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Biomedical subjects

D B Bogart

Publications and source records attributed to D B Bogart.

14 recordsLinked to original sources

Femoral artery catheterization complications: a study of 503 consecutive patients.

This report describes a prospective randomized trial of 503 patients who underwent a cardiac catheterization or interventional procedure at a single institution. In an effort to study femoral complications postprocedure, we evaluated three methods of femoral artery hemostasis as well as 38 variables that were felt to potentially relate to local complications. Only a marginally significant relationship between the hemostasis method and complication rate was found. The factors that contributed to femoral artery complications were: restarting heparin postsheath removal, number of procedures done during one hospitalization, noncompliance of the patient with bedrest after the procedure, number of arterial punctures to initiate the procedure, and preprocedure treatment with corticosteroids.

Adult

Current therapy of impending myocardial infarction and acute cholecystitis.

The authors discuss the treatment of severe coronary artery disease and acute cholecystitis using laparoscopic laser in one instance and percutaneous transluminal coronary angioplasty (PTCA) in the other. Their report demonstrates that both can be applied with relative safety in close temporal proximity.

Acute Disease

Foreign body retrieval using a simple snare device.

We report three patients who had intravascular catheter fragments removed using an easily made snare device fashioned from a 0.038 inch movable-core J-wire and a multi-purpose catheter. The device is easily manipulated and facilitates safe removal of embolized catheters.

Adult

Use of exchange wires in coronary angioplasty.

A 300 cm exchange guide wire was used as the primary wire in 59 consecutive patients referred for percutaneous transluminal coronary angioplasty. The success rate of the angioplasty using this as the only wire was 92% (54 of 59), and we were able to pass the exchange guide wire into the distal vessel in 56 of the 59 patients (95%). We believe the exchange wire technique has a place in the first-line approach to complex coronary angioplasty.

Angioplasty, Balloon

Symptomatic upper extremity venous thrombosis associated with permanent transvenous pacemaker electrodes.

Symptomatic arm vein thrombosis secondary to permanent transvenous cardiac pacing electrodes is an uncommon occurrence with an incidence of 1 to 3 percent. Two patients with this problem are presented who were treated with streptokinase followed by conventional anticoagulation therapy with heparin and warfarin. Near total resolution of the thromboses was accomplished in both patients. In follow-up periods of nine and 20 months, the patients have remained asymptomatic. An aggressive approach to this problem may decrease the current high morbidity.

Aged

Progression of aortic stenosis.

We assessed progressive stenosis of the aortic valve in 11 adult patients (mean age of 48 years) with aortic stenosis who had undergone two cardiac catheterizations without intervening aortic valve surgery. The mean time between cardiac catheterization was 59 months (range 20 to 133). No patients had mitral valve disease. Two patients had coronary artery disease. The results showed that progressive stenosis of the aortic valve occurred in 10 of 11 patients with a significant decrease in the calculated mean aortic valve area from 1.2 +/- 0.2 sq cm to 0.7 +/- 0.1 sq cm (P less than 0.005); a significant increase in mean left ventricular peak systolic pressure from 149 +/- 8 mm Hg to 199 +/- 3 mm Hg (P less than 0.01), and a significant increase in mean left ventricular aortic pressure gradient from 31 +/- 4 mm Hg to 75 +/- 13 mm Hg (P less than 0.005). On an individual basis, the change in left ventricular pressure and the left ventricular-aortic gradient did not always reflect the decrease in aortic valve area because of variations in cardiac output. The shortest period of time in which progression of aortic stenosis occurred was 27 to 29 months. Thus, progressive stenosis of the aortic valve occurs in adults with isolated aortic valvular stenosis. Significant decrease in the aortic valve area can develop in as short a period as 27 to 29 months.

Adult

Echocardiographic features of an aneurysm of the left sinus of Valsalva.

The echocardiographic features of an aneurysm of the left sinus of Valsalva are described and correlated with angiographic findings. The echocardiogram showed the presence of a thin line of echoes occurring proximal to the anterior leaflet of the mitral valve and moving in and out of apposition with the posterior aortic wall. During systole, this line of echoes moved away from the aorta into the left atrium, and during diastole, the line moved into the aorta. Recognition of these features provides a potential noninvasive way to diagnose aneurysms of the left sinus of Valsalva prior to rupture.

Adult

Prosthetic valve endocarditis: reviewing the problem.

Bacterial endocarditis is a serious complication of valve replacement, with an overall mortality of 59%. Fever, although a constant feature of the condition, is a nonspecific finding; other manifestations may or may not be present and the diagnosis may be overlooked. Any patient with a prosthetic heart valve and bacteremia should be considered to have endocarditis and should be treated accordingly.

Anti-Bacterial Agents

Pulmonary arterial pulsus alternans secondary to primary pulmonary hypertension.

Pulsus alternans of the pulmonary artery without systemic pulsus alternans is uncommon and is associated with multiple diseases. Two cases of pulmonary hypertension with pulmonary arterial pulsus alternans and right-sided heart failure are described. Primary pulmonary hypertension was demonstrated at autopsy in both cases. These two case reports constitute another previously unreported cause for pulsus alternans in the pulmonary circuit.

Adult

Rapid diagnosis of primary influenza pneumonia.

Primary influenza pneumonia is a disease of high mortality. Differentiation between a bacterial and viral etiology for the pulmonary infiltrates frequently presents a diagnostic dilemma. Rapid diagnosis is essential; and once established, the patient requires careful supportive therapy. This report describes two patients with primary influenza pneumonia complicated by severe respiratory failure. Early diagnosis of the pulmonary infiltrates was accomplished by obtaining bronchial secretions with fiberoptic bronchoscopy and staining them with influenza-A fluorescent conjugate. One patient died of the complications of this illness, despite maximal supportive therapy. The other patient survived the illness and at the time of hospital discharge was showing marked improvement in his exercise tolerance. There was subsequent gradual return of ventilation and gas transport function to normal values.

Female