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M H Bronstein

Publications and source records attributed to M H Bronstein.

8 recordsLinked to original sources
PubMed1995

Arterial conduits in emergency coronary artery surgery.

The internal thoracic artery (ITA) is considered to be the conduit of choice for coronary bypass (CABG), but there has been some reluctance to utilize the ITA for revascularization in emergency situations. In a 9-year retrospective analysis from 1986 through 1993, 484 patients had emergency CABG, 237 were not associated with failed PTCA (noninstrumented) and 247 were within 24 hours of PTCA (instrumented). About 62% of noninstrumented and 49.3% of instrumented patients received one or more ITA grafts, the others receiving only saphenous vein grafts (SVGs). Those who received an ITA graft tended toward male sex, better ejection fraction, and a generally lower clinical risk score. Instrumented patients tended toward a lower incidence of diabetes and left main coronary disease, higher ejection fraction, and lower clinical risk score than noninstrumented patients. The postoperative results were not significantly different between ITA and SVG groups with respect to new Q waves, need for reexploration, sternal wound infection, respiratory complications, or stroke. However, ITA patients more often had an event-free postoperative course, received fewer blood transfusions, and experienced fewer cardiac deaths (2.7% vs 9.4%, p < 0.01). There were few obvious differences in postoperative results between instrumented and noninstrumented patients. These results indicate that the ITA can be used for emergency CABG in selected patients with good results.

Aged↗
PubMed1995

Pituitary adenomas complicating cardiac surgery: summary and review of 11 cases.

From the literature and our own experience, 11 cases of hemorrhage or infarction of a pituitary adenoma associated with cardiac surgery have been identified over a 13-year period. Males outnumbered females by 10 to 1. Symptoms observed were headache, lethargy, confusion, obtundation, unilateral ptosis, meiosis, and opthalmoplegia involving cranial nerves III, IV, and VI, visual field deficits, and hemiparesis. Diagnosis in most recent cases has been confirmed with computerized tomography or magnetic resonance imaging. All patients received adrenocortical steroid therapy initially. Eight patients underwent transsphenoidal hypophysectomy and all survived. One patient underwent decompression craniotomy and died. Intracranial surgery was deferred in 1 patient who survived and in another who died of a massive stroke. Residual neurological deficits were noted to be either absent, minimal, or resolving in 7 of the 9 patients who survived their initial hospitalization. While numerous mechanisms have been proposed to explain the hemorrhage and necrosis of a pituitary adenoma during heart surgery, no direct cause has been clearly identified. Surgical treatment is commonly necessary since untreated pituitary apoplexy is often fatal. Transsphenoidal hypophysectomy with decompression is the preferred method of treatment with a low perioperative mortality and fairly good long-term prognosis.

Adenoma↗
PubMed1994

Relationship of the proinflammatory cytokines to myocardial ischemia and dysfunction after uncomplicated coronary revascularization.

The proinflammatory cytokines have been implicated in mediating myocardial dysfunction associated with myocardial infarction, severe congestive heart failure, and sepsis. We tested the hypothesis that cytokine levels are elevated after uncomplicated coronary artery bypass grafting and associated with episodes of postoperative myocardial ischemia and dysfunction. Coronary artery bypass grafting was performed under general anesthesia with moderate systemic hypothermia and cold-blood potassium cardioplegic solution. Tumor necrosis factor-alpha and interleukin-6 levels were determined by bioassays, and interleukin-8 levels were measured by a sandwich enzyme-linked immunosorbent assay. Myocardial function and ischemic episodes were assessed by intraoperative transesophageal echocardiography and perioperative 12-channel Holter monitoring. A total of 22 patients were studied, with no deaths or complications. Arterial tumor necrosis factor-alpha rose in a bimodal distribution, peaking at 2 and 18 to 24 hours after the operation (at 20.2 +/- 6.4 pg/ml, [mean +/- standard error of the mean]) and 5.8 +/- 1.6 pg/ml, respectively; before cardiopulmonary bypass: 0.90 +/- 0.20 pg/ml, p < 0.001 for both peaks) then progressively declined to levels before bypass. Arterial interleukin-6 was maximally elevated immediately on termination of cardiopulmonary bypass and peaked again 12 to 18 hours after cardiopulmonary bypass (at 7520 +/- 2439 pg/ml and 6216 +/- 1928 pg/ml, respectively; before bypass: 746 +/- 187 pg/ml, p < 0.0001 for both peaks). Arterial interleukin-8 levels were more variable but followed a similar pattern, peaking in the early period after cardiopulmonary bypass and again at 16 to 18 hours after the operation (at 4110 +/- 1403 pg/ml and 1760 +/- 1145 pg/ml, respectively; before bypass: 461 +/- 158, p < 0.05 for both peaks). By multivariate analysis, the aortic crossclamp time was independently predictive of postoperative cytokine levels. Left ventricular wall motion abnormalities were associated with both interleukin-6 and interleukin-8 levels, worsening scores being associated with increasing levels (for interleukin-6, p = 0.003; for interleukin-8, p = 0.05). Postoperative myocardial ischemic episodes were associated with interleukin-6 levels, six of seven (85%) patients with episodes of myocardial ischemia after a peak in interleukin-6 concentrations (p < 0.01). We conclude that proinflammatory cytokines are elevated after uncomplicated coronary revascularization and may contribute to postoperative myocardial ischemia and segmental wall motion abnormalities.

Aged↗
PubMed1976

Surgical management of severe aortic coarctation and interrupted aortic arch in neonates.

Forty-four infants, 2 to 90 days of age, with severe obstructive lesions of the aortic arch, underwent emergency surgical correction between Jan. 1, 1966, and April 1, 1975. The typical clinical presentation was severe congestive heart failure and acidemia. Resection of an aortic coarctation with end-to-end anastomosis was performed in 31 patients. Eight (26 per cent) died after the operation. Since 1969, the mortality rate has been reduced to 14 per cent (3 of 22 patients) even though the incidence of major associated cardiac lesions has remained essentially constant (56 per cent from 1966 through 1969, 64 per cent from 1970 through March, 1975). This suggests that the higher survival rate has resulted from improved surgical techniques and postoperative care. The mortality rate in the infants operated upon during the second and third months of life was twice as high as that in those operated upon before the age of 1 month. Eight patients with Type A interrupted aortic arch were operated upon and 5 survived. Five patients with Type B aortic arch were operated upon and 3 survived.

Aorta↗
PubMed1975

Is mediastinoscopy necessary in the evaluation of lung cancer?

The records of 96 consecutive patients who underwent mediastinoscopy and were ultimately shown to have bronchogenic carcinoma were reviewed. Indirect tests for mediastinal tumor metastases in these patients included bronchoscopy and chest roentgenograms in all 96, mediastinal laminagrams in 65, esophagograms in 27, carinal biopsy in 23, bronchograms in 5, pulmonary angiograms in 5, azygograms in 2, and aortograms in 2 patients. Of the 43 patients in this series in whom all indirect tests revealed no metastases, mediastinoscopy showed nodal involvement in 11 (28%), who were thus spared unnecessary thoracotomy. On the other hand, if negative mediastinoscopy had not cast doubt on the validity of indirect tests that seemed to show metastases, an operation might actuallly have been denied to 14 patients who were ultimately proved to have anatomically resectable disease.

Angiography↗
PubMed1965

Hepatic abscess.

Explore the source record for details and available documents.

Liver Abscess↗