Biomedical subjects
A Nacht
Publications and source records attributed to A Nacht.
Intracardiac shunts.
Unsuspected intracardiac shunts can be a cause of acute deterioration in critically ill patients. Shunts can be acquired or congenital conditions that become symptomatic only with changed physiologic conditions. Transesophageal echocardiography is an excellent tool for the diagnosis of intracardiac shunts.
Superiority of transesophageal echocardiography in detecting aortic arch atheromatous disease: identification of patients at increased risk of stroke during cardiac surgery.
It has been shown that transesophageal echocardiography (TEE) is useful in evaluating atheromatous disease of the aortic arch and that such disease is a risk factor for stroke in medical patients. Data obtained by traditional methods of evaluating the aortic arch prior to cardiac surgery, namely, chest x-ray (CXR) and cardiac catheterization (CATH), were compared with that detected by TEE. Images of the descending thoracic aorta and aortic arch seen on intraoperative TEE in 258 cardiac surgical patients were graded as I = normal, II = intimal thickening or plaques < 5 mm thick or with a mobile component (severe disease). The aortic knob seen on CXR in 209 of these patients was graded as normal, < 1/2 or > or = > 1/2 ring of calcification. Calcification in the aortic root (graded as 0, 1+, 2+) and irregularities in the aortic lumen seen at CATH in 33 patients were also examined. Data were analyzed with respect to age, gender, type of surgery, and stroke. Increasing age correlated strongly with increasing severity of aortic arch and descending thoracic aortic disease seen by TEE. Severe disease was not present in patients under age 50 but was present in about 20% of those over age 70. Atheromatous disease was found by TEE in 55% of patients with a normal CXR and 91% of those with heavily calcified aortic knobs. Ischemic strokes occurred in seven patients. Severe arch disease correlated significantly with stroke (P < .01). Other variables did not correlate with stroke.(ABSTRACT TRUNCATED AT 250 WORDS)
The use of blood products in shock.
It is often necessary to transfuse blood products in shock. Use of these products can be life-saving, but they also carry considerable risk. It is important, therefore, that the physician be aware of the indications as well as possible complications, so that a proper decision can be made weighing the risk versus the benefit.
Radial artery pressures compared with subclavian artery pressure during coronary artery surgery.
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