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Biomedical subjects

M A Berman

Publications and source records attributed to M A Berman.

At least 73 records · Page 4Linked to original sources

Prediction of left ventricular pressure in infants with aortic stenosis.

Peak systolic left ventricular pressure was predicted in five infants with aortic stenosis by use of a wall stress constant, K. K was determined in 10 normal infants according to the formula K = P . Ds/Ws, where P = arterial pressure by Doppler, DS = end-systolic LV dimension, and WS = end-systolic wall thickness. Left ventricular peak systolic pressure was estimated in five infants using the formula P = K. Ws/Ds. Excellent correlation was obtained between measured left ventricular pressure and left ventricular-aortic pressure difference at cardiac catheterisation and echo estimates. Echocardiographic assessment of the severity of aortic stenosis may be applied to infants with good results.

Aortic Valve Stenosis↗

Cervical aortic arch with retroesophageal aortic obstruction: report of a case with successful surgical intervention.

The clinical, roentgenographic, hemodynamic, and angiographic features of a patient with a right cervical aortic arch and retroesophageal aortic obstruction associated with a ventricular septal defect are presented. Surgical relief of the aortic obstruction was successfully achieved by placement of a bypass graft between the left common carotid artery and the descending thoracic aorta.

Aorta, Thoracic↗

d-Transposition of the great arteries and atresia of the mitral and pulmonary valves: association with a normal anatomic left ventricle.

The clinical, angiographic, and pathologic features are presented for a case of d-transposition of the great arteries with atresia of the mitral and pulmonary valves and two well-developed ventricles. The morphologic left ventricle appeared to be functioning as a systemic ventricular aneurysm, and this may have led to the patient's death. A possible explanation for this anomaly is given.

Female↗

B-lymphocytes activation by the Fc region of IgG.

Strong stimulation of DNA synthesis (up to 150-fold) and blast transformation can be induced in mouse spleen cells by Fc fragments of human IgG. The mitogenic response is optimal on day 5 of culture and is dependent on the concentration of Fc fragments with a sedimentation rate of 3-5S. Intact IgG is also stimulatory, but only when modified by heat aggregation, and produces only a 10-fold increase in [3H]thymidine uptake. The stimulation by aggregated IgG is dependent on the Fc portion, since aggregated (or soluble) Fab or F(ab')2 fragments are inactive. The results show that the response is T-cell independent and that it is a function of nylon wool adherent, surface Ig-positive, Fc receptor-bearing B lymphocytes. Fc fragments do not induce plaque-forming cells to human IgG in normal mouse spleen cell cultures, but rather trigger polyclonal antibody synthesis (anti-goat erythrocytes, anti-2,4,6-trinitrophenyl). It is postulated that the Fc region of antibodies plays a role in the regulation of the humoral immune response by triggering clonal expansion of B lymphocytes.

Animals↗

The hemodialysis-induced reaction in patients with leukemia.

The white blood cell count response was documented in various patients following transfusions of 500 ml of autologous or unrelated donor blood that had been subjected to 10 minutes of dialysis with 15 minutes of stagnation. Patients studied included 1 patient with acute nonlymphocytic (ANLL) and 2 patients with chronic lymphocytic leukemia (CLL). The control group consisted of 4 patients with renal failure. The ANLL patient showed a normal two-phase reaction after administration of donor's blood. It is possible that even under conditions of severe disturbance of hemopoiesis the general dependence on normal humoral regulation remains. The CLL patients showed a marked drop in circulating WBC in the first descending phase of the hemodialysis-induced reaction (HDIR). All blood cell types including lymphocytes and blast cells took part in this decrease of blood count; this suggests a cell-nonspecific effect. It is presumed that leukocytes that leave the circulation do not return into the blood and the procedure may be considered as a form of leukophoresis in vivo, with possible therapeutic value.

Aged↗

One hundred consecutive coarctation resections followed from one to thirteen years.

The technique of operative repair for coarctation of the aorta is now well standardized and the immediate surgical mortality has been lowered to less than 5% in most large series. Long term follow up, however, is only recently being reported. This paper describes the current status of 100 consecutive patients who underwent elective resection from 1--13 yr ago. There was only one operative death. In contrast with other reports, residual systemic hypertension is rare in the 97 survivors. These observations confirm that coarctation of the aorta can be repaired surgically with an acceptable operative mortality; the outlook of the survivors appears excellent.

Adolescent↗

Diagnosis of cor triatriatum by echocardiography.

The echocardiographic findings in a case of cor triatriatum are described. The diagnosis was suggested by a normal anterior mitral valve echo and a dense band of echoes posterior to the aortic root and within the body of the left atrium; it was documented at cardiac catheterization and proved surgically. Echocardiography is an important diagnostic aid in assessing pulmonary venous obstruction in children.

Echocardiography↗

Late development of severe pulmonary venous obstruction following the Mustard operation.

While four patients with d-transposition of the great arteries who had a Mustard operation before 2 years of age developed severe pulmonary venous obstruction 2, 3 1/2, 3 9/12, and 5 years following their operation, initial postoperative catheterization (less than 1 year) revealed only minimal pulmonary artery wedge and right ventricular end-diastolic pressure differences, with normal peak systolic pulmonary artery pressures. Serial clinical examination, including height and weight percentiles, chest X-rays, electrocardiograms, and the presence of a continuous murmur in one patient suggested development of pulmonary venous obstruction. Repeat catheterizations demonstrated pulmonary artery pressures greater than or equal to systemic and pulmonary artery wedge minus right ventricular end-diastolic differences greater than 13. Successful relief of the pulmonary venous obstruction included insertion of a Dacron patch to enlarge the pulmonary venous atrium, incision of the obstructing orifice, and repair of associated intra-atrial defects. Operation and postoperative course have been unremarkable. It is concluded that pulmonary venous obstruction can be both an early and progressively late sequela of the Mustard operation. Serial examinations with a high index of suspicion should allow repeated catheterizations to document the occurrence. Operative revision of the obstruction appears to be effective with minimal risk.

Body Height↗

Echocardiographic assessment of the severity of aortic stenosis in children and adolescents.

The magnitude of ventricular hypertrophy in response to afterloading is determined by wall stress, with wall thickness increasing in proportion to ventricular load until systolic wall stress is normalized. With use of echocardiographic measurements of left ventricular end-systolic wall thickness (Ws) and cavity transverse dimension (Ds), the pressure constant k was calculated in 16 patients without left heart obstruction according to the formula k = P-Ds/Ws. The mean value for k was 225 +/- 6.7 (standard deviation) mm Hg. From this value, left ventricular pressure was estimated in 13 patients with aortic stenosis aged 4 to 17 years using the formula P = k-Ws/Ds. No subject had evidence of cardiac failure. Peak systolic aortic pressure difference (delta P) was calculated by subtracting cuff-measured brachial arterial peak systolic pressure from the estimated left ventricular pressure. Excellent correlation was obtained between the estimated delta P and that found at cardiac catheterization (r = 0.89). In two patients, echocardiographic data predicted significant obstruction in the presence of normal electrocardiographic, vectorcardiographic and vector lead tracings. Echocardiography offers a noninvasive method for estimating the severity of aortic stenosis, in the absence of myocardial failure; it appears to be more sensitive than other currently employed techniques.

Adolescent↗

Markedly improved pulmonary function after open heart surgery in infancy utilizing surface cooling, profound hypothermia, and circulatory arrest.

The use of surface-induced profound hypothermia with limited cardiopulmonary bypass and circulatory arrest markedly diminished the need for mechanical ventilation for patients undergoing cardiac surgery. Eleven of twenty-two patients were extubated in the operating room and five more patients within 70 minutes postoperatively. Five patients required mechanical ventilation. Four of the five were extubated within 24 hours (mean, 19.05 hours); only one patient required mechanical ventilation greater than 24 hours. This experience would indicate that as the age of surgery is decreased, in conjunction with improved technics of cardiac surgery and anesthesia, the need for mechanical ventilation should be diminished.

Anesthesia, Inhalation↗