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Biomedical subjects

E T Gelfand

Publications and source records attributed to E T Gelfand.

At least 19 recordsLinked to original sources
PubMed1990

Antimicrobial prophylaxis for open heart operations.

Between 1986 and 1988, 450 adults undergoing coronary artery bypass, cardiac valve replacement, or both were enrolled into a prospective, randomized, comparative trial of cephalothin versus cefamandole as perioperative prophylaxis. They were assessed during their hospitalization and at 6 weeks and 6 months after discharge for postoperative infectious complications. Eleven patients had major postoperative infections including 5 with sternal wound infections (three bacteremic), 6 with bacteremia, 1 with prosthetic valve endocarditis, and 3 with severe venous donor graft site infections. Eight major infections occurred in patients receiving cephalothin prophylaxis and three in patients receiving cefamandole, with all five sternal wound infections occurring in the cephalothin group. Postoperative pathogens responsible for the major infections included gram-negative aerobes in 5 patients, Staphylococcus aureus in 4, and Staphylococcus epidermidis in 2. Preoperative colonizing staphylococcal isolates were not predictive of postoperative staphylococcal pathogens. Although there was no statistically significant difference in rate of major postoperative infectious complications using either cephalothin or cefamandole prophylaxis, there was a trend in favor of cefamandole. Gram-negative aerobes are becoming increasingly important pathogens in this setting.

Aged↗
PubMed1990

Endoscopic diagnosis and treatment of postoperative bronchopleural fistula.

The diagnosis and closure of small postresection bronchopleural fistulae can be accomplished with selective bronchography and placement of fibrin sealant through the flexible fiberoptic bronchoscope. This method of diagnosis and closure of the bronchopleural fistula avoids both general anesthesia and a thoracotomy. This technique is successful in small bronchopleural fistulae and patients with multiple postresection bronchial stumps.

Adult↗
PubMed1985

Alterations in plasma-, monocyte-, and lymphocyte-associated fibronectin during cardiopulmonary bypass surgery.

The changes in plasma fibronectin and IgG, and monocyte- and lymphocyte-associated fibronectin were studied in patients undergoing elective cardiopulmonary bypass surgery. A significant fall (P = less than 0.0005) in plasma fibronectin occurred during bypass, resulting largely from hemodilution as assessed by IgG concentrations, but also related to consumption of fibronectin. Plasma levels were still reduced 48 hours following the operative procedure, despite variable amounts of blood components infused in the immediate post-bypass period. Monocyte-associated fibronectin increased significantly (P = less than 0.05) during bypass, and lymphocyte-associated fibronectin levels decreased. Our studies confirm a reduction in circulating fibronectin in cardiac surgery, with accompanying fall in lymphocyte-associated levels presumed to reflect nonspecific adsorption. In contrast, the increased binding to monocytes may be an important functional aspect requiring further investigation, together with assessment of monocyte-macrophage function, before empiric use of cryoprecipitate therapy in these patients is recommended.

Adult↗
PubMed1983

Middle-latency auditory evoked responses during open-heart surgery with hypothermia.

Middle-latency auditory evoked responses (MLRs) were recorded from infants and adults before and during open heart surgery. Hypothermia was induced through perfusion cooling by cardiopulmonary bypass. In infants deep hypothermia (to 15 degrees C nasopharyngeal temp.) was often followed by the induction of total circulatory arrest. In adults nasopharyngeal temperatures of 25 degrees C were reached. The MLRs were elicited by unfiltered clicks presented through an insert type earphone and recorded with a vertex to ipsilateral earlobe electrode configuration. The MLRs proved to be resistant to muscle relaxation induced by pancuronium and to anesthesia induced and maintained in most cases by fentanyl. In most cases MLR peak latencies were progressively delayed as temperature decreased. Hypotension resulted in decreased MLR (Pa) amplitude.

Adolescent↗
PubMed1983

Coronary artery bypass in patients under 40 years of age.

Coronary artery bypass surgery was performed in 92 patients, ranging in age from 20 to 40 years. The male-to-female ratio was 5:1. The operative mortality was 3.3%. Sixty-two patients were followed up for a mean of 3.5 years. Complete relief of angina was reported by 79% of patients and an additional 10% experienced some improvement. The survival rate at 3.5 years was 97%. The results favour myocardial revascularization in young adults.

Adult↗
PubMed1981

Carcinoid tumor of the thymus associated with recurrent pericarditis.

A 49-year-old man with carcinoid tumor of the thymus presented with the clinical picture of acute pericarditis. Recurrent bouts persisted after removal of the tumor without other evidence to indicate tumor recurrence. There were no associated manifestations of an endocrine disorder.

Carcinoid Tumor↗
PubMed1981

Pulmonary resection in cystic fibrosis: a case report.

There is limited experience world wide in the management of patients with cystic fibrosis who undergo thoracotomy. Because of their shortened life-span and the diffuse nature of pulmonary involvement, resection is seldom performed for uncontrolled pulmonary infections. An 8-year-old boy with cystic fibrosis and a chronic infection of the right lung with abscess formation underwent pulmonary resection after 1 week of antibiotic therapy with tobramycin, ticarcillin and cloxacillin, and physiotherapy. Postoperatively, he was kept in the intensive care unit for 48 hours. Physiotherapy was begun immediately after operation and continued every 2 hours for the first day. The preoperative antibiotic therapy was continued. The postoperative course was smooth and the boy did well for 1 year. Over the next 6 months his condition deteriorated and he died 18 months after operation. Pulmonary resection should not be used in patients whose pulmonary infections can be controlled medically but may be of value for those with uncontrollable localized infections.

Anti-Bacterial Agents↗
PubMed1980

Extended aortic bypass.

At the University of Alberta Hospital, six patients recently underwent placement of Dacron bypass grafts from the ascending aorta to the infrarenal abdominal aorta or femoral arteries for a variety of vascular problems. The operations were performed in patients with (1) multiple aortic coarctations, (2) congenital aortic arch interruption and congenital mitral stenosis, (3) recoarctation of the thoracic aorta after previous coaractation repair (two patients), (4) aortoiliac occlusive disease in a patient with multiple previous abdominal operations including an abdominal-perineal resection and left lower quadrant colostomy, and (5) idiopathic retroperitoneal fibrosis and multiple previous operations on the abdominal aorta. Surgical access was through midline sternotomy and laparotomy incisions, and groin incisions were used as required. Careful attention was paid to placing as much graft as possible in an extraperitoneal position. All patients survived the operation and had essentially uneventful postoperative courses with good results. This technique has previously been described. However, attention is drawn to it once again as an excellent means of bypassing the thoracic and abdominal aorta in selected patients with complex vascular problems.

Adult↗
PubMed1978

Hypothermic coronary perfusion for myocardial protection during aortocoronary bypass.

Numerous methods have been used in an attempt to prevent myocardial injury that results from the interruption of aortic flow during cardiac operations. The authors describe a relatively simple means of inducing cardioplegia during coronary bypass surgery by coronary perfusion with cold lactated Ringer's solution through the aortic root. When the results following the employment of hypothermic coronary perfusion for intraoperative cardioplegia were compared with those obtained without its use, the procedure was found to confer a degree of intraoperative myocardial protection and appeared to lead to a decrease in intraoperative myocardial infarction, subendocardial ischemia and intraoperative mortality.

Coronary Artery Bypass↗
PubMed1978

Myocardial protection during aortic valve replacement: normothermia versus hypothermia.

The operative results in 32 patients who underwent aortic valve replacement with aortic occlusion and normothermic myocardium (group 1) were compared with 54 similar patients in whom the myocardium was protected by hypothermic coronary perfusion through the aortic root (group 2). The operative mortality and the incidence of heart failure, subendocardial ischemia and myocardial infarction were the same in the two groups. The maximal concentrations of cardiac enzymes after operation in group 2 patients were significantly lower than those in group 1. The postoperative cardiac performance was significantly different in that only 5.6% of group 2 patients required inotropic agents after operation compared with 25% of group 1 patients. The patients in group 2 were easier to defibrillate after cardiopulmonary bypass.

Adult↗
PubMed1978

Survival after late disc dislodgement of a mitral Wada-Cutter prosthesis.

A 33-year-old woman, 6 years after placement of a Wada-Cutter prosthesis, suffered from free mitral regurgitation secondary to the dislodgement of the disc occulder into the left atrium. She was operated on approximately 14 hours after the onset of symptoms and survived; this patient is the third reported survivor following dislodgement of a Wada disc.

Adult↗
PubMed1977

Hypothermic coronary perfusion for intraoperative cardioplegia.

Hypothermic asanguineous perfusion has been used to arrest 170 hearts at the beginning of 1/2 to 2 hours of intraoperative coronary ischemia. This method of producing cardioplegia has facilitated valve replacement and coronary artery bypass operations. Inadequate myocardial protection has not been experienced since we began using this method of arresting the heart for cardiac operations.

Adult↗
PubMed1977

Missile migration from lung to heart with delayed systemic embolization.

A bullet migrated from the heart to the left femoral artery in a youth ten days after he sustained a gunshot wound to the right chest. The bullet apparently traversed the pulmonary venous system at the time of the injury and lodged in the interior of the left ventricle. The production of an embolism in the systemic circulation was a delayed and unanticipated event.

Adolescent↗
PubMed1977

Accidental pneumatic rupture of the esophagus.

A case of accidental pneumatic rupture of the thoracic esophagus in a 6-year-old boy is reported. Early operation with transthoracic esophageal repair resulted in survival of the patient, and follow-up at 18 months has demonstrated normal esophageal function and anatomy. A search of the literature has yielded 11 similar cases.

Child↗
PubMed1974

Pneumothorax in pulmonary eosinophilic granuloma.

The cases are described of two patients with pulmonary eosinophilic granuloma who presented with spontaneous pneumothorax. Prolonged air leak and recurrence of the pneumothorax after initial re-expansion of the lung occurred in both patients. In one of the patients the pneumothorax was simultaneously bilateral and almost complete.Thoracotomy, with aggressive and total pleurodesis, is recommended in the management of these patients to prevent recurrence and complications. Lung biopsy should be performed in all patients undergoing thoracotomy for recurrent pneumothorax.

Adolescent↗