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Biomedical subjects

A Appelbaum

Publications and source records attributed to A Appelbaum.

At least 19 recordsLinked to original sources
PubMed2001

Significance of balloon imprint during coronary angioplasty.

Balloon imprint during angioplasty is often seen, but not at all inflations. We prospectively studied 235 consecutive patients undergoing 282 PTCAs during a 4-month period, who were divided into two groups: those with balloon imprint during inflation (159 patients, 190 lesions; 67%) and those without (76 patients, 92 lesions; 33%). Clinical and lesion characteristics and immediate outcome were compared. Patients undergoing urgent PTCA had less balloon imprint than those undergoing nonurgent PTCA (14.2% vs. 28.3%; P < 0.005). Although not reaching statistical significance, younger patients and diabetic patients tended toward less balloon imprint (P < 0.06). Patients with observed imprint had less visible thrombus at lesion site (31.1% vs. 42.4%; P < 0.05), and a tendency without statistical significance toward more dissections but less acute closure was observed (P < 0.07). In addition, more stents were implanted in the imprint group (79.5% vs. 66.3%; P < 0.02). Patients needing pressure > 6 atm to break the imprint had more eccentric lesions (68% vs. 27.1%; P < 0.000) and more dissections (13.9% vs. 5.1%; P < 0.03) than those needing lower pressure. Patient and lesion characteristics may determine the appearance of balloon imprint at PTCA, which in turn influences the procedure and its immediate outcome. Cathet Cardiovasc Intervent 2001;53:331-333.

Aged↗
PubMed2001

The drug thief at Georgetown U Medical Center.

The article gives the anatomy of a $2 billion class-action lawsuit. A drug-abusing hospital employee may have exposed hundreds of patients to HIV, hepatitis, and other viruses during his period of employment. Not only has the episode been embarrassing for the prestigious medical center, but it also has focused attention on the potential consequences for hospitals that do not screen employees for drug use.

District of Columbia↗
PubMed2000

Hospital-acquired brevundimonas vesicularis septicaemia following open-heart surgery: case report and literature review.

Brevundimonas vesicularis (B. vesicularis) is a pseudomonad rarely encountered in human infection. A case of nosocomial septicaemia with this organism following open-heart surgery is presented, with a review of the literature. The isolate demonstrated resistance to ciprofloxacin and aztreonam, which has not yet been reported. Treatment with piperacillin/tazobactam resulted in full recovery. A review of the literature reveals that B. vesicularis is a virulent organism involved in serious infections such as central nervous system infection or bacteraemia, some of which are nosocomial. Meanwhile, empiric therapy for B. vesicularis infection should include a broad-spectrum antimicrobial agent until susceptibility results are known.

Adult↗
PubMed1999

Upper posterior mediastinal tumor supplied by an atrial branch of the left circumflex artery.

We report a case of a 39-year-old woman with an upper posterior mediastinal tumor. The tumor was demonstrated by echocardiography and further defined by computerized tomography and magnetic resonance imaging. The tumor was fed by a large atrial branch of the left circumflex artery. Because of its location (adjacent to large vessels), it could not be resected by surgery.

Adult↗
PubMed1999

The ice storm of the century: how hospitals met the challenge.

A huge ice storm in January 1998 affected hospitals and communities in northern New York State and parts of Maine and Canada. This article discusses how some of the region's health facilities and their security departments helped patients, staff, and their communities deal with the unique and prolonged emergency.

Canada↗
PubMed1998

Ketamine attenuates the interleukin-6 response after cardiopulmonary bypass.

UNLABELLED: Cardiopulmonary bypass (CPB) has been proposed as a model for studying the inflammatory cascade associated with the systemic inflammatory response syndrome. Serum interleukin-6 (IL-6) concentration seems to be a good indicator of activation of the inflammatory cascade and predictor of subsequent organ dysfunction and death. Prolonged increases of circulating IL-6 are associated with morbidity and mortality after cardiac operations. In the present study, we compared the effects of adding ketamine 0.25 mg/kg to general anesthesia on serum IL-6 levels during and after elective coronary artery bypass grafting (CABG). Thirty-one patients undergoing elective CABG were randomized to one of two groups and prospectively studied in a double-blind manner. The patients received either ketamine 0.25 mg/kg or a similar volume of isotonic sodium chloride solution in addition to large-dose fentanyl anesthesia. Blood samples for analysis of serum IL-6 levels were drawn before the operation; after CPB; 4, 24, and 48 h after surgery; and daily for 6 days beginning the third day postoperatively. Ketamine suppressed the serum IL-6 response immediately after CPB and 4, 24, and 48 h postoperatively (P < 0.05). During the first 7 days after surgery, the serum IL-6 levels in the ketamine group were significantly lower than those in the control group (P < 0.05). On Day 8 after surgery, IL-6 levels were no different from baseline values in both groups. A single dose of ketamine 0.25 mg/kg administered before CPB suppresses the increase of serum IL-6 during and after CABG. IMPLICATIONS: In this randomized, double-blind, prospective study of patients during and after coronary artery bypass surgery, we examined whether small-dose ketamine added to general anesthesia before cardiopulmonary bypass suppresses the increase of the serum interleukin-6 (IL-6) concentration. Serum IL-6 levels correlate with the patient's clinical course during and after coronary artery bypass. Ketamine suppresses the increase of serum IL-6 during and after coronary artery bypass surgery.

Aged↗
PubMed1996

Surgical treatment of right ventricular myxoma in infancy.

Myxomas are the most common of all primary cardiac tumors in adults. They are extremely rare in infancy. We report on a 5-month-old infant who was admitted in a state of cardiogenic shock. Echocardiography showed a right ventricular myxoma completely occluding the right ventricular outflow tract. prompt surgical removal of the tumor resulted in a excellent outcome.

Echocardiography, Doppler↗
PubMed1987

Pseudoaneurysm of the left ventricle.

Pseudoaneurysm of the left ventricle is relatively rare. Five patients aged 50-61 years with this disorder are the subject of this report. In 4, the pseudoaneurysm occurred following myocardial infarction and in one after aortic valve replacement. The symptoms appeared 3 months to 12 years after the primary event. Clinically, all were admitted with congestive heart failure combined with some degree of angina. In four patients the diagnosis was made by ventriculography and in one case by a multiple gated acquisition radionucleide scan (MUGA). All were operated on soon after diagnosis. In two patients direct suture closure of the orifice was carried out, while in the other three a synthetic patch was necessary to close the aperture. Four patients survived operation and are well two to 14 years following surgery. The literature on post infarction pseudoaneurysm is reviewed and analyzed. This study argues for early surgical treatment, affording relatively low postoperative mortality.

Female↗
PubMed1987

Cardiac myxomas--surgical experience with a multi-faceted tumor.

Eleven patients underwent surgery for cardiac myxomas during an 11-year period. There were 7 females and 4 males, ranging in age from 21-75 (mean 55) years. Presenting symptoms were quite variable: paroxysmal shortness of breath (5), stroke (4), peripheral emboli (2), pulmonary emboli (2), palpitations (2) and fever of unknown origin (1). Diagnosis was made by angiography in 3 cases, echocardiography in 7 and intraoperatively in 1. Seven of the tumors were in the left atrium, two in the right atrium and 2 in the left ventricle. In two patients the tumor recurred. One patient died of a recurrent diffusely invading myxoma of the left ventricle. Ten patients are alive 1-10 years postoperatively (mean 6 years).

Adult↗
PubMed1987

Long-term results of surgical repair of coarctation of the aorta--evaluation by exercise test.

Thirty-six patients have been operated on for coarctation of the aorta. The age at operation ranged from 4 to 45 years with a mean of 14 years. Preoperative systolic blood pressure (BP) was above the normal mean + 2 SD in 34 (94%) of the patients. The surgical techniques used for correction of coarctation were: resection and end-to-end anastomosis (50%), resection and graft interposition (25%), patch graft angioplasty (22%) and subclavian artery to descending aorta bypass graft (3%). There was no hospital mortality. Systolic BP measured on hospital discharge available in 30 patients showed an average decrease of 26 mm Hg. The mean follow-up period in 16 of 30 patients (53%) was 7.2 years. All of these patients had a further decrease in systolic BP, and in 14 of 16 (87%) BP was within the mean + 2 SD. Twelve patients were examined in the vascular diagnostic laboratory to determine adequacy of the repair by hemodynamic measures. After average of 7.8 years following operation, all of them had ankle systolic BP higher than brachial systolic pressure; ankle BP did not drop after treadmill walking exercise and the directional Doppler velocity curves from the legs were normal. This study suggested that BP continued to decrease after hospital discharge. We were unable to demonstrate correlation between age at operation and decrease in BP. The adequacy of surgical repair can be assessed by mild effort stress test combined with ankle/arm ratio measurement and directional Doppler velocity curves.

Adolescent↗
PubMed1987

Systemic to pulmonary shunting masquerading as patent ductus arteriosus: a pitfall in clinical diagnosis.

Patent ductus arteriosus (PDA) frequently complicates the course of respiratory distress syndrome in premature infants. A 920-g, 28 weeks' gestation infant with clinical and radiographic evidence of left to right shunting, was presumed to have a patent ductus arteriosus. Following ductal ligation the signs persisted. Aortic angiogram demonstrated multiple collateral vessels arising from the systemic circulation and communicating with pulmonary vessels. Accurate diagnosis of left to right shunting is imperative if such collateral shunting is not to go undiagnosed.

Arteriovenous Malformations↗
PubMed1986

Narrowing of saphenous vein bypass graft by a sternal spur: repair without cardiopulmonary bypass.

We report a case in whom severe angina has recurred postoperatively secondary to narrowing of a saphenous vein aortocoronary bypass graft (SVBG) caused by compression from a sternal spur. Surgical repair was accomplished by anastomosing a new vein graft to the previous one, bypassing the narrowed segment, without the use of cardiopulmonary bypass (CPB). Although this technique is applicable to only a small proportion of cases undergoing SVBG reoperations, it might reduce the hazards associated with extensive mediastinal dissection and cardiopulmonary bypass in these cases.

Angina Pectoris↗