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Biomedical subjects

L H Cohn

Publications and source records attributed to L H Cohn.

At least 253 records · Page 14Linked to original sources
PubMed1978

Insulin therapy for depressed myocardial contractility after prolonged ischemia.

Insulin was administered to two patients whose diminished myocardial contractility made it difficult to terminate cardiopulmonary bypass. In both instances, bypass was successfully terminated shortly after the insulin injection. These clinical observations led to experiments under the controlled conditions provided by the isolated, working rat heart preparation. The recovery of contractility after 30 minutes of severe ischemia was assessed in all 11 control and 11 insulin-treated hearts. Myocardial performance, as judged by the product of heart rate and peak systolic blood pressure, was significantly greater in the insulin-treated hearts. These clinical observations and experimental findings suggest the need for more extensive study of the potential value of insulin in treating depressed contractility after prolonged myocardial ischemia.

Animals↗
PubMed1978

Late results of operation for acute aortic dissection producing aortic insufficiency.

Since July, 1970, 8 patients with acute dissecting aneurysms of the ascending aorta producing aortic insufficiency have undergone immediate operation employing a technique in which the origin of the dissection is resected, the dissected base of the aorta is lined with nondistensible prosthetic cloth for support, and the native aortic valve is resuspended. Aortic continuity is then reestablished with end-to-end anastomosis or use of a short segment of woven graft (not necessarily circumferential). There were no operative deaths. Mean follow-up has been 60 months (range, 25 to 82 months). One late death has occurred (cerebral hemorrhage at 48 months); of the remaining 7 patients, 2 have faint murmurs of aortic insufficiency, but all are in New York Heart Association Functional Class I. This technique of aortic reconstruction in acute ascending dissections allows preservation of the native aortic valve while preventing late aortic root dilatation or major valve insufficiency.

Adult↗
PubMed1978

Severe stenosis occurring in antibiotic sterilised homograft valves.

This paper describes 3 patients who developed late severe stenosis in fresh antibiotics sterilised homograft valves. Two were in the aortic position and one in the mitral. All 3 patients underwent successful reoperation. This complication has not been previously reported in valves prepared by this method.

Adult↗
PubMed1978

Aortic valve replacement for ochronosis of the aortic valve.

A patient with generalized ochronosis developed severe cardiovascular symptoms related to ochronotic deposits on the aortic valve and in the coronary arteries. A transvalvular gradient of 100 mm Hg and obstruction of the left anterior descending coronary artery were found by catheterization. Aortic valvular replacement and aortocoronary bypass were performed successfully, and the patient has been well two years since operation. This represented the first reported case of aortic valve replacement for this rare metabolic condition. With increased mobility of these patients due to aggressive orthopedic joint treatment, more patients with this syndrome may require surgery for cardiovascular symptoms.

Aortic Valve↗
PubMed1978

Myocardial revascularization in patients with multivessel coronary artery disease and minimal angina pectoris.

Mortality risk in coronary artery disease (CAD) is more closely related to angiographic findings of multiple coronary artery obstructions and left ventricular asynergy than to the severity of angina pectoris, the major symptom of CAD. Since coronary revascularization surgery is most frequently performed to relieve chest pain, there are few reports evaluating the results of coronary artery bypass surgery in patients with minimal or no angina pectoris but with anatomically severe disease. From July, 1970, through December, 1976, 844 patients had coronary artery bypass surgery performed at the Peter Bent Brigham Hospital for chronic or unstable angina pectoris. Twenty patients (2.3%) were operated on because of severe coronary obstruction but who had minimal or no angina. Fourteen patients underwent coronary arteriography because of a positive exercise tolerance test, and six because of a prior myocardial infarction. All but one patient had multivessel CAD, and four patients had significant left main coronary lesions. There was no operative mortality. One late death occurred 5 years postoperatively, for a 5.0% cumulative mortality. Average follow-up has been 34 months (range, 19 to 80 months). Of 12 patients with both pre- and postoperative exercise tests, eight have reverted to normal, and four show a less ischemic response to exercise. Coronary revascularization may have a beneficial effect on the patient with "asymptomatic" but anatomically severe CAD.

Adult↗
PubMed1978

Conservative management of uremic pericardial effusions.

Although there has been a recent trend toward early operative treatment of uremic pericardial effusions unresponsive to intensified dialysis, this approach may be unnecessarily aggressive. Review of 787 patients in our chronic dialysis program since 1969 has shown 54 patients (6.9 percent) to have developed 56 episodes of large pericardial effusion. All were managed by increasing the frequency of dialysis. If the effusion failed to diminish or if life-threatening signs of tamponade developed, pericardiocentesis was performed. In 63 percent (35/56) the effusion resolved with increased dialysis. In 37 percent (21/56), pericardiocentesis was performed, with 57 percent (12/21) requiring only one aspiration. During a mean follow-up of 34 months (2 to 100 months) only 5.5 percent (3/54) have undergone operation: one partial pericardiectomy incidental to pulmonary decortication and two pericardiectomies for late (3 months and 5 months, respectively) constriction. There were five complications of pericardiocentesis: one pneumothorax, one pneumoperitoneum, one costochondritis, and two myocardial punctures without sequelae. The one death related to pericardial effusion in this series occurred in a home-dialysis patient who arrived in the emergency room moribund. Our experience suggests that the great majority of uremic pericardial effusions can be effectively controlled with simple needle aspiration by experienced personnel and that pericardial resection is usually not necessary.

Adolescent↗
PubMed1977

Portacaval diversion for severe hypercholesterolemia. Report of a case with measurements of glucose tolerance, insulin, and glucagon levels.

An end-to-side portacaval shunt was performed in a patient with severe coronary arteriosclerosis and type IIa hypercholesterolemia. By one year postoperatively there was a decrease of serum cholesterol concentration of more than 40%. No adverse side effects were noted. Intravenous and oral glucose tolerance tests were performed and were within normal range preoperatively and postoperatively. However, preoperatively, during the oral test, the serum insulin levels exceeded the normal range. In addition, glucagon levels revealed less tendency to suppression during the preoperative oral tests. Psychological testing revealed no abnormalitites, and serum ammonia levels were only slightly elevated.

Adult↗
PubMed1977

Results of reoperation for recurrent angina pectoris.

Although a coronary bypass operation improves the quality of life and possibly prolongs it, a small percentage of patients do not have satisfactory results and require reoperation. From July, 1970, to March 1975, 358 patients underwent coronary bypass for chronic disabling or preinfarction angina. Angina requiring operation recurred in 24 men and 2 women. Hyperlipoproteinemia was present in 19 of the 26 (73%), and 3 patients had early-onset diabetes mellitus. Only 2 of 14 patients with progression of arteriosclerosis were helped by a second operation. Of 7 patients with occluded grafts, local disease, and no progression, 5 were helped by reoperation. Patients with occluded coronary bypass grafts without progression of arteriosclerosis benefit substantially from a second revascularization procedure. Aguarded prognosis must be held, however, for those with progression of arteriosclerosis with hyperlipoproteinemia or juvenile-onset diabetes who undergo reoperation. Patients with initially diffuse disease and graft occlusion also seem to benefit less from a second operation.

Angina Pectoris↗
PubMed1977

Mitral regurgitation due to intermittent prosthetic valvular dysfunction.

A second case of malfunction of a Harken disk valve due to undue disk wear is reported. Two and one-half years after aortic and mitral valvular replacement, the patient had paraprosthetic aortic insufficiency and physical findings suggesting intermittent dysfunction of his prosthetic mitral valve. Catheterization showed intermittent hemodynamic abnormalities; fluoroscopic and cineangiographic findings indicated intermittent mitral regurgitation secondary to undue mitral disk wear. At operation, the excised valve showed normal struts and sewing ring but severe disk wear. There was loss of disk substance and rim notching.

Cardiac Catheterization↗
PubMed1976

Small vessel replacement with gore-tex (expanded polytetrafluoroethylene).

Conduits of expanded, fibrillated polytetrafluoroethylene (PTFE [Gore-tex]) have been evaluated as small vessel prostheses in dogs during a 6-month period. A configuration of high porosity and low density, long fibril Gore-tex was found to yield the best patency in canine arteries (femoral and carotid) and veins (femoral) as compared with more dense, less porous PTFE with shorter fibrils. Host tissue reaction showed minimal inflammation, excellent infiltration, and formation of a smooth neointima, which suggested satisfactory acceptance of the prosthesis.

Animals↗
PubMed1976

Surgical treatment of congenital unilateral pulmonary arterial stenosis with contralateral pulmonary hypertension.

This report describes the diagnosis and surgical treatment of a 48 year old patient with congenital right pulmonary arterial ostial stenosis, no intra- or extracardiac shunts and systemic levels of pressure in the main and left pulmonary artery with pulmonary vascular obstruction in the left lung. Operation consisted of a bypass graft of 10 mm woven Dacron from the main pulmonary artery to the distal right pulmonary artery producing an immediate 50 percent reduction in mean left pulmonary arterial pressure. Late postoperative evaluation revealed equal perfusion of both lungs, maintenance of the reduced pulmonary arterial pressure and improvement from New York Heart Association functional class IV to class I.

Arterial Occlusive Diseases↗
PubMed1976

Emergency aortic valve replacement.

The aortic valve was replaced as an emergency in twenty-seven patients between July 1970 and December 1974. Twenty-two patients had critical aortic stenosis and five had acute aortic insufficiency. The indications for emergency surgery were cardiac arrest in five patients, low cardiac output in four patients, and medically intractable pulmonary edema in eighteen patients. Cardiac catheterization was not undertaken in ten persons because of their critical condition. The clinical diagnosis in these patients was supported by noninvasive maneuvers. No surgical deaths occurred. Twenty-five patients are well, active and NYHA Class I at five to thirty-three months after surgery. There has been one late death and one patient has some residual exertional dyspnea. One patient required reoperation to relieve a clotted prosthetic valve. These results suggest that the patient with aortic valve disease may be offered a reasonable chance for survival, even when desperately ill.

Adult↗