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Biomedical subjects

A Schachner

Publications and source records attributed to A Schachner.

At least 37 records · Page 2Linked to original sources
PubMed1990

Rapid percutaneous tracheostomy.

We describe a new method of performing percutaneous tracheostomy rapidly and safely using a specialized instrument kit. The technique permits the safe insertion of a full-sized 7.0 (ID) or 7.5 mm (ID) cuffed cannula into the trachea within 1-2 min, through the membranous second intercartilagenous space. Animal studies have demonstrated a superior healing process compared to that seen after conventional tracheostomy techniques.

Animals↗
PubMed1989

Percutaneous tracheostomy--a new method.

A rapid method of definitive low tracheostomy utilizing an original instrument kit and percutaneous approach is described. Through a horizontal, shallow (1.5-cm) skin incision in the neck, a 12-ga needle is introduced into the tracheal lumen. A flexible metal guidewire is gently introduced through the needle, which is then removed. A specially designed percutaneous tracheostomy tool slides over the guidewire into the trachea; by squeezing its handles, the intercartilaginous space is enlarged, securing the placement of a cuffed tracheal cannula. After extensive and successful investigation in both cadaver and animal trials, the procedure was carried out in 80 patients who had a variety of underlying diseases, without serious complications. Of these 80 patients, 33 required airway control after neurosurgical interventions or after severe head trauma, 23 had percutaneous tracheostomy performed before radical excision for head and neck cancer, and the remaining 24 suffered from severe cardiorespiratory problems. Twenty-nine procedures were performed in the operating theater, and 51 procedures were carried out at the patient's bedside in the ICU, ED, or in the ward. There was no infection at the stoma site, and late healing was remarkable. It should be strongly emphasized that in the majority of our patients the procedure was carried out safely at the bedside. This resolved the logistic problem of moving very sick ICU patients (who are sometimes on high PEEP levels) to the OR. Although our experience is totally restricted to elective situations, we do postulate that it could be as effective in a variety of urgent situations.

Adult↗
PubMed1989

Increased creatine kinase (CK) MB isoenzyme in patients with "normal" total CK activity suspected of acute myocardial infarction.

Many laboratories screen patients suspected of acute myocardial infarction (AMI) with a test for total creatine kinase (CK) and perform testing for CK-MB isoenzyme only in patients with elevated total CK. To find out whether this practice could result in missing patients with AMI who can have "normal" (within the reference interval) total CK with increased CK-MB (greater than or equal to 5%), we prospectively and sequentially monitored CK and CK-MB in patients admitted for suspected AMI. We found that 12.5% of patients with the final diagnosis of AMI had initially low total CK and high CK-MB (as determined by electrophoresis), but the majority of these patients showed subsequently increased total CK above the reference value. It is suggested that the presence of CK-MB in patients with low total CK does not represent a laboratory error and most of these patients have AMI. Total CK assay could be abandoned in favor of CK-MB testing in patients suspected of AMI.

Age Factors↗
PubMed1986

Repair of coarctation of the aorta in the first three months of life.

Coarctation of the aorta was surgically treated in 28 infants (16 male, 12 female) aged 2 days-3 months, with 19 younger than 1 month. Body weight at operation was 1.6-4.2 (mean 2.8) kg. 3 infants had coarctation alone, 10 had a wide patent ductus arteriosus as the only associated anomaly and 15 had a variety of other anomalies. Resection with end-to-end anastomosis was performed in only one case, while 21 underwent subclavian flap aortoplasty and six patch graft aortoplasty. Additional procedures were banding of the pulmonary artery in five cases and open aortic commissurotomy in one case. The early mortality was 10.7% (3 infants) and three more died later. Further cardiac surgery was subsequently performed on four of the infants. Of the 22 survivors, two had significant recurrence of coarctation which, however, was successfully corrected in one case. The blood pressure was within normal limits in all survivors, except those with recoarctation.

Aortic Coarctation↗
PubMed1985

Bronchial adenoma: surgical experience with long-term follow-up (4-17 years).

Of 16 patients with bronchial adenoma who were operated on at Beilinson Medical Center from 1967 to 1980, only three presented the "triad" of cough, hemoptysis, and recurrent pulmonary infections. In two patients the tumor was diagnosed incidentally and in five patients histological evidence of adenoma was made during bronchoscopy. One patient died of myocardial infarction following reoperation for bleeding, and one patient was lost to follow-up. The remaining 14 patients were followed for 4 to 17 years without evidence of local recurrence or distant metastases. We conclude that the long-term prognosis of patients with bronchial adenoma is excellent, and limited surgical procedure should be the treatment of choice whenever possible.

Adenoma↗
PubMed1983

Carcinoma of lung with a solitary cerebral metastasis. Surgical management and review of the literature.

During the years 1975 to 1980, 10 male patients and 1 female, with ages ranging between 40 to 61 years, underwent combined resection of primary lung cancer and solitary brain metastasis. In 8 patients the lung cancer was diagnosed and treated first. In those patients, craniotomy for removal of a solitary brain metastasis was carried out 8 to 60 months (mean, 27 months) after excision of the lung tumor. In 3 patients, brain metastasis was diagnosed and treated first and lung excision followed, 2 to 4 weeks after craniotomy. The most common histologic type of the tumor was adenocarcinoma (63.6%). There were no operative deaths. Three patients survived less than 6 months after surgery and were considered as a failure of surgical treatment. Seven patients lived longer than 1 year and three of them are still alive with a follow-up period between 2 to 3 1/2 years after both operations. One of the patients underwent recently successfully second brain intervention for removal of recurrent histologically identical solitary brain metastasis and is well. Our results and those reported in literature encourage the combined surgical removal of primary lung cancer and a solitary brain metastasis.

Adenocarcinoma↗
PubMed1983

Two years experience with Medtronic-Hall prostheses in 75 patients with special reference to its thrombogenicity and hemolysis.

Seventy-five patients received 80 Medtronic-Hall valve prostheses during a 24-month period at the Beilinson Medical Center. The mean age was 50 years and the majority of patients had rheumatic heart disease. All operations were elective. There were 4 early and 2 late deaths (8%). Four patients needed re-operation for paravalvular leaks, 3 of them survived the second operation and one patient with prosthetic valve endocarditis did not. One patient was re-operated on successfully because of a mycotic aneurysm in the ascending aorta. Mild subclinical hemolysis (elevated SLDH and reduced haptoglobin) was found in the majority of patients. Hemolysis was found to be significantly lower in type D 16 prostheses patients. Mild hemorrhagic complications occurred in 2 patients due to anticoagulant therapy. Three patients suffered from prosthetic valve endocarditis (PVE), 2 of them responded to prompt medical therapy. There were no thromboembolic episodes. Most surviving patients experienced marked postoperative improvement. Within the 24-month follow-up period, the Medtronic-Hall valve compared favorably with other disk or ball prostheses previously and currently used in our department.

Adolescent↗
PubMed1983

Myocardial protection in infant open heart surgery.

Myocardial protection was evaluated in 2 groups of 5 infants each undergoing correction of either tetralogy of Fallot (TOF) or subcristal ventricular septal defect (VSD). In group A, profound hypothermia and total circulatory arrest (PHTCA) was utilized. In group B, profound hypothermia and total circulatory arrest combined with potassium cardioplegia (PHTCA + K) was the method of protection used. The analysis was carried out by sequential measurements of clinical, electrocardiographic, enzymatic (CK-MB) and ultrastructural parameters. There were no operative deaths. One infant had a second operation for recurrent VSD. The average anoxic time was 35.4 min in group A (PHTCA) and 32.6 min in group B (PHTCA + K). Analysis of our data demonstrated that when potassium cardioplegia was added to PHTCA, there was less intraoperative myocardial damage according to physiological, ultrastructural and biochemical parameters than when profound hypothermia and total circulatory arrest was applied alone.

Creatine Kinase↗
PubMed1982

Aortico-left ventricular tunnel: collective review.

Aortico-left ventricular tunnel (ALVT) is an extremely rare congenital entity in which an abnormal communication between the aorta and the left ventricle bypasses the aortic valve. The condition usually results in gross aortic regurgitation, rapid cardiac decompensation, and death. An additional case of ALVT managed by successful surgical repair is described. The 38 cases reported in the literature are reviewed with emphasis on the clinical and pathological features, diagnosis, natural history, and management. Early operation is recommended to prevent distortion of the aortic valve, dilatation of the left ventricle, and distortion of the aortic anulus.

Adolescent↗
PubMed1981

Retrograde embolization of a detached polyethylene catheter.

The increasing use of intravenous polyethylene catheters has led to a growing incidence of accidental breakage of catheters and migration to the heart. In this communication, we describe a patient in whom the broken fragment of catheter migrated retrogradely from the subclavian vein to the inferior vena cava and left iliac vein. The possible mechanism for such retrograde migration is postulated.

Aged↗
PubMed1980

Repeated mitral valve replacement in the growing child with congenital mitral valve disease.

The successful second-replacement of mitral valve prostheses in two children, age 5 and 9 years, is reported. In one, a parachute mitral valve deformity was first corrected at the age of 10 months by the small-size 00 Starr-Edwards prosthesis. The second child had mitral valve disease caused by Marfan's syndrome 1; the valve was initially replaced at the age of 3 years by a size 0 Starr-Edwards prosthesis. For both patients, in the period between the two interventions, the left ventricle had grown in size and the mitral anulus was not a limiting factor in the insertion of a larger prosthesis of the Björk-Shiley type. Follow-up periods of 1 and 6 years, respectively, confirm excellent clinical results. Problems concerning valve replacements in pediatric patients are discussed.

Child↗
PubMed1979

Retrograde (atrial) dislodgement of a Cross-Jones mitral valve occluder.

Fatal atrial dislodgement of a lenticular disc occurred seven years after surgery in a 54-year-old patient, who had had a mitral valve replacement with a Cross-Jones prosthesis, for ruptured chordae tendinae. A marked distortion of the titanium ring reinforced silicone rubber lens disc due to material wear was the cause of this complication. From the literature available to us, atrial dislodgement of a prosthetic mitral occluder has not been previously recorded. We therefore intend to recommend elective replacement of the Cross-Jones prosthesis in all patients who have had their artificial valve functioning for more than five years.

Heart Valve Prosthesis↗