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Biomedical subjects

G Jacobs

Publications and source records attributed to G Jacobs.

At least 127 records · Page 7Linked to original sources
PubMed1982

Clinical results of mechanical support of the failing left ventricle.

Six patients received mechanical support for a failing left ventricle after corrective cardiac operations. Despite intra-aortic balloon pumping and pharmacologic support, intractable failure persisted and cardiopulmonary bypass could not be withdrawn. The left ventricular assist device (LVAD) consists of a nonpulsatile centrifugal pump and two thromboresistant cannulas. Balloon counterpulsation added a pulsatile effect. LVAD support was continued for 72 to 168 hours and five patients were weaned from LVAD support. Two died of persistent low cardiac output within 3 days after pump removal, and a fourth died of multiple organ failure and pneumonia 8 weeks after LVAD removal. Autopsy studies in the first three patients showed myocardial necrosis greater than 50% of the left ventricular mass. Two patients survived after 72 and 74 hours of LVAD support. One patient is fully employed and active 27 months after a cardiac operation; the second is fully active 20 months after operation. Repeat cardiac catheterizations in both have shown all grafts patent and good ventricular function. These two long-term survivors justify the concept of LVAD support and its continued use in selected postoperative patients.

Adult↗
PubMed1981

[Stapling devices on stomach and small bowel (author's transl)].

Sutures, blind closures, and anstomoses can be performed on the stomach and the small bowel with LDS, GIA, TA, and EEA staplers. The advantage of using these devices is a fast, clean operation, with safety comparable to the conventional technique. Leakage in sutures and anastomoses occur in 1% and after duodenal closure in 2.6%. Bleeding has been observed with the GIA and LDS staplers (0.7%-1%). Mortality is equal to the conventional technique. The time saved during operations and fewer infections justify the elevated costs of the stapling devices.

Duodenum↗
PubMed1981

Pusher-plate type TAH system operated in the left and right free-running variable rate mode.

A TAH system utilizing two pusher-plate type pumps was developed and tested in two calves for 45 and 108 days with excellent results. A Hall effect sensor was utilized to operate each pump with a full stroke at variable rates (VR); each pump was then allowed to run independently at different rates depending on its own preload and afterload. With this system, the animals' atrial pressures were kept to near-normal levels (less than 10 mmHg). However, significant differences in the left and right pump flows were observed (left higher than right) and they ranged from 5 to 30% of the left flow with a mean of 15%. These flow differences may be due to the bronchial circulation and related shunts. Right pump flows averaged 70 to 95 ml/min-kg and circulating blood volume ranged from 67 to 95 ml/kg. When various control modes including fixed rate and master-slave type simultaneously or alternatively ejecting VR modes were applied in the same animals and both pump flows were forced to be equal, unphysiological atrial pressures resulted. This result indicates that perhaps left and right flow differences are necessary physiological conditions to regulate the atrial pressures within normal ranges. Metabolic data also indicated that under simultaneously and alternately ejecting modes, A-V O2 content differences were increased due to decreased right pump flow as compared with those of the free-running VR mode. The left and right free-running VR mode of operation imposed minimal constraints on the animals' cardiovascular system and therefore yielded excellent hemodynamic and metabolic results.

Animals↗
PubMed1981

Terminal hepatic failure following a small dose of sulfamethoxazole-trimethoprim.

Fatal hepatotoxicity is a known complication of sulfamethoxazole and sulfamethoxazole-trimethoprim. We report a case of a man previously exposed to sulfamethoxazole-trimethoprim who died of liver failure following subsequent ingestion of only two tablets of the drug (160 mg trimethoprim and 800 mg sulfamethoxazole). This case indicates the danger to a susceptible patient of even small (e.g., "rechallenge") doses of sulfamethoxazole.

Aged↗
PubMed1981

Hemodynamic regulation in total artificial heart recipients.

The right and left atrial pressures (RAP and LAP), circulating blood volume (CBV) and pump output were analyzed in 17 calves implanted with a free-diaphragm-type total artificial heart. A high RAP and increased CBV were common features in these animals, while the LAP was maintained in a nearly normal range throughout the course. Some correlation was seen between RAP, CBV and pump output, which was maintained in the range of 86.6 to 130.1 ml/min/kg. In the atrial myocardium various morphological changes were observed accompanied by thickening of the cell, which was conspicuous after one month of implantation. To improve this high venous pressure problem, an automatic controller for pusher-plate-type pumps wtih a greater sensitivity was introduced. A preliminary in vivo study using this new system is also reported.

Animals↗
PubMed1980

Initial clinical experience with a new temporary left ventricular assist device.

A new, simple left ventricular assist system has been developed and its use in experimental animals has been evaluated. The system achieves ventricular drainage by a transaortic valve cannula and utilizes a new centrifugal pump; the blood access is unique in requiring only a simple end-to-side synthetic graft anastomosis to the ascending aorta. Adequate pulsatility is obtained by concomitant use of an intraaortic balloon pump. This case report documents our initial clinical experience with this system in a postoperative patient with profound left ventricular failure unresponsive to all usual treatment. There was temporary recovery of left ventricular function upon decannulation after five and a half days of assist pumping. Despite the eventual death of the patient, the system functioned adequately, suggesting that it has good potential for use in a small, selected group of patients.

Assisted Circulation↗
PubMed1980

Chronic nonpulsatile blood flow in an alive, awake animal 34-day survival.

Most acute studies of nonpulsatile blood flow have shown effects on systemic organs. There have been few long-term studies of the effects of nonpulsatile blood flow due to lack of an appropriate experimental model and, consequently, it is unknown whether mammalian physiology can adapt to chronic nonpulsatile blood flow. The following case report documents the effects of chronic nonpulsatile blood flow in an alive, awake animal maintained with fibrillating ventricles for a period of 34 days.

Animals↗