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Biomedical subjects

B S Alpert

Publications and source records attributed to B S Alpert.

At least 73 records · Page 4Linked to original sources
PubMed1991

Eleven consecutive combined latissimus dorsi and serratus anterior free muscle transplantations.

We reviewed our experience with 11 consecutive combined latissimus dorsi and serratus anterior free-muscle transplantations from 1980 to 1990. All 11 flaps were successful and there was minimal morbidity. This combined muscle flap is ideal for soft-tissue coverage in extensive lower extremity wounds, in mutilating hand injuries with dorsal and palmar defects, and in situations when a long vascular pedicle is needed to get out of the "zone of injury."

Adult↗
PubMed1991

The muscle flap in the treatment of chronic lower extremity osteomyelitis: results in patients over 5 years after treatment.

Preliminary reports have indicated that debridement of the bony sequestrum followed by muscle-flap coverage allows successful treatment of chronic osteomyelitis. To determine the long-term effectiveness of this procedure, 34 consecutive patients with chronic osteomyelitis of the distal lower extremity treated with debridement, a 10- to 14-day course of culture-specific antibiotics, and immediate muscle-flap coverage were evaluated. Patients were treated from 1979 through 1984, and long-term (greater than 5 years) follow-up was available for 27 (79 percent). Twenty-three (85 percent) of these patients underwent microvascular muscle transplantation (gracilis or latissimus dorsi), and four underwent local muscle flaps (gastrocnemius or soleus) for immediate wound coverage. Twenty-four patients (89 percent) healed and were without recurrence over long-term (greater than 5 years, mean 7.4 years) follow-up. Of the three with recurrence, two were cured (greater than 5 years follow-up) after additional muscle-flap procedures. Thus the overall success rate was 96 percent, with a minimum 5-year follow-up. Guidelines for muscle-flap selection and treatment techniques in current use are presented. Debridement and immediate muscle-flap coverage provide effective, single-stage treatment of chronic osteomyelitic wounds and allow antibiotics to be restricted to short-term use. Furthermore, muscle flaps covered with skin grafts provide durable coverage while allowing subsequent ancillary procedures (i.e., bone grafts) to be performed under the flaps.

Adult↗
PubMed1991

Children's cardiovascular reactivity: stability of racial differences and relation to subsequent blood pressure over a one-year period.

After measuring blood pressure and heart rate at rest and during a video game procedure in 477 children enrolled in 3rd grade, 434 (91%) children had these measurements repeated a year later in 4th grade. Black children demonstrated greater blood pressure and heart rate reactivity than White children in both years, and an increase in heart rate reactivity from 3rd to 4th grade. Gender effects were inconsistent. Systolic and diastolic blood pressures during the video game were more highly correlated from year-to-year than were the resting measures. Regression analysis indicated that systolic reactivity was significantly related to subsequent systolic pressure at rest, particularly among Black girls. Diastolic reactivity was associated with subsequent resting diastolic pressure only among White children. Associations between reactivity and future blood pressure were independent of initial resting blood pressure. This study suggests that cardiovascular reactivity to psychological stress may be one important factor in future level of blood pressure and that the increased heart rate reactivity of Black children may be associated with the prevalence of hypertension among Black adults.

Black or African American↗
PubMed1991

Patterns of sodium excretion during sympathetic nervous system arousal.

The purpose of this study was to examine Na+ handling and regulation during 1 hour of behaviorally induced sympathetic nervous system (SNS) arousal followed by 2 hours of recovery. Two patterns of response were observed among experimental subjects, despite similar changes in blood pressure and heart rate. In one group (n = 19), Na+ excretion increased significantly during SNS arousal, which then decreased significantly during recovery (12.3 versus 16.0 versus 13.1 meq/hr, baseline, SNS arousal, recovery, respectively). Changes in Na+ excretion were correlated with changes in creatinine clearance from baseline to SNS arousal (r = 0.54) and SNS arousal to recovery (r = 0.58), and were accompanied by significant increases in plasma renin activity (1.5 versus 2.0 ng/ml/hr) and aldosterone (8.5 versus 10.3 ng/ml/hr) from baseline to SNS arousal. Na+ excretion decreased during SNS arousal in the other group of subjects (n = 17) and remained below baseline levels during recovery (16.2 versus 12.7 versus 11.9 meq/hr). These changes were associated with significant decreases in creatinine clearance from baseline to recovery (138 versus 121 ml/min/1.73 m2) and significant increases in plasma renin activity from baseline to SNS arousal (1.3 versus 2.2 ng/ml/hr) but not in aldosterone. Control subjects (n = 24) maintained baseline levels of each variable throughout the procedure. These results suggest that individuals differ in Na+ handling and regulation during behavioral arousal. Decreases in Na+ have been reported previously in humans and animals at risk for the development of hypertension.

Adrenocorticotropic Hormone↗
PubMed1991

Sodium excretion and racial differences in ambulatory blood pressure patterns.

The influence of Na+ excretion and race on casual blood pressure and ambulatory blood pressure patterns was examined in a biracial sample of healthy, normotensive children and adolescents (10-18 years; n = 140). The slopes relating 24-hour urinary Na+ excretion to systolic blood pressure were different for both black and white subjects for casual blood pressure (p less than 0.001) and blood pressure during sleep (p less than 0.03). For casual blood pressure, the slope was significant for black subjects (beta = 0.17; p less than 0.001) but not for white subjects. For blood pressure during sleep, the slope was again significant for black subjects (beta = 0.08; p less than 0.01) but not for white subjects. Na+ excretion was also related to awake levels of systolic blood pressure for black subjects (beta = 0.08, r = 0.36; p less than 0.01), although the slopes for both black and white subjects were not significantly different. Further analyses indicated the results were not due to racial differences in 24-hour urinary K+ excretion. However, plasma renin activity was marginally related to Na+ excretion in white subjects (r = 0.22; p less than 0.06) but not black subjects, a finding that is consistent with previous studies. Na+ excretion was not associated with diastolic blood pressure or heart rate in either group under any condition. The results of this study support research that has demonstrated a stronger relation between Na+ handling and casual blood pressure in black subjects and extend these findings to blood pressure while the subject is both awake and asleep.

Adolescent↗
PubMed1991

Lower extremity replantation.

Replantation of the traumatically amputated lower extremity is a technically feasible surgical undertaking. Successful outcome must be judged by functional achievements of the patient toward returning to the preinjury level. Appropriate patient selection significantly increases the potential for obtaining a satisfactory outcome. Patients in whom peripheral nerve injury precludes return of sensation in the extremity or in whom severe joint destruction will yield an immobile extremity will have marginal results. The risks of replantation, including blood transfusions, sepsis, and prolonged hospitalization, must be weighted heavily against prosthetic substitution as an alternative. If the lower extremity can be successfully replanted, however, this provides a superior functional and aesthetic result for the patient. Salvage replantation to preserve maximal functional length and durability of an extremity must always be considered when assessing a patient with a traumatic amputation. Free-tissue transfer to salvage a threatened replanted limb must be similarly a part of the armamentarium of the replantation surgeon. Although lower limb replantation may continue to be controversial, improved surgical techniques and increasing experience make it an excellent alternative to prosthetic substitution. In the well-motivated patient, an excellent result may be achieved.

Adult↗
PubMed1991

Microvascular reconstruction of the lower extremity in the elderly.

The natural changes of aging increase perioperative medical risk factors in the elderly population. Aggressive preoperative patient evaluation and perioperative monitoring can effectively decrease morbidity and mortality rates to equal those of younger patients. The surgical strategy must take into account the increased incidence of atherosclerosis in the inflow and free-tissue transfer recipient vessels. Lower extremity microvascular reconstruction can be performed safely and successfully in the elderly patient.

Aged↗
PubMed1991

Microsurgery: directions for the 1990s.

Speculating on the possible advances of microsurgery in the 1990s has encompassed discussion of transplantation technique, biochemistry, monitoring, and nerve and motor reconstruction. This article, however, is by no means exhaustive, and many other discoveries and innovations may come from areas not discussed here. The only clearly incorrect possibility concerning microsurgery in the 1990s is that nothing exciting will happen.

Fingers↗
PubMed1991

Ambulatory blood pressure patterns in children and adolescents: influence of renin-sodium profiles.

A renin-sodium nomogram for normotensive children and adolescents was developed at our institution. The ambulatory blood pressure patterns of subjects classified by the nomogram were then compared. A biracial sample of 159 children and adolescents were classified as having a low, intermediate, or high renin-sodium profile based on the relationship between their plasma renin activity and 24-hour urinary sodium excretion. Casual (106/58 vs 107/61 vs 106/62 mm Hg) and awake (116/69 vs 117/69 vs 116/70 mm Hg) blood pressure values were comparable among subjects with low, intermediate, and high renin-sodium profiles. Subjects with high renin-sodium profiles, however, had a smaller decline in systolic blood pressure with sleep than did subjects with low renin-sodium profiles (7 vs 11 mm Hg; P less than .04), and higher diastolic blood pressure readings during sleep than subjects with intermediate renin-sodium profiles (65 vs 62 mm Hg; P less than .05). Subjects with high renin-sodium profiles also had greater variance of diastolic blood pressure readings during sleep than either subjects with low renin-sodium profiles (P less than .01) or those with intermediate renin-sodium profiles (P less than .02). The blunted nocturnal decline and increased nocturnal variance of blood pressure among subjects with high renin-sodium profiles may be a marker or mechanism for the future development of essential hypertension.

Adolescent↗
PubMed1990

Treatment of migraine headache in a postoperative microsurgical patient.

Immediately following a double-toe transfer to her hand, a 40-year-old woman developed a severe migraine headache unrelieved by narcotics. Medical consultation was obtained, and available medical treatments were discussed in relation to their possible effects on the patient's recent microvascular procedure. Intravenous steroids were administered, with resolution of the headache. This case illustrates an approach to the management of medical problems in which treatment options are weighed against their possible microsurgical effects.

Adult↗
PubMed1990

Significance of the Doppler-derived gradient across a residual aortic coarctation.

Few data exist which address the significance of the Doppler gradient across a residual narrowing in older children who have had a coarctation repaired. Therefore, we evaluated 11 patients with repaired aortic coarctation with and without residual obstruction by Doppler echocardiography. The Doppler-derived transcoarctation pressure gradient correlated poorly with catheter-measured peak-to-peak and catheter maximal instantaneous gradients when only the maximal velocity across the repair was utilized in the simplified Bernoulli equation, [r = 0.73, standard of error of the estimate (SEE) = 5.0 mmHg and r = 0.56, SEE = 7.6 mmHg, respectively]. However, when the precoarctation velocity was included in the simplified Bernoulli equation, the correlation between Doppler-derived and catheter-measured gradients became excellent. The maximal Doppler gradient correlated well with catheter peak-to-peak gradient (r = 0.95, SEE = 2.2 mmHg) and catheter maximal instantaneous gradient (r = 0.94, SEE = 3.2 mmHg). However, the maximal Doppler gradient slightly overestimated the catheter peak-to-peak gradient and underestimated the catheter maximal instantaneous gradient. The Doppler mean gradient showed excellent correlation with the catheter mean gradient (r = 0.97, SEE = 0.85 mmHg). Precoarctation velocities were generally twofold greater than published normals due to a spatial acceleration phenomenon. All subjects had residual hypoplasia of the transverse aorta such that its transverse diameter was 29% less than, and its cross-sectional area was 50% less than, the ascending and descending aorta.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Serratus anterior muscle transplantation for treatment of soft tissue defects in the hand.

The inferior three slips of the serratus anterior muscle have been used as a free tissue transfer in 18 patients for the reconstruction of dorsal and palmar defects in the hand. Mean follow-up was 2.8 years. There were 12/18 flaps for palmar coverage and 6/18 for dorsal coverage. All flaps survived. On the basis of this experience we conclude that this flap has three attributes making it suitable for palmar and dorsal metacarpal resurfacing: (1) low donor site morbidity, (2) the three separate slips are easily divisible for contouring, and (3) durability and adhesion provide a stable resurfacing for grasp.

Adolescent↗
PubMed1990

Functional restoration in the upper extremity using free muscle transplantation.

Since 1973, fourteen free muscle transfers for functional upper limb reconstruction have been performed in twelve patients at the Ralph K. Davies Medical Center in San Francisco. All of the patients in this series had lost finger flexion, extension, and/or thumb opposition and were not candidates for simpler methods of reconstruction because of weakness or traumatic loss of balancing musculature. The 12 patients have been followed for one to 9 years. All muscles were successfully transferred without flap loss. Evaluation of the EMG data has shown evidence of reinnervation beginning at approximately two months with fibrillation potentials decreasing and recruitment of increasing numbers of motor units over two to three years. Eleven of the 14 muscles attained movement against resistance; two had movement against gravity and one regained only a flicker of motion. In our experience, the use of free muscle transplantation to restore function is not only technically feasible, but moreover, has resulted in a relatively high degree of patient satisfaction.

Adolescent↗
PubMed1990

Scalp reconstruction by microvascular free tissue transfer.

We report on a series of patients with scalp defects who have been treated with a variety of free flaps, spanning the era of microvascular free tissue transfer from its incipient stages to the present. Between 1971 and 1987, 18 patients underwent scalp reconstruction with 21 free flaps: 11 latissimus dorsi, 3 scalp transfers between identical twins, 3 groin, one combined latissimus dorsi and serratus anterior, two serratus anterior, and one omentum. These flaps were used to cover scalp defects resulting from burns, trauma, radiation, and tumors in patients ranging from 7 to 79 years of age. Follow-up has ranged from 3 weeks to 7 years. All of our flaps survived and covered complex defects, many of which had failed more conservative attempts at cover. One patient received radiation therapy to his flap without unfavorable sequelae. This experience began with a pioneering omental flap and includes cutaneous and muscle flaps. The latissimus dorsi is our first choice for free flap reconstruction of extensive, complicated scalp wounds because of its large size, predictable blood supply, ease of harvesting, and provision of excellent vascularity to compromised beds.

Adolescent↗
PubMed1990

Race, sex, and family history of hypertension and erythrocyte sodium pump [3H]ouabain binding.

We studied the binding properties of [3H]ouabain to erythrocytes from normotensive children (n = 83) between the ages of 10 and 18 years (mean resting arterial pressure: 102/57 mm Hg) from normotensive and essential hypertensive parents. Arterial blood pressures of 101/57 and 104/57 mm Hg (subjects with normotensive and hypertensive parents, respectively) were not significantly different between the two groups. Forty-four children had normotensive parents and 39 had hypertensive parents, 51 were white and 32 were black, and 41 were girls and 42 were boys. By using the [3H]ouabain-binding technique, we determined the density of sodium pump sites and the equilibrium dissociation constants in erythrocytes from these children. Possible effects of race, sex, or parental hypertension status on pump sites and dissociation constants were tested with a three-way analysis of variance (ANOVA). Race had a major effect on the dissociation constant: blacks had a significantly higher value than did whites (p = 0.002). We also found a race by sex by parental hypertension status interaction (p = 0.04) with black girls with hypertensive parents having the highest value. There was no effect of race, sex, or status on sodium pump site density. Age, height, weight, resting arterial blood pressure, and plasma Na+ and K+ concentrations did not correlate with the dissociation constants. These data suggest that, among the groups we studied, black girls with hypertensive parents had erythrocytes with the lowest binding affinity for ouabain.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Aerobic fitness and the diurnal rhythm of blood pressure in adolescents.

We examined the effects of aerobic fitness and race on the diurnal rhythm of blood pressure of 175 healthy adolescents who performed a cycle ergometer maximal exercise test while oxygen consumption was measured. A median split of maximum oxygen consumption for boys and girls separately classified them as either "more-fit" or "less-fit" subjects. Ambulatory blood pressure recordings were also performed, and the data were analyzed for means while subjects were awake and asleep. Less-fit black boys had higher systolic pressures than more-fit black boys while awake (124 vs. 115 mm Hg; p less than 0.009) and asleep (117 vs. 108; p less than 0.001). Less-fit black boys also had higher systolic pressures than less-fit white boys while awake (114; p less than 0.002) and asleep (105; p less than 0.001), and they had higher systolic pressures than more-fit white boys while asleep (105; p less than 0.01). Less-fit black girls had higher systolic pressures than more-fit black girls while awake (116 vs. 109; p less than 0.004) and asleep (109 vs. 100; p less than 0.001). Less-fit black girls also had higher diastolic pressures than more-fit black girls while awake (71 vs. 66; p less than 0.002) and asleep (66 vs. 61; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗