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Biomedical subjects

D Bregman

Publications and source records attributed to D Bregman.

At least 73 records · Page 4Linked to original sources
PubMed1977

An improved method of myocardial protection with pulsation during cardiopulmonary bypass.

A new valveless pulsatile assist device (PAD) has been developed that converts roller pump flow into synchronized pulsatile flow. The PAD can also be used as an arterial counter-pulsator (ACtP) before and after cardiopulmonary bypass (CPB). The PAD was employed in 100 adult patients undergoing open heart surgery for coronary artery and/or valvular heart disease. Seventy-three of these patients were NYHA class III or IV, had ejection fractions of less than 0.3, or an LVEDP greater than or equal to 18 mm Hg. Sixty-one patients underwent coronary artery bypass alone, 17 valve replacement alone, three ventricular aneurysm alone, 12 combined coronaries and valves, and seven combined coronaries and ventricular aneurysms. The device functioned as a hemodynamically effective ACtP before and after CPB. During CPB, pulse pressures of 40-50 mm Hg were readily obtained. Urinary outputs during CPB were increased on the PAD when compared to a control group (9.18 +/- 0.68 cc/min vs 3.90 +/- 0.34 cc/min). In addition, during CPB, coronary graft blood flow (CBF) increased an average of 21.4 +/- 6.1% with the PAD, and after CPB, CBF increased an average of 25.0 +/- 5.9%. Free plasma hemoglobins after CPB were not elevated. Only one patient had a perioperative myocardial infarction, and this patient was successfully treated with intra-aortic balloon pumping. It is suggested from these data that use of the PAD may decrease both the incidence of perioperative myocardial infarction and the need for postoperative intra-aortic balloon pumping.

Assisted Circulation↗
PubMed1977

Increased cardiac output by downstream pumping with a reversed unidirectional intra-aortic balloon.

Downstream and upstream pumping with unidirectional intra-aortic balloons was compared in 8 open-chest normal mongrel dogs anesthetized with pentobarbital. Downstream pumping effect a 32 per cent increase in cardiac index, a 24 per cent decrease in systemic resistance, and a 2 per cent decrease in heart rate. Upstream pumping did not significantly affect these parameters. Mean aorta pressure proximal and distal to the balloon was not altered significantly by pumping in either direction. This unique observation of increased cardiac output may have important implications for the treatment of low output cardiac failure. Preliminary studies including baroreceptor denervation suggest that a reflex mechanism may be involved.

Animals↗
PubMed1977

Diagnostic criteria for influenza B-associated Reye's syndrome: clinical vs. pathologic criteria.

Between December 15, 1973, and Jun 30, 1974, a total of 379 cases of Reye's syndrome was reported to the Center for Disease Control. One hundred forty-seven (40%) were confirmed by either autopsy or biopsy, while 232 were diagnosed by clinical and laboratory parameters. Comparisons of the epidemiologic and demographic characteristics, the hospital course, the outcome, and the laboratory abnormalities of the clinically diagnosed and the pathologically confirmed cases revealed no significant differences. In the epidemiologic setting of influenza B outbreaks, children who have the acute onset of noninflammatory encephalopathy associated with elevated serum transaminase levels, hypoprothrombinemia, and elevated blood ammonia levels should be considered to have Reye's syndrome. Further evaluation of diagnostic criteria is needed, however, for sporadically occurring, nonepidemic cases of noninflammatory encephalopathy associated with hepatic dysfunction.

Acid-Base Imbalance↗
PubMed1976

Transmission of hepatitis B associated with hemodialysis: role of malfunction (blood leaks) in dialysis machines.

In the first 10 months of 1974, 26 of 60 susceptible patients in a commercial hemodialysis unit developed asymptomatic infection with hepatitis B virus; 17 (65%) of the 26 cases occurred in 14 weeks from July to October. In a case-control study, 15 of 16 cases for whom records were available were found to be associated with malfunctions of dialysis machines (primarily leaks or ruptures in dialysis membranes) that had occurred before patients converted to hepatitis B surface antigen (HBs Ag) positivity. In comparison, 17 of 34 controls were associated with machine malfunctions (P less than 0.01). In addition, the mean number of malfunctions in machines per patient was significantly greater for cases of infection (2.25 +/- 1.34) than for controls (1.06 +/- 1.39) (P less than 0.01). Furthermore, a direct correlation was demonstrated between an increase in blood leaks in machines used with susceptible patients and subsequent increases in cases of hepatitis for the various beds in the unit (r=0.994, P less than 0.0001). The mean period from the last blood leak to HBs Ag seroconversion was 67 days. Six of the 36 blood leaks associated with cases of infection occurred less than 6 hr after leaks in the contaminated area, whereas only one of 36 leaks associated with controls demonstrated this relationship (P less than 0.05). These data suggest that the conversion to HBs Ag positivity was linked to the occurrence of machine malfunctions (blood leaks) and that events which occurred during these episodes caused the spread of infection.

Hepatitis B↗
PubMed1976

Giant lipoma of the mesentery: report of an unusual case and review of the literature.

A patient with a huge mesenteric lipoma is discussed. A review of the literature reveals that there are less than 30 reported cases and consequently this diagnosis is rarely made preoperatively. An upper gastrointestinal series with a small bowel follow-through and a mesenteric arteriogram may suggest this condition. Surgical excision is the treatment of choice, since these large tumors may undergo malignant degeneration.

Female↗
PubMed1976

Anomalous origin of the right coronary artery from the pulmonary artery.

Anomalous origin of a coronary artery from the pulmonary artery is a relatively rarer congenital anomaly which almost exclusively involves the left coronary artery. A previously healthy 25-year-old woman had a cardiopulmonary arrest. Following resuscitation, investigations revealed an even rarer anomaly, an anomalous right coronary artery arising from the pulmonary artery. Successful surgical repair was accomplished by reimplanting the right coronary artery into the aortic root. The patient is currently asymptomatic 2 years postoperatively. The pertinent literature is reviewed.

Adult↗
PubMed1975

Intraoperative unidirectional intra-aortic balloon pumping in the management of left ventricular power failure.

Unidirectional intra-aortic balloon pumping (IABP) was applied to 28 adult patients undergoing open-heart surgery over a 35 month period. The patients were divided into three groups according to the temporal sequence of initiating IABP. Group A consisted of 4 patients who were in a low output state or in cardiogenic shock prior to study. All patients survived cardiac catheterization and surgery, and 3 (75 per cent) were long-term survivors. Group B included 15 patients who could not be weaned from cardiopulmonary bypass with the usual supportive measures. Twelve patients (80 per cent) were weaned from bypass with IABP, and 11 (73 per cent) were discharged from the hospital. Group C was composed of 9 patients who manifested a low cardiac output syndrome within the first 24 hours following surgery. IABP was initiated in the recovery room. Six patients (67 per cent) were discharged. The total experience with these 28 patients therefore includes 24 patients (86 per cent) who were weaned from IABP, 20 (71 per cent) who were discharged, and 18 (64 per cent) who were long-term survivors. The present criteria for the use of IABP in the cardiac surgical patient are defined.

Adolescent↗