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Biomedical subjects

J W Rubin

Publications and source records attributed to J W Rubin.

35 records · Page 2Linked to original sources
PubMed1977

Chylothorax: therapeutic alternatives.

Persistent loss of chyle, rich in metabolites, water and electrolytes, can be quickly devastating, particularly in debilitated patients and children. Chylothorax of traumatic origin, especially when loss of chyle is rapid, is most effectively arrested with direct closure of the fistula or ligation of the thoracic duct. Thoracic duct ligation is indicated when a controlled fat diet or parenteral hyperalimentation without oral intake and closed chest drainage are not effective in arresting chylous pleural effusions.

Adolescent↗
PubMed1976

Permanent cardiac pacemakers: twelve-year experience with 287 patients.

Our total pacemaker experience was evaluated to determine survival, complications, effectiveness of follow-up techniques, and future goals for surveillance. A retrospective review of 287 patients with 570 pulse generators revealed 164 alive and 104 dead; 3 recovered normal conduction, 14 transferred care, and 2 have been lost to follow-up. Average age at initial implantation was 67 years. Overall mean generator life has been 22 months. The one-, three-, five-, and ten-year survival is 84, 71, 60, and 39%, respectively. The 738 operations performed averaged 2.6 procedures per patient. Of the total survivors, 108 (66%) had no complications; 56 (34%) have had at least one complication, 70% during the first year of the initial implantation. Fifty episodes of premature interruption of pacing service were detected. Ninety-one patients (32% of the group) have required an operative procedure on their pacemaker system more frequently than every two years. Of the replacements, 89 (29%) were for reasons other than end of generator life; 66 (63%) of the deaths occurred before replacement of the first generator. Mortality in the first two years was 23%. Once survival exceeded two years the average annual death rate was 3.7% (expected, 3.2%). Survival in our series compares favorably with that of other groups who report by the actuarial method. These data suggest that some deaths, reduced patient productivity, and the high cost to health care providers may be due in part to inadequate follow-up after the first pacemaker implantation. If follow-up observation is done frequently during the first year after initial implantation and once minimum generator longevity has passed, the goals of pacemaker therapy may be achieved.

Adolescent↗
PubMed1975

Twelve-year experience with mitral valve replacement.

Between 1962 and 1974, 203 mitral prostheses were implanted in 201 patients. Of the 102 survivors, 29 have Beall, 25 Kay-Shiley, 22 Starr-Edwards (SE) 6000, and 27 SE 6320 valves. Full rehabilitation was achieved in 25 patients with Beall and 23 with SE 6320 valves. Sixteen with SE 6000 valves remain normally active. Only 8 with Kay-Shiley prostheses have resumed normal activities. Systemic embolization occurred with the following frequencies per 1,000 patient-months: 13.7 for those receiving the Kay-Shiley valve; 7.2 in the SE 6000 group; 4.3 after SE 6320 implantations; and 3;1 for the Beall group. Other prosthesis-related complications that were much less frequent included detachment (10), bacterial endocarditis (5), and hemolysis (10). Three Kay-Shiley valves malfunctioned. Life table analyses reveal the following survival rates: 33% after 11 years in the SE 6000 patients, 50% after 7.5 years in the Kay-Shiley group, 69% 2.5 years after SE 6320 implantation, and 65% 3.5 years after replacement with a Beall valve. Evidence is presented to support the extension of operative treatment to patients with less advanced valvular heart disease. Postoperative anticoagulation remains an unresolved issue despite lower rates of thromboembolism. More cumulative analyses of survival and morbidity and follow-up hemodynamic data are needed to assess the Beall and SE 6320 prostheses now employed in our valve replacement program.

Adolescent↗
PubMed1975

Clinical evaluation of priming solutions for pump oxygenator perfusion.

Various hemodilution agents are now used routinely to prime heart-lung machines for cardiac operations. Hemodilution has resulted in considerable conservation of blood as well as diminution of plasma and corpuscle damage by decreasing the concentration of these elements in blood during extracorporeal circulation. Controversy has existed regarding the relative efficacy of various hemodilution solutions. This study covers 68 patients, divided into three groups, for whom hemodilution was done as follows: (1) the pump was primed with a 5% dextrose solution containing no colloid; (2) Ringer's lactate solution containing approximately 1% low-molecular-weight dextran was used; and (3) a new plasma expander, hydroxyethyl starch, was used as the colloid component of an electrolyte solution. Evaluations and comparisons were carried out for flow rates, blood pressure, urine volume, hematocrit, BUN, blood loss, clotting factors, and the patient's clinical course with regard to pulmonary and neurological complications. We conclude that a colloid is beneficial, especially with longer perfusions.

Adolescent↗
PubMed1975

First-degree atrioventricular block: a cause of false malfunction of a mitral disc-valve prosthesis. Case report.

Malfunction of a prosthetic mitral disc valve was clinically suspected on the basis of absent valve closing sound and an early opening click in a patient with first-degree atrioventricular (A-V) block. Premature closure and opening of the prosthetic valve was demonstrated by echocardiography. All abnormal auscultatory, phonocardiographic, and echocardiographic findings disappeared promptly upon spontaneous restoration of normal A-V conduction. The possible hemodynamic mechanism is discussed, and attention is drawn to this conduction abnormality as a cause of erroneous diagnosis of prosthetic mitral valve malfunction.

Adult↗
PubMedDate not supplied

Aortic valve rheumatoid nodules producing clinical aortic regurgitation and a review of the literature.

The majority of cardiac involvement in rheumatoid arthritis (RA) is an incidental finding at postmortem, as less than 3% of patients with RA have clinical cardiac signs or symptoms. Most cardiac involvement in RA involves the pericardium and has been known since Charcot first described an RA patient with pericarditis in 1881. Cardiac involvement takes two different forms: non-specific inflammatory changes and specific granuloma formation. Specific rheumatoid nodules in the heart are an infrequent complication of RA. This is the first case report of a surgically excised heart valve with rheumatoid nodules. A 74-year-old RA patient with a high seropositive rheumatoid factor presented with severe aortic regurgitation and underwent a valve replacement. The native aortic valve showed significant stenosis with multiple, classic rheumatoid nodules.

Aged↗