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Biomedical subjects

S E Abrams

Publications and source records attributed to S E Abrams.

11 recordsLinked to original sources
PubMed1996

The effect of dietary fiber in tube-fed elderly patients.

Diarrhea is a common problem with potentially serious consequences for elderly tube-fed patients. A review of the literature indicates that diarrhea has been associated with the use of antibiotics, low blood albumin concentration, and a lack of fiber in the diet. This study documents the observed effect of dietary fiber on the incidence of diarrhea in 50 tube-fed patients. Over a 3-week period, patients who received fiber-containing formula had fewer liquid/loose stools than patients who received fiber-free formula. Nurses who care for elderly, tube-fed patients can help to improve outcomes by advocacy and interdisciplinary collaboration with registered dietitians and primary providers and by teaching assistive staff the importance of accurate recording of bowel function.

Adult↗
PubMed1995

Responses of the post-term arterial duct to oxygen, prostaglandin E2, and the nitric oxide donor, 3-morpholinosydnonimine, in lambs and their clinical implications.

BACKGROUND: Nitric oxide is a potent dilator of the pulmonary vasculature. There have been no previous reports on the action of nitric oxide on the arterial duct. OBJECTIVES: To determine the responses of isolated post-term arterial duct rings from lambs to oxygen, prostaglandin E2 (PGE2) and the nitric oxide donor, 3-morpholinosydnonimine (SIN-1). SETTING: Experimental laboratory. SUBJECTS: Six neonatal lambs. METHODS: Lambs aged 1-5 days were killed and the arterial duct and aorta excised and cut into rings. These were mounted on tension gauges in organ baths containing Krebs-Henseleit solution. Rings were exposed to increasing concentrations of oxygen, PGE2 and after preconstriction with potassium (40 mmol/l) to SIN-1. Tension and relaxation responses were recorded. RESULTS: Increased oxygen tension resulted in increased tension in the ductal rings above 88.9 mm Hg as previously described. No response to PGE2 occurred before or after ductal rings were exposed to oxygen. SIN-1 caused relaxation of smooth muscle in the arterial duct to a similar degree as that in the aortic rings. CONCLUSIONS: As previously shown, oxygen is a potent constrictor of the arterial duct. The post-term arterial duct does not relax in response to PGE2 possibly as a result of inactivation by oxygen of the special sensitivity of the duct to PGE2. SIN-1 is a potent smooth muscle relaxing agent in the term arterial duct and may have a role in the initial management of neonates with duct dependent pulmonary circulation.

Animals↗
PubMed1995

Single catheter approach for occlusion of a patent arterial duct with a Rashkind double umbrella.

OBJECTIVES: To determine the benefits of using a single venous catheter and a single angiogram during catheter occlusion of a patient arterial duct with the Rashkind double umbrella compared with those of venous and arterial catheters and multiple angiograms. DESIGN: Retrospective review of case notes. PATIENTS: 103 consecutive patients. The long sheath could not be advanced adequately in two patients. 101 patients had 104 implantations. Median (range) age was 35 (7-549) months and median (range) weight 13 (7-62) kg. Fifty four implantations were performed using the venous and arterial method and 50 using the venous only method. RESULTS: Median procedure times (70 v 90 min), number of angiograms (one v four), and angiographic dye volume used (2 v 7 ml/kg) were significantly reduced using the venous only method compared with those of the venous and arterial method. There was no significant difference in fluoroscopy time (venous only 9 v venous and arterial 10 min). CONCLUSIONS: Considerable improvements can be made in the technique of catheter closure of patent arterial ducts using the Rashkind double umbrella without compromising outcome using venous cannulation alone and a single angiogram, rather than venous and arterial cannulation and multiple angiograms. reduced risk to arteries from cannulation, The benefits are reduced radiation exposure, reduced risk to arteries from cannulation, shorter procedures, and lower equipment costs.

Adolescent↗
PubMed1994

Radiofrequency thermal angioplasty maintains arterial duct patency. An experimental study.

BACKGROUND: Long-term maintenance of arterial duct patency by a catheter technique would be a valuable nonsurgical method of palliation for duct-dependent circulations. We used a new method: percutaneous radiofrequency thermal balloon angioplasty of neonatal lamb arterial ducts. METHODS AND RESULTS: Radiofrequency balloons 5 or 6 mm in diameter were introduced via the femoral vein of 32 neonatal lambs and inflated to 4 atm. In 28, a radiofrequency generator was used to heat the saline/contrast mixture in the balloon to 65 degrees C (n = 2), 75 degrees C (n = 2), 85 degrees C (n = 10), 100 degrees C (n = 8), and 120 degrees C (n = 6). In 4 lambs, angioplasty alone was performed. Lambs were recatheterized to assess patency at intervals up to 78 weeks. Immediate results showed the arterial duct to be patent in all cases, with a mean rise in systolic pulmonary artery pressure of 13 +/- 8 mm Hg and a mean rise in pulmonary artery oxygen saturation of 12 +/- 15%. With a mean follow-up of 45.7 +/- 28 weeks, 3 of the 4 (75%) angioplasty alone ducts closed, but only 5 of the 28 (18%) radiofrequency-treated ducts (P < .05). The mean rise in oxygen saturation between the superior vena cava and the pulmonary artery was 7.6 +/- 7% at last follow-up. Follow-up angiography of the arterial ducts showed the development of stenoses in all patent ducts. CONCLUSIONS: Radiofrequency thermal balloon angioplasty leads to long-term arterial duct patency in lambs in > 80% of the treated group and is significantly more effective than balloon angioplasty alone.

Angioplasty, Balloon↗
PubMed1993

Arterial duct morphology with reference to angioplasty and stenting.

We studied the angiographic morphology of the arterial duct in neonates with congenital heart diseases. We defined the variations in ducto-aortic angle, number of tortuosities and site of insertion into the aorta of the duct in five diagnostic groups: (i) patent arterial duct (unobstructed) (n = 27), (ii) coarctation of the aorta (n = 24), (iii) pulmonary stenosis (n = 23), (iv) pulmonary atresia (n = 19) with or without ventricular septal defect, (v) hypoplastic left heart syndrome (n = 3). In the patent arterial duct group the angles ranged from 80 to 139 degrees, mean 107 degrees; in the coarctation group, 76 to 136 degrees, mean 104 degrees; in the pulmonary stenosis group, -60 to 111 degrees, mean 43 degrees; in the pulmonary atresia group, -55 to 115 degrees, mean 25 degrees; in the hypoplastic left heart syndrome 92 to 105 degrees, mean 98 degrees. The angles for the pulmonary atresia and stenosis groups were significantly less than those for the coarctation and patent ductus groups (P < 0.001). A ventricular septal defect in patients with pulmonary atresia or pulmonary stenosis was significantly associated with a smaller angle, a more proximal and a more tortuous duct (P < 0.01). The varying morphology of the duct in neonates with congenital heart lesions, especially with right heart obstruction requires special attention when attempting catheter techniques of ductal stenting. In particular the angle of approach and the presence of tortuosities may increase the difficulty of endovacular stenting.

Angioplasty↗
PubMed1993

Arterial duct angioplasty as an adjunct to dilatation of the valve for critical pulmonary stenosis.

OBJECTIVE: To assess the efficacy of arterial duct angioplasty in maintaining adequate ductal patency in neonates with critical pulmonary valve stenosis. PATIENTS: Two neonates presenting with cyanosis due to critical pulmonary valve stenosis with severe right ventricular hypoplasia underwent percutaneous balloon dilatation of the pulmonary valve. Despite successful dilatation, both remained cyanosed while receiving prostaglandin E2 infusions. RESULTS: Angioplasty of the arterial duct resulted in increased arterial oxygen saturations. Adequate arterial duct patency was maintained for three months during which time right ventricular dimensions increased enough to allow sufficient pulmonary circulation without the duct. CONCLUSIONS: Arterial duct angioplasty is an effective additional treatment for patients with critical pulmonary valve stenosis whose right ventricle is too small to provide adequate forward flow after balloon dilatation of the valve. Arterial duct angioplasty sustains adequate patency of the duct while the right ventricle grows sufficiently to undertake the pulmonary circulation.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

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Attitude of Health Personnel↗