Biomedical subjects
W Berman
Publications and source records attributed to W Berman.
Use of atrial epicardial electrodes to diagnose and treat postoperative arrhythmias in children.
Temporary Teflon-coated stainless steel wires were placed on the right atrium of 100 consecutive infants and children undergoing open heart surgery. The patients' ages ranged from 1 day to 17 years. The wires were used for diagnosis or treatment 40 times in 30 patients. Atrial electrograms were recorded 14 times to diagnose arrhythmias and conduction disturbances that were unsuspected or misdiagnosed from the standard electrocardiogram. In 10 patients, atrial pacing was used to treat postoperative arrhythmias. Atrial pacing was also used as an adjunct to therapy in 16 children with postoperative low cardiac output and bradycardia with intact atrioventricular conduction. The wires were removed before discharge and no complications resulted from their use. Previous studies have demonstrated the usefulness of temporary atrial wires after cardiac surgery in adults. This experience confirms that the technique is easy and safe and can be of great diagnostic and therapeutic value in children.
The physiologic effects of digoxin under steady-state drug conditions in newborn and adult sheep.
The physiologic response to the chronic administration of digoxin was studied in 12 adult and 13 newborn sheep. Vascular pressures, cardiac output, isovolumic contraction phase indexes and systolic time intervals were measured before and after 2 weeks of digoxin therapy. Physiologic measurements were correlated with drug levels in plasma and myocardium. Resting myocardial function in newborns exceeded that in ewes. In ewes, the heart rate decreased from 98 to 74 beats/min, the preejection period (PEP) decreased from 76 to 57 msec, the ratio of PEP to left ventricular ejection time (LVET) decreased from 0.323 to 0.223 and dP/dt max increased from 2415 to 3460 mm Hg . sec-1 as plasma concentrations of digoxin increased to a mean of 1.8 ng/ml. Although the final steady-state plasma concentration of digoxin in newborn lambs averaged 1.7 ng/ml, cardiac output, PEP, PEP/LVET and dP/dt max did not change significantly from baseline values. These studies suggest that developmental differences in the physiologic response to digoxin are due either to a limited capacity for improvement in myocardial contractility shortly after birth or to an age-related difference in the effect of digoxin on myocardial tissue.
Pharmacokinetics of inhibitors of prostaglandin synthesis in the perinatal period.
Explore the source record for details and available documents.
Hematologic effects of prostaglandins and thromboxanes and inhibitors of their synthesis in the perinatal period.
Explore the source record for details and available documents.
Repair of divided anomalous anterior descending coronary artery in tetralogy of Fallot.
Coronary artery anomalies in tetralogy of Fallot have often compromised surgical repair and imposed an increased mortality rate. Thus accidental division of the anterior descending coronary artery crossing the right outflow tract has previously usually resulted in death. The case is presented of a 13-year-old boy with tetralogy of Fallot in whom the anomalous left anterior descending coronary artery was divided. The blood supply to the left anterior descending artery was successfully restored using a reversed saphenous vein graft.
Left bundle branch block due to hyperkalemia in premature infants.
Explore the source record for details and available documents.
Echocardiographic visualisation of the interatrial baffle after Mustard's operation.
Explore the source record for details and available documents.
Galactose metabolism in isolated perfused suckling-rat liver.
The metabolic conversion of 1, 2, or 4 mM galactose to glucose was studied in isolated livers of suckling rats. Whereas galactose uptake during perfusion with 1 and 2 mM galactose was linear throughout the 90-min experiment, uptake was delayed for 35 min when 4 mM galactose was perfused. Studies with radioactive galactose revealed a parallel disappearance of galactose and the appearance of [14C]glucose; about 80% of the galactose taken up was converted to glucose. Galactose perfusion appeared to reduce the basal amount of glucose derived from substrates other than galactose. The specific activities in the galactose-perfused livers of the three major galactose metabolizing enzymes, galactokinase, galactose-1-phosphate uridylyltransferase, and uridine diphosphogalactose-4-epimerase, revealed that the transferase was significantly lower, whereas that of galactokinase and epimerase were significantly higher than in livers perfused without galactose. No meaningful changes were observed in the levels of either phosphorylated or uridylated hexoses in these studies.
Myocardial performance in the newborn lamb.
We compared myocardial performance in newborn lambs over the first 3 wk of life with that of ewes. Heart rate was higher in newborn lambs than in ewes. The ratio of left ventricular preejection period to left ventricular ejection time was similar for newborns (0.31 +/- 0.02) and ewes (0.31 +/- 0.01). Cardiac output in ml/min per kg body weight in the newborn was 397 +/- 55 at 1 wk, 314 +/- 30 at 2 wk, and 274 +/- 10 at 3 wk, compared to 125 +/- 8 in ewes. Stroke work was comparable in both age groups. Left ventricular dP/dtmax averaged 3,723 mmHg/s in lambs compared to a mean value of 2,257 in ewes. These studies establish that the myocardium of newborn sheep contracts vigorously in vivo and equals or exceeds the level of performance of the myocardium of adult sheep, as estimated by a variety of indices of myocardial function.
Dilatation of the ductus arteriosus by prostaglandin E1 in aortic arch abnormalities.
Infants with aortic arch interruption of juxtaductal coarctation of the aorta may depend on patency of the ductus arteriosus to provide adequate lower body perfusion. In many such infants the ductus arteriosus constricts after birth, resulting in severe heart failure, poor systemic perfusion and acidemia. We infused prostaglandin E1 (PGE1) at a rate of 0.05--0.1 microgram/kg/min into seven infants with aortic arch interruption and eight infants with coarctation. In one infant in each group the ductus arteriosus was already closed and did not reopen. In one infant with coarctation an adequate trial was not accomplished, and in another adequate pressure measurements were not obtained. Of the remaining 11, the ductus arteriosus was effectively dilated by PGE1 in 10 infants. This was evidenced by an increase in descending aortic blood pressures and a reduction in the pressure difference between the main pulmonary artery and descending aorta in six infants with aortic arch interruption and between ascending and descending aorta in four infants with coarctation. Lower body perfusion improved and left ventricular failure was improved. The infant who did not respond was 5 months old. There were no complications.
Modified Shumacker repair of transposition of the great arteries.
Seven infants weighing from 6.4 to 10.3 kg underwent correction of transposition of the great arteries by the venous transposition operation as described by Shumacker. In this operation, a new atrial septum is constructed using a bipedicled right atrial flap, and the lateral atrial wall is constructed using a viable pericardial flap. Three of the patients had an associated ventricular septal defect. Six of the seven patients survived and have had an excellent clinical result. Although atrial arrhythmias were common in the early postoperative period, all patients are now in sinus rhythm. Two patients have had postoperative cardiac catheterization and cineangiography, which showed excellent hemodynamic results. The modified Shumacker operation preserves two of the three internodal pathways, provides a compliant, viable atrial septum, and permits fabrication of a generous-size physiological left atrium. This appears to offer advantages not present in the Mustard procedure.
Partial anomalous pulmonary venous connection to the azygous vein with intact atrial septum.
A five-year-old girl with partial anomalous pulmonary venous connection to the azygous vein with intact atrial septum is reported. The clinical and roentgenographic features suggested the correct diagnosis. Surgical correction of this previously unreported defect was accomplished by creating an atrial septal defect and constructing a baffle to direct the blood flow from the azygous vein to the left atrium.
A heroin addiction scale for the MMPI: effectiveness in differential diagnosis in a psychiatric setting.
This study examined the discriminative utility of the Cavior Heroin Addiction Scale (HE) in separating samples of male heroin addict, alcoholic, and polydrug abuser samples from psychiatric control samples matched on sex, age, race, and education level. Heroin addicts were the only substance abuser samples that did not differentiate from its control sample. Heroin addicts obtained higher mean HE values than did the alcoholics although the polydrug abusers obtained higher mean HE values than both alcoholics and heroin addicts. HE was found to be less successful in separating these samples than was the MacAndrew Alcoholism Scale. This poorer performance is related to HE's confounding systematic relation to subject age and race, or to differences in scale construction methodology.
Digitalis toxicity and serum levels.
Explore the source record for details and available documents.
The relationship of age to the metabolism and protein binding of digoxin in sheep.
The relationship of age to the protein binding and metabolism of digoxin was studied in newborn and adult sheep. Protein binding, studied by equilibrium dialysis, varied directly with albumin concentration. The percentage of digoxin bound to protein did not differ with age: 17.2 +/- 1.2% in newborn lambs and 17.6 +/- 1.7% in ewes. The percentage of drug bound did not change significantly over a concentration range of 0.5 to 5 ng/ml. Metabolic studies were performed by thin-layer chromatography on samples of serum, myocardium and urine obtained after animals had been treated for 4 days with [3H]-digoxin. In both newborns and adults, more than 70% of digoxin remained unmetabolized. The mean metabolic composition of all three tissues for newborns and adults, respectively, was: digoxin--80.3%, 77.0%; digoxigenin bisdigitoxoside--9.6%, 12.5%; digoxigenin monodigitoxoside--6.4%, 7.0%; digoxigenin--3.7%, 3.5%. These studies suggest that age-related differences in the effects of digoxin in sheep are not due to variations in drug binding or drug metabolism.
The measurement of pulmonic valve area by angiocardiographic and hemodynamic methods.
The validity of angiocardiographic measurements in assessing the severity of pulmonic valve stenosis was determined. The pulmonic valve orifice area was measured in the lateral projection on cineangiocardiographic films in 24 patients with valvar pulmonic stenosis. The valve orifice area was also obtained in the same patients by the Gorlin and Bache formulae. The right ventricular output value required for insertion in these formulae was obtained by angiocardiographic right ventricular volume measurement and by the Fick method. The correlation between the directly measured valve orifice area and the area calculated using the Fick principle and the Bache formula was 0.80. The substitution of angiocardiographically measured right ventricular stroke volume for the Fick value gave a correlation of 0.82. The results support validity of employing direct angiocardiographic measurements of pulmonic valve orifice area and angiocardiographic right ventricular volume measurements for quantitative assessment of the severity of pulmonic valve stenosis. The angiocardiographic methods thus represent an alternative to the Fick technique which can be used in conditions where the Fick method cannot be expected to give valid results.
Risks of facial plastic surgery in an otolaryngology program.
By reviewing 680 rhinoplasty, facelift, blepharoplasty, otoplasty, and chin implant procedures that were performed during a two-year period by UCLA Head and Neck Surgery (Otolaryngology) residents, we have found that the rate of major and minor complications compares favorably with that rate achieved by physicians in practice who have reported their results in the literature. Three hundred and sixty-eight rhinoplasties resulted in 1.6% major complications, 14.4% in minor complications, and 5.2% in revision surgeries. One hundred fourteen facelifts had 5.3% major complications, and 24.5% had minor complications. One hundred fifty-six blepharoplasties had no major complications, and 7.7% had minor complications; 21 chin implants resulted in no major complications, and 9.5% resulted in minor complications; and 21 bilateral otoplasties had no major complications, and 14.3% had minor complications, with 4.8% revisions.