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Otolaryngologist (ear, nose, throat)
19 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score Rankings
University of Michigan Medical School (1991)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Awards  
Patients' Choice Award (2012)
Compassionate Doctor Recognition (2012)
Associations
American Academy of Otolaryngology: Head and Neck Surgery
American Board of Otolaryngology

Affiliations ?

Dr. Green is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • University of Michigan Hospitals & Health Centers
    Otolaryngology
    1500 E Medical Center Dr, Ann Arbor, MI 48109
    • Currently 4 of 4 crosses
    Top 25%
  • Ann Arbor Veterans Affairs Medical Center
    2215 Fuller Rd, Ann Arbor, MI 48105
  • University of Michigan Health System
  • C.S. Mott Children's Hospital
    1500 E Medical Center Dr, Ann Arbor, MI 48109
  • Publications & Research

    Dr. Green has contributed to 103 publications.
    Title Awake Extracorporeal Membrane Oxygenation for Management of Critical Distal Tracheal Obstruction.
    Date April 2010
    Journal Otolaryngology--head and Neck Surgery : Official Journal of American Academy of Otolaryngology-head and Neck Surgery
    Title Cricotracheal Resection with Hilar Release for Pediatric Airway Stenosis.
    Date April 2010
    Journal Archives of Otolaryngology--head & Neck Surgery
    Excerpt

    To determine the effectiveness of cricotracheal resection and hilar release for high-grade, long-segment airway stenosis.

    Title Obesity and Risk of Peri-operative Complications in Children Presenting for Adenotonsillectomy.
    Date March 2009
    Journal International Journal of Pediatric Otorhinolaryngology
    Excerpt

    Adenotonsillectomy (T&A) is a very common surgical procedure in children. With the rising prevalence of childhood overweight and obesity, our goal was to describe the prevalence of overweight/obesity in children presenting for T&A in our institution. We also sought to compare the frequency of peri-operative complications and the likelihood of being admitted following T&A between overweight/obese and normal weight children.

    Title Does High Bmi Influence Hospital Charges in Children Undergoing Adenotonsillectomy?
    Date September 2008
    Journal Obesity (silver Spring, Md.)
    Excerpt

    BACKGROUND: Obesity is a highly prevalent chronic problem with health and fiscal consequences. Data from adults and nonsurgical pediatric patients suggest that obesity has serious implications for the US economy. OBJECTIVE: Our goal was to describe the impact of BMI on hospital charges in children undergoing adenotonsillectomy (AT). METHODS AND PROCEDURES: We carried out a retrospective comparative analysis of the electronic anesthesia record and the charges from billing data from a large tertiary institution on children aged 3-18 years who had AT during the year 2005-2007. The main outcome measures were mean total hospital charges, likelihood of admission, and length of hospital stay (LOS). RESULTS: Of 1,643 children, 68.9% were aged <10 years, 76% were whites, and 74.1% had private commercial insurance. Most (75.3%) children were discharged on the day of surgery. Obese and overweight children were more likely to be admitted than their normal-weight peers (X(2)=26.3, P<0.001). Among those admitted, BMI showed a positive correlation with LOS (r=0.20, P<0.001). Obese and overweight patients had significantly higher total hospital charges than their healthy-weight counterparts (P=0.001). Anesthesia, postanesthesia care unit (PACU), and pharmacy and laboratory charges were also higher for obese than normal-weight children (P<0.05). DISCUSSION: Overweight and obese children undergoing AT accrued higher hospital charges and had longer postoperative LOS than their healthy-weight peers. If these findings are extendable to other surgical procedures, they could have far-reaching implications for the US economy.

    Title Brenner Tumors of the Ovary: Sonographic and Computed Tomographic Imaging Features.
    Date January 2007
    Journal Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
    Excerpt

    OBJECTIVE: The purpose of this study was to describe the sonographic appearance of ovarian Brenner tumors with computed tomographic (CT) correlation. METHODS: Twenty-two female patients (age range, 32-78 years; mean, 58 years) with 25 ovarian Brenner tumors were identified from pathologic records from 1990 to 2005. Corresponding pathologic reports and images (17 sonographic and 14 CT) were reviewed independently. RESULTS: Tumors ranged in size from 0.3 to 12 cm (mean, 2.5 cm); all were benign. Sixteen (64%) of 25 were found incidentally. Eight (36%) of 22 patients had a total of 12 associated benign ovarian neoplasms (1 was contralateral); 3 patients had bilateral Brenner tumors. Eight (47%) of 17 tumors were not seen on sonography, and 5 (36%) of 14 were not seen on CT. Of the tumors seen on imaging, most were solid (67% on sonography and 78% on CT). Four tumors appeared at least partially cystic, of which 3 had coexistent cystic ovarian lesions. CONCLUSIONS: Brenner tumors are most often solid neoplasms found incidentally and frequently seen in association with other benign ovarian epithelial neoplasms.

    Title Residency Training As Technology Matures a Survey of Radiology Residents' Training Experiences.
    Date December 2006
    Journal Academic Radiology
    Excerpt

    RATIONALE AND OBJECTIVES: The aim of the study is to assess radiology resident training experience in cardiac magnetic resonance imaging (MRI), positron emission tomography (PET), obstetrical (OB) ultrasound (US), carotid US, and barium esophagram. MATERIALS AND METHODS: One hundred eighteen radiology residents completed surveys. Surveys assessed resident year of residency training, hospital size, program affiliation with an academic institution, state, performance of the examinations listed, number of examinations performed per week, and number of weeks spent on rotations for each modality. The study was approved by the institutional review board and was Health Insurance Portability and Accountability Act (HIPAA) compliant. t-Test and chi-square test were performed, and results were analyzed for statistical significance. RESULTS: Most (94 respondents; 80%) respondents were third-year residents, 101 residents (86%) stated their program was affiliated with an academic institution, 92 residents (78%) performed cardiac MRI, 104 (88%) performed PET, 84 (71%) performed OB US, 71 (60%) performed carotid US (one did not respond), and all performed esophagrams (although one did not respond). Only performance of cardiac MRI and PET correlated positively with a larger average hospital size (P < .01). Residents at an academically affiliated program were significantly more likely to perform cardiac MRI (P < .05). Geographic region significantly affected likelihood of performance of cardiac MRI only. CONCLUSION: Such factors as hospital size, academic institution affiliation, and geography affect radiology resident training, particularly for such maturing applications as cardiac MRI and PET. This information may be useful in attempts to standardize radiology residency training.

    Title Auriculo-condylar Syndrome is Associated with Highly Variable Ear and Mandibular Defects in Multiple Kindreds.
    Date October 2005
    Journal American Journal of Medical Genetics. Part A
    Excerpt

    We report on 20 individuals in 4 kindreds with auriculo-condylar syndrome (ACS), an autosomal dominant disorder characterized by congenital auricular clefts, mandibular condyle hypoplasia, temporomandibular joint (TMJ) abnormalities, micrognathia, microstomia, and a round facial appearance with prominent cheeks. Affected individuals have varying degrees of glossoptosis, respiratory distress, masticatory abnormalities, and malocclusion. Data from these families and those previously described suggest that this is a unique disorder with widely variable expression, including lack of obvious external anomalies in some individuals and severe ear malformations, condyle agenesis, and characteristic facial features in others. Early recognition of this condition should permit appropriate counseling and anticipatory guidance, including evaluation for reconstructive surgery and orthodontia and intervention for upper airway obstruction and sleep apnea.

    Title Changes in Speech and Language Development of a Young Child After Decannulation.
    Date October 2005
    Journal Journal of Communication Disorders
    Excerpt

    This report reviews the speech and language development of a child who, as result of complete subglottic stenosis, was aphonic from birth until 2 years and 11 months of age at which time laryngotracheal reconstruction provided normal respiration. The boy had congenital subglottic stenosis requiring neonatal tracheostomy. The congenital subglottic stenosis progressed to complete subglottic stenosis during the neonatal period. The child's speech and language development was monitored for a 24-week period following airway reconstruction. LEARNING OUTCOMES: The reader will learn about and be able to describe: (1) the speech and language development of a child who was aphonic from birth until 35 months of age, (2) the effects of surgical repair of a tracheotomy on the child's speech and language development, (3) the likely importance of babbling in speech and language development.

    Title Pharmacokinetics and Pharmacodynamics of Atenolol During Pregnancy and Postpartum.
    Date April 2005
    Journal Journal of Clinical Pharmacology
    Excerpt

    Preexisting hypertension complicates 5% of all pregnancies. The objective of this study was to evaluate steady-state atenolol pharmacokinetics and pharmacodynamics (n = 17) during the second trimester (2nd T), third trimester (3rd T), and 3 months postpartum. Pregnancy as compared to 3 months postpartum (nonpregnant control) resulted in significant (P < .05) changes, including the following: 42% (2nd T) and 50% (3rd T) increase in creatinine clearance, 38% (2nd T) and 36% (3rd T) increase in atenolol renal clearance, 12% (2nd T) and 11% (3rd T) decrease in atenolol half-life, 20% (2nd T) and 28% (3rd T) increase in cardiac output, 15% (2nd T) and 23% (3rd T) increase in resting heart rate, and 22% (2nd T) and 21% (3rd T) decrease in total peripheral resistance in subjects on steady-state oral atenolol for treatment of hypertension in pregnancy. In conclusion, the renal clearance of atenolol along with creatinine clearance is increased during pregnancy. However, this does not translate into an increase in apparent oral clearance of atenolol, possibly related to the high variability in bioavailability. Atenolol administration did not appear to change the pattern of the increase in cardiac output and the decrease in total peripheral resistance, which normally occurs during pregnancy.

    Title Cloning and Characterization of Alpha9 Subunits of the Nicotinic Acetylcholine Receptor Expressed by Saccular Hair Cells of the Rainbow Trout (oncorhynchus Mykiss).
    Date October 2004
    Journal Neuroscience
    Excerpt

    alpha9/alpha10 Subunits are thought to constitute the nicotinic acetylcholine receptors mediating cholinergic efferent modulation of vertebrate hair cells. The present report describes the cloning and sequence analysis of subunits of the alpha9-containing receptor of a hair-cell layer from the saccule of the rainbow trout (Oncorhynchus mykiss). A major alpha9 subunit, termed alpha9-I, displayed typical features of a nicotinic alpha subunit, with total coding sequence of 572 amino acids including a 16 amino-acid signal peptide. It possessed an extended cytoplasmic loop between membrane-spanning regions M3 and M4, compared with mammalian homologs. Transcript for alpha9-I was robustly expressed in the saccular hair cell layer and less prominently in trout olfactory mucosa, spleen, pituitary gland, and liver, as determined by reverse transcription-polymerase chain reaction. alpha9-I cDNA was not detected in trout brain, skeletal muscle, retina, and kidney. The alpha9-I nicotinic receptor protein was immunolocalized, with an affinity-purified antibody directed against a trout alpha9-I epitope, to hair-cell and neural sites in the saccular hair-cell layer. Foci were found at basal and basolateral membrane sites on hair cells as well as on afferent nerve. Receptor clustering was observed in hair cells bordering non-sensory epithelium. Since in higher vertebrates the alpha9 is reported to associate with another nicotinic subunit, alpha10, we examined the possibility of expression of additional nicotinic subunits in trout saccular hair cells. Message for another nicotinic subunit, termed alpha9-II, was found to be expressed in the hair cells, although more difficult to amplify than alpha9-I. In contrast to alpha9-I, alpha9-II was expressed in brain, as well as in olfactory mucosa, less prominently in pituitary gland and liver, but not in spleen, skeletal muscle, retina, or kidney. The cloned alpha9-II had a total coding sequence of 550 amino acids, which included a 17-amino-acid signal peptide, and an extended M3-M4 loop. A third nicotinic subunit message, termed alpha9-III, was PCR-amplified from trout olfactory mucosa where it was strongly expressed. However, message for alpha9-III was not detected in hair cells. Message for alpha9-III was moderately expressed in trout brain, retina, and pituitary gland but not in trout spleen, skeletal muscle, liver, and kidney. Thus, alpha9-I and alpha9-II may together contribute to the formation of the hair-cell nicotinic receptor of teleosts, where no ortholog of alpha10 appears to exist. The current work is, to our knowledge, the first description of alpha9 coding sequences directly from a vertebrate hair cell source. Further, the generality of hair cell expression of subunits for the alpha9-containing nicotinic cholinergic receptor has been extended to fishes, suggesting a similar efferent mechanism across all vertebrate octavolateralis sensory systems.

    Title Ama Policy: Grassroots to Global--what It is and How You Can Get Involved.
    Date October 2004
    Journal Ajr. American Journal of Roentgenology
    Title Adnexal Mass with Pelvic Pain.
    Date June 2004
    Journal Radiologic Clinics of North America
    Excerpt

    In a pregnant woman who presents with acute pelvic pain and an adnexal mass, pregnancy-related etiologies, such as ectopic pregnancy or ovarian torsion, are typically the first diagnoses to be considered. Many other causes of pelvic pain associated with an adnexal mass can occur in pregnant patients, however. Some causes are benign and others require urgent management and treatment. Clinical presentation and physical examination can be misleading in pregnancy. The location of pain may be atypical for the pathologic entity, the pain may be muted, and in the case of infection, fever and leukocytosis can be absent. US examination is a safe and effective method for evaluating these patients. Sonographic characterization of adnexal masses may make a definitive diagnosis or focus the differential, which allows for prompt and appropriate treatment of patients.

    Title Voltage-gated Ca2+ Channel Ca(v)1.3 Subunit Expressed in the Hair Cell Epithelium of the Sacculus of the Trout Oncorhynchus Mykiss: Cloning and Comparison Across Vertebrate Classes.
    Date June 2003
    Journal Brain Research. Molecular Brain Research
    Excerpt

    Full-length sequence (>6.5 kb) has been determined for the Ca(V)1.3 pore-forming subunit of the voltage-gated Ca(2+) channel from the saccular hair cells of the rainbow trout (Oncorhynchus mykiss). Primary structure was obtained from overlapping PCR and cloned fragments, amplified by primers based on teleost, avian, and mammalian sources. Trout saccular Ca(V)1.3 was localized to hair cells, as evidenced by its isolation from an epithelial layer in which the hair cell is the only intact cell type. The predicted amino acid sequence of the trout hair cell Ca(V)1.3 is approximately 70% identical to the sequences of avian and mammalian Ca(V)1.3 subunits and shows L-type characteristics. The trout hair cell Ca(V)1.3 expresses a 26-aa insert in the I-II cytoplasmic loop (exon 9a) and a 10-aa insert in the IVS2-IVS3 cytoplasmic loop (exon 30a), neither of which is appreciably represented in trout brain. The exon 9a insert also occurs in hair cell organs of chick and rat, and appears as an exon in human genomic Ca(V)1.3 sequence (but not in the Ca(V)1.3 coding sequence expressed in human brain or pancreas). The exon 30a insert, although expressed in hair cells of chick as well as trout, does not appear in comparable rat or human tissues. Further, the IIIS2 region shows a splice choice (exon 22a) that is associated with the hair cell organs of trout, chick, and rat, but is not found in human genomic sequence. The elucidation of the primary structure of the voltage-gated Ca(2+) channel Ca(V)1.3 subunit from hair cells of the teleost, representing the lowest of the vertebrate classes, suggests a generality of sensory mechanism for Ca(V)1.3 across hair cell systems. In particular, the exon 9a insert of this channel appears to be the molecular feature most consistently associated with hair cells from fish to mammal, consonant with the hypothesis that the latter region may be a signature for the hair cell.

    Title Clinical Presentation of Dfnb1.
    Date February 2003
    Journal Advances in Oto-rhino-laryngology
    Title Genetic Evaluation and Counseling for Congenital Deafness.
    Date February 2003
    Journal Advances in Oto-rhino-laryngology
    Title Linkage of Otosclerosis to a Third Locus (otsc3) on Human Chromosome 6p21.3-22.3.
    Date September 2002
    Journal Journal of Medical Genetics
    Excerpt

    Clinical otosclerosis (OMIM 166800/605727) has a prevalence of 0.2-1% among white adults, making it the single most common cause of hearing impairment in this group. It is caused by abnormal bone homeostasis of the otic capsule with the consequent development of sclerotic foci that invade the stapedio-vestibular joint (oval window) interfering with free motion of the stapes. Impaired ossicular chain mobility results in a conductive hearing loss. We identified the first locus for otosclerosis (OTSC1) on chromosome 15 in 1998 and reported a second locus (OTSC2) on chromosome 7 last year. Here we present results of a genome wide linkage study on a large Cypriot family segregating otosclerosis. Results of this study exclude linkage to OTSC1 and OTSC2 and identify a third locus, OTSC3, on chromosome 6p. The defined OTSC3 interval covers the HLA region, consistent with reported associations between HLA-A/HLA-B antigens and otosclerosis.

    Title Performance of Cochlear Implant Recipients with Gjb2-related Deafness.
    Date August 2002
    Journal American Journal of Medical Genetics
    Excerpt

    Congenital profound hearing loss affects 0.05-0.1% of children and has many causes, some of which are associated with cognitive delay. For prelingually-deafened cochlear implant recipients, the etiology of deafness is usually unknown. Mutations in GJB2 have been established as the most common cause of heritable deafness in the United States. In this report, we identify cochlear implant recipients with GJB2-related deafness and examine the performance of these individuals. Cochlear implant recipients received a battery of perceptive, cognitive, and reading tests. Neither subjects nor examiners knew the etiology of deafness in these individuals. The implant recipients were then examined for mutations in GJB2 using an allele-specific polymerase chain reaction assay, single-strand conformation polymorphism analysis, and direct sequencing. GJB2 mutations were the leading cause of congenital deafness among the cochlear implant recipients screened. Cochlear implant recipients with GJB2-related deafness read within one standard deviation of hearing controls better than other congenitally deaf cochlear implant recipients and non-cochlear implant recipients. Individuals with congenital deafness should be offered GJB2 screening. Positive results establish an etiologic diagnosis and provide prognostic, genetic, and therapeutic information. Effective rehabilitation for profoundly deaf individuals with GJB2-related deafness is possible through cochlear implantation.

    Title Pendred Syndrome, Dfnb4, and Pds/slc26a4 Identification of Eight Novel Mutations and Possible Genotype-phenotype Correlations.
    Date August 2001
    Journal Human Mutation
    Excerpt

    Mutations in PDS (SLC26A4) cause both Pendred syndrome and DFNB4, two autosomal recessive disorders that share hearing loss as a common feature. The hearing loss is associated with temporal bone abnormalities, ranging from isolated enlargement of the vestibular aqueduct (dilated vestibular aqueduct, DVA) to Mondini dysplasia, a complex malformation in which the normal cochlear spiral of 2(1/2) turns is replaced by a hypoplastic coil of 1(1/2) turns. In Pendred syndrome, thyromegaly also develops, although affected persons usually remain euthyroid. We identified PDS mutations in the proband of 14 of 47 simplex families (30%) and nine of 11 multiplex families (82%) (P=0.0023). In all cases, mutations segregated with the disease state in multiplex families. Included in the 15 different PDS allele variants we found were eight novel mutations. The two most common mutations, T416P and IVS8+1G>A, were present in 22% and 30% of families, respectively. The finding of PDS mutations in five of six multiplex families with DVA (83%) and four of five multiplex families with Mondini dysplasia (80%) implies that mutations in this gene are the major genetic cause of these temporal anomalies. Comparative analysis of phenotypic and genotypic data supports the hypothesis that the type of temporal bone anomaly may depend on the specific PDS allele variant present.

    Title The M34t Allele Variant of Connexin 26.
    Date March 2001
    Journal Genetic Testing
    Excerpt

    GJB2 encodes the protein Connexin 26, one of the building blocks of gap junctions. Each Connexin 26 molecule can oligomerize with five other connexins to form a connexon; two connexons, in turn, can form a gap junction. Because mutations in GJB2 are the most common cause of congenital severe-to-profound autosomal recessive nonsyndromic hearing loss, the effect of the Connexin 26 allele variants on this dynamic 'construction' process and the function of any gap junctions that do form is particularly germane. One of the more controversial allele variants, M34T, has been hypothesized to cause autosomal dominant nonsyndromic hearing loss. In this paper, we present clinical and genotypic data that refutes this hypothesis and suggests that the effect of the M34T allele variant may be dependent on the mutations segregating in the opposing allele.

    Title Genetic Testing for Hereditary Hearing Loss: Connexin 26 (gjb2) Allele Variants and Two Novel Deafness-causing Mutations (r32c and 645-648deltaga).
    Date January 2001
    Journal Human Mutation
    Excerpt

    Mutations in GJB2 are the most common cause of hereditary congenital hearing loss in many countries and are found in about half of persons with severe-to-profound congenital autosomal recessive non-syndromic hearing loss (ARNSHL). We report the results of GJB2 mutation screening in 209 consecutive persons with congenital deafness of indeterminate etiology using an allele-specific polymerase chain reaction assay, single-strand conformational polymorphism analysis, and direct sequencing. GJB2 allele variants were detected in 74 of 209 deaf individuals (35%). Over one-fourth of screened individuals were either homozygous (n=31) or heterozygous (n=24) for the 35delG mutation. Of those with the 35delG mutation, 51 (92.7%) were diagnosed with GJB2-related deafness. Nineteen persons were identified with other GJB2 allele variants - two novel deafness-causing mutations (R32C, 645-648delTAGA), one mutation of unknown significance (E47K), and one benign polymorphism (I128I). While these data enable health care professionals to provide parents and patients with improved genetic counseling data, difficulty still exists is determining whether some missense mutations compromise auditory function and are deafness-causing.

    Title Genetic Testing to Identify Deaf Newborns.
    Date September 2000
    Journal Jama : the Journal of the American Medical Association
    Title Pathogenesis and Treatment of Juvenile Onset Recurrent Respiratory Papillomatosis.
    Date April 2000
    Journal Otolaryngologic Clinics of North America
    Excerpt

    Juvenile onset recurrent respiratory papillomatosis is the most common cause of laryngeal tumors in children. This disease is caused by infection of the human papillomavirus, a virus whose complete genetic structure is now known. New, more directed agents show promise for improved control of papillomatosis in preliminary studies. Concurrently, there is an increasing awareness of methods to reduce surgical morbidity. At present, the role of preventive efforts including elective caesarian section remains uncertain.

    Title Temporal Bone Histopathology in Connexin 26-related Hearing Loss.
    Date February 2000
    Journal The Laryngoscope
    Excerpt

    OBJECTIVE: Mutations in GJB2, a gene that encodes a gap junction protein, Connexin 26 (Cx26), are responsible for approximately one third of sporadic severe-to-profound or profound congenital deafness and half of severe-to-profound or profound autosomal recessive nonsyndromic hearing loss (ARNSHL). Mouse mutants homozygous for knockouts of this gene are nonviable, precluding histopathologic studies of the associated inner ear pathology in this animal model. Therefore, we studied archival temporal bone sections to identify temporal bone donors with Cx26-related deafness. STUDY DESIGN: Temporal bone donors with a history of congenital severe-to-profound or profound deafness were identified in the registry of the Temporal Bone Library at the University of Iowa. Histological findings were interpreted in a blinded fashion. DNA extracted from two celloidin-embedded mid-modiolar sections from each temporal bone was screened for the 35delG Cx26 mutation. The entire coding region of Cx26 was screened for other deafness-causing mutations if the 35delG mutation was detected. RESULTS: Of five temporal bone donors with congenital severe-to-profound deafness, one donor was found to have Cx26-related deafness. This individual was a Cx26 compound heterozygote, carrying the 35delG mutation and a noncomplementary Cx26 missense mutation on the opposing allele. Microscopic evaluation of this temporal bone showed no neural degeneration, a good population of spiral ganglion cells, near-total degeneration of hair cells in the organ of Corti, a detached and rolled-up tectorial membrane, agenesis of the stria vascularis, and a large cyst in the scala media in the region of the stria vascularis. CONCLUSION: This study is the first to report the temporal bone histopathology associated with Cx26-related deafness. Preservation of neurons in the spiral ganglion suggests that long-term successful habilitation with cochlear implants may be possible in persons with severe-to-profound or profound Cx26-related deafness.

    Title Mutations in Col11a2 Cause Non-syndromic Hearing Loss (dfna13).
    Date December 1999
    Journal Nature Genetics
    Excerpt

    We report that mutation of COL11A2 causes deafness previously mapped to the DFNA13 locus on chromosome 6p. We found two families (one American and one Dutch) with autosomal dominant, non-syndromic hearing loss to have mutations in COL11A2 that are predicted to affect the triple-helix domain of the collagen protein. In both families, deafness is non-progressive and predominantly affects middle frequencies. Mice with a targeted disruption of Col11a2 also were shown to have hearing loss. Electron microscopy of the tectorial membrane of these mice revealed loss of organization of the collagen fibrils. Our findings revealed a unique ultrastructural malformation of inner-ear architecture associated with non-syndromic hearing loss, and suggest that tectorial membrane abnormalities may be one aetiology of sensorineural hearing loss primarily affecting the mid-frequencies.

    Title Carrier Rates in the Midwestern United States for Gjb2 Mutations Causing Inherited Deafness.
    Date June 1999
    Journal Jama : the Journal of the American Medical Association
    Excerpt

    CONTEXT: Mutations in the GJB2 gene are the most common known cause of inherited congenital severe-to-profound deafness. The carrier frequency of these mutations is not known. OBJECTIVES: To determine the carrier rate of deafness-causing mutations in GJB2 in the midwestern United States and the prevalence of these mutations in persons with congenital sensorineural hearing loss ranging in severity from moderate to profound, and to derive revised data for counseling purposes. DESIGN: Laboratory analysis, performed in 1998, of samples from probands with hearing loss for mutations in GJB2 using an allele-specific polymerase chain reaction assay, single-strand conformation polymorphism analysis, and direct sequencing. SETTING AND SUBJECTS: Fifty-two subjects younger than 19 years sequentially referred to a midwestern tertiary referral center for hearing loss or cochlear implantation, with moderate-to-profound congenital hearing loss of unknown cause, parental nonconsanguinity, and nonsyndromic deafness with hearing loss limited to a single generation; 560 control neonates were screened for the 35delG mutation. MAIN OUTCOME MEASURE: Prevalence of mutations in the GJB2 gene by congenital deafness status. RESULTS: Of 52 sequential probands referred for congenital sensorineural hearing loss, 22 (42%) were found to have GJB2 mutations. The 35delG mutation was identified in 29 of the 41 mutant alleles. Of probands' sibs, all homozygotes and compound heterozygotes had deafness. Fourteen of 560 controls were 35delG heterozygotes, for a carrier rate expressed as a mean (SE) of 2.5% (0.66%). The carrier rate for all recessive deafness-causing GJB2 mutations was determined to be 3.01% (probable range, 2.54%-3.56%). Calculated sensitivity and specificity for a screening test based on 35delG mutation alone were 96.9% and 97.4%, respectively, and observed values were 94% and 97%, respectively. CONCLUSIONS: Our data suggest that mutations in GJB2 are the leading cause of moderate-to-profound congenital inherited deafness in the midwestern United States. Screening of the GJB2 mutation can be offered to individuals with congenital deafness with high sensitivity and specificity by screening only for the 35delG mutation. A positive finding should establish an etiologic diagnosis and affect genetic counseling.

    Title Androgen Receptors Mediate Hypertrophy in Cardiac Myocytes.
    Date August 1998
    Journal Circulation
    Excerpt

    BACKGROUND: The role of androgens in producing cardiac hypertrophy by direct action on cardiac myocytes is uncertain. Accordingly, we tested the hypothesis that cardiac myocytes in adult men and women express an androgen receptor gene and that myocytes respond to androgens by a hypertrophic response. METHODS AND RESULTS: We used reverse transcription-polymerase chain reaction methods to demonstrate androgen receptor transcripts in multiple tissues and [3H]phenylalanine incorporation and atrial natriuretic peptide secretion as markers of hypertrophy in cultured rat myocytes. Messenger RNA encoding androgen receptors was detected in myocytes of male and female adult rats, neonatal rat myocytes, rat heart, dog heart, and infant and adult human heart. Both testosterone and dihydrotestosterone produced a robust receptor-specific hypertrophic response in myocytes, determined by indices of protein synthesis and atrial natriuretic peptide secretion. CONCLUSIONS: Androgen receptors are present in cardiac myocytes from multiple species, including normal men and women, in a context that permits androgens to modulate the cardiac phenotype and produce hypertrophy by direct, receptor-specific mechanisms. There are clinical implications for therapeutic or illicit use of androgens in humans.

    Title Analysis of Nicotinic Acetylcholine Receptor Subunits in the Cochlea of the Mouse.
    Date December 1996
    Journal Comparative Biochemistry and Physiology. Part C, Pharmacology, Toxicology & Endocrinology
    Excerpt

    The present study was designed to catalogue and compare nicotinic receptor subunit messages in the mammalian cochlea. Fourteen nicotinic acetylcholine receptor subunit messages were examined by polymerase chain reaction (PCR) analysis and nucleotide sequencing. Total RNA was extracted from the auditory organs of 14- to 18-day-old CBAJ mice, and mRNA was purified using oligo-dT cellulose. After reverse transcription, resulting cDNA was amplified by PCR with the use of primers specific for the nucleotide sequences representing the following nicotinic receptor subunits: muscle types alpha 1, beta 1, gamma, delta and epsilon and neuronal types alpha 2,3,4,5,6,7 and beta 2,3,4. cDNA from cochlear tissue corresponding to the muscle-type receptor subunit beta 1 and to neuronal-type receptor subunits alpha 2,4,5,6 and beta 2,3 was amplified, whereas cDNA for muscle types alpha 1, gamma, delta and epsilon and neuronal types alpha 3,7 and beta 4 was not. All PCR products were homologous in nucleotide sequence to the corresponding reference cDNAs from which the primers were designed. The current results indicate that nicotinic acetylcholine receptor (nAChR) subunits that are similar or identical to the stated muscle and neuronal types are expressed in the murine cochlea. The presence of messages corresponding to the muscle-type beta 1 and neuronal-type nAChR subunits may be correlated with the atypical cholinergic response of cochlear hair cells to agonists and antagonists.

    Title Calcium Channel Subunits in the Mouse Cochlea.
    Date August 1996
    Journal Journal of Neurochemistry
    Excerpt

    Messages for subunits of voltage-gated calcium channels were examined in the cochlea of the CBAJ mouse by PCR analysis. Total RNA was extracted from the auditory organs of 16-18-day-old animals. After reverse transcription, resulting cDNA was amplified by PCR with primers targeted to nucleotide sequences corresponding to 12 different calcium channel subunits. PCR products representing subunit gene expression were strongly and consistently amplified for alpha1C, alpha1D, alpha1E, alpha2delta, beta1, beta3, and beta4 but not for alph1A, alpha1B, alpha1S, beta2, or gamma. The chosen primers amplified cochlear cDNA to yield an overall pattern of bands different from that of any tissue studied thus far, in particular with respect to the alpha2delta and beta1 subunits; the alpha2delata product was found to be significantly shorter than the corresponding brain and skeletal muscle isoforms. Nucleotide sequencing confirmed the identity of mouse cochlear subunit cDNAs. The results suggest that L-type and presumptive R-type calcium channels are expressed in the mammalian cochlea and that the alpha2delta subunits may be coded by a characteristic splice-variant mRNA.

    Title Internal Thoracic Artery Grafts: 20-year Clinical Follow-up.
    Date January 1995
    Journal Journal of the American College of Cardiology
    Excerpt

    OBJECTIVES. This study compared the long-term clinical results of coronary artery bypass surgery in patients with internal thoracic artery grafts with those in patients with vein grafts only. BACKGROUND. Aortocoronary artery bypass surgery has been performed for > 25 years, primarily utilizing the saphenous vein and internal thoracic artery as conduits. Although the internal thoracic artery has been shown to confer a clinical advantage, it is not known for how many years this benefit will continue. METHODS. All consecutive patients undergoing initial coronary artery bypass surgery between 1970 and 1973 were followed for up to 20 years. Clinical evaluation included survival, late myocardial infarction, need for reoperation and recurrence of angina. Patients were analyzed in three groups: vein grafts only (214 patients); a single internal thoracic artery graft with or without associated vein grafts (490 patients); and bilateral internal thoracic artery grafts (39 patients). Use of the operating microscope was also analyzed with regard to effect on survival. RESULTS. The internal thoracic artery graft and use of the operating microscope were independent predictors of mortality and reduced the risk of dying by a factor of 0.68 and 0.76, respectively. An internal thoracic artery graft resulted in a mean survival of 4.4 years longer than that with vein grafts alone. The internal thoracic artery graft compared with vein grafts was associated with fewer reoperations (p < 0.001), fewer late myocardial infarctions, lower associated mortality rates (p < 0.04) and less early recurrence of angina (p = 0.03). CONCLUSIONS. The internal thoracic artery graft and use of the operating microscope confer a superior clinical advantage over the saphenous vein graft throughout a 20-year follow-up period. The advantage of an internal thoracic artery graft does not decrease with time, suggesting that the choice of conduit at the initial operation is more important clinically than progression of coronary artery disease.

    Title Five-year Follow-up of Microsurgical Multiple Internal Thoracic Artery Grafts.
    Date August 1994
    Journal The Annals of Thoracic Surgery
    Excerpt

    In a consecutive series of 143 patients requiring multiple coronary artery bypass grafts, 317 of 441 anastomoses (72%) were constructed from internal thoracic arteries. Of these 143 patients, 103 had bilateral, 51 sequential, and 49 free internal thoracic artery grafts. When compared with an earlier series of 494 patients who underwent only one internal thoracic artery anastomosis, the surgical morbidity and mortality were not increased, but, during 5 years of follow-up, the incidences of postoperative angina and myocardial infarction were found to decrease significantly--32.5% versus 10.5% (p < 0.001) and 5.7% versus 1.4% (p < 0.03), respectively. We conclude that, for patients with multivessel disease, multiple internal thoracic artery grafts confer better protection from the clinical manifestations of ischemic heart disease than does one internal thoracic artery graft. The use of high magnification (8 to 12x, surgical microscope) was essential to the success of this method.

    Title Analysis of Gamma-aminobutyric Acida Receptor Subunits in the Mouse Cochlea by Means of the Polymerase Chain Reaction.
    Date September 1993
    Journal Journal of Neurochemistry
    Excerpt

    Thirteen GABAA receptor subunits were examined in the cochlea of the CBAJ mouse by PCR analysis. Total RNA was extracted from the auditory organs of 14-18-day-old animals, and mRNA was isolated using oligo-dT cellulose. After reverse transcription, resulting cDNA was amplified by PCR with primers specific for nucleotide sequences representing GABAA subunits. PCR products corresponding to subunits alpha 1-alpha 6, beta 1-beta 3, and gamma 2 were amplified, whereas those representing gamma 1, gamma 3, and delta were not amplified above background. These results provide the most direct evidence to date that GABAA receptors composed of the detected subunits are expressed in the mammalian cochlea, lending new support to previous studies implicating GABA as a cochlear transmitter. The pronounced expression of alpha 2 and alpha 6 subunits suggests type II and "cerebellar-type" benzodiazepine pharmacology in the cochlea.

    Title Sternal Blood Flow During Mobilization of the Internal Thoracic Arteries.
    Date May 1993
    Journal The Annals of Thoracic Surgery
    Excerpt

    A laser Doppler tissue perfusion monitor was used to measure sternal blood flow before, during, and after mobilization of the internal thoracic arteries in 24 patients undergoing coronary artery bypass grafting. To minimize chest wall injury, a narrow pedicle was mobilized. Bilateral flow data were available from 15 of the 24 patients. Analysis of these 39 studies showed no significant reduction of sternal blood flow as a consequence of mobilization of the internal thoracic arteries except in 2 patients who were both diabetic and obese.

    Title Diagnostic Coronary Arteriography.
    Date August 1992
    Journal Catheterization and Cardiovascular Diagnosis
    Title Anastomosis of the Internal Mammary Artery to the Distal Left Anterior Descending Coronary Artery.
    Date July 1990
    Journal Circulation
    Title Bilateral Internal Thoracic Artery Surgery: 17-year Experience.
    Date April 1990
    Journal European Heart Journal
    Excerpt

    Angiographic comparisons of late morphology of internal thoracic artery (ITA) and saphenous vein grafts (SVG) in the same patients established morphologic superiority of the ITA grafts (1983). 15-year clinical follow-up of 748 consecutive patients having ITA and SVGs (532) or SVGs alone (216) established the clinical advantages given to patients by ITA grafts (1986): (1) higher cumulative survival rate (P less than 0.01); (2) less early recurrence of angina (P less than 0.01); (3) fewer late myocardial infarctions (P less than 0.02); (4) lower reoperation rate (P less than 0.001). Benefits to patients having bilateral ITA grafts (38) exceeded even those of single ITA grafts: (1) operative mortality = 0%; (2) cumulative survival (10 years) = 89.0%; (3) annual recurrence of angina = 1.5%; (4) annual late myocardial infarction = 1.1%; (5) mortality rate = 0%; (6) annual reoperation rate = 0%. These data prompted routine use of bilateral ITA grafts for all patients requiring multiple bypasses, and use of each ITA for as many bypasses as seemed feasible. Since 1986, ITA anastomoses have accounted for two thirds of anastomoses in all patients requiring multiple bypasses (average 3.2 anastomoses/patient). Results have been gratifying. Potential technical pitfalls are emphasized, and means of avoiding them described.

    Title Prospective Study of Feasibility of Routine Use of Multiple Internal Mammary Artery Anastomoses.
    Date October 1989
    Journal The Journal of Cardiovascular Surgery
    Excerpt

    A study of 100 consecutive patients requiring multiple coronary artery bypasses was undertaken to evaluate the feasibility of routine use of multiple internal mammary artery (IMA) anastomoses. In 99 patients the IMA was used and in 80 patients bilateral IMA bypasses were done. In 15 patients multiple anastomoses with a single IMA precluded the need for bilateral IMA bypasses. In only 4 patients were bilateral IMA left to be contraindicated. By combination of use of both IMAs, free grafts and sequential grafts, the IMA accounted for 70% of the 318 anastomoses in these 100 patients. Scrupulous attention to technique and the use of the operating microscope are necessary to achieve multiple IMA anastomoses. It was concluded that the IMA can be used to supply the majority of anastomoses needed for coronary artery revascularization in nearly all patients.

    Title Invited Letter Concerning: Preparation of the Internal Mammary Artery Graft: Which is the Best Method?
    Date August 1989
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Title Use of Internal Thoracic Artery for Coronary Artery Grafting.
    Date July 1989
    Journal Circulation
    Excerpt

    Because of excellent long-term patency (greater than 90% at 7 years), internal thoracic artery (ITA) bypass grafts are preferred over saphenous vein grafts for myocardial revascularization. ITA grafts can be used for up to 70% of all distal anastomoses and in up to 95% of patients. ITA grafts are more technically demanding; inadequate length, traumatic arterial injury, torsion, separation of intima and adventitia, and anastomotic stricture are important pitfalls. Postoperative problems of bleeding, phrenic nerve injury, mediastinal infection, and arm paresis or paresthesia are complications attributed to ITA grafts, but they are uncommon if meticulous technique is used.

    Title Reoperations and the Internal Mammary Artery.
    Date May 1989
    Journal Advances in Cardiology
    Title Role of Internal Mammary Artery in Reoperations for Coronary Artery Disease.
    Date May 1989
    Journal Advances in Cardiology
    Title Reoperation for Coronary Artery Disease. 10 Years of Clinical Follow-up.
    Date October 1988
    Journal Circulation
    Excerpt

    From a 15-year follow-up study of 743 patients who underwent initial operation for coronary artery disease, 64 patients required reoperation for recurrence of angina and were followed-up for 15 years or less (mean, 6.2 years). Patients undergoing reoperation tended to be older but not significantly so (50.9 +/- 8.3 years vs. 57.5 +/- 9.7 years), had more left main coronary artery disease (p less than 0.001), and had more triple-vessel disease (p less than 0.001) than those undergoing the initial operation. There were no significant differences in sex, prior myocardial infarctions, or prevalence of abnormal ventriculograms between the two groups. The cumulative survival rate during a 10-year follow-up period after reoperation did not differ from the rate after the initial operations. There was less relief of angina in the first year after reoperation than after initial operation, but thereafter, the annual increases in recurrence of angina were similar. Although there were more myocardial infarctions after reoperation in the first 6 postoperative years, the cumulative incidence after 10 years did not differ between the two groups. We conclude that reoperation yields a similar survival benefit but produces less early relief of angina than initial operation.

    Title Use of the Internal Mammary Artery in Myocardial Revascularization.
    Date May 1988
    Journal The Annals of Thoracic Surgery
    Excerpt

    Internal mammary artery-coronary artery anastomosis is currently considered the newest and best technique for surgical revascularization of ischemic myocardium. The origin and evolution of this technique are reviewed.

    Title Clinical Implications of Internal Mammary Artery Bypass Grafts: the Coronary Artery Surgery Study Experience.
    Date April 1988
    Journal Circulation
    Excerpt

    From the Coronary Artery Surgery Study Registry, all patients undergoing initial bypass surgery procedures with independent vein grafts were identified. The 950 patients receiving an internal mammary artery bypass graft were compared with the 6027 patients receiving vein graft alone. Improved survival rates with internal mammary artery grafts were noted at hospitals in which these grafts were performed infrequently as well as those in which the internal mammary artery graft was used frequently. The improved survival was noted in patients with normal (p = .004) as well as impaired (p = .004) ventricular function, in men (p = .0001) as well as women (p = .005), in patients over age 65 (p = .01) as well as younger patients (p less than .0001), and in those with (p = .05) or without (p less than .0001) critical stenosis of the left main coronary artery. The internal mammary artery bypass graft was an independent predictor of survival (p = .0004) and reduced the risk of dying by a factor of 0.64. It was concluded that the internal mammary artery graft is the bypass vessel of choice and should not be denied any subgroup.

    Title Technical Factors Influencing Ima Graft Patency.
    Date August 1987
    Journal The Annals of Thoracic Surgery
    Title Comparison of Arterial Blood Gas with Continuous Intra-arterial and Transcutaneous Po2 Sensors in Adult Critically Ill Patients.
    Date May 1987
    Journal Critical Care Medicine
    Excerpt

    We compared the partial pressure of oxygen directly via a continuous intra-arterial probe (PiaO2) and indirectly using a transcutaneous device (PtcO2) with simultaneously obtained arterial blood PaO2. The PiaO2 values were measured using a bipolar oxygen sensor placed through an 18-ga arterial catheter. The PtcO2 values were measured using a transcutaneous O2-CO2 sensor placed on the abdomen. Seven critically ill, hemodynamically stable, ventilator-dependent adult patients were studied. Measurements were obtained at varying concentrations (0.25 to 1.0) of inspired oxygen after a 10-min stabilization. A total of 78 simultaneous values were obtained; by linear regression: PiaO2 = 0.91 PaO2 + 1.39 (r = .98, standard errors of the estimate [SEE] = 18.6); PtcO2 = 0.39 PaO2 + 36.2 (r = .89, SEE = 14.1). To assess these instruments as trend monitors, we compared the changes in simultaneous PaO2, PiaO2, and PtcO2 values; by linear regression: delta PiaO2 = 0.90 delta PaO2 + 3.88 (r = .96, SEE = 27.7); delta PtcO2 = 0.43 delta PaO2 + 5.6 (r = .94, SEE = 15.2). We conclude that, although these instruments correlate highly with the PaO2, the SEE was substantial and therefore may limit their clinical reliability in adults. Any acute or clinically significant change in PiaO2 or PtcO2 should be confirmed with a blood gas PaO2.

    Title Left Recurrent Laryngeal Nerve Injury Following Internal Mammary Artery Bypass.
    Date May 1987
    Journal The Annals of Thoracic Surgery
    Excerpt

    To our knowledge, recurrent laryngeal nerve injury has not been reported previously as a complication of internal mammary artery mobilization for coronary artery bypass. We recently experienced this complication and are presenting a case history of the problem and comments.

    Title Management of Patients with Atherosclerotic Vein Grafts.
    Date May 1987
    Journal The Annals of Thoracic Surgery
    Title Bypass Surgery with the Internal Mammary Artery Graft: 15 Year Follow-up.
    Date November 1986
    Journal Circulation
    Excerpt

    We performed a 15 year follow-up of 748 patients undergoing bypass surgery, comparing 532 patients with one or two internal mammary artery grafts with or without additional saphenous vein grafts to 216 patients with saphenous vein grafts alone. During the 15 years of follow-up the 532 patients with at least one internal mammary artery bypass graft had better cumulative survival (p less than .01), less early recurrence of angina (p less than .01), fewer myocardial infarctions (p less than .02), fewer reoperations (p less than .001), and better cumulative event-free survival (p less than .01) than the 216 patients with vein grafts alone. Patients who developed angina postoperatively had a better cumulative survival (p less than .01) in the presence of an internal mammary graft than with vein grafts alone. The 38 patients with double internal mammary grafts had the best survival rates, with lowest recurrence of angina and rate of late myocardial infarction and no need for reoperation. We conclude the internal mammary graft gives better protection against the clinical manifestations of coronary artery disease than does the saphenous vein graft.

    Title Endarterectomy of the Left Coronary System.
    Date April 1986
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Title Coronary Bypass Surgery Highlights Blood Vessel Biology.
    Date April 1986
    Journal The Annals of Thoracic Surgery
    Title Intracavitary Coronary Arteries.
    Date August 1985
    Journal The Annals of Thoracic Surgery
    Title Sternotomy Infection After Harvesting of the Internal Mammary Artery.
    Date December 1984
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Excerpt

    Use of the internal mammary artery for coronary revascularization does not increase the incidence of postoperative median sternotomy wound infection. When infection does occur in these patients, however, successful treatment is more likely to require more aggressive surgical manipulation, such as the use of vascularized muscle pedicle grafts, to eventually close the sternal defect.

    Title Brain Damage in Profound Hypothermia.
    Date December 1984
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Title Late Results of Coronary Artery Grafting: is There a Flag on the Field?
    Date December 1984
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Title Antibodies to Trypanosoma Cruzi in Coyotes in Texas.
    Date August 1984
    Journal The Journal of Parasitology
    Title Aortocoronary Paraganglioma. Anatomic Relationship of Left Coronary Artery to Paraganglia of Aorta.
    Date April 1984
    Journal New York State Journal of Medicine
    Title Long-term Fate of the Internal Mammary Artery and Saphenous Vein Grafts.
    Date October 1983
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Excerpt

    Thirty-four patients, each receiving internal mammary artery (IMAG) as well as saphenous vein grafts (SVGs), returned with symptoms 3 to 12 years after operation and underwent angiographic studies. At a mean follow-up period of 6.8 years, two (6%) IMAGs were occluded and 33 (94%) were in excellent condition. Of the 57 SVGs, 28 (48%) were totally occluded, 12 (22%) had severe atherosclerosis, and only 17 (30%) were in good condition. Seven patients (20%) had new significant lesions in the ungrafted coronary arteries. Failure of SVGs was the predominant cause of symptoms in this group of patients. Late failure of the SVGs appears to be due to progressive atherosclerosis in the grafts. The IMAGs tend to remain free from atherosclerosis and perform much better than the SVGs in the long run.

    Title Internal Mammary Artery Versus Saphenous Vein Graft. Comparative Performance in Patients with Combined Revascularisation.
    Date August 1983
    Journal British Heart Journal
    Excerpt

    Thirty three patients with coronary artery disease undergoing combined myocardial revascularisation with internal mammary artery and saphenous vein grafts underwent angiographic studies up to 10 years after operation. Each patient had one internal mammary artery graft and one or more saphenous vein grafts. Eleven symptom-free patients, studies one month to five years (mean 1.9 years) after operation, had intact internal mammary artery and saphenous vein grafts in a good state of preservation. Of the six patients developing symptoms within the first year after surgery, three had evidence of poor flow in the internal mammary artery graft because of large side branches and the other three had stenosis or occlusion of the saphenous vein grafts. Sixteen patients developed symptoms after several years free of symptoms and were studied three to 10 years (mean six years) after operation. Of the 23 saphenous vein grafts in this group, 17 (74%) were either occluded or severely stenosed and six (26%) were in good condition. One internal mammary artery graft was occluded and the remaining 15 were in good condition. Saphenous vein graft failure was the predominant cause of late development of symptoms in patients with combined revascularisation. Long term performance of the internal mammary artery grafts is far superior to the saphenous vein grafts.

    Title Technique of Internal Mammary-coronary Artery Anastomosis.
    Date October 1979
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Title Aortocoronary Bypass Surgery: a 7-year Follow-up.
    Date August 1979
    Journal Circulation
    Excerpt

    Follow-up of 748 consecutive patients who underwent aortocoronary artery bypass grafts was obtained for 5 to 94 months (average, 59 months). Operative mortality of 2.5% did not vary with number of vessels bypassed. There was a linear 3.5% annual recurrence rate of angina, and average annual late infarction rate of 1.4%. The cumulative survival rates did not differ for the number of grafts performed or for men and women, but did differ for left main coronary stenosis and impaired ejection fractions. The late cumulative survival rates for the entire group approached those of the general U.S. population.

    Title Coronary Bypass Surgery. Five-year Follow-up of a Consecutive Series of 140 Patients.
    Date February 1979
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Title Choice of Grafts.
    Date July 1978
    Journal Cleveland Clinic Quarterly
    Title Mammary-coronary Artery Anastomosis for Myocardial Revascularization.
    Date April 1978
    Journal Postgraduate Medicine
    Excerpt

    My experience with the use of mammary-coronary artery anastomosis for myocardial revascularization in 1,500 patients over a nine-year period has been described. The procedure was used in approximately 85% of patients undergoing coronary bypass surgery, but mammary arteries accounted for only one third of the grafts. Patency rates as determined by arteriography performed from two weeks to seven years after operation were more than 95%. No late alterations in the mammary artery grafts have been seen. Clinical results have been so gratifying that I regard the procedure as the one of choice for bypass of stenosis of the left anterior descending coronary artery.

    Title Training in Microvascular Surgery.
    Date May 1977
    Journal Surgery
    Excerpt

    This is the first report that analyzes the time required for a general surgeon to master the technique of anastomosis of arteries with diameters of 1.25 and 1.5 mm. Probes of 0.25 mm gradation were used to calibrate the lumens of the arteries and the anastomoses. The Zeiss microscope was used at 25 magnifications to repair a transverse division of the abdominal aorta of a 120 gram rat. Fifteen hours were required for the surgeon (S.H.) to become accustomed to the use of the equipment. Then a series of 40 rats were operated upon and kept alive from 1 to 6 weeks. Patency rate was 100% (40 of 40). No anastomosis was less than 1.25 mm in diameter. After the initial practice period of 15 hours, quality of anastomosis was unchanged, but time required to perform it diminished from 45 minutes to 15 minutes during the course of 40 procedures that occupied 35 laboratory hours.

    Title Coronary Artery Bypass Surgery. Long-term Follow-up.
    Date March 1977
    Journal New York State Journal of Medicine
    Title Editorials: Coronary Controversy.
    Date March 1976
    Journal The Annals of Thoracic Surgery
    Title Resection and Repair of "giant" Left Ventricular Aneurysm with Pre- and Postoperative Ventriculograms.
    Date September 1974
    Journal New York State Journal of Medicine
    Title Coronary Bypass Grafting in 376 Consecutive Patients, with Three Operative Deaths.
    Date February 1974
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Title Coronary Bypass Grafting in 476 Patients Consecutively Operated On.
    Date February 1974
    Journal Chest
    Title Aortic Valve Replacement Combined with Coronary Bypass Grafts. Long-term Results.
    Date August 1973
    Journal New York State Journal of Medicine
    Title Exposure of the Circumflex Coronary Artery and Its Branches.
    Date March 1973
    Journal Surgery
    Title Intracoronary Pressure and Flow in Impending Myocardial Infarction.
    Date December 1972
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Title Internal Mammary Artery-to-coronary Artery Anastomosis. Three-year Experience with 165 Patients.
    Date October 1972
    Journal The Annals of Thoracic Surgery
    Title Evaluation of Internal Mammary Artery Implantation.
    Date September 1972
    Journal The American Journal of Cardiology
    Title Left Heart Decompression by Closed Gravity Drainage.
    Date August 1972
    Journal The Annals of Thoracic Surgery
    Title Surgical Therapy for Coronary Artery Disease.
    Date April 1972
    Journal Current Problems in Surgery
    Title Rate of Blood Flow from the Internal Mammary Artery.
    Date February 1972
    Journal Surgery
    Title Coronary Artery Bypass Grafts for Congestive Heart Failure. A Report of Experiences with 40 Patients.
    Date November 1971
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Title Coronary Artery Bypass Surgery. Prophylaxis Prior to Resection of Abdominal Aortic Aneurysm.
    Date October 1971
    Journal New York State Journal of Medicine
    Title Arterial and Venous Microsurgical Bypass Grafts for Coronary Artery Disease.
    Date August 1971
    Journal The Journal of Thoracic and Cardiovascular Surgery
    Title Bypass Grafting for Occlusive Disease of the Coronary Arteries: a Report of Experience with 195 Patients.
    Date July 1971
    Journal Annals of Surgery
    Title What Percentage of Patients with Angina Pectoris Are Candidates for Bypass Grafts?
    Date July 1971
    Journal Circulation
    Title Choice of Saphenous Vein Segments for Aortocoronary Grafts.
    Date July 1971
    Journal Surgery
    Title Suture Anastomosis of the Internal Mammary Artery to the Anterior Descending Coronary Artery.
    Date April 1971
    Journal Verhandlungen Der Deutschen Gesellschaft Für Kreislaufforschung
    Title Direct Revascularization. Internal Mammary Artery to Left Coronary Artery Anastomosis.
    Date September 1970
    Journal New York State Journal of Medicine
    Title Microvascular Technique in Coronary Artery Surgery.
    Date March 1970
    Journal American Heart Journal
    Title Limb Salvage by Bypass Grafting to Ankle.
    Date November 1969
    Journal New York State Journal of Medicine
    Title Coronary Artery Bypass Grafting.
    Date May 1969
    Journal Surgical Forum
    Title Coronary Arterial Bypass Grafts.
    Date June 1968
    Journal The Annals of Thoracic Surgery
    Title Surgical Correction of Absence of Proximal Segment of Left Pulmonary Artery.
    Date February 1968
    Journal Circulation
    Title The Length of the Left Main Coronary Artery.
    Date January 1968
    Journal Surgery
    Title Method for Study of Saliva and Bacteria in Dental Enamel Decalcification.
    Date August 1967
    Journal Journal of Dental Research
    Title Comparative Calcification by Saliva from Human Beings with Light and Heavy Calculus Formation.
    Date August 1967
    Journal Journal of Dental Research
    Title Human Blood Types and Dental Caries Experience.
    Date April 1967
    Journal Journal of Dental Research
    Title Free Grafting and Revascularization of Intestine. I. Replacement of the Cervical Esophagus.
    Date March 1967
    Journal Surgery
    Title Free Grafting and Revascularization of Intestine. Ii. Partial Replacement of the Oropharynx.
    Date February 1967
    Journal Surgery
    Title Anatomical Relationships in Lymph Node Dissection of the Neck.
    Date February 1967
    Journal Surgery
    Title Properties of a Salivary Bacteriolysin and Comparison with Serum Beta Lysin.
    Date November 1966
    Journal Journal of Dental Research
    Title Experimental Microvascular Suture Anastomosis.
    Date July 1966
    Journal Circulation
    Title Does Electroconvulsive Therapy Prevent Suicide?
    Date
    Journal Convulsive Therapy
    Excerpt

    To examine the issue of whether or not electroconvulsive therapy (ECT) protects against suicidal death, we followed a complete population of 1,494 adult hospitalized psychiatric patients for 5-7 years. During that time there were 76 deaths, of which 16 or 21% were by suicide. Cause of death was not significantly related to age, gender, or research diagnosis. Patients who committed suicide were more apt to have received ECT than those who died from other causes, but this difference was not significant. A control group of living patients matched for age, sex, and diagnosis had very similar exposures to ECT, which further indicates that ECT does not influence long-term survival. These findings combined with a close examination of the literature do not support the commonly held belief that ECT exerts long-range protective effects against suicide.

    Title Political Principles and Nih.
    Date
    Journal Science (new York, N.y.)
    Title Syndromes of the First and Second Branchial Arches, Part 1: Embryology and Characteristic Defects.
    Date
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    A variety of congenital syndromes affecting the face occur due to defects involving the first and second BAs. Radiographic evaluation of craniofacial deformities is necessary to define aberrant anatomy, plan surgical procedures, and evaluate the effects of craniofacial growth and surgical reconstructions. High-resolution CT has proved vital in determining the nature and extent of these syndromes. The radiologic evaluation of syndromes of the first and second BAs should begin first by studying a series of isolated defects: CL with or without CP, micrognathia, and EAC atresia, which compose the major features of these syndromes and allow more specific diagnosis. After discussion of these defects and the associated embryology, we proceed to discuss the VCFS, PRS, ACS, TCS, Stickler syndrome, and HFM.

    Title Syndromes of the First and Second Branchial Arches, Part 2: Syndromes.
    Date
    Journal Ajnr. American Journal of Neuroradiology
    Excerpt

    SUMMARY: A variety of congenital syndromes affecting the face occur due to defects involving the first and second BAs. Radiographic evaluation of craniofacial deformities is necessary to define aberrant anatomy, plan surgical procedures, and evaluate the effects of craniofacial growth and surgical reconstructions. High-resolution CT has proved vital in determining the nature and extent of these syndromes. The radiologic evaluation of syndromes of the first and second BA should begin first by studying a series of isolated defects (cleft lip with or without CP, micrognathia, and EAC atresia) that compose the major features of these syndromes and allow a more specific diagnosis. After discussion of these defects and the associated embryology, we discuss PRS, HFM, ACS, TCS, Stickler syndrome, and VCFS.

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