Biomedical subjects

R E Kleiger

Publications and source records attributed to R E Kleiger.

At least 91 records · Page 5Linked to original sources

PubMed1976

Pulmonary hypertension in patients using oral contraceptives. A report of six cases.

Six young women who had taken progestational agents for a period of time ranging from six months to five years developed symptoms and signs of pulmonary hypertension. Cardiac catheterization confirmed the presence of severe pulmonary hypertension without evidence of other cardiac or pulmonary abnormalities to explain this phenomenon. Three of the patients had potential predispositions to pulmonary hypertension, including a corrected patent ductus arteriosus with mild pulmonary hypertension in one, collagen vascular disease in a second, and family history of pulmonary hypertension in a third. Three patients had no known predisposing factors. Although the relationship between oral contraceptives and severe pulmonary hypertension is problematic, there have been isolated reports of cases of pulmonary hypertension secondary to oral contraceptive usage. These cases and the possible pathophysiologic mechanisms responsible are discussed.

Adult↗

PubMed1976

Severe coarctation of the aorta with pulmonary edema. An unusual presentation of a traumatic aortic aneurysm.

A patient with an unrecognized rupture of the ascending aorta developed severe pulmonary edema three weeks following the initial injury. This is a distinctly unusual manifestation of this injury. Emergency resection of the traumatic aneurysm was required to reverse the rapidly deteriorating clinical situation. The early recognition and surgical treatment of this lesion would have avoided this complication.

Adult↗

PubMed1976

The indications for pericardiectomy in the uremic pericardial effusion.

Uremic pericarditis developed in 37 of 295 patients (8 percent) admitted to the chronic hemodialysis program at our institution. Sixteen patients (43%) underwent limited pericardiectomy through a left anterior thoracotomy approach with no operative deaths and minimal morbidity (19%). Twenty-one patients (57%) were treated successfully with intensive hemodialysis. The use of pericardiocentesis did not avert cardiac tamponade in any patient in our series. The procedure was associated with two life-threatening complications and its use, therefore, has been limited in the therapy of uremic pericarditis. We recommend surgical intervention in all patients with hemodynamic instability and echocardiographic evidence of enlarging effusions or an effusion unchanged in size following 10 days of intensive hemodialysis.

Adult↗

PubMed1976

How to detect and treat arrhythmias in chronic lung disease.

Investigators suspect that arrhythmias are behind the high incidence of sudden death in patients with severe chronic bronchitis and emphysema. Continuous electrocardiographic monitoring may help boost survival statistics, since it has repeatedly shown its ability to detect irregularities that standard ECGs miss. So-called benign arrhythmias, such as atrial fibrillation, frequent ventricular premature contractions, and atrial flutter, are anything but harmless. In patients whose heart and lung function is already impaired by severe airway obstruction, these rhythm disorders can rapidly progress to a fatal cardiac arrest. Deciding how to treat the arrhythmia depends on the type of disturbance and the patient's clinical status. Direct-current shock or antiarrhythmic drugs can turn the tide in a desperately ill patient with acute respiratory failure. Correction of coexisting metabolic and ventilatory disorders often is crucial to successful therapy.

Aged↗

PubMed1976

Surgical treatment of unstable angina by saphenous vein and internal mammary artery bypass grafting.

During a 3 year period, direct myocardial revascularization was performed on an urgent basis in 48 patients with intermittent resting chest pain which persisted more than 24 hours despite in-hospital medical therapy and was accompanied by electrocardiographic changes representative of ischemia. Sixteen patients had saphenous vein (SV) grafts exclusively, and 32 patients each had one or two internal mammary artery (IMA) grafts with or without additional vein grafts. Follow-up ranges from 5 to 41 months (mean, 22 months). Twelve patients had single grafts to the left anterior descending coronary artery (LAD), 18 had double grafts, 16 had triple grafts, and 2 had quadruple grafts. The LAD required grafting in every patient. There was one operative death (2 per cent) and one late death from noncardiac causes. There were two (4 per cent) early postoperative myocardial infarcts and no late infarcts. Actuarial analysis projects a survival rate of 96 per cent 3 years postoperatively. Eighty-one per cent of the survivors are in Functional Class I, 17 per cent are in Class II, and 2 per cent are in Class III. All patients had postoperative angiography 2 weeks after operation. Eighty-six per cent of the SV grafts and all IMA grafts were open. No significant differences were observed between mean preoperative and postoperative left ventricular end-diastolic pressures or ejection fractions, but these parameters were noted to improve after operation in several patients. The remarkably high early and late survival rates, the low incidence of myocardial infarction, and the excellent functional results after rather long follow-up indicate that emergency coronary revascularization provides an effective therapy for unstable angina. The use of IMA grafts, when feasible, is a safe and possibly preferable approach in these patients.

Adult↗

PubMed1976

The left ventricle in emphysema and chronic bronchitis.

There's no doubt that chronic obstructive lung disease can have a disastrous impact on the heart's right ventricle--often producing hypertrophy or even failure--but its effects on the left ventricle are less clear. Some researchers speculate that disease of the right ventricle leads to disease of the left, while others consider the lung disease itself to be the more likely mechanism. Ordinarily, the left ventricle holds up well, even in far-advanced emphysema and chronic bronchitis. Recognizing the cases that do occur is important, however, since only minimal left ventricular failure can seriously compromise respiratory function. Treatment is the same as for left ventricular failure of any cause, but special precautions should be observed, particularly in prescribing diuretics. If frank pulmonary edema supervenes, mechanical ventilation and supplemental oxygen are necessary.

Aged↗

PubMed1975

Idiopathic paroxysmal ventricular tachycardia in infants and children.

Seven children with idiopathic PVT ranging in age from one day to 18 yr, have been observed during the past three years. The presenting complaints and frequency of paroxysms varied greatly. Three patients presented with syncope; four were asymptomatic. Lidocaine was effective in terminating acute symptomatic attacks; procaine amide and propranolol were effective in long-term control of the arrhythmia. Monitoring of the dynamic ECG was invaluable in establishing the diagnosis, characterizing the arrhythmia, and evaluating the effects of activity and therapy.

Adolescent↗

PubMed1974