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T V Bilfinger

Publications and source records attributed to T V Bilfinger.

12 recordsLinked to original sources
PubMed1992

Pediatric myocardial protection in the United States: a survey of current clinical practice.

A nationwide survey of institutions in the United States that perform congenital heart disease surgery was conducted to obtain an overview of the current use of myocardial protection in pediatric patients (aged 0-16 years). One hundred and one (55%) of 183 institutions responded, completing a 4-page questionnaire about pediatric cases in 1989. A total of 12,072 cases were represented. Caseloads ranged from 7 to 498 at these institutions (mean 124, median 30). Cardioplegia was used by 100 institutions (44 blood, 45 crystalloid, 11 both). Administration was guided by formulas alone in 69 and by clinical criteria alone in 32. A wide variety of compositions of cardioplegic solutions was found with no preference for any particular type. No correlation between caseloads and cardioplegic solutions was found. Hypothermia was used by all institutions, with a mean of 25.8 +/- 3.5 degrees C for a simple ventricular septal defect closure. Deep hypothermia and circulatory arrest were used in 3048 cases (25.2%). A clear trend indicated that circulatory arrest was used more frequently in larger institutions (p less than 0.0001). Fibrillation as a strategy was used in 45 institutions. Twenty-five institutions changed cardioplegia technique during 1989. The findings suggest that, even though no consensus exists about its ideal composition, cardioplegia in conjunction with hypothermia is currently the strategy most often used for pediatric myocardial protection.

Adolescent↗
PubMed1991

Coronary artery bypass grafting. The relationship of surgical volume, hospital location, and outcome.

The relationship between mortality, surgical volume, and location was investigated in the university medical centers (UMCs) in the Greater New York metropolitan area for patients undergoing coronary artery bypass grafting (CABG) in 1986. Three high-volume and five low-volume institutions, with a total of 49 surgeons, performed a total of 3,408 CABG operations. The crude mortality rates were 4% for simple, 14.7% for complex, and 5.3% combined for all UMC CABG operations. The crude mortality rates for CABG operations in high- and low-volume centers were respectively 3.6% and 4.8% for simple and 16.1% and 11.3% for complex operations. No statistically significant differences between urban (N = 6), suburban (N = 2), high-volume (N = 3), or low-volume (N = 5) centers or physicians were found (all p values greater than 0.05). Taken together, these findings suggest that surgical volume and location are not significant factors for predicting outcome for CABG.

Coronary Artery Bypass↗
PubMed1990

Cardiac surgery for inmates in the Texas Department of Corrections.

All Texas prison inmates requiring hospitalization since 1983 have been transferred to a separate prison hospital adjacent to a tertiary care university hospital. We reviewed and analyzed the data regarding one major tertiary care service, namely cardiac surgery, to describe the rate of utilization of this service and its results. From January 1, 1984, to June 30, 1988, 73 inmates underwent 74 cardiac operations, 50 of which were coronary revascularizations. The age-adjusted rates of utilization for coronary artery bypass grafting were substantially higher for inmates over age 45 than for that described for the general population, whereas the utilization rates for valve surgery were comparable. There were no perioperative or late deaths, and 86% of the inmate patients are currently employed within the Texas Department of Corrections system or were employed at the time of their release. The utilization rates and the results of this representative tertiary medical care service for the state's prison population are comparable to those achieved in the private sector, and may have a substantial beneficial effect on inmate rehabilitation.

Adolescent↗
PubMed1989

Blood conservation in coronary artery bypass surgery: prediction with assistance of a computer model.

A computer assisted model was created with the data from 514 consecutive coronary bypass patients in order to predict the potential need of a blood transfusion. During this time period strict management protocols were used. In this series 261 (55.9%) patients were never and 46 (9.9%) were only intraoperatively transfused. Intra- and postoperative transfusions were necessary for 160 (34.2%) patients. Preoperative hematocrit, age, sex, and weight were the statistically significant parameters in the development of the model.

Adult↗
PubMed1989

Renal revascularization in anuric patients: determinants of outcome.

We describe three patients who recently had surgical revascularization for prolonged anuria due to renal artery occlusion. A review of the literature revealed 31 similar patients with sufficient data to allow comparison. There was no correlation between the interval of anuria and the surgical outcome regarding survival, renal function, and blood pressure. On renal angiography, 16 patients had nephrogram as evidence of collateral circulation. Seven patients had no renal perfusion. There was no significant difference in renal function, blood pressure, or survival after renal reperfusion in patients with or without nephrogram. In patients who received vascular grafts, the postoperative serum creatinine level and blood pressure were significantly lower than those of patients who had thromboendarterectomy (P less than .05). In contradistinction to commonly held concepts, these findings are independent of collateral circulation.

Anuria↗
PubMed1988

Aortic arch thrombosis in the neonate.

Thrombotic occlusion of the aortic arch in the neonate is a rare lesion for which successful operative repair with survival beyond the immediate postoperative period has not been previously reported. We report a case in which surgical repair of this lesion with survival was achieved and discuss the diagnostic and technical aspects of management of aortic arch thrombosis in the neonate.

Aorta, Thoracic↗
PubMed1986

Pyogenic liver abscesses in nonimmunocompromised children.

Pyogenic liver abscesses are rare in previously healthy children. This review reports ten such cases of pyogenic abscess seen between 1963 and 1984. The mean age in these children was 6.3 years. One child died. Of the nine survivors, five had successful open surgical drainage. Two abscesses were drained percutaneously. Another abscess drained spontaneously into the biliary system, and one abscess was treated with antibiotics alone. The single most helpful diagnostic test was abdominal ultrasonography. Our experience is evaluated in the context of other reports of pyogenic abscesses in children.

Adolescent↗