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Biomedical subjects

A Kantrowitz

Publications and source records attributed to A Kantrowitz.

At least 19 recordsLinked to original sources
PubMed1993

Sacral root stimulation for controlled micturition: prevention of detrusor-external sphincter dyssynergia by intraoperative identification and selective section of sacral nerve branches.

Electrical stimulation of the S2 nerve root can be used to produce detrusor contraction and voiding in patients with spinal cord injury, but concurrent stimulation of the external urethral sphincter causes detrusor-sphincter dyssynergia. This has been managed with a second surgical procedure, peripheral transection of the pudendal nerve. In this study, performed in dogs after spinal cord transection, laminectomy and ventral foraminotomy permitted tracing of the S2 root into the pelvis, where its branches were identified by electrical stimulation and urodynamic recording. The pudendal (somatic) branch was sectioned; the autonomic branch innervating the detrusor was preserved. Electrical stimulation of the proximal S2 root then produced detrusor contraction without contraction of the external urethral sphincter. This approach, which requires a single operation and spares pudendal nerve functions mediated by nerve roots other than S2, may enable a neurostimulator to provide effective voiding, without detrusor-external sphincter dyssynergia, in man.

Animals↗
PubMed1992

Percutaneous intra-aortic balloon counterpulsation.

Intra-aortic balloon pumping is the mainstay in the management of acute left ventricular dysfunction in the critical care setting. Percutaneous insertion affords rapid initiation of the procedure. Complications are in greatest part vascular and infectious. The advent of new-generation, totally automatic, closed-loop IABP systems offers the prospect of increasing the effectiveness of IABP support under most conditions, and especially during arrhythmias. This and other developments suggest that despite its standing as the most widely used temporary cardiac assist device, IABP has still to realize its full therapeutic potential.

Critical Care↗
PubMed1990

Origins of intraaortic balloon pumping.

In 1968, the Journal of the American Medical Association published a paper on the "Initial clinical experience with intraaortic balloon pumping in cardiogenic shock," which gave the results of the first clinical use of the procedure developed in our laboratory. For more than 2 years, our group was the only one using intraaortic balloon pumping clinically. Later, intraaortic balloon pumping was used by others, and despite poor clinical salvage, the hemodynamic benefit was demonstrated convincingly. At the present time, approximately 70,000 balloon pump procedures are performed annually.

History, 20th Century↗
PubMed1988

Intraaortic balloon pumping for prolonged circulatory support.

Prolonged circulatory support with an intraaortic balloon pump (IABP) is controversial, in part because it has not been performed frequently enough to base treatment policy on adequate data. To help clarify this problem, 733 cases of consecutive patients who were supported by IABP between 1967 and 1982 were analyzed. Twenty-seven patients were supported for 20 days or more (range 20 to 71). Twelve (44%) had prior histories of chronic congestive heart failure. Complications were more frequent in prolonged-support patients than in those assisted for less than 20 days (vascular, 37% vs 15%, p = 0.001; infectious, 67% vs 25%, p = 0.0001; and bleeding, 26% vs 15%, p = 0.04, respectively). The survival rate of prolonged-support patients, however, was 63% (17 of 27), essentially the same as that of the controls (57%, p = 0.5). Of 17 prolonged-pumping patients discharged alive from the hospital, 9 died within 6 months but 8 survived greater than 2 years. Among congestive heart failure patients, none was a long-term survivor. Prolonged IABP support in congestive heart failure patients lacking surgically correctable lesions can extend life while arrangements for definitive therapy are made (transplant, permanent mechanical assistance). Where definitive therapy is unavailable, IABP may provide additional months of life.

Adult↗
PubMed1988

Risks associated with intraaortic balloon pumping in patients with and without diabetes mellitus.

Between 1967 and 1982, intraaortic balloon pumping (IABP) was attempted in 733 patients. Of these, 132 were diabetic: 51 patients were managed with diet alone, 46 patients took oral hypoglycemic agents and 35 patients required insulin. Vascular complications associated with IABP occurred in 34% of the insulin-dependent diabetics, in 18% of other diabetics and in 14% of nondiabetic patients. Infectious complications were 37, 22 and 25%, respectively. Seventy-five diabetic patients (57%) were discharged alive from the hospital after balloon pumping, essentially the same proportion as among nondiabetic patients (58%). It is concluded that although diabetics incur a higher complication rate, IABP is not contraindicated.

Adult↗
PubMed1987

Intraaortic balloon pump insertion: a randomized study comparing percutaneous and surgical techniques.

To compare the percutaneous and surgical techniques of intraaortic balloon pump insertion, 101 patients referred for this procedure were randomly assigned to either percutaneous or surgical insertion. Insertion using the designated technique was successful in 45 (88%) of 51 patients with percutaneous insertion and 48 (96%) of 50 patients with surgical insertion (difference not statistically significant). The time from the beginning of the insertion procedure to the initiation of counterpulsation was 13 +/- 8 minutes for the percutaneous technique versus 31 +/- 16 minutes for the surgical technique (p less than 0.001). In the percutaneous group, 10 patients required Fogarty thrombectomy after balloon pump removal, and 1 patient developed severe leg ischemia requiring immediate termination of balloon pump support. In the surgical group, one patient developed leg ischemia requiring surgical intervention, three patients developed sepsis with bacteremia (including one patient who required vein patch repair of the femoral artery), one patient developed a wound infection requiring debridement and one patient had a cerebral embolus. Aortic dissection, aortoiliac perforation or amputation did not occur in either group. Major vascular complications occurred in 11 patients (22%) with percutaneous insertion versus 2 patients (4%) with surgical insertion (p less than 0.05). It is concluded that although the percutaneous technique for intraaortic balloon pump insertion is faster than the surgical technique and is technically easy, it is associated with a higher incidence of vascular complications.

Blood Pressure↗
PubMed1986

Intraaortic balloon pumping 1967 through 1982: analysis of complications in 733 patients.

Between June 1967 and December 1982, 872 attempts at intraaortic balloon pumping (IABP) were made in 733 patients. Nearly 75% of the patients were men; the proportion of women has increased in recent years. The principal indication for IABP support initially was cardiogenic shock, but over the years, preoperative support, weaning from cardiopulmonary bypass and unstable angina have become the primary indications. Complications of IABP were classified and distributed by severity (minor: I [15%] and II [26%]; major: III [3%] and IV [1%]) and type ([vascular [22%], infectious [22%], and bleeding [7%]). Vascular complication rates were higher in women (32 vs 18%; p = 0.0001), in diabetic patients (32 vs 20%, p = 0.003), and in hypertensive patients (27 vs 20%, p = 0.02). These did not vary with the duration of IABP support (range of duration 0 to 76 days). The rate of infectious complications was related to location where IABP was performed (coronary care unit 26%, operating room 12%). The rate of fever and bacteremia increased significantly with duration of IABP support, but the rate of local wound infection did not. In conclusion, most IABP complications are minor, resolve after balloon removal, are related to vascular status of the patient and, with the exception of bacteremia, are independent of IABP duration.

Adolescent↗
PubMed1986

Restoring cardiac function: an emerging spectrum of therapeutic options.

A spectrum of techniques for restoring cardiac function is emerging. Among patients with global congestive heart failure (CHF), cardiac transplantation may help a small minority for whom allografts are available; the total artificial heart may eventually benefit a larger number. For patients with left-sided CHF, parallel-assist techniques maximally augment cardiac output. In-series techniques can help others without major arrhythmias and some residual cardiac output. As compared with parallel assist, in-series methods offer lesser hemodynamic augmentation but greater intrinsic reliability and the possibility of deactivation of support for hours or days without increased risk. Additional advantages include simplicity of management and documented long-term clinical efficacy.

Heart Failure↗
PubMed1984

Prolonged left ventricular dysfunction induced by sequential multifocal ischemic infarcts in dogs.

A method of creating multifocal ischemia in animals leading to left ventricular (LV) functional impairment is described. In a series of 10 mongrel dogs, electrodes were implanted in multiple branches of the coronary arteries. Subsequently, in seven animals, an 800-microA anodal current was applied for 3 h repeatedly over a span of 4-9 weeks. After current application, serum creatine kinase cardiac isoenzyme increased by 12.2 +/- 4.6 U/L (p less than 0.01) and ischemic electrocardiographic changes were consistently present. After an average of 10.7 current applications, all animals were tachypneic on mild exertion. Repeated measurement of LV function demonstrated a substantial reduction in cardiac reserve. No significant changes in three control animals were observed. The animals were sacrificed 80 days (range 49-108 days) after the initial current application. Presacrifice cineangiography and postmortem examination disclosed coronary artery occlusions, stenoses, recanalizations, and collateralization in the distributions expected on the basis of the time elapsed since electrode activation. In all cases, the myocardium exhibited diffuse fibrosis. This method reliably brings about multifocal myocardial ischemic changes in dogs and may provide a chronic LV failure model particularly suitable for the evaluation of LV assist systems.

Animals↗