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Biomedical subjects

V Parsonnet

Publications and source records attributed to V Parsonnet.

At least 163 records · Page 9Linked to original sources
PubMed1977

Permanent pacing of the heart: 1952 to 1976.

The theory and science of electrical pacing of the heart is scarcely 2 decades old, but developments in these areas have in a way revolutionized modern cardiology. This report, basically a review of the major developments during that time, describes the present state of the art, and calls attention to the many people who have brought us to this point. Results of a recent national survey reveal that about 156,000 patients in the United States are living with implanted pacemakers or about 1 in every 1,300 persons. The rate of new implants is 270/million each year, the highest in the world. The impact of such a volume is considerable, affecting industrial growth, federal legislation and control, insurance plans and a multitude of medical programs. New power sources, some touted to last a lifetime, will have a great impact but will not change the current state of the art materially because 30 percent or more of pacemaker operations are for problems other than routine battery exhaustion. The need for improvements in other pacemaker components is emphasized.

Arrhythmias, Cardiac↗
PubMed1977

Popliteal aneurysms.

A review of 64 popliteal aneurysms in 43 patients treated over a 14-year period revealed that thrombotic occlusion with ischemia and threatened limb loss was the most frequent complication (68%). Ten major amputations (23%) were necessary, four of which were the primary operations soon after admission. No limb loss occurred after operation in 11 patients with asymptomatic aneurysms. Direct revascularization was successful in 29 limbs (83%). Popliteal aneurysms should be resected, preferably in the asymptomatic stage, unless medical contraindications exist. Once thrombosis occurs, limb loss becomes a threatening likelihood.

Adult↗
PubMed1976

Peripheral nerve division for relentless ischemic foot pain.

During a three-year interval, 12 multisensory peripheral nerve divisions in ten patients were performed for intractable ischemic foot pain. The two major indications, after concluding that revascularization was impossible, were (1) the presence of localized, dry, and contained acral gangrene in patients who were not candidates for a lesser amputation and (2) patient or family refusal of a limb amputation.

Aged↗
PubMed1976

Vascular complications of intra-aortic balloon pumping.

Vascular injury or occlusion from intra-aortic balloon pumping (IABP) that results in actual or potential limb ischemia occurs more frequently than reported. In a series of 79 IABP patients, 36 lived long enough to have the balloon catheter removed; thirteen (36%) of them had vascular complications. The complications were in three patients with an injury at the insertion site, eight patients with arterial thromboses, and two with arterial occlusion by the large balloon catheter. Local artery revision, thrombectomy alone, or thrombectomy with femorofemoral cross-over grafting was required in 11 patients. Femorofemoral crossover graft was utilized when arterial occlusion would have ordinarily required premature balloon removal or when immediate arterial occlusion by the catheter was recognized at the time of balloon insertion. This was preferable to transferring, replacing, or discontinuing IABP, since the same factors that led to thrombosis in the first place would have eventually come into play again. Patients should be observed frequently and have Doppler limb pulse determinations every four hours to avoid ischemic catastrophies. Proper IABP weaning and the use of a Fogarty catheter at the time of balloon removal is mandatory to prevent complications. Femorofemoral crossover graft is indicated for ischemic limbs when IABP must be continued.

Adult↗
PubMed1976

Normal and abnormal function of the pacemaker magnetic reed switch.

Application of the special test magnet over a demand pacemaker actuates a magnetic reed switch which converts the pacemaker to fixed-rate pacing. The magnetic reed switch is a simple and generally very reliable component. This review discusses the normal and abnormal functions of the pacemaker magnetic reed switch. An understanding of the theoretical and practical aspects of this subject is important in the overall management of patients with implanted pacemakers.

Aged↗
PubMed1976

Endarterectomy of the left anterior descending and mainstem coronary arteries: a technique for reconstruction of inoperable arteries.

The proximal left anterior descending coronary artery (PLAD) is an area of predilection for such severe and diffuse calcific arteriosclerosis that reconstruction of these vessels often is impossible. The branches of this segment include the septal perforators, median artery, the left anterior descending coronary artery, and its first and second diagonal branches. Successful endarterectomy, therefore, would revascularize large areas of the left ventricle and interventricular septum. We have performed 45 such operations during the past 13 months. Following endarterectomy there are several methods of reconstructing the endarterectomized vessel, the preferable technique being the addition of a saphenous vein bypass to the endarterectomized segment. Patients selected for this operation were mostly in the fair (58%) and poor risk (42%) categories; there were no good risk patients. Diffuse arterial disease was the rule. The average ejection fraction was 0.48. The operation was successful with respect to graft patency, bypass flow rates, and symptomatic relief. The operative mortality rate in the entire group was 15%, including the 19 poor risk patients in six of whom elective preoperative use of an antra-aortic balloon pump was required. Most of the surviving patients (92%) were either symptom free or greatly improved. Only two patients were clinically unchanged. There was one late sudden death. This operation is indicated when there is extensive involvement of the life main, the proximal left anterior descending coronary artery and its major branches. It is the only possible way to revascularize otherwise inoperable arteries.

Aged↗
PubMed1975

Crossover femorofemoral grafts followed up five years or more. An analysis.

Crossover femorofemoral grafts continue to provide satisfactory long-term patency with low morbidity and mortality in the treatment of unilateral atherosclerotic iliac artery occlusion. In our series of patients, early failures were primarily a result of the inability to provide adequate runoff for the graft, and late failures were due to progressive atherosclerotic involvement of runoff vessels. Clear-cut progression of the atherosclerotic process in the donor iliac artery segment has not been observed in this series. In fact, there is evidence that suggests that this process may have been retarded when compared with other types of reconstructive procedures. There is a noticeably late mortality (33%) due to other disease processes and associated cardiovascular disorders. These facts continue to support the application of crossover femorofemoral grafts in the surgical treatment of unilateral atherosclerotic illiac artery occlusions.

Adult↗