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Biomedical subjects

R F Brodman

Publications and source records attributed to R F Brodman.

At least 37 records · Page 2Linked to original sources
PubMed1992

Histological evaluation of the inferior epigastric artery in patients with known atherosclerosis.

Comparative histological studies have been performed on the various arterial conduits available for myocardial revascularization including the inferior epigastric artery which has recently become the focus of intense investigation. In this study, 10 patients with known risk factors for atherosclerotic disease had their inferior epigastric artery harvested and the entire specimen examined for the microscopical presence of atherosclerosis or its precursors. Histopathological findings that have been shown to be theoretically protective against the progression of atherosclerosis were observed. These include the paucity of fenestrae in the internal elastic lamina, no medical calcification, the absence of foam cells and the absence of intimal smooth muscle cells. No specimen had atherosclerotic disease and only 3 specimens showed changes consistent with minimal intimal hyperplasia. Morphometric analysis of the 3 diseased specimens revealed only minimal luminal narrowing. These findings suggest that the inferior epigastric artery may not be prone to atherosclerosis. Thus, the inferior epigastric artery appears to be a safe myocardial conduit and long-term patency can be anticipated.

Abdominal Muscles↗
PubMed1991

Ventricular tachycardia/fibrillation: therapeutic alternatives.

It is now clear that no single therapy is appropriate for a consecutive series of patients with ventricular tachycardia or ventricular fibrillation (VT/VF). Drug responders by electrophysiological studies, patients who are not inducible following surgery, and patients treated with an implantable cardioverter defibrillator (ICD) all can have similarly low sudden death rates and virtually identical long-term mortality. However, many patients fail to respond to drugs, and surgical risks are excessive in others, and always higher than for an ICD implant. Nevertheless, overall survival in each of these groups (and probably for patients treated with antitachycardia pacers and ablation) is about 60% at 60 months. Major challenges now are: (1) choosing therapy to maximize risk-benefit ratio; and (2) treatment of the pump failure and progressive disease that now accounts for most cardiac mortality.

Anti-Arrhythmia Agents↗
PubMed1990

Isolated left carotid artery in CHARGE association: diagnosis and repair.

Isolation of the left carotid artery is extremely rare. We report a case of isolation of the left carotid artery with CHARGE association. Aortic arch abnormalities should be looked for in all children with CHARGE association. The technique of repair involved implantation of the isolated left carotid artery to the ascending aorta.

Anastomosis, Surgical↗
PubMed1990

Daily bedside electrophysiological testing following surgery for the WPW syndrome.

A simple technique is described that allows daily bedside evaluation of the results of surgery for the Wolff-Parkinson-White (WPW) syndrome, using standard postoperative myocardial wires, a single-channel ECG machine, and a temporary pacer capable of rapid stimulation. Rate incremental atrial and ventricular ramp pacing was performed daily in 40 postoperative WPW patients. This technique, together with underdrive pacing in some individuals permits quick assessment of anterograde and retrograde conduction. Two surgical failures were identified in early postoperative days, and promptly returned to the operating room for successful reoperation. No additional failures were identified at formal predischarge electrophysiological testing or following discharge. The technique permits reassurance on a daily basis to apparent successes and early identification in the event of failure, permitting prompt intervention.

Arrhythmias, Cardiac↗
PubMed1989

Posterior septal and right free-wall Kent pathways visualized in situ and removed at operation.

This article describes the first posterior septal and first and second right free-wall pathways identified at operation for Wolff-Parkinson-White syndrome and confirmed histologically. All pathways were found in the areas of preexcitation identified by pre and intraoperative mapping. They bridged the atrium and ventricle, and postoperative electrophysiological testing confirmed division of the pathways. Kent bundles may be identified at the time of surgery but they appear to be gossamer structures usually destroyed during surgical manipulation of the coronary sulcus. Visualization of the suspected bypass tract should not alter or limit the extent of surgical dissection.

Biopsy↗
PubMed1988

A technique for donor lung procurement and preservation for transplantation after completion of cardiac donation.

The scarcity of donor lungs for transplantation has been caused, in part, by the belief that a single donor cannot provide usable lungs if it serves as a heart donor. However, the appropriate division of the left atrial wall provides sufficient cuffs for individual transplantation of the heart and each lung into three separate recipients. With the described technique, the results of the present studies demonstrate the feasibility of donor lung procurement and preservation for transplantation after cardiac donation. Use of this method will allow the most effective and efficient use of the limited supply of donor organs and thereby permit therapeutic single lung transplantation in selected patients. Cardiac donation should no longer preclude lung donation as it has in the past.

Animals↗
PubMed1985

Multiple organ procurement from one donor.

To maximize organ utilization, we assessed the feasibility of retrieving the heart and two single lungs or the heart and a separate bilateral lung block for transplantation into multiple recipients. In eight dogs the excision of the heart-lung block or of the left lung was followed by six hours of lung preservation. Four of these lungs and all eight hearts were transplanted successfully. In addition, satisfactory retrieval of the three separate organs or of the heart and a separate bilateral lung block was done in six human cadavers. An appropriate division of the left atrial wall provided suitable cuffs for individual transplantation of the three organs or for the heart and bilateral lung block. This study demonstrates the feasibility of multiple organ donation from a single donor followed by separate organ transplantation.

Animals↗
PubMed1984

A bullet shaped tip for the circular stapling device.

A stainless steel bullet shaped tip has been designed for attachment to the shaft of the circular stapling device. It is useful when the shaft of this circular stapling device must transverse a viscus wall. This modification of the circular stapler has been used in vertical stapling of the stomach for morbid obesity, in low intestinal anastomoses using the side-to-end technique and in re-establishing intestinal continuity after a Hartmann procedure.

Humans↗
PubMed1981

Staple suturing of the colon above the peritoneal reflection.

We review the few reports in the literature involving the results of stapled colonic anastomoses. Our personal experience with 88 consecutive stapled colonic anastomoses performed above the peritoneal reflection is analyzed. There were no mortalities and no evidence of anastomotic leaks in our series. With proper attention to the usual tenets of good colonic surgery and knowledge of the limitations of the stapling instruments, stapling colonic anastomoses is a safe technique.

Adult↗
PubMed1977

Dextran 40-induced coagulopathy confused with von Willebrand disease.

In a patient who had undergone reconstructive surgery on the subclavian artery and was treated postoperatively with aspirin and dextran 40, a bleeding diathesis developed within 24 hours. This was at first thought to be von Willebrand disease, since the bleeding time was longer than ten minutes; the factor VIII level, 28%; and the activated partial thromboplastin time, 50 seconds (normal 30 to 38). The patient's defect responded to discontinuance of the low-molecular-weight, dextran and aspirin therapy and administration of a cryoprecipitate. Later studies of the coagulation mechanism up to two and one-half months were entirely normal. The postoperative defect therefore was assumed to have been the result of the administration of dextran and aspirin. It is possible that in a similar future case, discontinuance of dextran infusion and administration of a single bolus of 12 bags of cryoprecipitate may be adequate treatment.

Blood Coagulation Disorders↗