the serious and often lethal intraoperative and postoperative complications previously associated with this procedure
— id: 28943, year: 1979, vol: 78, page: 633, stat: Journal Article,

Constant-pressure aortic root perfusion versus cardioplegia and hypothermia. Comparison of methods of myocardial protection
Cunningham, J N Jr; Abbas, J S; Adams, P X; Nathan, I; Klugman, I; Spencer, F C
1979 Apr;77(4):496-503, Journal of thoracic & cardiovascular surgery
Both coronary perfusion and hypothermic cardioplegia are widely used methods of myocardial protection during aortic valve replacement. A theoretical objection to coronary perfusion is that it is not synchronized with cardiac contractions. Accordingly, a special pump was designed to provide perfusion at a constant range of pressure. Twenty dogs were studied during 4 hours of bypass. In six dogs no manipulations were carried out and hearts were allowed to beat in a nonworking state. Seven dogs underwent 2 hours of aortic cross-clamping and constant-pressure aortic root perfusion. Seven dogs underwent 2 hours of uninterrupted aortic occlusion with myocardial protection being maintained by cold potassium-induced arrest, Contractility did not change significantly in any of the three groups. All animals demonstrated significant hyperemia after bypass but normal endocardial/epicardial flow ratios. Although compliance deteriorated in all groups, the most striking changes were seen following 4 hours of bypass alone or constant-pressure aortic root perfusion. Hypothermic potassium arrest, in contrast, provided a slightly greater degree of myocardial protection, perhaps both by limiting the degree of ischemic injury directly and by excluding the heart from the circulating blood and the pump oxygenator system
— id: 107092, year: 1979, vol: 77, page: 496, stat: Journal Article,

Preservation of ATP, ultrastructure, and ventricular function after aortic cross-clamping and reperfusion. Clinical use of blood potassium cardioplegia
Cunningham, J N Jr; Adams, P X; Knopp, E A; Baumann, F G; Snively, S L; Gross, R I; Nathan, I M; Spencer, F C
1979 Nov;78(5):708-720, Journal of thoracic & cardiovascular surgery
— id: 106541, year: 1979, vol: 78, page: 708, stat: Journal Article,

CLINICAL USE OF POTASSIUM BLOOD CARDIOPLEGIA - PRESERVATION OF ADENOSINE-TRIPHOSPHATE, ULTRASTRUCTURE, AND VENTRICULAR-FUNCTION FOLLOWING AORTIC CROSSCLAMPING AND REPERFUSION
CUNNINGHAM, JN; ADAMS, PX; ISOM, OW; KNOPP, EA; BAUMANN, FG; CULLIFORD, AC; COLBIN, S; SPENCER, FC
1979 ;79(13):2042-2042, New York state journal of medicine
— id: 50126, year: 1979, vol: 79, page: 2042, stat: Journal Article,

Trends in cardiovascular surgery (1961 to 1977): review of the New York City and State experience
Griffiths, S P; Zazula, B M; Courtney, D; Spencer, F C; Malm, J R
1979 Sep;44(3):555-562, American journal of cardiology
— id: 107090, year: 1979, vol: 44, page: 555, stat: Journal Article,

TRENDS IN CARDIOVASCULAR-SURGERY (1961 TO 1977) - REVIEW OF NEW-YORK-CITY AND STATE EXPERIENCE
Griffiths, SP; Zazula, BM; Courtney, D; Spencer, FC; Malm, JR
1979 ;44(3):555-562, American journal of cardiology
— id: 30002, year: 1979, vol: 44, page: 555, stat: Journal Article,

Simplified distal pancreatectomy with the Auto Suture stapler: preliminary clinical observations
Pachter HL; Pennington R; Chassin J; Spencer FC
1979 Feb;85(2):166-170, Surgery
The most serious complication following distal pancreatectomy is the development of a pancreatic fistula or subphrenic abscess. These complications are particularly prone to occur following distal pancreatectomy for trauma. The injured pancreas is divided in a contaminated field, often in the presence of hemorrhage and partly devitalized tissues, in which identification and secure closure of the transected pancreatic duct may be difficult. A review of 12 surgical publications describing experience with 234 distal pancreatectomies performed for trauma found the average pancreatic fistula rate to be 13% an in some reports as high as 25% to 30%. In an attempt to decrease the high postoperative fistula rate after distal pancreatectomy, transection of the gland with the autosuture has been investigated. There are at least three theoretical advantages of this technique. The pancreas is transected through healthy tissue, the pancreatic duct is closed securely, and stainless steel sutures are used, which probably are more resistant to the development of infection than other suture material. This report describes a technique of distal pancreatectomy for both trauma surgery and elective surgery with the TA-55 Auto Suture stapler. TA-55 Auto Suture stapler, with 3.5 mm staples, is placed across the mobilized pancreas, and two rows of staggered stainless steel staples are laid down. The gland distal to the stapler then is amputated. At present this technique has been used in a total of 12 cases--four for trauma and eight during elective procedures. One fistula related to pancreatectomy performed with the Auto Suture stapler developed, for a complication rate of 8.3%. This preliminary experience indicates that a more widespread evaluation of this technique is indicated
— id: 60005, year: 1979, vol: 85, page: 166, stat: Journal Article,

Recent concepts in the treatment of hepatic trauma: facts and fallacies
Pachter HL; Spencer FC
1979 Oct;190(4):423-429, Annals of surgery
— id: 60003, year: 1979, vol: 190, page: 423, stat: Journal Article,

Principles of surgery
Schwartz, Seymour I.; Shires, G. Tom; Spencer, Frank Cole; Storer, Edward H
New York : McGraw-Hill, c1979,
— id: 169, year: 1979, vol: , page: , stat: ,

The Gibbon lecture--competence and compassion: two qualities of surgical excellence
Spencer, F C
1979 Nov;64(11):15-22, Bulletin of the American College of Surgeons
— id: 107089, year: 1979, vol: 64, page: 15, stat: Journal Article,

RISKS OF EARLY COMMISSUROTOMY - REPLY
Spencer, FC
1979 ;97(1):133-134, American heart journal
— id: 30171, year: 1979, vol: 97, page: 133, stat: Journal Article,

Asymmetric septal hypertrophy with aortic valve disease (case 28-1979)
Thomas SJ; Glassman E; Adams PX; Spencer FC
1979 Dec 13;301(24):1346-1346, New England journal of medicine
— id: 63841, year: 1979, vol: 301, page: 1346, stat: Journal Article,

Mechanism of relief of angina after coronary bypass surgery: an angiographic study
Winer, H E; Glassman, E; Spencer, F C
1979 Aug;44(2):202-208, American journal of cardiology
Coronary angiography was performed before and after coronary revascularization in 67 patients. The interval between studies ranged from 1 to 38 months (average 9.9). The patients were separated into four clinical groups on the basis of their symptoms at the time of restudy; Group I, 13 asymptomatic patients; Group II, 19 patients with nonanginal chest pain (18 cases) or dyspnea (1 case); Group III, 12 patients whose angina was relieved but not eliminated; and Group IV, 23 patients whose angina was not alleviated. The graft patency rate was 72 percent in Group I, 78 percent in Group II, 61 percent in Group IIII and 34 percent in Group IV. The sum of diseased, but not bypassed and unsuccessfully bypassed arteries per patient was 1.6 in Groups I and II. 2.9 in Group III and 4.0 in Group IV. The incidence of perioperative myocardial infarction, defined using enzymatic and electrocardiographic criteria, was 8 percent for Group I, 26 percent for Group II, 25 percent for Group III and 52 percent for Group IV. Anginal relief after coronary bypass surgery is achieved by successful and complete revascularization rather than by perioperative myocardial infarction
— id: 107091, year: 1979, vol: 44, page: 202, stat: Journal Article,

Clinical experience using potassium-induced cardioplegia with hypothermia in aortic valve replacement
Adams PX; Cunningham JN; Trehan NK; Brazier JR; Reed GE; Spencer FC
1978 Apr;75(4):564-568, Journal of thoracic & cardiovascular surgery
— id: 18167, year: 1978, vol: 75, page: 564, stat: Journal Article,

Technique and experience using potassium cardioplegia during myocardial revascularization for preinfarction angina
Adams, P X; Cunningham, J N Jr; Brazier, J; Pappis, M; Trehan, N; Spencer, F C
1978 Jan;83(1):12-19, Surgery
— id: 107097, year: 1978, vol: 83, page: 12, stat: Journal Article,

Benign tumors of right atrium necessitating extensive resection and reconstruction
Culliford AT; Isom OW; Trehan NK; Doyle E; Gorstein F; Spencer FC
1978 Aug;76(2):178-182, Journal of thoracic & cardiovascular surgery
Two patients with gigantic benign right atrial tumors were successfully treated at New York University Medical Center. Both patients required extensive resection and reconstruction for cure. Although these tumors are rare, thorough exploration employing cardiopulmonary bypass is required before an appraisal of resectability can be made. Reconstruction can be readily accomplished with autologous pericardium and thereby provides an opportunity for cure of these unusual and rare lesions
— id: 18166, year: 1978, vol: 76, page: 178, stat: Journal Article,

Surgery for chronic constrictive pericarditis. Does surgical approach and degree of pericardial resection significantly influence outcome?
Culliford AT; Lipton M; Isom OW; Cunningham J; Boyd AD; Adams P; Reed G; Spencer FC
1978 Sep;78(11):1719-1721, New York state journal of medicine
— id: 28945, year: 1978, vol: 78, page: 1719, stat: Journal Article,

Coronary artery surgery
Cunningham, J N Jr; Isom, O W; Spencer, F C
1978 ;12:347-387, Advances in surgery
— id: 107096, year: 1978, vol: 12, page: 347, stat: Journal Article,

Does coronary bypass increase longevity?
Isom, O W; Spencer, F C; Glassman, E; Cunningham, J N; Teiko, P; Reed, G E; Boyd, A D
1978 Jan;75(1):28-37, Journal of thoracic & cardiovascular surgery
— id: 107043, year: 1978, vol: 75, page: 28, stat: Journal Article,

Experience with routine open abdominal paracentesis
Manganaro AJ; Pachter HL; Spencer FC
1978 May;146(5):795-796, Surgery, gynecology & obstetrics
— id: 60007, year: 1978, vol: 146, page: 795, stat: Journal Article,

The role of peritoneal lavage in severe acute pancreatitis
Ranson, J H; Spencer, F C
1978 May;187(5):565-575, Annals of surgery
Encouraged by reports of the therapeutic efficacy of peritoneal lavage in small series of five or six patients with acute pancreatitis, we have evaluated this treatment in 24 patients with 'severe' pancreatitis. One hundred and three patients with 'severe' pancreatitis (28% mortality) were separated from 347 with 'mild' pancreatitis (0.9% mortality) by previously described early objective signs. Early treatment (Day 0-7) of 'severe' pancreatitis included peritoneal lavage through catheters placed nonoperatively in 18 (Group A) and by catheters placed at laparotomy in six (Group C). Early treatment of nonlavaged patients with 'severe' pancreatitis was by standard nonoperative measures in 61 (Group B) and included early operation in 18 (Group D). Lavage was continued for 48-96 hours, usually using 36-48 L/24 hours of balanced isotonic dialysate fluid, and was uncomplicated. Lavage led to striking immediate clinical improvement and no lavaged patient (Groups A and C) died during the first 10 days of treatment of pancreatitis. By contrast, 45% of deaths in nonlavaged patients (Group B and D) occurred during this early period, usually from cardiovascular or respiratory failure. Although lavage reduced mortality in subgroups of patients, ultimate overall survival was no affected (Group A, 83%; B, 84%; C, 33%; D,33%). Late peripancreatic abscesses caused most deaths in lavaged patients. These data show that peritoneal complications of severe acute pancreatitis and dramatically reduces early mortality. Lavage does not prevent the late local sequelae of peripancreatic necrosis
— id: 92894, year: 1978, vol: 187, page: 565, stat: Journal Article,

Vascular trauma
Rich, Norman M.; Spencer, Frank Cole
Philadelphia : W. B. Saunders Co., 1978,
— id: 191, year: 1978, vol: , page: , stat: ,

Surgery of the chest
Sabiston, David C; Spencer, Frank Cole; Gibbon, John Heysham
Philadelphia : Saunders, 1978,
— id: 974, year: 1978, vol: , page: , stat: ,

A plea for early, open mitral commissurotomy
Spencer, F C
1978 May;95(5):668-670, American heart journal
— id: 107095, year: 1978, vol: 95, page: 668, stat: Journal Article,

The significance of myocardial preservation and subclinical myocardial infarction following coronary bypass
Spencer, F C
1978 Sep;26(3):197-198, Annals of thoracic surgery
— id: 107094, year: 1978, vol: 26, page: 197, stat: Journal Article,

The influence of coronary bypass grafting on longevity
Spencer, F C; Isom, O W
1978 Nov;2(6):731-738, World journal of surgery
— id: 107093, year: 1978, vol: 2, page: 731, stat: Journal Article,

MECHANISM OF RELIEF OF ANGINA BY BYPASS GRAFTING
Winer, HE; Glassman, E; Spencer, FC
1978 ;58(4):16-16, Circulation
— id: 29765, year: 1978, vol: 58, page: 16, stat: Journal Article,

Infective endocarditis. An analysis of 54 surgically treated patients
Boyd, A D; Spencer, F C; Isom, O W; Cunningham, J N; Reed, G E; Acinapura, A J; Tice, D A
1977 Jan;73(1):23-30, Journal of thoracic & cardiovascular surgery
One hundred seventy-seven patients were admitted to the New York University Medical Center from 1970 through 1975 with infective endocarditis. Fifty-four of these patients required surgical treatment. The over-all mortality rate was 28 per cent. Two thirds of the deaths were early (10 patients) and one third late (5 patients). The mortality rate was 90 per cent in 10 patients treated for 4 to 6 weeks in whom the infection was uncontrolled and the clinical condition was deteriorating. However of the 12 patients with uncontrolled infection who were operated upon promptly within 10 days, 83 per cent survived. The fact that fungal and gram-negative infections responded poorly to medical therapy suggests the need for prompt, early surgical intervention. The mortality rate in the 32 patients operated upon in whom the infection was controlled was 12.5 per cent. It is our conclusion that all patients with infective endocarditis who develop progressive congestive failure, recurrent embolization, or progressive sepsis, despite treatment, shold have prompt valve replacement within 7 days of the institution of appropriate antimicrobial therapy
— id: 107044, year: 1977, vol: 73, page: 23, stat: Journal Article,

Open-heart surgical centers. Standards and monitoring
Brewer, L A 3rd; Scannell, J G; Spencer, F C
1977 Mar;73(3):327-331, Journal of thoracic & cardiovascular surgery
This article contains the essence of a report presented to the Council of The American Association for Thoracic Surgery (AATS) by an Ad Hoc Committee on Issues composed of the authors, on October 13, 1976. Because of urgent demand to have this information immediately available, early publication was desirable. However, to have official endorsement of the AATS would have necessitated waiting until April, 1977, the date of the next meeting of the Association. Since this would delay publication of this information for more than one year, it was considered reasonable by the Council that it be published as a free-standing statement of the authors
— id: 107099, year: 1977, vol: 73, page: 327, stat: Journal Article,

Coronary revascularization with significant impairment of left ventricular contractility
Isom OW; Spencer FC; Culliford AT
1977 ;8(2):265-272, Cardiovascular clinics
— id: 28948, year: 1977, vol: 8, page: 265, stat: Journal Article,

Use of autologous fascia lata as a pericardial substitute following open-heart surgery
Kohanna, F H; Adams, P X; Cunningham, J N Jr; Spencer, F C
1977 Jul;74(1):14-19, Journal of thoracic & cardiovascular surgery
Thirteen patients requiring repeat open-heart surgery had autologous free fascia lata grafts implanted to effect complete pericardial closure. In four patients, the graft was used to augment the pericardial space because of myocardial failure and enlargement. In the remainder, fascia lata was used because shrinkage, scarring, or absence of the pericardium from prior operation prevented primary closure. No hemodynamic problems related to implantations of the grafts were seen. The harvesting of the grafts produced no functional deficits, and complications at the donor site were insignificant. Complete pericardial closure with fascia lata protects underlying myocardial structures (i.e., saphenous vein grafts) in the event that further reoperation for bleeding or infection is required. In addition, it provides for compartmentalization of the mediastinum, allowing accurate assessment of the site of postoperative bleeding
— id: 107098, year: 1977, vol: 74, page: 14, stat: Journal Article,

Combined tricuspid and pulmonic stenosis. Clinical, echocardiographic, hemodynamic, surgical, and pathological features
Mehl SJ; Kaltman AJ; Kronzon I; Dworkin L; Adams P; Spencer FC
1977 Jul;74(1):55-60, Journal of thoracic & cardiovascular surgery
A 30-year-old man with a history of a murmur since childhood had progressive ascites for 2 years. The patient was found to have severe stenoses of the pulmonic and tricuspid valves with a well-developed right ventricle. Impressive clinical improvement occurred after pulmonic valvotomy, infundibulectomy, and replacement of the stenotic tricuspid valve with a porcine xenograft. The clinical, echocardiographic, hemodynamic, surgical, and pathological features are presented
— id: 20304, year: 1977, vol: 74, page: 55, stat: Journal Article,

Prevention, diagnosis, and treatment of pancreatic abscess
Ranson, J H; Spencer, F C
1977 Jul;82(1):99-106, Surgery
Since pancreatic abscesses are a highly lethal complication of acute pancreatitis, factors influencing the genesis of major peripancreatic infection (MPI) were analyzed in 330 patients with pancreatitis. MPI developed in 28 (8.5%). Management of MPI was reviewed in 35 patients, including seven admitted with MPI. Etiology and severity of pancreatitis influenced MPI frequency. MPI was common in postoperative pancreatitis (39%), compared with alcoholic (6.6%), biliary (3.6%), or other causes (15%). 'Severity' of pancreatitis was estimated by 11 early prognostic signs, which were reported previously. With fewer than three signs, MPI developed in 2.7%, three to five signs, 32%; more than five signs, 50%. Treatment of pancreatitis also influenced MPI. Early laparotomy increased MPI incidence from 1.6% to 23% in mild pancreatitis and from 24% to 67% in severe pancreatitis. Early oral feeding also appeared to predispose to MPI. Prolonged nasogastric suction and avoidance of early operation reduced MPI incidence from 16% in the first 100 patients to 5% in the next 230 patients. Outcome of MPI reflected severity of underlying pancreatitis. Mortality with fewer than three signs was 14%; with three to five signs, 65%; with more than six signs, 100%. Mortality was only 26% in 19 patients treated with radical sump drainage of the entire peripancreatic retroperitoneum, compared to 75% of 16 patients treated with conventional local drainage. In summary, MPI is related to etiology and severity of pancreatitis as quantified by early signs. Early laparotomy for pancreatitis increased MPI. Treatment of MPI with wide sump drainage appears more effective than local drainage
— id: 92895, year: 1977, vol: 82, page: 99, stat: Journal Article,

Sternal and costochondral infections following open-heart surgery. A review of 2,594 cases
Culliford AT; Cunningham JN Jr; Zeff RH; Isom OW; Teiko P; Spencer FC
1976 Nov;72(5):714-726, Journal of thoracic & cardiovascular surgery
From a series of 2,594 patients undergoing open-heart surgery, 39 had sternal or costochondral infections. Most of these infections were associated with a number of predisposing factors: prolonged perfusion time, excessive postoperative bleeding, depressed cardiac output in the postoperative period, and a history of re-exploration for the control of hemorrhage. One important factor was the use of bilateral internal mammary artery implants. The prognosis for patients with sternal wound infections appears related to the length of time required for institution of treatment and the adequacy of initial therapy. Most of these infections are caused by staphylococcus, although the more complicated infections often are caused by fungus. The prevention of serious sternal infections depends on a combination of proper preoperative preparation, attention to minute details at the time of operation, and recognition of variables predisposing to wound complications
— id: 28949, year: 1976, vol: 72, page: 714, stat: Journal Article,

The influence of diabetes and hypertension on the results of coronary revascularization
Engelman RM; Bhat JG; Glassman E; Spencer FC; Boyd AD; Reed GE; Isom OW; Pasternack BS
1976 Jan-Feb;271(1):4-12, American journal of the medical sciences
The effects of diabetes and hypertension on the early postoperative course of patients undergoing coronary revascularization were studied by reviewing the records of 177 patients operated upon in 1972. There were 121 nondiabetic, nonhypertensive; 32 hypertensive; ten diabetic; and 14 diabetic-hypertensive patients. The incidence of postoperative low cardiac output, renal insufficiency and arrhythmia was significantly higher in the hypertensive patient. Operative mortality ranged from 0 in diabetic patients, to 0.8 per cent in nondiabetic, nonhypertensives, to 7.1 per cent in diabetic-hypertensives and 12.5 per cent in hypertensive patients, suggesting an increased risk for the hypertensive patient. The one- to two-year follow-up results documented symptomatic improvement in 90.7 per cent of patients with little adverse effect apparent from diabetes or hypertension. Pre- and postoperative coronary angiography was carried out in 103 patients between 1968 and 1973 with a mean elapsed time between operation and postoperative angiogram of 9.3 months. The progression of atherosclerosis was graded on a 0-4 basis in both grafted and ungrafted coronary arteries. While hypertension appeared to contribute to disease progression, the incidence of vein graft and internal mammary artery bypass occlusion was not significantly affected by either diabetes or hypertension. This study has shown that while hypertension contributes to increased morbidity and mortality in the early postoperative period and an increased rate of progression of atherosclerosis, neither diabetes nor hypertension appeared to influence the one- to two-year results of coronary revascularization.
— id: 10310, year: 1976, vol: 271, page: 4, stat: Journal Article,

Gibbon's Surgery of the chest
Gibbon, John Heysham; Sabiston, David C.; Spencer, Frank Cole
Philadelphia : Saunders, 1976,
— id: 396, year: 1976, vol: , page: , stat: ,

Operative management of tricuspid regurgitation
Reed, G E; Boyd, A D; Spencer, F C; Engelman, R M; Isom, O W; Cunningham, J N Jr
1976 Dec;54(6 Suppl):III96-III98, Circulation
From January 1968 to June 1975 tricuspid regurgitation was encountered in 238 patients of a total of 1074 patients undergoing operations on the mitral valve. During this time tricuspid annuloplasty (TA) was performed in 137 patients and the tricuspid valve was replaced (TVR) in 101 patients. Comparison of hospital mortality of 15% (20 of 137) for TA as against 40% (40 or 101) for TVR suggests the superiority of repair over replacement. A new technique for repair makes this operation even more attractive. It satisfies the dual objectives of producing competency but not obstruction by creating a measured orifice. As experience with TA was gained, the incidence of valve replacement dropped from 69% (22 of 32) in the first 2 years of the study to 16% (11 of 70) for the last 2 years
— id: 107023, year: 1976, vol: 54, page: III96, stat: Journal Article,

Masked abnormal drainage of the inferior vena cava into the left atrium
Singh A; Doyle EF; Danilowicz D; Spencer FC
1976 Aug;38(2):261-264, American journal of cardiology
A 6 year old boy with a large atrial septal defect, partial anomalous pulmonary venous drainage and unrecognized anomalous insertion of the inferior vena cava into the left atrium had cyanosis after closure of the atrial defect. Repeat study revealed direct drainage of the inferior vena cava into the left atrium with moderate arterial oxygen desaturation. At repeat operation an unusual positioning of the inferior vena cava was seen. After reopening of the atrial defect, the pulmonary venous and systemic venous drainage anomalies were identified. A Dacron patch was inserted so as to divert flow to the proper atrium. Repeat catheterization 3 months after operation revealed a normal heart with no obstruction; arterial oxygen saturation was normal. The child has continued to do well 3 years after operation
— id: 18076, year: 1976, vol: 38, page: 261, stat: Journal Article,

Deductive reasoning in the lifelong continuing education of a cardiovascular surgeon
Spencer, F C
1976 Nov;111(11):1177-1183, Archives of Surgery (Chicago)
— id: 107100, year: 1976, vol: 111, page: 1177, stat: Journal Article,

Letter: Pulmonary valve ring size
Spencer, F C
1976 Jun;21(6):578-578, Annals of thoracic surgery
— id: 107101, year: 1976, vol: 21, page: 578, stat: Journal Article,

CLINICAL EXPERIENCE USING POTASSIUM INDUCED CARDIOPLEGIA WITH HYPOTHERMIA IN AORTIC-VALVE REPLACEMENT
Trehan, N; Adams, P; Brazier, J; Cunningham, J; Reed, G; Spencer, F
1976 ;54(4):181-181, Circulation
— id: 28733, year: 1976, vol: 54, page: 181, stat: Journal Article,

Esophagogastrostomy. Analysis of 55 cases
Boyd, A D; Cukingnan, R; Engelman, R M; Localio, S A; Slattery, L; Tice, D A; Bardin, J A; Spencer, F C
1975 Nov;70(5):817-825, Journal of thoracic & cardiovascular surgery
At the New York University Medical Center from January, 1969, through December, 1973, esophagogastrostomies were performed in 56 patients. In 30 (Group A), fundoplications were combined with the esophagogastrostomies; in the other 26 (Group B), esophagogastrostomies only were performed. These two groups have been compared in an effort to determine the effectiveness of fundoplication in preventing gastric reflux following esophagogastrostomy. The operative mortality rate (10 per cent) and the 3 year survival rate (20 per cent) were approximately equal in the two groups. Clinical evidence of reflux was noted in 10 per cent of Group A and 47 per cent of Group B patients, while complications of reflux were noted in 5 per cent of Group A and in 33 per cent of Group B patients. The results of the present study suggest that fundoplication, while not prolonging survival, does prevent the symptoms and complications of gastric reflux and improves the quality of survival in these unfortunate patients. This leads us to recommend the routine use of fundoplication with esophagogastrostomy in patients with carcinoma of the esophagus and gastric cardia
— id: 107025, year: 1975, vol: 70, page: 817, stat: Journal Article,

Allogeneic unresponsiveness to orthotopic cardiac transplants in DL-A-identical radiation chimeras
Boyd, A D; Spencer, F C; Hirose, H; Engelman, R M; Cannon, F D; Ferrebee, J W; Rapaport, F T
1975 Dec;7(4):475-477, Transplantation proceedings
Nine Cooperstown beagles of known DL-A genotypes were exposed to supralethal total-body irradiation and received bone-marrow allografts from DL-A-identical donors. Four to 5 months later, the resulting chimeras received orthotopic cardiac allografts from their corresponding donors of marrow. Six chimeras died of operative complications in the immediate postoperative period. The other 3 chimeras survived from 173 to 547 days; 1 dog died at 173 days as a result of right-sided heart failure, secondary to stenosis at the site of the pulmonary artery anastomosis. The other two recipients continue to be active and healthy at 545 and 547 days. The results indicate that dogs can be rendered specifically tolerant to orthotopic cardiac allografts by supralethal total-body irradiation and the transplantation of marrow obtained from the prospective allograft donor
— id: 107024, year: 1975, vol: 7, page: 475, stat: Journal Article,

Induction of tolerance to cardiac allografts by irradiation and bone marrow transplantation
Boyd, A D; Spencer, F C; Hirose, H; Engelman, R M; Cannon, F D; Ferrebee, J W; Rapaport, F T
1975 ;26:304-305, Surgical forum
— id: 107028, year: 1975, vol: 26, page: 304, stat: Journal Article,

ESOPHAGOGASTROSTOMY - ANALYSIS OF 55 CASES
Boyd, AD; Cukingnan, R; Engelman, RM; Localio, SA; Slattery, L; Tice, DA; Bardin, JA; Spencer, FC
1975 ;70(5):817-825, Journal of thoracic & cardiovascular surgery
— id: 28474, year: 1975, vol: 70, page: 817, stat: Journal Article,

Influence of primary closure of the pericardium after open-heart surgery on the frequency of tamponade, postcardiotomy syndrome, and pulmonary complications
Cunningham, J N Jr; Spencer, F C; Zeff, R; Williams, C D; Cukingnan, R; Mullin, M
1975 Jul;70(1):119-125, Journal of thoracic & cardiovascular surgery
Experiences with primary closure of the pericardium in a series of 100 patients undergoing open-heart operations are described. The pericardium was kept under tension during the operation to minimize shrinkage and permit closure at the end of the procedure. In 28 patients one pleural space was opened for drainage, whereas in 72 patients intra- and extrapericardial sumps alone were used for drainage. Measurements of sump drainage revealed that most postoperative bleeding originates from outside the pericardium. There were no instances of cardiac tamponade although 19 patients lost more than 1 L. of blood after operation and 5 required reoperation for hemorrhage. Transpleural drainage tubes were shown to be ineffective and in addition were associated with a fourfold increase in postcardiotomy syndrome and a significantly greater frequency of pleural effusion and atelectasis when compared to the use of mediastinal sump drainage alone. We have concluded that closing the pericardium and using mediastinal sump drainage minimizes the risk of cardiac tamponade and allows early localization of the site of postoperative bledding. Another advantage of pericardial closure and drainage is that postoperative adhesions and postcardiotomy syndrome will be less significant. As a consequence the danger of injuring the heart in a subsequent operation is lessened
— id: 107103, year: 1975, vol: 70, page: 119, stat: Journal Article,

INFLUENCE OF PRIMARY CLOSURE OF PERICARDIUM AFTER OPEN-HEART SURGERY ON FREQUENCY OF TAMPONADE, POSTCARDIOTOMY SYNDROME, AND PULMONARY COMPLICATIONS
Cunningham, JN; Spencer, FC; Zeff, R; Williams, CD; Cukingnan, R; Mullin, M
1975 ;70(1):119-125, Journal of thoracic & cardiovascular surgery
— id: 28481, year: 1975, vol: 70, page: 119, stat: Journal Article,

The significance of coronary arterial stenosis during cardiopulmonary bypass
Engelman, R M; Spencer, F C; Boyd, A D; Chandra, R
1975 Nov;70(5):869-879, Journal of thoracic & cardiovascular surgery
Myocardial infarction may develop during an uneventful open-heart operation. In order to better understand this complication, we undertook an experimental study. The left circumflex coronary artery of 20 dogs was narrowed to 50 per cent of its area by a metal screw clamp to produce a localized coronary stenosis. Regional myocardial perfusion in the distribution of both the stenotic circumflex and normal left anterior descending (LAD) coronary arteries was measured by injection of a radioactive-labeled microsphere (15 +/- 5 mu). Circumflex coronary artery flow was measured with an electromagnetic flow probe. An epicardial electrogram was recorded in the distribution of the left circumflex. Measurements of regional myocardial perfusion, circumflex flow, and the epicardial electrogram were performed in each animal during the control (prebypass) state and during cardiopulmonary bypass with a beating and fibrillating ventricle. Half the animals had cardiopulmonary bypass performed at 50 mm. Hg perfusion pressure and half at 100 mm. Hg. The animals were put to death at the end of the study, and the hearts were sectioned, weighed, and counted. A cast was made of the stenotic circumflex coronary artery, the degree of stenosis is measured, and the per cent area stenosis calculated. The study showed that the effect of a 50 per cent coronary stenosis in reducing distal flow is apparent only during cardiopulmonary bypass at reduced pressure. The mechanism whereby a myocardial infarction develops during cardiopulmonary bypass could evolve from the development of a 'critical' stenosis out of a mild-moderate one at a reduced perfusion pressure during cardiopulmonary bypass
— id: 107026, year: 1975, vol: 70, page: 869, stat: Journal Article,

INFLUENCE OF DIABETES AND HYPERTENSION ON RESULTS OF CORONARY REVASCULARIZATION
Engelman, RM; Bhat, JG; Glassman, E; Spencer, FC; Boyd, AD; Pasternack, BS; Reed, GE; Isom, OW
1975 ;35(1):135-135, American journal of cardiology
— id: 28587, year: 1975, vol: 35, page: 135, stat: Journal Article,

SIGNIFICANCE OF CORONARY ARTERIAL-STENOSIS DURING CARDIOPULMONARY BYPASS
Engelman, RM; Spencer, FC; Boyd, AD; Chandra, R
1975 ;70(5):869-879, Journal of thoracic & cardiovascular surgery
— id: 28475, year: 1975, vol: 70, page: 869, stat: Journal Article,

A method of closed-chest cannulation of the left atrium for left atrial-femoral artery bypass
Glassman, E; Engelman, R M; Boyd, A D; Lipson, D; Ackerman, B; Spencer, F C
1975 Feb;69(2):283-290, Journal of thoracic & cardiovascular surgery
A large-bore polyvinyl catheter was devised for passage into the left atrium by means of a modified transseptal catheterization technique. This was performed without difficulty using both pulsatile and nonpulsatile bypass in the closed-chest animal as well as in 3 terminally ill patients. Blood was drained from the left atrium and returned to the femoral artery through an extracorporeal circuit. The shock syndrome produced by coronary embolization in dogs was successfully managed in this fashion. The results of the clinical trials were encouraging. Assisted left heart circulation using a closed-chest left atrial-femoral artery bypass seems feasible by this technique
— id: 107027, year: 1975, vol: 69, page: 283, stat: Journal Article,

PREDICTIVE VALUE OF ENZYME STUDIES IN MYOCARDIAL-INFARCTION - REPLY
Glassman, E; Rose, M; Spencer, FC
1975 ;36(3):413-413, American journal of cardiology
— id: 28518, year: 1975, vol: 36, page: 413, stat: Journal Article,

Long-term survival following coronary bypass surgery in patients with significant impairment of left ventricular function
Isom OW; Spencer FC; Glassman E; Dembrow JM; Pasternack BS
1975 Aug;52(2 Suppl):I141-I147, Circulation
To assess the influence of coronary revascularization on the long-term survival of patients with debilitating angina and significant impairment of left ventricular function, analysis was done of 62 consecutive patients with severe angina and hypokinetic left ventricles (LVED larger than or equal to 20) undergoing coronary bypass at N.Y.U. Medical Center between January, 1971 and May 1974. Follow-up was 98% complete, range 4 to 41 months with a mean of 23 months. Multiple bypasses were done in 94% of the group; a left-ventricular scar was excised in 16%. There were six operative deaths (mortality 9.7%) and three late deaths, all within eight months after operation. Angina was either absent or substantially improved in 90% of surviving patients. Life-table analysis shows a two-year survival of 85%, very similar to the survival rate for patients with good ventricular function. Hence, with current techniques impaired ventricular function is not a major contraindication to bypass grafting
— id: 10315, year: 1975, vol: 52, page: I141, stat: Journal Article,

The current status of bypass grafting for coronary artery disease
Isom, O W; Spencer, F E
1975 Jul;68(7):897-907, Southern medical journal
— id: 129776, year: 1975, vol: 68, page: 897, stat: Journal Article,

PRE-BYPASS MYOCARDIAL DAMAGE IN PATIENTS UNDERGOING CORONARY REVASCULARIZATION - UNRECOGNIZED VULNERABLE PERIOD
Isom, OW; Spencer, FC; Feigenbaum, H; Cunningham, J; Roe, C
1975 ;52(4):119-119, Circulation
— id: 28512, year: 1975, vol: 52, page: 119, stat: Journal Article,

New diagnostic and therapeutic techniques in the management of pyogenic liver abscesses
Ranson, J H; Madayag, M A; Localio, S A; Spencer, F C
1975 May;181(5):508-518, Annals of surgery
An unexplained increase in the frequency of pyogenic liver abscesses of unknown etiology has, fourtunately, been paralleled by significant advances in diagnostic and therapeutic methods. This report reviews experience with 14 patients operated upon at NYU Medical Center since 1971. Eight cases (57%) were cryptogenic. Other abscesses were associated with biliary disease (3); abdominal sepsis (2); and trauma (1). Abscesses were present on hospitalization in 12 patients. Clinical findings included fever (101-108 F); 100%; leucocytosis, 71%; anorexia and vomiting, 50%; localized tenderness and hepatomegaly, 50%; hypoalbuminemia, 86%; hypocholesterolemia, 78%; elevated SGOT, 71%; and elevated aikaline phosphatase, 43%. Technetium hepatic scintiscans showed focal defects in 10 of 12 patients (83%), but did not detect multiple abscesses in 2 of these. Hepatic arteriography performed in 10 patients was highly accurate, outlining single abscesses in 6 and multiple abscesses in 4. Furthermore, in one patient a false positive scintiscan was demonstrated by negative arteriography, confirmed by autopsy. In 4 patients, arteriography indicated an abscess in the posterior-superior area of the right hepatic lobe. With precise anatomical localization, a trans-thoracic approach permitted uncomplicated drainage in each case. This approach provides excellent exposure and direct drainage for abscesses in this area. An additional therapeutic adjunct in two patients, with 4 and 11 abscesses each, was postoperative intraportal infusion of antibiotics through the umbilical vein. Thirteen patients (83%) recovered, one dying from pulmonary embolism. Primary hepatic abscesses occur with increasing frequency. Primary hepatic abscesses occur with increasing frequency. Primary hepatic abscesses occur with increasing frequency. The methods described allow more precise preoperative diagnosis and direct surgical drainage
— id: 92899, year: 1975, vol: 181, page: 508, stat: Journal Article,

Arrhythmias following cardiac surgery: relation to serum digoxin levels
Rose, M R; Glassman, E; Spencer, F C
1975 Mar;89(3):288-294, American heart journal
Arrhythmias were analyzed in 50 patients undergoing cardiac surgery: 27 with valve surgery, 15 with coronary artery bypass (CAB), 5 with CAB and valve surgery, and 3 with miscellaneous procedures. The role of electrolyte abnormalities, pericarditis, serum osmolarity, digoxin level, and the type of surgery performed was evaluated. Thirty-seven out of 50 patients (74 per cent) had a postoperative arrhythmia, and a total of 78 different arrhythmias were noted. Twenty-six out of 27 patients with valve surgery had an arrhythmia vs. six out of 15 patients with CAB (p less than 0.001). Atrial fibrillation was the most common arrhythmia in all groups. Although postoperative hypocalcemia, hypomagnesemia, pericarditis, and wide shifts in osmolarity were common, they did not correlate with arrhythmias. Seventeen patients developed postoperative arrhythmias compatible with digitalis toxicity, including junctional rhythm, atrioventricular dissociation, or atrial tachycardia with block. However, the range of serum digoxin levels in these patients was zero to 2.80 ng. per milliliter. This suggests increased sensitivity to digitalis glycosides or the effects of surgical trauma as the etiology of arrhythmia in many patients. The distinction between digitalis-induced arrhythmia and spontaneously occurring arrhythmia cannot be made with certainty in most postoperative patients. Therapy should reflect an awareness of the potential for postoperative digitoxicity
— id: 107105, year: 1975, vol: 89, page: 288, stat: Journal Article,

ARRHYTHMIAS FOLLOWING CARDIAC-SURGERY - RELATION TO SERUM DIGOXIN LEVELS
Rose, MR; Glassman, E; Spencer, FC
1975 ;89(3):288-294, American heart journal
— id: 28495, year: 1975, vol: 89, page: 288, stat: Journal Article,

COMPARISON OF CORONARY-ARTERY SIZE DETERMINED BY ANGIOGRAPHY AND AT TIME OF OPERATION
Schloss, M; Kronzon, I; Glassman, E; Spencer, FC; Isom, OW
1975 ;52(4):238-238, Circulation
— id: 28514, year: 1975, vol: 52, page: 238, stat: Journal Article,

Observations on the functioning of committees
Spencer, F C
1975 Sep;78(3):394-400, Surgery
Basic defects in performance of committees are described and guidelines for more effective committee functioning are suggested. To date most experiences with management technology have been with industry. Hopefully, the principles used will be found to be partly applicable to medical schools
— id: 107102, year: 1975, vol: 78, page: 394, stat: Journal Article,

Robert M. Zollinger, MD
Spencer, F C
1975 ;26:v-vi, Surgical forum
— id: 107106, year: 1975, vol: 26, page: v, stat: Journal Article,

OBSERVATIONS ON FUNCTIONING OF COMMITTEES
Spencer, FC
1975 ;78(3):394-400, Surgery
— id: 28603, year: 1975, vol: 78, page: 394, stat: Journal Article,

Successful aortic valve replacement for aortic regurgitation associated with osteogenesis imperfecta
Weisinger, B; Glassman, E; Spencer, F C; Berger, A
1975 May;37(5):475-477, British heart journal
The occurrence of severe aortic regurgitation in two patients with typical findings of osteogenesis imperfecta is described. Both patients manifested severe haemodynamic abnormalities and underwent successful aortic valve replacement. The operative and pathological findings are discussed
— id: 107104, year: 1975, vol: 37, page: 475, stat: Journal Article,

SUCCESSFUL AORTIC-VALVE REPLACEMENT FOR AORTIC REGURGITATION ASSOCIATED WITH OSTEOGENESIS IMPERFECTA
WEISINGER, B; GLASSMAN, E; SPENCER, FC; BERGER, A
1975 ;37(5):475-477, British heart journal
— id: 98736, year: 1975, vol: 37, page: 475, stat: Journal Article,

ISOLATED MITRAL-VALVE REPLACEMENT WITH BALL VALVE PROSTHESES - ANALYSIS OF 210 CASES
Zeff, RH; Isom, OW; Cunningham, JN; Pasternack, BS; Glassman, E; Teiko, P; Spencer, FC
1975 ;52(4):260-260, Circulation
— id: 28515, year: 1975, vol: 52, page: 260, stat: Journal Article,

EFFECT OF PULMONARY-HYPERTENSION ON ELDERLY PATIENTS UNDERGOING MITRAL-VALVE OPERATIONS
Acinapur[...], AJ; Reed, GE; Boyd, A; Isom, OW; Spencer, FC
1974 ;50(4):157-157, Circulation
— id: 28349, year: 1974, vol: 50, page: 157, stat: Journal Article,

Tricuspid annuloplasty. Five and one-half years' experience with 78 patients
Boyd, A D; Engelman, R M; Isom, O W; Reed, G E; Spencer, F C
1974 Sep;68(3):344-351, Journal of thoracic & cardiovascular surgery
— id: 107030, year: 1974, vol: 68, page: 344, stat: Journal Article,

TRICUSPID ANNULOPLASTY - 5 AND ONE-HALF YEARS EXPERIENCE WITH 78 PATIENTS
Boyd, AD; Engelman, RM; Isom, OW; Reed, GE; Spencer, FC
1974 ;68(3):344-351, Journal of thoracic & cardiovascular surgery
— id: 28330, year: 1974, vol: 68, page: 344, stat: Journal Article,

Salmonella septicemia after open heart surgery in an asymptomatic carrier
Danilowicz D; Posnock E; Chase R; Spencer FC
1974 Dec;34(7):864-867, American journal of cardiology
— id: 18082, year: 1974, vol: 34, page: 864, stat: Journal Article,

Effect of normothermic anoxic arrest on coronary blood flow distribution of pigs
Engelman, R M; Spencer, F C; Adler, S; Gouge, T H; Chandra, R; Boyd, A D
1974 ;25(0):176-179, Surgical forum
— id: 107034, year: 1974, vol: 25, page: 176, stat: Journal Article,

INFLUENCE OF DIABETES AND HYPERTENSION ON RESULTS OF CORONARY REVASCULARIZATION
Engelman, RM; Bhat, JG; Glassman, E; Spencer, FC; Boyd, AD; Pasterna[...], BS; Reed, GE; Isom, OW
1974 ;50(4):171-171, Circulation
— id: 28350, year: 1974, vol: 50, page: 171, stat: Journal Article,

Changes in the underlying coronary circulation secondary to bypass grafting
Glassman, E; Spencer, F C; Krauss, K R; Weisinger, B; Isom, O W
1974 Aug;50(2 Suppl):II80-II83, Circulation
— id: 107108, year: 1974, vol: 50, page: II80, stat: Journal Article,

Factors influencing long-term survival after isolated aortic valve replacement
Isom OW; Dembrow JM; Glassman E; Pasternack BS; Sackler JP; Spencer FC
1974 Aug;50(2 Suppl):II154-II162, Circulation
— id: 10319, year: 1974, vol: 50, page: II154, stat: Journal Article,

CLOSED CHEST LEFT ATRIAL-FEMORAL BYPASS, A SUPERIOR MODE OF THERAPY FOR CARDIOGENIC-SHOCK - EXPERIMENTAL AND CLINICAL STUDIES
Lipson, D; Engelman, RM; Boyd, AD; Gouge, TH; Spencer, FC; Glassman, E; Ackerman, B
1974 ;50(3):408-408, Bulletin of the New York Academy of Medicine
— id: 28462, year: 1974, vol: 50, page: 408, stat: Journal Article,

MASKED PULMONARY VENOUS OBSTRUCTION IN INFANCY
Lynfield, J; Doyle, EF; Danilowi[...], D; Kiely, B; Spencer, FC
1974 ;8(4):352-352, Pediatric research
— id: 28372, year: 1974, vol: 8, page: 352, stat: Journal Article,

The training of surgeons: how many, in what, and by whom?
Miller, L D; Saxbe, W B Jr; Hughes, E F; Bergland, R M; O'Neill, J A Jr; Ravitch, M M; Barton, B; Spencer, F C; Moore, F D
1974 Jul;76(1):170-198, Surgery
— id: 107109, year: 1974, vol: 76, page: 170, stat: Journal Article,

Experience with open mitral commissurotomy in 100 consecutive patients
Mullin, M J; Engelman, R M; Isom, O W; Boyd, A D; Glassman, E; Spencer, F C
1974 Dec;76(6):974-982, Surgery
— id: 107029, year: 1974, vol: 76, page: 974, stat: Journal Article,

Prognostic signs and the role of operative management in acute pancreatitis
Ranson JH; Rifkind KM; Roses DF; Fink SD; Eng K; Spencer FC
1974 Jul;139(1):69-81, Surgery, gynecology & obstetrics
— id: 19516, year: 1974, vol: 139, page: 69, stat: Journal Article,

Respiratory complications in acute pancreatitis
Ranson JH; Turner JW; Roses DF; Rifkind KM; Spencer FC
1974 May;179(5):557-566, Annals of surgery
— id: 19583, year: 1974, vol: 179, page: 557, stat: Journal Article,

Electrocardiographic and serum enzyme changes of myocardial infarction after coronary artery bypass surgery
Rose, M R; Glassman, E; Isom, O W; Spencer, F C
1974 Feb;33(2):215-220, American journal of cardiology
— id: 107110, year: 1974, vol: 33, page: 215, stat: Journal Article,

ELECTROCARDIOGRAPHIC AND SERUM ENZYME CHANGES FOLLOWING CORONARY-ARTERY BYPASS SURGERY
ROSE, MR; GLASSMAN, E; ISOM, OW; SPENCER, FG
1974 ;50(3):411-411, Bulletin of the New York Academy of Medicine
— id: 39891, year: 1974, vol: 50, page: 411, stat: Journal Article,

The long-term influence of coronary bypass grafts on myocardial infarction and survival
Spencer FC; Isom OW; Glassman E; Boyd AD; Engelman RM; Reed GE; Pasternack BS; Dembrow JM
1974 Oct;180(4):439-451, Annals of surgery
— id: 10318, year: 1974, vol: 180, page: 439, stat: Journal Article,

Late thrombosis of Starr-Edwards tricuspid ball valve prosthesis
Suwansirikul, S; Glassman, E; Raia, F; Spencer, F C
1974 Nov;34(6):737-740, American journal of cardiology
— id: 107107, year: 1974, vol: 34, page: 737, stat: Journal Article,

Double outlet right ventricle with pulmonic stenosis and anteriorly positioned aorta(Taussig-Bing variant). Report of a case and surgical correction
Agarwala B; Doyle EF; Danilowicz D; Spencer FC; Mills NM
1973 Nov;32(6):850-854, American journal of cardiology
— id: 18084, year: 1973, vol: 32, page: 850, stat: Journal Article,

Aneurysm of aberrant right subclavian artery. Rare cause of superior mediastinal tumor
Engelman, R M; Madayag, M; Spencer, F C
1973 Jan 15;73(2):290-292, New York state journal of medicine
— id: 107118, year: 1973, vol: 73, page: 290, stat: Journal Article,

CLOSED CHEST LEFT ATRIAL-FEMORAL BYPASS - THERAPY FOR CARDIOGENIC-SHOCK
ENGELMAN, RM; GLASSMAN, E; BOYD, AD; SPENCER, FC
1973 ;5(8):12-13, European surgical research
— id: 39777, year: 1973, vol: 5, page: 12, stat: Journal Article,

EFFECT OF BYPASS GRAFTING ON CORONARY CIRCULATION
GLASSMAN, E; KRAUSS, KR; WEISINGE.B; SPENCER, FC
1973 ;48(4):53-53, Circulation
— id: 39843, year: 1973, vol: 48, page: 53, stat: Journal Article,

Patterns of myocardial metabolism during cardiopulmonary bypass and coronary perfusion
Isom OW; Kutin ND; Falk EA; Spencer FC
1973 Nov;66(5):705-719, Journal of thoracic & cardiovascular surgery
— id: 22210, year: 1973, vol: 66, page: 705, stat: Journal Article,

Evaluation of anticoagulant therapy in cloth-covered prosthetic valves
Isom, O W; Williams, C D; Falk, E A; Spencer, F C; Glassman, E
1973 Jul;48(1 Suppl):III48-III50, Circulation
— id: 107115, year: 1973, vol: 48, page: III48, stat: Journal Article,

Closed-chest left atrial-femoral bypass for cardiogenic shock: experimental and clinical studies
Lipson, D E; Glassman, E; Engelman, R M; Boyd, A D; Gouge, T H; Ackerman, B; Spencer, F C
1973 ;24:180-181, Surgical forum
— id: 107038, year: 1973, vol: 24, page: 180, stat: Journal Article,

Hyperglycemia during cardiopulmonary bypass
Mills, N L; Beaudet, R L; Isom, O W; Spencer, F C
1973 Feb;177(2):203-205, Annals of surgery
— id: 107117, year: 1973, vol: 177, page: 203, stat: Journal Article,

Dedication: Dr. D.M. Hume
Rapaport, F T; Spencer, F C
1973 Jun;5(2):I-II, Transplantation proceedings
— id: 107116, year: 1973, vol: 5, page: I, stat: Journal Article,

Late complications of intraoperative coronary artery perfusion
Reed, G E; Spencer, F C; Boyd, A D; Engelman, R M; Glassman, E
1973 Jul;48(1 Suppl):III80-III84, Circulation
— id: 107035, year: 1973, vol: 48, page: III80, stat: Journal Article,

ELECTROCARDIOGRAPHIC AND SERUM ENZYME CHANGES FOLLOWING CORONARY-ARTERY BYPASS SURGERY
ROSE, MR; GLASSMAN, E; ISOM, OW; SPENCER, FC
1973 ;48(4):52-52, Circulation
— id: 39842, year: 1973, vol: 48, page: 52, stat: Journal Article,

FREQUENCY AND DETECTION OF MULTIPLE VENTRICULAR SEPTAL-DEFECTS AT OPERATION
SCHECHTE.F; SPENCER, FC; DOYLE, EF; RUTKOWSK.MR
1973 ;48(4):214-214, Circulation
— id: 39771, year: 1973, vol: 48, page: 214, stat: Journal Article,

Long-term evaluation of aortic valvuloplasty for aortic insufficiency and ventricular septal defect
Spencer FC; Doyle EF; Danilowicz DA; Bahnson HT; Weldon CS
1973 Jan;65(1):15-31, Journal of thoracic & cardiovascular surgery
— id: 18087, year: 1973, vol: 65, page: 15, stat: Journal Article,

Avoidance of heart block in correction of tetralogy of Fallot
Spencer, F C
1973 Aug;66(2):329-329, Journal of thoracic & cardiovascular surgery
— id: 107114, year: 1973, vol: 66, page: 329, stat: Journal Article,

Preinfarction angina: current therapeutic considerations
Spencer, F C; Glassman, E
1973 Sep 7;32(3):382-384, American journal of cardiology
— id: 107113, year: 1973, vol: 32, page: 382, stat: Journal Article,

The surgical residency: length and quality
Spencer, F C; Reemtsma, K; Ebert, P A
1973 Nov;74(5):791-793, Surgery
— id: 107111, year: 1973, vol: 74, page: 791, stat: Journal Article,

PREINFARCTION ANGINA - CURRENT THERAPEUTIC CONSIDERATIONS
SPENCER, FC; GLASSMAN, E
1973 ;32(3):382-384, American journal of cardiology
— id: 39855, year: 1973, vol: 32, page: 382, stat: Journal Article,

Chronic infection of the costal cartilages after thoracic surgical procedures
Williams, C D; Cunningham, J N; Falk, E A; Isom, O W; Chase, R N; Spencer, F C
1973 Oct;66(4):592-598, Journal of thoracic & cardiovascular surgery
— id: 107112, year: 1973, vol: 66, page: 592, stat: Journal Article,

The wet lung: diagnostic considerations
Berman, I R; Spencer, F C
1972 Mar;175(3):458-458, Annals of surgery
— id: 107122, year: 1972, vol: 175, page: 458, stat: Journal Article,

Bronchopleural fistulas: how often should they occur?
Boyd, A D; Spencer, F C
1972 Feb;13(2):195-196, Annals of thoracic surgery
— id: 107045, year: 1972, vol: 13, page: 195, stat: Journal Article,

Long-term evaluation of cloth-covered metallic ball prostheses
Isom, O W; Williams, C D; Falk, E A; Glassman, E; Spencer, F C
1972 Sep;64(3):354-367, Journal of thoracic & cardiovascular surgery
— id: 107120, year: 1972, vol: 64, page: 354, stat: Journal Article,

Afternoon Panel Discussion
Johnson WD; Spencer FC; Buckley MJ; Ross RS
1972 Oct;48(9):1179-1185, Bulletin of the New York Academy of Medicine
— id: 107119, year: 1972, vol: 48, page: 1179, stat: Journal Article,

Bypass grafting for preinfarction angina
Spencer, F C
1972 Jun;45(6):1314-1318, Circulation
— id: 107121, year: 1972, vol: 45, page: 1314, stat: Journal Article,

Surgical procedures for coronary atherosclerosis
Spencer, F C
1972 Jan;14(4):399-419, Progress in cardiovascular diseases
— id: 107124, year: 1972, vol: 14, page: 399, stat: Journal Article,

Surgical procedures for coronary artery disease
Spencer, F C; Glassman, E
1972 ;23:229-244, Annual review of medicine
— id: 107123, year: 1972, vol: 23, page: 229, stat: Journal Article,

Role of DL-A system of canine histocompatibility in cardiac transplantation
Boyd, A D; Rapaport, F T; Ferrebee, J W; Cannon, F D; Dausset, J; Lower, R R; Spencer, F C
1971 Mar;3(1):152-154, Transplantation proceedings
— id: 107046, year: 1971, vol: 3, page: 152, stat: Journal Article,

Cardiac valve replacement. Results in patients with advanced disability
Bryant, L R; Trinkle, J K; Spencer, F C; Danielson, G K; Shabetai, R; Reeves, J T
1971 May 10;216(6):996-1002, JAMA
— id: 107129, year: 1971, vol: 216, page: 996, stat: Journal Article,

The control of hemorrhage by dacron aortic prostheses
Cortes, L E; Boyd, A D; Spencer, F C; Reed, G E
1971 ;22:170-171, Surgical forum
— id: 107048, year: 1971, vol: 22, page: 170, stat: Journal Article,

Mycotic infections on prosthetic and homograft heart valves: report of the first case of endocarditis caused by Hormodendrum dermatitidis
Engelman, R M; Chase, R M; Spencer, F C; Benjamin, M V; Rosenthal, S A
1971 Mar;173(3):455-461, Annals of surgery
— id: 18905, year: 1971, vol: 173, page: 455, stat: Journal Article,

What percentage of patients with angina pectoris are candidates for bypass grafts?
Glassman, E; Spencer, F C; Tice, D A; Weisinger, B; Green, G E
1971 May;43(5 Suppl):I101-I104, Circulation
— id: 107130, year: 1971, vol: 43, page: I101, stat: Journal Article,

Histocompatibility studies in a closely bred colony of dogs. II. Influence of the DL-A system of canine histocompatibility upon the survival of cardiac allografts
Rapaport, R T; Boyd, A D; Spencer, F C; Lower, R R; Dausset, J; Cannon, F D; Ferrebee, J W
1971 Feb 1;133(2):260-274, Journal of experimental medicine
— id: 107047, year: 1971, vol: 133, page: 260, stat: Journal Article,

Binocular loupes (microtelescopes) for coronary artery surgery
Spencer, F C
1971 Jul;62(1):163-164, Journal of thoracic & cardiovascular surgery
— id: 107127, year: 1971, vol: 62, page: 163, stat: Journal Article,

Bypass grafting for occlusive disease of the coronary arteries
Spencer, F C
1971 May;20(5):68-73, Maryland state medical journal
— id: 107131, year: 1971, vol: 20, page: 68, stat: Journal Article,

Surgery of the tricuspid valve
Spencer, F C
1971 ;3(2):301-311, Cardiovascular clinics
— id: 107132, year: 1971, vol: 3, page: 301, stat: Journal Article,

Surgical treatment of coronary artery disease
Spencer, F C
1971 ;3:240-260, Modern trends in surgery
— id: 107133, year: 1971, vol: 3, page: 240, stat: Journal Article,

Bypass grafting for occlusive disease of the coronary arteries: a report of experience with 195 patients
Spencer, F C; Green, G E; Tice, D A; Glassman, E
1971 Jun;173(6):1029-1044, Annals of surgery
— id: 107128, year: 1971, vol: 173, page: 1029, stat: Journal Article,

Coronary artery bypass grafts for congestive heart failure. A report of experiences with 40 patients
Spencer, F C; Green, G E; Tice, D A; Wallsh, E; Mills, N L; Glassman, E
1971 Oct;62(4):529-542, Journal of thoracic & cardiovascular surgery
— id: 107125, year: 1971, vol: 62, page: 529, stat: Journal Article,

Surgical correction of postmyocardial infarction scar
Tice, D A; Spencer, F C; Cheng, T O; Dolgin, M; Glassman, E
1971 Sep 15;71(8):2172-2172, New York state journal of medicine
— id: 77351, year: 1971, vol: 71, page: 2172, stat: Journal Article,

Accidental burns associated with electrocautery
Wald, A S; Mazzia, V D; Spencer, F C
1971 Aug 16;217(7):916-921, JAMA
— id: 107126, year: 1971, vol: 217, page: 916, stat: Journal Article,

Prolonged survival of cardiac allografts in a closely-bred dog colony
Boyd, A D; Ferrebee, J W; Cannon, F D; Gherunpong, C; Lower, R R; Spencer, F C; Rapaport, F T
1970 ;21:188-190, Surgical forum
— id: 107050, year: 1970, vol: 21, page: 188, stat: Journal Article,

Why has bronchial resection and anastomosis been reported infrequently for treatment of bronchial adenoma?
Boyd, A D; Spencer, F C; Lind, A
1970 Mar;59(3):359-365, Journal of thoracic & cardiovascular surgery
— id: 107049, year: 1970, vol: 59, page: 359, stat: Journal Article,

Efficiency of aortic vents in the prevention of air embolism
Brenner, W I; Wallsh, E; Spencer, F C
1970 ;21:139-142, Surgical forum
— id: 107139, year: 1970, vol: 21, page: 139, stat: Journal Article,

Postpneumonectomy esophageal fistula: successful one-stage repair
Engelman, R M; Spencer, F C; Berg, P
1970 Jun;59(6):871-876, Journal of thoracic & cardiovascular surgery
— id: 107136, year: 1970, vol: 59, page: 871, stat: Journal Article,

Cardiac tamponade following open-heart surgery
Engelman, R M; Spencer, F C; Reed, G E; Tice, D A
1970 May;41(5 Suppl):II165-II171, Circulation
— id: 107137, year: 1970, vol: 41, page: II165, stat: Journal Article,

Biochemical analyses of human papillary muscles and guinea pig ventricles in failure
Gertler, M M; Saluste, E; Spencer, F
1970 Dec;135(3):817-824, Proceedings of the Society for Experimental Biology & Medicine
— id: 150052, year: 1970, vol: 135, page: 817, stat: Journal Article,

Arterial and venous microsurgical bypass grafts for coronary artery disease
Green, G E; Spencer, F C; Tice, D A; Stertzer, S H
1970 Oct;60(4):491-503, Journal of thoracic & cardiovascular surgery
— id: 107134, year: 1970, vol: 60, page: 491, stat: Journal Article,

Venous bypass grafts for occlusive disease of the coronary arteries
Spencer, F C
1970 Apr;79(4):568-571, American heart journal
— id: 107138, year: 1970, vol: 79, page: 568, stat: Journal Article,

Surgical therapy for coronary artery disease
Spencer, F C; Green, G E; Tice, D A; Glassman, E
1970 Sep;:3-49, Current problems in surgery
— id: 107135, year: 1970, vol: , page: 3, stat: Journal Article,

Cloth-covered aortic and mitral valve prostheses. Experiences with 113 patients
Spencer, F C; Reed, G E; Clauss, R H; Tice, D A; Reppert, E H
1970 Jan;59(1):92-108, Journal of thoracic & cardiovascular surgery
— id: 107140, year: 1970, vol: 59, page: 92, stat: Journal Article,

Surgical therapy for coronary artery disease
Spencer, Frank Cole
Chicago IL : Year Book Medical Publishers, 1970,
— id: 977, year: 1970, vol: , page: , stat: ,

A technique for treating significant gastrostomy leakage in infants and children
Wallsh E; Sisler GE; Lynfield J; Davis DA; Spencer FC
1970 Jun;5(3):376-378, Journal of pediatric surgery
— id: 23023, year: 1970, vol: 5, page: 376, stat: Journal Article,

Treatment of median sternotomy infection by mediastinal irrigation with an antibiotic solution
Bryant, L R; Spencer, F C; Trinkle, J K
1969 Jun;169(6):914-920, Annals of surgery
— id: 107141, year: 1969, vol: 169, page: 914, stat: Journal Article,

Complications of ventriculoatrial shunting for hydrocephalus requiring cardiac operation
Engelman, R M; Ransohoff, J; Cortes, L E; Spencer, F C
1969 Nov;8(5):464-469, Annals of thoracic surgery
— id: 67762, year: 1969, vol: 8, page: 464, stat: Journal Article,

Surgery of the chest. Edited by John H. Gibbon, David C. Sabiston [and] Frank C. Spencer; with the collaboration of 48 authorities
Gibbon, John Heysham; Sabiston, David C.; Spencer, Frank Cole
Philadelphia, Saunders, 1969,
— id: 288, year: 1969, vol: , page: , stat: ,

Mangement of thoracic injuries
Hood, R. Maurice; Spencer, Frank C.
Springfield IL : CC Thomas, 1969,
— id: 976, year: 1969, vol: , page: , stat: ,

Transthoracic removal of thoracic disc. Report of three cases
Ransohoff, J; Spencer, F; Siew, F; Gage, L Jr
1969 Oct;31(4):459-461, Journal of neurosurgery
— id: 67764, year: 1969, vol: 31, page: 459, stat: Journal Article,

A critique of implantation of a systemic artery for myocardial revascularization
Spencer, F C
1969 Mar;11(5):351-370, Progress in cardiovascular diseases
— id: 107142, year: 1969, vol: 11, page: 351, stat: Journal Article,

Cardiac arrest and ventricular fibrillation: pathogenesis and prevention
Spencer, F C
1969 Feb;35(2):77-82, American surgeon
— id: 107143, year: 1969, vol: 35, page: 77, stat: Journal Article,

Chronic subphrenic abscess
Acinapura, A J; Kostecki, R J; Becker, M H; Spencer, F C
1968 May;115(5):691-694, American journal of surgery
— id: 107148, year: 1968, vol: 115, page: 691, stat: Journal Article,

Surgical correction of absence of proximal segment of left pulmonary artery
Green GE; Reppert EH; Cohlan SQ; Spencer FC
1968 Jan;37(1):62-69, Circulation
— id: 21610, year: 1968, vol: 37, page: 62, stat: Journal Article,

Cerebral and cardiac complications from bacterial endocarditis. A successfully managed case with unusual complications
Noonan, J A; Wilson, C B; Spencer, F C; Talbert, W M Jr
1968 Dec;116(6):666-674, American journal of diseases of children
— id: 107145, year: 1968, vol: 116, page: 666, stat: Journal Article,

Resection of an internal carotid artery aneurysm under regional anesthesia: posterior cervical block
Paul RS; Abadir AR; Spencer FC
1968 Jul;168(1):147-153, Annals of surgery
— id: 27349, year: 1968, vol: 168, page: 147, stat: Journal Article,

Blood case monitoring in the operating room and recovery room
Spencer, F C
1968 Jan;167(1):143-144, Annals of surgery
— id: 107150, year: 1968, vol: 167, page: 143, stat: Journal Article,

Surgical treatment of valvular heart disease. V. Prosthetic replacement of the mitral valve
Spencer, F C
1968 Oct;76(4):576-580, American heart journal
— id: 107147, year: 1968, vol: 76, page: 576, stat: Journal Article,

Surgical treatment of valvular heart disease. VII. Prosthetic cardiac valves. Prognosis and management
Spencer, F C
1968 Dec;76(6):839-844, American heart journal
— id: 107144, year: 1968, vol: 76, page: 839, stat: Journal Article,

Technical considerations of coronary perfusion during aortic valve replacement
Spencer, F C; Malette, W
1968 Nov-Dec;9(6):562-572, Journal of cardiovascular surgery
— id: 107146, year: 1968, vol: 9, page: 562, stat: Journal Article,

Implantation of the splenic artery into the left ventricle for coronary artery disease
Spencer, F C; Reppert, E H; Boyd, A D; Cortes, L E
1968 Dec;34(12):831-836, American surgeon
— id: 107051, year: 1968, vol: 34, page: 831, stat: Journal Article,

Monitoring of blood gas tensions and pH during surgical operations
Tice, D A; Grosfeld, J L; Mazzia, V D; Spencer, F C
1968 Feb;96(2):247-251, Archives of Surgery (Chicago)
— id: 107149, year: 1968, vol: 96, page: 247, stat: Journal Article,

"Absent" left pulmonary artery with tetralogy of Fallot
Wallsh E; Reppert EH; Doyle EF; Spencer FC
1968 Mar;55(3):333-336, Journal of thoracic & cardiovascular surgery
— id: 58450, year: 1968, vol: 55, page: 333, stat: Journal Article,

Postoperative changes in regional pulmonary blood flow
Bryant, L R; Spencer, F C; Greenlaw, R H; Prathnadi, P; Bowlin, J W
1967 Jan;53(1):64-76, Journal of thoracic & cardiovascular surgery
— id: 107154, year: 1967, vol: 53, page: 64, stat: Journal Article,

Postgastrectomy afferent loop volvulus and gangrene. A late complication simulating pancreatitis
Sisler GE; Haims BW; Spencer FC
1967 Dec;114(6):932-936, American journal of surgery
— id: 23024, year: 1967, vol: 114, page: 932, stat: Journal Article,

Mechanism of thrombus formation upon Starr-Edwards prosthetic mitral valves
Spencer, F C; Cortes, L; Marcarenhas, G; Ifuku, M; Koepke, J
1967 May;165(5):814-825, Annals of surgery
— id: 107153, year: 1967, vol: 165, page: 814, stat: Journal Article,

Surgical treatment of mitral insufficiency secondary to coronary artery disease
Spencer, F C; Reppert, E H; Stertzer, S H
1967 Dec;95(6):853-861, Archives of Surgery (Chicago)
— id: 107151, year: 1967, vol: 95, page: 853, stat: Journal Article,

Central venous pH changes during major operations
Trinkle, J K; Spencer, F C; Bosomworth, P P
1967 Nov;33(11):878-881, American surgeon
— id: 107152, year: 1967, vol: 33, page: 878, stat: Journal Article,

Combined aorto-iliac and femoropopliteal occlusive disease: limitations of total aortofemoropopliteal bypass
Benson, J R; Whelen, T J; Cohen, A; Spencer, F C
1966 Jan;163(1):121-130, Annals of surgery
— id: 107158, year: 1966, vol: 163, page: 121, stat: Journal Article,

Occlusive disease of subclavian artery
Bryant, L R; Spencer, F C
1966 Apr 11;196(2):123-128, JAMA
— id: 107157, year: 1966, vol: 196, page: 123, stat: Journal Article,

Mechanical devices to assist or replace the failing heart
Eiseman, B; Spencer, F C; Malette, W G
1966 ;17:463-472, Annual review of medicine
— id: 107159, year: 1966, vol: 17, page: 463, stat: Journal Article,

Successful replacement of the tricuspid valve 10 years after traumatic incompetence
Shabetai, R; Adolph, R J; Spencer, F C
1966 Dec;18(6):916-920, American journal of cardiology
— id: 107155, year: 1966, vol: 18, page: 916, stat: Journal Article,

Cardiac surgery in infants and children: past, present, and future
Spencer, F C
1966 Jan;22(1):1-21, Clinical proceedings -- Children's Hospital of the District of Columbia
— id: 107160, year: 1966, vol: 22, page: 1, stat: Journal Article,

Role of the phonocardiogram in evaluation of the severity of mitral stenosis and detection of associated valvular lesions
Surawicz, B; Mercer, C; Chlebus, H; Reeves, J T; Spencer, F C
1966 Nov;34(5):795-806, Circulation
— id: 107156, year: 1966, vol: 34, page: 795, stat: Journal Article,

PROLONGED MECHANICAL VENTILATION. I. FACTORS AFFECTING DELIVERED OXYGEN CONCENTRATIONS AND RELATIVE HUMIDITY
BOSOMWORTH, P P; SPENCER, F C
1965 Jun;31:377-381, American surgeon
— id: 107167, year: 1965, vol: 31, page: 377, stat: Journal Article,

FREQUENCY OF EXTRACRANIAL CEREBROVASCULAR DISEASE IN PATIENTS WITH CHRONIC PSYCHOSIS
BRYANT, L R; EISEMAN, B; SPENCER, F C; LIEBER, A
1965 Jan 7;272:12-17, New England journal of medicine
— id: 107180, year: 1965, vol: 272, page: 12, stat: Journal Article,

THE OCCASIONAL OPEN-HEART SURGEON
EISEMAN, B; SPENCER, F C
1965 Feb;31:161-162, Circulation
— id: 107178, year: 1965, vol: 31, page: 161, stat: Journal Article,

MEDICAL LIBRARY NEEDS
EISEMAN, B; SPENCER, F C; MENGUY, R; RUSH, B; BRYANT, L
1965 Apr;40:396-397, Journal of medical education
— id: 107172, year: 1965, vol: 40, page: 396, stat: Journal Article,

THE CHANGING ROLE OF SURGERY IN ANATOMY INSTRUCTION FOR MEDICAL STUDENTS
EISEMAN, B; SPENCER, F C; MENGUY, R; RUSH, B; BRYANT, L
1965 Apr;40:393-395, Journal of medical education
— id: 107173, year: 1965, vol: 40, page: 393, stat: Journal Article,

INTERMITTENT CLAUDICATION CAUSED BY A DISSECTING ANEURYSM OF THE AORTA
GRYBOSKI, W; SPENCER, F C
1965 May;58:593-596, Southern medical journal
— id: 107171, year: 1965, vol: 58, page: 593, stat: Journal Article,

SINGLE CORONARY ARTERY WITH CORONARY ARTERIOVENOUS FISTUALA COMMUNICATING WITH THE RIGHT VENTRICLE
NOONAN, J A; SPENCER, F C
1965 Jun;15:848-852, American journal of cardiology
— id: 107165, year: 1965, vol: 15, page: 848, stat: Journal Article,

SUBCLAVIAN STEAL SYNDROME: SURGICAL TREATMENT OF THREE PATIENTS
ROSENBERG, J C; SPENCER, F C
1965 May;31:307-312, American surgeon
— id: 107170, year: 1965, vol: 31, page: 307, stat: Journal Article,

HISTOLOGIC CHANGES IN LONG-TERM AUTOLOGOUS ARTERIAL PATCH GRAFTS IN CORONARY ARTERIES
ROSSI, N P; KOEPKE, J A; SPENCER, F C
1965 Feb;57:335-342, Surgery
— id: 107177, year: 1965, vol: 57, page: 335, stat: Journal Article,

CHANGES IN OXYGEN CONSUMPTION IN SHOCK; CORRELATION WITH OTHER KNOWN PARAMETERS
RUSH, B F Jr; ROSENBERG, J C; SPENCER, F C
1965 Jun;5:252-255, Journal of surgical research
— id: 107166, year: 1965, vol: 5, page: 252, stat: Journal Article,

Effect of dibenzyline treatment on cardiac dynamics and oxidative metabolism in hemorrhagic shock
Rush, B F Jr; Rosenberg, J C; Spencer, F C
1965 Dec;162(6):1013-1016, Annals of surgery
— id: 107162, year: 1965, vol: 162, page: 1013, stat: Journal Article,

THE CURRENT STATUS OF THE SURGICAL TREATMENT OF OCCLUSIVE DISEASE OF THE CAROTID ARTERY
SPENCER, F C
1965 May;58:156-159, Journal of the Tennessee Medical Association
— id: 107169, year: 1965, vol: 58, page: 156, stat: Journal Article,

TREATMENT OF CARDIAC FAILURE FROM AORTIC VALVE DISEASE WITH A BALL-VALVE PROSTHESIS IN 13 PATIENTS
SPENCER, F C; EISEMAN, B
1965 Jul;63:495-7 PASSIM, Journal of the Kentucky Medical Association
— id: 107164, year: 1965, vol: 63, page: 495, stat: Journal Article,

AN OPERATIVE TECHNIQUE WITH CARDIOPULMONARY BYPASS FOR PRODUCING CHRONIC ANOXEMIA IN CALVES
SPENCER, F C; EISEMAN, B; REEVES, J T
1965 Feb;49:269-274, Journal of thoracic & cardiovascular surgery
— id: 107179, year: 1965, vol: 49, page: 269, stat: Journal Article,

ASSISTED CIRCULATION FOR CARDIAC FAILURE FOLLOWING INTRACARDIAC SURGERY WITH CARDIOPULMONARY BYPASS
SPENCER, F C; EISEMAN, B; TRINKLE, J K; ROSSI, N P
1965 Jan;49:56-73, Journal of thoracic & cardiovascular surgery
— id: 107181, year: 1965, vol: 49, page: 56, stat: Journal Article,

PLICATION OF THE INFERIOR VENA CAVA FOR PULMONARY EMBOLISM: LONG-TERM RESULTS IN 39 CASES
SPENCER, F C; JUDE, J; RIENHOFF, W F 3rd; STONESIFER, G
1965 May;161:788-801, Annals of surgery
— id: 107168, year: 1965, vol: 161, page: 788, stat: Journal Article,

THE SIGNIFICANCE OF AIR EMBOLISM DURING CARDIOPULMONARY BYPASS
SPENCER, F C; ROSSI, N P; YU, S C; KOEPKE, J A
1965 Apr;49:615-634, Journal of thoracic & cardiovascular surgery
— id: 107174, year: 1965, vol: 49, page: 615, stat: Journal Article,

Successful replacement of a thrombosed mitral ball-valve prosthesis
Spencer, F C; Trinkle, J K; Reeves, J T
1965 Dec 13;194(11):1249-1251, JAMA
— id: 107161, year: 1965, vol: 194, page: 1249, stat: Journal Article,

THE TREATMENT OF ARTERIOSCLEROTIC GANGRENE OF THE FOOT BY ARTERIAL RECONSTRUCTION AND LOCAL AMPUTATION
SPENCER, F C; WINSLOW, P R
1965 Mar;63:174-7 PASSIM, Journal of the Kentucky Medical Association
— id: 107176, year: 1965, vol: 63, page: 174, stat: Journal Article,

INTRACARDIAC PRESSURE CHANGES WITH OVERTRANSFUSION OF NORMAL DOGS
SPENCER, F C; YU, S C; ROSSI, N P
1965 Jul;162:74-80, Annals of surgery
— id: 107163, year: 1965, vol: 162, page: 74, stat: Journal Article,

INCREASED PULMONARY VASCULAR RESISTANCE FOLLOWING PROLONGED PUMP OXYGENATION
YONG, N K; EISEMAN, B; SPENCER, F C; ROSSI, N
1965 Apr;49:580-587, Journal of thoracic & cardiovascular surgery
— id: 107175, year: 1965, vol: 49, page: 580, stat: Journal Article,

MAN'S BEST FRIEND?
EISEMAN, B; SPENCER, F C
1964 Jan;159:159-160, Annals of surgery
— id: 107192, year: 1964, vol: 159, page: 159, stat: Journal Article,

EXTENSIVE CARCINOMA OF THE DUODENUM TREATED BY PANCREATICO-DUODENECTOMY AND RIGHT HEMICOLECTOMY
GALLAGHER, J A; TESLUK, H; SPENCER, F C
1964 Aug;62:599-601, Journal of the Kentucky Medical Association
— id: 107183, year: 1964, vol: 62, page: 599, stat: Journal Article,

LONG-TERM COMPARISON OF VEIN PATCH WITH DIRECT SUTURE. TECHNIQUE OF ANASTOMOSIS OF SMALL ARTERIES
NORTON, L W; SPENCER, F C
1964 Dec;89:1083-1088, Archives of Surgery (Chicago)
— id: 107182, year: 1964, vol: 89, page: 1083, stat: Journal Article,

PULMONARY INJURY FROM PROLONGED OXYGENATION WITH VENOUS BLOOD
ROSSI, N P; YU, S C; KOEPKE, J; SPENCER, F C
1964 ;15:277-279, Surgical forum
— id: 107190, year: 1964, vol: 15, page: 277, stat: Journal Article,

THE LERICHE SYNDROME-PRESENT CONCEPTS OF DIAGNOSIS AND TREATMENT
SPENCER, F C
1964 Aug;57:443-446, Medical record & annals
— id: 107184, year: 1964, vol: 57, page: 443, stat: Journal Article,

DELAYED ARTERIAL EMBOLECTOMY--A NEW CONCEPT
SPENCER, F C; EISEMAN, B
1964 Jan;55:64-72, Surgery
— id: 107191, year: 1964, vol: 55, page: 64, stat: Journal Article,

THE SURGICAL TREATMENT OF HEART FAILURE AND ADAMS-STOKES ATTACKS FROM COMPLETE HEART BLOCK WITH A CARDIAC PACEMAKER
SPENCER, F C; EISEMAN, B; REEVES, J T
1964 May;62:365-368, Journal of the Kentucky Medical Association
— id: 107187, year: 1964, vol: 62, page: 365, stat: Journal Article,

EXPERIMENTAL CORONARY ARTERIAL SURGERY WITH HYPOTHERMIA AND CARDIOPULMONARY BYPASS
SPENCER, F C; EISEMAN, B; YONG, N K; PRACHUABMOH, K
1964 Apr;29:SUPPL:140-SUPPL:144, Circulation
— id: 107188, year: 1964, vol: 29, page: SUPPL:140, stat: Journal Article,

AORTIC VALVE REPLACEMENT IN ELDERLY PATIENTS WITH CARDIAC FAILURE
SPENCER, F C; TRINKLE, J K; EISEMAN, B; REEVES, J T; SURAWICZ, B
1964 Jul 13;189:103-107, JAMA
— id: 107185, year: 1964, vol: 189, page: 103, stat: Journal Article,

INTERNAL MAMMARY-CORONARY ARTERY ANASTOMOSES PERFORMED DURING CARDIOPULMONARY BYPASS
SPENCER, F C; YONG, N K; PRACHUABMOH, K
1964 Jul-Aug;5:292-297, Journal of cardiovascular surgery
— id: 107186, year: 1964, vol: 5, page: 292, stat: Journal Article,

Treatment of chest injuries
Spencer, Frank Cole
Chicago : Year Book Medical Publishers, 1964,
— id: 987, year: 1964, vol: , page: , stat: ,

CHANGES IN INTRACARDIAC PRESSURES WITH OVERTRANSFUSION OF NORMAL DOGS
YU, S C; ROSSI, N P; SPENCER, F C
1964 ;15:283-285, Surgical forum
— id: 107189, year: 1964, vol: 15, page: 283, stat: Journal Article,

Current status of palliative vs. corrective procedures in congenital heart surgery
BAFFES, T G; COOLEY, D A; DAMMANN, J F Jr; GLENN, W W; SPENCER, F C
1963 Apr;43:337-349, Diseases of the chest
— id: 107200, year: 1963, vol: 43, page: 337, stat: Journal Article,

Factors Affecting Hepatic Vascular Resistance in the Perfused Liver
Eiseman, B; Knipe, P; Koh, Y; Normell, L; Spencer, F C
1963 Apr;157(4):532-547, Annals of surgery
— id: 107199, year: 1963, vol: 157, page: 532, stat: Journal Article,

TRAUMATIC CARDIAC AND PERIPHERAL VASCULAR INJURIES
SPENCER, F C
1963 Aug;62:600-604, Northwest medicine
— id: 107196, year: 1963, vol: 62, page: 600, stat: Journal Article,

Coronary artery patch graft. Experiment with cardiopulmonary bypass and hypothermia
SPENCER, F C; EISEMAN, B; NORTON, L W; KOH, Y C
1963 Jan;86:81-86, Archives of Surgery (Chicago)
— id: 107201, year: 1963, vol: 86, page: 81, stat: Journal Article,

OPERATIVE CHOLANGIOGRAPHY IN MANAGEMENT OF TRAUMATIC HEMOBILIA
SPENCER, F C; MENGUY, R; EISEMAN, B
1963 Aug;54:376-381, Surgery
— id: 107194, year: 1963, vol: 54, page: 376, stat: Journal Article,

RECONSTRUCTIVE SURGERY OF OCCLUSIVE DISEASE OF FEMORAL AND POPLITEAL ARTERIES
SPENCER, F C; RIENHOFF, W F 3rd
1963 Nov;54:709-712, Surgery
— id: 107193, year: 1963, vol: 54, page: 709, stat: Journal Article,

EXPERIENCES WITH WIRE CLOSURE OF ABDOMINAL INCISIONS IN 293 SELECTED PATIENTS
SPENCER, F C; SHARP, E H; JUDE, J R
1963 Aug;117:235-238, Surgery, gynecology & obstetrics
— id: 107195, year: 1963, vol: 117, page: 235, stat: Journal Article,

Cytologic survey for squamous cancer of the cervix in Honolulu, 1949-1962
SPENCER, F C; YAMAMURA, D S
1963 Jul 1;86:646-652, American journal of obstetrics & gynecology
— id: 107197, year: 1963, vol: 86, page: 646, stat: Journal Article,

Aneurysm of the aorta treated by excision. Review of 237 cases followed up to seven years
VASKO, J S; SPENCER, F C; BAHNSON, H T
1963 Jun;105:793-801, American journal of surgery
— id: 107198, year: 1963, vol: 105, page: 793, stat: Journal Article,

[Experiences in open heart surgery with the use of cardiopulmonary bypass circulation.]
BAHNSON, H T; SPENCER, F C; BENSON, D W
1962 May;34(Special):858-864, Dia medico (Buenos Aires)
— id: 107210, year: 1962, vol: 34(Special), page: 858, stat: Journal Article,

Surgical treatment and follow-up of 147 cases of tetralogy of Fallottreated by correction
BAHNSON, H T; SPENCER, F C; LANDTMAN, B; WOLF, M D; NEILL, C A; TAUSSIG, H B
1962 Oct;44:419-432, Journal of thoracic & cardiovascular surgery
— id: 107202, year: 1962, vol: 44, page: 419, stat: Journal Article,

Atresia or absence of the aortic isthmus
BLAKE, H A; MANION, W C; SPENCER, F C
1962 May;43:607-614, Journal of thoracic & cardiovascular surgery
— id: 107209, year: 1962, vol: 43, page: 607, stat: Journal Article,

Occlusive lesions of the great vessels of the aortic arch. Surgical and pathological aspects
COHEN, A; MANION, W C; SPENCER, F C; CZARNECKI, S W; DEBAKEY, M E
1962 Jun;84:628-642, Archives of Surgery (Chicago)
— id: 107208, year: 1962, vol: 84, page: 628, stat: Journal Article,

Observations on traumatic perforations of the esophagus in dogs
CRANE, P S; DELEON, A R; SPENCER, F C
1962 Aug;52:373-377, Surgery
— id: 107205, year: 1962, vol: 52, page: 373, stat: Journal Article,

Current status of surgery of the lesions of the aortic arch
GAERTNER, R A; SPENCER, F C; BAHNSON, H T
1962 Jan;4:373-390, Progress in cardiovascular diseases
— id: 107214, year: 1962, vol: 4, page: 373, stat: Journal Article,

Alveolar hypoxia versus hypoxemia in the development of pulmonary hypertension
REEVES, J T; LEATHERS, J E; EISEMAN, B; SPENCER, F C
1962 ;19:561-572, Medicina thoracalis
— id: 107212, year: 1962, vol: 19, page: 561, stat: Journal Article,

The diagnosis and treatment of renovascular hypertension
SPENCER, F C
1962 Jan;55:17-21, Medical record & annals
— id: 107213, year: 1962, vol: 55, page: 17, stat: Journal Article,

The present role of hypothermia in cardiac surgery
SPENCER, F C; BAHNSON, H T
1962 Aug;26:292-300, Circulation
— id: 107204, year: 1962, vol: 26, page: 292, stat: Journal Article,

The treatment of aortic regurgitation associated with a ventricular septal defect
SPENCER, F C; BAHNSON, H T; NEILL, C A
1962 Feb;43:222-233, Journal of thoracic & cardiovascular surgery
— id: 107211, year: 1962, vol: 43, page: 222, stat: Journal Article,

A report of the successful surgical treatment of aortic regurgitation from a dissecting aortic aneurysm in a patient with the Marfan syndrome
SPENCER, F C; BLAKE, H
1962 Aug;44:238-245, Journal of thoracic & cardiovascular surgery
— id: 107203, year: 1962, vol: 44, page: 238, stat: Journal Article,

Technique of carotid endarterectomy
SPENCER, F C; EISEMAN, B
1962 Jul;115:115-117, Surgery, gynecology & obstetrics
— id: 107206, year: 1962, vol: 115, page: 115, stat: Journal Article,

Plication of the inferior vena cava for pulmonary embolism: a report of 20 cases
SPENCER, F C; QUATTLEBAUM, J K; QUATTLEBAUM, J K Jr; SHARP, E H; JUDE, J R
1962 Jun;155:827-837, Annals of surgery
— id: 107207, year: 1962, vol: 155, page: 827, stat: Journal Article,

Intracardiac surgery performed with cardiopulmonary bypass
BAHNSON, H T; SPENCER, F C
1961 May;29:474-480, Postgraduate medicine
— id: 107218, year: 1961, vol: 29, page: 474, stat: Journal Article,

Abdominal aortic aneurysm. Successful excision in a patient 89 years of age
KNOWLES, P W; SPENCER, F C; STEENBURG, R W
1961 Nov 11;178:661-663, JAMA
— id: 107215, year: 1961, vol: 178, page: 661, stat: Journal Article,

Aneurysms of the previously ligated patent ductus arteriosus
ROSS, R S; FEDER, F P; SPENCER, F C
1961 Mar;23:350-357, Circulation
— id: 107219, year: 1961, vol: 23, page: 350, stat: Journal Article,

An unusual case of paradoxic embolism after cardiac surgery
RUEBNER, B H; HANNIBAL, M J; SPENCER, F C
1961 Jun;108:370-373, Bulletin of the Johns Hopkins Hospital
— id: 107217, year: 1961, vol: 108, page: 370, stat: Journal Article,

Diagnosis and treatment of hypertension due to occlusive disease of the renal artery
SPENCER, F C; STAMEY, T A; BAHNSON, H T; COHEN, A
1961 Oct;154:674-697, Annals of surgery
— id: 107216, year: 1961, vol: 154, page: 674, stat: Journal Article,

Excision of aneurysm of the ascending aorta with prosthetic replacement during cardiopulmonary bypass
BAHNSON, H T; SPENCER, F C
1960 Jun;151:879-890, Annals of surgery
— id: 107224, year: 1960, vol: 151, page: 879, stat: Journal Article,

Physiological principles in the use of the cardiopulmonary bypass
BAHNSON, H T; SPENCER, F C
1960 Feb;29:227-234, Australian & New Zealand journal of surgery
— id: 107227, year: 1960, vol: 29, page: 227, stat: Journal Article,

Cusp Replacement and Coronary Artery Perfusion in Open Operations on the Aortic Valve
Bahnson, H T; Spencer, F C; Busse, E F; Davis, F W
1960 Sep;152(3):494-503, Annals of surgery
— id: 107222, year: 1960, vol: 152, page: 494, stat: Journal Article,

Experiences with open heart sugery during cardiopulmonary bypass in 270 cases
BAHNSON, H T; SPENCER, F C; GAERTNER, R A; BENSON, D W
1960 Apr;26:227-235, American surgeon
— id: 107226, year: 1960, vol: 26, page: 227, stat: Journal Article,

Emergency Use of Antegrade Aortography in Diagnosis of Acute Aortic Rupture
Blake, H A; Inmon, T W; Spencer, F C
1960 Dec;152(6):954-956, Annals of surgery
— id: 107221, year: 1960, vol: 152, page: 954, stat: Journal Article,

Chronic sanguineous chylopercardium and chylothorax
HILLS, R G; SPENCER, F C
1960 ;72:168-174, Transactions of the American Clinical & Climatological Association
— id: 107229, year: 1960, vol: 72, page: 168, stat: Journal Article,

An experimental evaluation of partitioning of the inferior vena cava to prevent pulmonary embolism
SPENCER, F C
1960 ;10:680-684, Surgical forum
— id: 107228, year: 1960, vol: 10, page: 680, stat: Journal Article,

Surgical investigation of the cervix with the trachelotome
SPENCER, F C; BENSON, R C
1960 Jul;80:60-63, American journal of obstetrics & gynecology
— id: 107223, year: 1960, vol: 80, page: 60, stat: Journal Article,

Surgical Repair of Ruptured Aneurysm of Sinus of Valsalva in Two Patients
Spencer, F C; Blake, H A; Bahnson, H T
1960 Dec;152(6):963-968, Annals of surgery
— id: 107220, year: 1960, vol: 152, page: 963, stat: Journal Article,

Anatomical variations in 46 patients with congenital aortic stenosis
SPENCER, F C; NEILL, C A; SANK, L; BAHNSON, H T
1960 Apr;26:204-216, American surgeon
— id: 107225, year: 1960, vol: 26, page: 204, stat: Journal Article,

Surgical treatment of occlusive disease of the carotid artery
BAHNSON, H T; SPENCER, F C; QUATTLEBAUM, J K Jr
1959 May;149(5):711-720, Annals of surgery
— id: 107234, year: 1959, vol: 149, page: 711, stat: Journal Article,

The use of hypothermia after cardiac arrest
BENSON, D W; WILLIAMS, G R Jr; SPENCER, F C; YATES, A J
1959 Nov-Dec;38:423-428, Anesthesia & analgesia
— id: 107232, year: 1959, vol: 38, page: 423, stat: Journal Article,

Estimation of cardiac output soon after intracardiac surgery with cardiopulmonary bypass
BOYD, A D; TREMBLAY, R E; SPENCER, F C; BAHNSON, H T
1959 Oct;150:613-626, Annals of surgery
— id: 107052, year: 1959, vol: 150, page: 613, stat: Journal Article,

Congenital aortic stenosis
SISSMAN, N J; NEILL, C A; SPENCER, F C; TAUSSIG, H B
1959 Mar;19(3):458-468, Circulation
— id: 107236, year: 1959, vol: 19, page: 458, stat: Journal Article,

Open heart surgery for acquired valvular heart disease
SPENCER, F C
1959 Oct;8:592-592, Maryland state medical journal
— id: 107233, year: 1959, vol: 8, page: 592, stat: Journal Article,

Intracardiac surgery employing hypothermia and coronary perfusion performed on 100 patients
SPENCER, F C; BAHNSON, H T
1959 Nov;46:987-995, Surgery
— id: 107231, year: 1959, vol: 46, page: 987, stat: Journal Article,

Use of a mechanical respirator in the management of respiratory or pulmonary disease
SPENCER, F C; BENSON, D W; LIU, W C; BAHNSON, H T
1959 Dec;38:758-770, Journal of thoracic & cardiovascular surgery
— id: 107230, year: 1959, vol: 38, page: 758, stat: Journal Article,

Division of the pubis for massive hemorrhage from fractures of the pelvis
SPENCER, F C; ROBINSON, R A
1959 Apr;78(4):535-537, A.M.A. archives of surgery
— id: 107235, year: 1959, vol: 78, page: 535, stat: Journal Article,

Surgical treatment of thirty-five cases of drainage of pulmonary veins to the right side of the heart
BAHNSON, H T; SPENCER, F C; NEILL, C A
1958 Dec;36(6):777-799, Journal of thoracic surgery
— id: 107237, year: 1958, vol: 36, page: 777, stat: Journal Article,

The use of ethylene oxide for gas sterilization of a pump oxygenator
SPENCER, F C; BAHNSON, H T
1958 May;102(5):241-244, Bulletin of the Johns Hopkins Hospital
— id: 107240, year: 1958, vol: 102, page: 241, stat: Journal Article,

The treatment of congenital aortic stenosis with valvotomy during cardiopulmonary bypass
SPENCER, F C; NEILL, C A; BAHNSON, H T
1958 Jul;44(1):109-124, Surgery
— id: 107239, year: 1958, vol: 44, page: 109, stat: Journal Article,

The influence of ligation of intercostal arteries on paraplegia in dogs
SPENCER, F C; ZIMMERMAN, J M
1958 ;9:340-342, Surgical forum
— id: 107241, year: 1958, vol: 9, page: 340, stat: Journal Article,

The clinical use of hypothermia following cardiac arrest
WILLIAMS, G R Jr; SPENCER, F C
1958 Sep;148(3):462-468, Annals of surgery
— id: 107238, year: 1958, vol: 148, page: 462, stat: Journal Article,

The influence of hypothermia on cerebral injury resulting from circulatory occlusion
ZIMMERMAN, J M; SPENCER, F C
1958 ;9:216-218, Surgical forum
— id: 107242, year: 1958, vol: 9, page: 216, stat: Journal Article,

Diagnosis and treatment of intracavitary myxomas of the heart
BAHNSON, H T; SPENCER, F C; ANDRUS, E C
1957 Jun;145(6):915-925, Annals of surgery
— id: 107245, year: 1957, vol: 145, page: 915, stat: Journal Article,

Staphylococcal infections of the heart and great vessels due to silk sutures
BAHNSON, H T; SPENCER, F C; BENNETT, I L Jr
1957 Sep;146(3):399-406, Annals of surgery
— id: 89454, year: 1957, vol: 146, page: 399, stat: Journal Article,

Aneurysm of the common carotid artery treated by excision and primary anastomosis
SPENCER, F C
1957 Feb;145(2):254-257, Annals of surgery
— id: 107247, year: 1957, vol: 145, page: 254, stat: Journal Article,

The use of coronary perfusion and carbon dioxide regulation in intracardiac operations performed under hypothermia
SPENCER, F C; JUDE, J R; BAHNSON, H T
1957 Jul;42(1):76-89, Surgery
— id: 107244, year: 1957, vol: 42, page: 76, stat: Journal Article,

War wounds of the heart; report of two patients with unusual features
SPENCER, F C; KENNEDY, J A
1957 Mar;33(3):361-370, Journal of thoracic surgery
— id: 107246, year: 1957, vol: 33, page: 361, stat: Journal Article,

Study of the canine lung as an oxygenator of human and canine blood in extracorporeal circulation
WALDHAUSEN, J A; WEBB, R C; SPENCER, F C; BAHNSON, H T
1957 Oct;42(4):726-733, Surgery
— id: 107243, year: 1957, vol: 42, page: 726, stat: Journal Article,

The examination of the gastric mucosa through a large gastrotomy in the diagnosis of intestinal hemorrhage of obscure origin
MALONEY, J V Jr; SPENCER, F C
1956 Nov;40(5):904-912, Surgery
— id: 107248, year: 1956, vol: 40, page: 904, stat: Journal Article,

The nonoperative treatment of traumatic chylothorax
MALONEY, J V Jr; SPENCER, F C
1956 Jul;40(1):121-128, Surgery
— id: 107250, year: 1956, vol: 40, page: 121, stat: Journal Article,

Ischemic necrosis of remaining stomach following subtotal gastrectomy
SPENCER, F C
1956 Nov;73(5):844-848, A.M.A. archives of surgery
— id: 107249, year: 1956, vol: 73, page: 844, stat: Journal Article,

The trachelotome, a new instrument for coning the cervix
SPENCER, F C
1955 Aug;70(2):447-447, American journal of obstetrics & gynecology
— id: 107251, year: 1955, vol: 70, page: 447, stat: Journal Article,

The management of arterial injuries in battle casualties
SPENCER, F C; GREWE, R V
1955 Mar;141(3):304-313, Annals of surgery
— id: 107252, year: 1955, vol: 141, page: 304, stat: Journal Article,

Endometrial carcinoma; report of five cases
SPENCER, F C
1954 Mar-Apr;13(4):261-263, Hawaii medical journal
— id: 107254, year: 1954, vol: 13, page: 261, stat: Journal Article,

Relationship between obstetrician and pediatrician
SPENCER, F C
1954 Jul;4(1):125-126, Obstetrics & gynecology
— id: 107253, year: 1954, vol: 4, page: 125, stat: Journal Article,

Studies in the production of experimental mitral stenosis
MULLER, W H Jr; SPENCER, F C; COXE, J W 3rd; HEAD, W H Jr; LONGMIRE, W P Jr
1953 Nov;19(11):1015-1027, American surgeon
— id: 107255, year: 1953, vol: 19, page: 1015, stat: Journal Article,

The effect of cortisone on the healing of wounds in the cardiovascular system
MULLER, W H Jr; SPENCER, F C; LEWIS, A E
1953 Mar;33(3):399-406, Surgery
— id: 107256, year: 1953, vol: 33, page: 399, stat: Journal Article,

Traumatic aneurysm of the innominated artery
DICKINSON EH; HOOD RM; SPENCER FC
1952 Dec;3(12):1871-1879, United States Armed Forces medical journal
— id: 63828, year: 1952, vol: 3, page: 1871, stat: Journal Article,

Choledochal cyst; report of a case with unusual features
DICKINSON, E H; SPENCER, F C
1952 Oct;41(4):462-466, Journal of pediatrics
— id: 107257, year: 1952, vol: 41, page: 462, stat: Journal Article,

Arteriovenous fistulas and arterial aneurysms; the repair of major arteries injured in warfare, and the treatment of an arterial aneurysm with a vein graft inlay
GERBODE, F; HOLMAN, E; DICKENSON, E H; SPENCER, F C
1952 Aug;32(2):259-274, Surgery
— id: 107258, year: 1952, vol: 32, page: 259, stat: Journal Article,

The use of a solution of twenty-five per cent glucose and five per cent alcohol in parenteral nutrition; a preliminary report
SPENCER, F C; BEAL, J M
1952 Feb;135(2):234-238, Annals of surgery
— id: 107259, year: 1952, vol: 135, page: 234, stat: Journal Article,

Experimental pulmonic valvulotomy under direct vision by temporarily occluding the pulmonary artery
SPENCER, F C; MULLER, W H Jr; LONGMIRE, W P Jr
1952 Jan;135(1):34-38, Annals of surgery
— id: 107260, year: 1952, vol: 135, page: 34, stat: Journal Article,

Report of Hawaii Cancer Society Cytology Laboratory
SPENCER, F C; TILDEN, I L; QUISENBERRY, W B
1951 Jul-Aug;10(6):437-438, Hawaii medical journal
— id: 107261, year: 1951, vol: 10, page: 437, stat: Journal Article,

Coronary blood flow and cardiac oxygen consumption in unanesthetized dogs
SPENCER, F C; MERRILL, D L
1950 Jan;160(1):149-62, illust, American journal of physiology
— id: 107262, year: 1950, vol: 160, page: 149, stat: Journal Article,

The management of prolonged labor
SPENCER, F C
1948 May-Jun;7(5):389-391, Hawaii medical journal
— id: 107263, year: 1948, vol: 7, page: 389, stat: Journal Article,