Biomedical subjects
T Rotberg
Publications and source records attributed to T Rotberg.
[Changes in hepatic function in patients undergoing surgery with extracorporeal circulation].
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[Myocardial reinfarction in male and female].
1). In 1001 patients with acute myocardial infarction 403 cases were found (40.2%) showing possible relapse. A study was made of 125 cases (12.5%) with positive diagnosis of acute myocardial infarction relapse, and among them, 12 were found to be occurring for the third time. Is possible for the real frequency of the iterative infarction to be even higher, because many cases were dismissed (27.7%) for lacking of conclusive electrocardiographic data pointing to myocardial transmural infarction. 2). Investigations were conducted about the evolutive condition of the danger factors in the coronary profile as well in the male as in the female group. Besides, a comparative study was made about symptoms, complications, morbidity and mortality. Clinical, enzimatic and electrocardiographic proofs were found, in every case, of a new myocardial transmural necrosis which was in evolution, with waves of injury and ischemia. Thirty eight deaths were registered in hospitals (30.4%) and in 25 of these, a necropsic study was conducted. 3). This illness is more frequent among men than among women, in a 3.5 to 1 proportion. The recurrent myocardial necrosis tends to be more frequently present during the first year following the first episode. In women, the first myocardial infarction as well as the iterative infarction occur at an older age than in men. 4). The influence of personality and stress is a very important factor of danger in the iterative infarction. Familiar antecedents of ischemic cardiopathy constitute a danger factor in patients presenting a single episode of myocardial infarction; nevertheless they don't seem to have a determining influence in this group of relapsing infarction. Although this study confirms with statistics that smoking has a decisive influence in the first myocardial infarction, neither frequency nor mortality of the relapsing infarction are in any way modified by the diminishing or suppression of the smoking habit.
[Cardiac neurosis. Study of 100 cases with a healthy heart].
One-hundred records taken at chance from the archives of the Instituto Nacional de Cardiología de México, with the diagnosis of healthy heart, were studied. The following factors of these patients were analyzed: age, sex, civil status, socio-economic level, occupation, family antecedents, personal antecedents, smoking, alcoholism, presence of cardiac murmurs, arrhythmias, and electrocardiogram. In 80 of these patients there existed a clear neurotic alteration. The main symptoms which they suffered were: dyspnea, pain, palpitations, dizziness, and headaches. We found that the influence of the medical environment and living with cardiac patients in a neurotic individual were predisposing factors of a cardiac neurosis. In many cases the physician is responsable if he hesitates or does not advice properly. It can be concluded that it is necessary to establish a rehabilitation program for these patients since the illness is serious and invalidating and very frecuent, with repercussions at the familiar, social, and economic levels.
[Trans and postoperative myocardial infarct in heart surgery].
1. A study was made of 34 cases (33%) of myocardial infarction trans and immediately postoperative which occurred in 11,210 surgical interventions with and without extracorporeal circulation. 2. This presents a statistical relation of the frequency of myocardial infarction in realtion to the heart disease acquired with or without extracorporeal circulation with the mitral, aortic, and double prosthesis of the mitral and aortic valves. A correlation was also made with the ischemic heart disease subjected to revascularization. The same analysis was carried out in the congenital heart disease with or without extracorporeal circulation. 3. In all cases the antecedents, precipitating factors, and the clinical picture were studied and in 12 cases the necropsy was analized. The principal finding was transmural myocardial infarction with electrocardiographic proof and serial enzymes. 4. The group was divided into two sub-groups; Group "A" with acute myocardial infarction transoperative, and Group "B" with acute myocardial infarction in the first eight postoperative days. The electrical and mechanical complications were analized. 5. A correlation was made of the causes of mortality related to the type of congenital or acquired heart disease with or without extracorporeal circulation. 6. The frequency of this entity was studied with the total time of aortic clamping, and the complications such as the low cardiac output syndrome, rupture of the wall, aneurysms, acute pulmonary edema, and with the disturbances of rhythm and conduction. 7. The presence of 33.3% of normal coronaries in these of necropsy was emphasized. 8. The importance of the coronary profile of this group in relation to the consequences of a stress from anesthesia, surgery, extracorporeal circulation, and aortic clamping is mentioned. 9. The diagnostic parameters such as arterial hypotension with or without the low cardiac output syndrome, enzyme levels, and the action of the potassium ion are mentioned. 10. An analysis is made of the possible etiological factors of the precipitation of the myocardial necrosis in the cases with normal coronaries and those in which there was no important obstruction of the coronary macrocirculation. 11. In the subgroup "A" it was found that the frequency of myocardial infarction was less than in the subgroup "B", but there was greater mortality in group "A". The possible causal factors are analized.
[Intermediate syndrome: electrocardiographic, angiographic and clinical characteristics and their development under medical treatment].
An emphasis is placed on the definition and separation of the acute coronary insufficiency from the other "status anginosus", because the natural history and its physiopathology is of a distinct nature and actually still not very precise. A group of 19 patients was studied which filled all the clinical, electrocardiographic and enzymatic requisites of the genuine acute coronary insufficiency. Among these a subgroup of 13 patients was found with the classic Prinzmetal syndrome. In all cases the following were studied: antecedents, risk and coronary profile, the pain syndrome, electrocardiographic alterations, enzymatic modifications, coronariographic findings modifications, coronariographic findings and the ventricular function through ventriculography. The frequent occurance in the female sex is pointed out as well as the importance of the social and sensorial stress. We effected and described the correlation between the number and intensity of the pain crises and coronariographic findings. The electrocardiographic and coronariographic findings were correlated in the Prizmetal variety as well as in the entire group. An analysis was made of the correlation between the number and degree of coronary obstructions and the areas of ventricular diskinesia. The apparent paradox between an important number of cases with ventricular diskinesia and the limited number of cases with clinical and radiological left ventricular failure was mentioned and discussed. An analysis is made of the theoretic models of the ischemic heart disease in relation to the coronary macro and microcirculation and the possible influence of the catecolamines and the collateral circulation. The different physiopathological mechanisms introduced in this entity whose genuine world wide ocurrence is not very elevated. The evolution and morbi-mortality of those cases placed under medical care is analyzed.