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Biomedical subjects

D M Nicoloff

Publications and source records attributed to D M Nicoloff.

At least 73 records · Page 4Linked to original sources
PubMed1978

Late hemodynamic and angiographic findings after ascending aorta--pulmonary artery anastomosis.

Ascending aorta-pulmonary artery (Waterston) anastomosis was performed in 75 children, 51 of whom were younger than 1 month of age and 36 younger than 1 week of age at the time of operation. There were 21 operative and eight late deaths. Operative deaths occurred more frequently in infants with complex cardiac conditions and severe hypoxemia and acidosis preoperatively. The postoperative status of the pulmonary arteries or arterioles could not be correlate with the degree of cardiomegaly, the pulmonary vascular markings, or characteristics of the shunt murmur. Sixty-four percent of the patients catheterized had one or more postoperative structural abnormalities of the pulmonary arteries following the operation, most frequently kinking or narrowing of a pulmonary artery. Occlusion of a pulmonary artery occurred in five of 33 patients studied by angiography. Pulmonary vascular disease may also develop. Therefore, patients should be catheterized 1 year postoperatively to evaluate the level of pulmonary vascular resistance and the pulmonary arteries.

Aorta↗
PubMed1978

Composite replacement of the aortic valve and ascending aorta.

This report comprises 16 consecutive patients with ascending aortic aneurysms caused by cystic medical necrosis. We replaced the ascending aorta and aortic valve with a tightly woven Dacron graft containing a Lillehei-Kaster valve prosthesis and implanted the coronary ostia in the sides of the graft. All but two patients had massive aortic insufficiency. Postoperative catheterization was performed in 13 patients, and all surviving patients have been seen within the past 6 months. There was one perioperative death (6 percent) and two late deaths. Eleven survivors are in Class I and two are in Class II (N.Y.H.A.). Angiographically demonstrated late complications have included psuedoaneurysms of the coronary ostium (two), paravalvular leak (one), and pseudoaneurysm of the distal suture line (one). Two of these four patients were asymptomatic. Two of the four patients have had successful repair of these defects and a third is awaiting operation. Compositive replacement carries a low operative risk and minimizes problems of intraoperative bleeding. In view of the incidence of late suture line problems, routine angiography 6 to 12 months postoperatively is recommended. If new symptoms occur or if there is a change in the cardiac silhousette on chest roentgenogram, the patient should be recatheterized.

Adolescent↗
PubMed1977

Postoperative complete heart block in 64 children treated with and without cardiac pacing.

Between 1957 and 1973, a total of 64 children had complete heart block during intracardiac surgery were treated by one of three methods: (1) No pacemaker: Six of the 13 patients in this group had reversion to sinus rhythm. Seven patients continued to have complete heart block, and five of these died of Stokes-Adams episodes. Two patients continue to have complete heart block without pacemaker insertion. (2) Temporary pacemaker: Seventeen of 25 patients had reversion to sinus rhythm and the temporary pacemaker was removed; the other 8 continued to have complete heart block. Five of the eight died--three of Stokes-Adams episodes and two at the time of cardiac reoperation. Three remain asymptomatic without placement of a permanent pacemaker. Six died of postoperative complications unrelated to heart block or pacemaker implantation. None of the other 20 experienced Stokes-Adams attacks. There was one late death in this group. Although there are problems in using permanent pacemakers and electrode systems, in these patients with operatively induced complete heart block their use was associated with a low mortality rate.

Adolescent↗
PubMed1977

Open-heart surgery.

A randomized prospective study of the relative effectiveness of broad-spectrum versus specific antistaphylococcal antibiotic prophylaxis in open-heart surgery was done between May 1972 and June 1973. All patients undergoing open-heart surgery were assigned randomly (by hospital number) to receive either methicillin (M) or cephalothin (C) beginning the night before operation. There were 132 patients in the C group and 129 in the M group. There were no statistically significant differences in age or duration of hospitalization, cardiopulmonary bypass, urinary tract drainage, or postoperative fever. There was a significant difference in the ratio of male to total patients (0.67 C, 0.52 M, P less than .02) and duration of operation in hours (4.27 C, 3.87 M, P less than .02). A statistically significant higher rate of urinary tract infection (3 C, 22 M, P less than .05), pneumonia (0 C, 9 M, P less than .01), and episodes of sepsis and prosthetic endo carditis (0 C, 11 M, P less than .001) was found in the methicillin group. The incidence of wound infections and positive cultures from blood obtained immediately after termination of cardiopulmonary bypass was not significantly different. Cephalothin replaced methicillin as the routine antibiotic prophylaxis for open-heart surgery at our institution.

Adult↗
PubMed1977

Serial serum creatine phosphokinase MB isoenzyme activity after myocardial infarction. Studies in the baboon and man.

Serum CPK-MB iosenzyme activity was measured serially after mercury embolization of the left circumflex coronary artery in five baboons and after clinical acute myocardial infarction (AMI) in 20 patients. The calculated amount of enzyme released into the baboons' circulation (CPK-MBR) correlated well (r = 0.991) with the amount of MB isoenzyme depleted from the myocardium (CPK-MBD) when a previously determined decay constant (Kd) was used, but not when Kd was calculated from individual curves or when CPK-MM values were used. In clinical AMI, CPK-MMR averaged 97% (0 to 350%) greater than CPK-MBR, probably because of release of MM isoenzyme from nonmyocardial sources. The mean Kd for CPK-MB in patients (0.0012 min-1) was significantly (P less than 0.01) lower than that obtained in the baboon following bolus injections (0.0018 min-1), probably reflecting delayed myocardial release of enzyme. Therefore, in both experimental and clinical AMI, serial samples for CPK-MB activity, but not total or CPK-MM activity, could provide an accurate index of myocardial enzyme depletion.

Animals↗
PubMed1977

Antibiotic prophylaxis for open-heart surgery.

A randomized, prospective study of the relative effectiveness of broad-spectrum versus specific antistaphylococal antibiotic prophylaxis in patients having open-heart surgery was performed between May, 1972, and June, 1973. All patients undergoing open-heart surgery was assigned randomly (by hospital number) to receive either methicillin or cephalothin beginning the night before operation. There were 132 patients in the cephalothin group and 129 in the methicillin group. There was no statistically significant differences in age or duration of hospitalization, cardiopulmonary bypass, urinary tract drainage, or postoperative fever. There was a significant difference in the ratio of male to total patients (cephalothin group, 0.67; methicillin group, 0.52; p less than 0.02) and duration of operation (cephalothin group, 4.27 hours; methicillin group, 3.87 hours; p less than 0.05). The methicillin group had a statistically significant higher rate of urinary tract infection (cephalothin group, 3 cases; emthicillin group, 22 cases, p less than 0.05), pneumonia (cephalothin group, no cases; methicillin group, 9 cases; p less than 0.01), and episodes of sepsis and prosthetic valve endocarditis (cephalothin group, no cases; methicillin group, 11 cases, p less than 0.001). The incidence of wound infections and positive blood cultures from blood obtained immediately after termination of cardiopulmonary bypass was not significantly different between the two groups. Cephalothin has replaced methicillin as the routine prophylaxis for open-heart surgery at our institution.

Bacterial Infections↗
PubMed1976

Intrathoracic paraganglioma arising from aorticosympathetic paraganglion.

A slowly growing intrathoracic paraganglion arising from an aorticosympathetic ganglion was removed from a 22-year-old woman. It was adherent to the parietal pleura and azygos vein, but not to the spinal cord. She has been well for the two years since that time. This patient represents the sixth tumor reported in this location. Most of the reported tumors are benign with occasional local invasion as seen in paragangliomas in other locations (carotid and aortic bodies). Complete excision of the tumor is the treatment of choice, but partial excision may provide long-term survival. A new classification and terminology suggested by Glenner and Grimley is emphasized. It groups logically the tumors arising from the paraganglion cells on the basis of anatomic distribution, innervation, and microscopic structure.

Adult↗
PubMed1976

Free-water clearance and the early recognition of acute renal insufficiency after cardiopulmonary bypass.

The predictive value of free-water clearance measurements for the early recognition of acute renal insufficiency was evaluated in 59 patients immediately following cardiopulmonary bypass. Blood urea nitrogen and serum creatinine measurements were taken before and after operation. Intraoperatively, immediately after completion of bypass, urine and serum samples were obtained for osmolality. Duration of bypass, urine output, degree of hemolysis, and quality of perfusion were recorded. Fifty-four patients developed no signs of renal insufficiency following bypass, and all had free-water clearance values equal to or less than -20 ml per hour. Five patients who had free-water clearance values equal to greater than -8 ml per hour developed manifestations of an acute renal insufficiency state. There were no false-negative or false-positive determinations. Consequently, free-water clearance measurements appear to be a reliable indicator of those patients who will develop renal insufficiency following cardiopulmonary bypass. Early recognition provides an opportunity immediately after operation for initiating treatment consisting of administration of diuretics, potassium restriction, and oliguric fluid regimens.

Acute Kidney Injury↗
PubMed1976

Residual right-to-left shunt following repair of atrial septal defect.

Information about 5 patients with residual right-to-left shunts following repair of an atrial septal defect is presented. In each patient the defect was located low in the atrial septum adjacent to the inferior vena cava. During operation, either the eustachian valve of the inferior vena cava had been mistaken for the lower margin of the defect or the lower portion of the defect was not closed; blood flow was then diverted from the inferior vena cava into the left atrium. To prevent this occurrence, the inferior margin of the atrial septal defect should be closed first.

Adolescent↗
PubMed1976

Palliation of infants with truncus arteriosus through creation of a pulmonary artery ostial stenosis.

A surgical procedure for palliation of infants with truncus arteriosus and excessive pulmonary blood flow (types I, II, and III) is described. The technique involves the production of ostial stenosis of the pulmonary artery from within the truncus using cardiopulmonary bypass. This method has advantages over pulmonary artery banding, which in general has produced disappointing results.

Constriction↗
PubMed1976

Alveolar rhabdomyosarcoma involving the heart. An echocardiographic, angiographic and pathologic study.

A 12-year-old girl, who had had an above-knee amputation of the left leg for a soft tissue sarcoma six years prior to this admission, presented with syncope, angina, and signs of aortic stenosis. Echocardiography demonstrated a mass arising from the interventricular septum with obstruction of the left ventricular outflow tract and aortic valve. Cardiac catheterization and angiography confirmed these findings. At operation, a tumor was found involving the interventricular septum. Histologically, it was an alveolar rhabdomyosarcoma, and it appeared similar to the previous tumor. The patient was treated by partial surgical resection, cytotoxic drugs and localized radiation therapy and has been followed by serial echocardiography.

Cardiac Catheterization↗