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Biomedical subjects

D S Weiman

Publications and source records attributed to D S Weiman.

At least 37 records · Page 2Linked to original sources
PubMed1993

Perioperative respiratory management in cardiac surgery.

The perioperative respiratory care of the cardiac surgical patient can present many challenges to the caring physician that he or she may not see among the usual patient population. Knowledge of the effects of the heart-lung machine on pulmonary performance, awareness of the anatomic changes brought on by the surgeon, and consideration of the patient's baseline cardiac and pulmonary function need to be addressed so that the pulmonary problems that they present can be managed optimally.

Analgesia↗
PubMed1993

Physiology of lung resection.

Although we speak intuitively about the effects of lung resection, little thought is given to the precise physiologic mechanisms. The effects of different thoracic incisions on the chest wall mechanics, the removal of pulmonary parenchyma on lung function, and the interaction of the cardiopulmonary apparatus all combine to result in specific physiologic derangements after thoracic surgery.

Abdomen↗
PubMed1992

Safe intraaortic balloon pump placement through the ascending aorta using transesophageal ultrasound.

Intraaortic balloon pumping salvages a substantial number of patients who fail to be weaned from cardiopulmonary bypass after an open heart operation. Patients with severe peripheral vascular disease may require ascending aortic balloon pump insertion. We describe a simple method of direct aortic puncture for intraaortic balloon pump placement using transesophageal ultrasound as a means of avoiding complications during insertion and documenting correct balloon position.

Aorta↗
PubMed1991

Stair climbing as an exercise test to predict the postoperative complications of lung resection. Two years' experience.

The results of a clinically performed preoperative stair climb was compared to the presence of postthoracotomy complications in the retrospective hospital record review of 54 adult men. The stair climb was a maximum of five flights (125 steps) performed at the patient's rate and terminated at his request. Pulmonary function measurements and facets of the stair climb physiology were also examined in reference to the presence, type, and severity of complications experienced. Most minor complications such as transient arrhythmias, atelectasis, and pneumonia were clearly not predicted by the stair climb performance. The ability to climb three flights preoperatively most clearly separated those patients having the longer postoperative intubation and hospital stay, greater frequency of complications, and cumulative complication score (p less than 0.005). This retrospective study did not have sufficient numbers of fatal cardiopulmonary complications to exclude the possibility that these may be predicted by the results of this simple test.

Adult↗
PubMed1990

Pneumocystis carinii pneumonia manifested as a hilar mass and cavitary lesion: an atypical presentation in a patient receiving aerosolized pentamidine prophylaxis.

A case of Pneumocystis carinii pneumonia (PCP) in a patient with AIDS was manifested radiographically as a hilar mass and cavitary lesion. The patient had been receiving aerosolized pentamidine as prophylaxis against PCP. Nonuniform deposition of aerosolized pentamidine was probably responsible for this atypical radiographic appearance of PCP.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Failure of preoperative staging to assess unresectability in M0 bronchogenic carcinoma.

Despite extensive preoperative staging, unresectability of a bronchogenic carcinoma may not be known until an exploratory thoracotomy is done. Failures in anatomic staging occur because of inability to detect local extent of hilar lesions and inability to detect small deposits of metastatic disease. At the University of South Carolina, nine of 75 patients who underwent thoracotomies were found to be unresectable. Using an extensive staging protocol, the "back out" thoracotomy rate can be reduced to a minimum whereas no patient is denied a chance for surgical cure.

Carcinoma, Bronchogenic↗
PubMed1989

Submaximal invasive exercise testing and quantitative lung scanning in the evaluation for tolerance of lung resection.

Lung resection in patients with cardiopulmonary dysfunction is associated with increased risk. We studied 52 elderly male patients with airflow obstruction and a lung mass. Studies were performed at rest with routine ventilatory tests and lung scan quantitation of right-left lung function. Cycle ergometry exercise was then performed at 2 submaximal work loads (25 and 40 watts). Data were obtained using systemic and pulmonary artery catheterization for blood pressures, thermal dilution cardiac output, and blood gases. Twenty-nine patients underwent lung resection and seven failed to tolerate the procedure (death within 60 days or prolonged ventilator dependence). Those parameters most clearly separating the group tolerating surgery (n = 22) from the intolerant group (n = 7) were obtained during exercise and included: cardiac index (tolerant 5.5 +/- 1.3 vs intolerant 3.9 +/- 0.3 L/min/m2, p less than .01), O2 delivery (p less than .01) and calculated VO2 ml/kg/min (tolerant 11.3 +/- 2.1 vs intolerant 7.8 +/- 1.5 ml/kg/min, p less than .001). Pulmonary vascular pressures and calculated resistance did not predict intolerance. Calculated VO2 at 40 watts did not separate those patients who had survivable complications from those who did not (p much greater than .05). Multivariate analysis suggests that exercise VO2 is an important predictor of tolerance of lung resection because it reflects the effects of cardiac function and O2 transport. In our patients with COPD, submaximal exercise testing predicted intolerance of lung resection better than calculation using quantitative lung scanning. Exercise testing may accomplish this goal by uncovering deficits in O2 transport.

Aged↗
PubMed1988

Echocardiography in determining nonresectability of carcinoma of the lung. A brief report.

Numerous techniques are currently employed to determine resectability of lung cancer to spare patients an unnecessary thoracotomy. Echocardiography may be used to demonstrate invasion of hilar lesions into the heart. We report a case in which echocardiography demonstrated nonresectability of a lung cancer which was confirmed via a Chamberlain procedure.

Carcinoma, Small Cell↗
PubMed1987

Stair climbing as an indicator of pulmonary function.

Seventy male patients with a mean age of 56.8 years scheduled for pulmonary function testing were subjected to a stair climb in order to determine the relationship, if any, between the number of steps climbed and the results of pulmonary function testing. The number of steps completed was plotted against the different parameters which may be used as predictors of post-thoracotomy outcome. The stair climb acts as a stress test and, although there is a strong relationship to pulmonary function tests, it also is an indicator of many other parameters including cardiovascular status, cooperation, and determination. Based on results of this study, the stair climb can be used as a reliable screening test of pulmonary function. Also, preoperative patients who are unable to perform pulmonary function tests can be evaluated accurately for lung resection by use of the stair climb test.

Adult↗
PubMed1985

Partial anomalous pulmonary venous return: a ten-year experience.

In this report, 24 patients with partial anomalous pulmonary venous return were reviewed. Six of the eight patients with left-sided drainage were repaired without extracorporeal circulation by anastomosing the left-sided vein to the left atrium. Symptoms resolved in five of the six. Two of the eight were surgically repaired by using extracorporeal circulation, one of whom died in the operating room from complicated associated anomalies. Of the 16 patients with right-sided partial anomalous pulmonary venous return, all were repaired by using extracorporeal circulation and by placing a Dacron or pericardial patch to direct the venous drainage into the left atrium. Eight of these patients were restudied and had post-repair QP/QS of 1.0. Repair of partial anomalous pulmonary venous return can be accomplished with minimal morbidity and a low mortality-both of which are often related to associated anomalies.

Journal Article↗
PubMed1982

A comparison of in vitro cellular responses to mechanical and electrical stimulation.

In the last several decades, enormous interest has been generated toward understanding the cell as it is controlled by its external physical environment. The purpose of this study was to determine the effects of well-defined applied mechanical stress and time-varying electric fields on the cellular synthesis of connective tissue macromolecules. Chondrocytes harvested by trypsin digestion of 15-day-old chick embryo sternae were randomly dispersed and cultured on elastin membranes in a humidified atmosphere with 10 per cent CO2 and 90 per cent air. Following five days of growth in F12 media and 5 per cent fetal calf serum, the membranes underwent either 1) a 10 per cent cyclic mechanical stretch or 2) 60 Hz A.C. electrical stimulation with current densities of 1 to 1,000 nA/mm2 or 3) control without stimulation, each for an eight-hour period. C14-hydroxyproline incorporation into collagen, and H2 35 SO4 incorporation into glycosaminoglycans (GAGs) were measured by liquid scintillation techniques. Scanning and transmission electron microscopy analysis of control and stimulated cells demonstrated discernable differences. Both mechanically and electrically stimulated chondrocytes showed a two- to three-fold increase in GAG synthesis and a general depression in protein and collagen synthesis over controls. The general similarity in response to both mechanical and electrical stress suggests common processes by which they modulate cellular synthesis of cartilage connective tissue proteins.

Animals↗