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Biomedical subjects

B B Milstein

Publications and source records attributed to B B Milstein.

17 recordsLinked to original sources
PubMed1991

The Cardiothoracic Society (Pete's Club) 1959 to 1989.

Pete's Club was founded in 1959 by a group of young thoracic surgeons from the United Kingdom at a time when new operative techniques for the surgery of the lung and the oesophagus, together with the feasibility of open-heart surgery following the development of the artificial heart-lung machine, allowed a rapid expansion of this branch of surgery. Unrecognised problems were frequently encountered and therefore the constitution of the Club declared that the scientific business should be the discussion of mistakes and errors of judgement. No member was allowed to report a case which reflected credit on himself. In 1969 members were elected from the European continent and in 1981/1982 from Canada, the United States of America, Australia and New Zealand. The development of the Club is described, together with an assessment of its contribution to the present day safety of cardio-thoracic surgery.

History, 20th Century↗
PubMed1986

Empyema thoracis and infected pneumonectomy space: case for cyclical irrigation.

Between January, 1974, and July, 1984, 63 cases of pleural empyema were treated at Papworth Hospital, Cambridge. Twenty-one of these patients had cyclical irrigation of the empyema cavity, and 23 patients underwent decortication. The two groups were comparable in age and sex distribution. There was no significant difference in the duration of empyema between the two groups (7 and 10.4 weeks for the patients having irrigation and decortication, respectively) (p greater than 0.05). There was no correlation between the duration of empyema and the length of hospital stay in either group (r = 0.007 and 0.005 for the irrigation and decortication groups, respectively). However, both the mean duration of tube drainage (7 and 13.5 days) and the length of hospital stay (12.3 and 17.3 days) were significantly shorter in the irrigation than in the decortication group (p less than 0.01). There were two failures in the decortication group and three in the irrigation group. Cyclical irrigation was also used in 4 patients with infected pneumonectomy space with satisfactory results. We conclude that cyclical irrigation is an effective, simple, and time-saving technique that does not preclude the use of other procedures if it fails.

Adolescent↗
PubMed1985

Role of automatic staplers in the aetiology of bronchopleural fistula.

The incidence of bronchopleural fistula in 130 patients who had pneumonectomies has been reviewed. Patients were divided into two groups according to the type of automatic stapler used to close the bronchus. From January 1979 to February 1982 the parallel jaw stapler (TA-55) was used in 71 patients (group 1). The new hinged jaw stapler (Premium TA-55) was used in 59 patients from March 1982 to April 1984 (group 2). The incidence of bronchopleural fistula was 4.2% in group 1 and 15.2% in group 2 (p less than 0.05). The two staplers were tested on a cadaveric bronchial preparation. Radiographs were subsequently taken of the stapled segments. These showed that with the Premium TA-55 closure of staples was not uniform, being incomplete near the hinge unlike the old style TA stapler, which achieves complete and uniform closure of the staples. It is concluded that this undoubtedly contributes to the significantly higher incidence of bronchopleural fistula, and that the new hinged jaw stapler in its present design is not recommended for use during pneumonectomy.

Bronchial Fistula↗
PubMed1985

Haemodialysis and haemofiltration on cardiopulmonary bypass.

Over a three year period we have used haemodialysis and haemofiltration in parallel with cardiopulmonary bypass in 26 patients. Impaired renal function and excessive fluid retention have been the main indications. Patients on haemodialysis programmes for end stage renal failure did not require further dialysis until at least the third postoperative day, when they could tolerate the haemodynamic disturbance of dialysis. In the other patients these techniques proved valuable in reversing the effects of haemodilution and in controlling the concentration of serum potassium. Our experience has confirmed that haemodialysis and haemofiltration in parallel with cardiopulmonary bypass are useful adjuncts in the perioperative management of patients with impaired renal function undergoing open heart surgery. The techniques are also effective in correcting the fluid retention and biochemical imbalance in patients with congestive cardiac failure, including those with heart transplants.

Adolescent↗
PubMed1978

Heart valve replacement in the elderly.

From January 1973 to December 1976, 70 operations for heart valve replacement were performed on 68 patients aged 65--75 years. These comprised 40 aortic valve replacements, 27 mitral valve replacements, and three aortic and mitral valve replacements. Three patients died within 30 days of operation (early mortality 4.3%), and five died 12 weeks to three years after operation. Four patients showed no improvement. The results were excellent or good in the remaining 56 patients. Valve replacemnt can restore to a useful independent life elderly patients who would otherwise be a burden on costly social and medical domiciliary services. The indications for valve surgery in the elderly should therefore be the same as in any other age group.

Aged↗
PubMed1978

Esophageal intubation in the management of perforated esophagus with stricture.

Insertion of a Celestin tube was employed in the treatment of 5 elderly patients who sustained perforations of the thoracic or abdominal esophagus during dilation of benign or malignant strictures. Two perforations treated within 24 hours were closed by direct suture in addition to intubation. There was a delay of 24 to 48 hours between the occurrence of the perforation and treatment in the other 3 cases. Only 1 of the latter patients subsequently developed pleural effusion, and this responded to drainage. One patient died 3 weeks after intubation; there was no evidence to suggest continued leakage through the perforation. The Celestin tube appears to be effective in sealing off esophageal perforations while healing occurs and merits consideration in the management of esophageal perforations associated with stricture in elderly patients when more radical treatment is not envisaged.

Aged↗
PubMed1978

Repeat open intracardiac operation. Analysis of fifty operations.

Between December, 1972, and February, 1976, 50 open-heart operations were performed on 44 patients who had previously had open cardiotomies. Reasons for reoperation were failure of biological tissue valves (15 cases), failure of mechanical valves (12 cases), paraprosthetic reguritation (nine cases), recurrent or incompletely corrected congenital malformations (eight cases), prosthetic endocarditis (two cases), misdiagnoses (two cases), and miscellaneous causes (two cases). Operations performed included 20 aortic valve replacements, 10 mitral valve replacements, seven double valve replacements, five repairs of paraprosthetic leaks, one tricuspid valve replacement, and seven procedures for congenital defects. There were two deaths within 30 days of operation (operative mortality rate of 4 percent) and six deaths between 7 weeks and 3 years after operation. Postoperative complications were slightly more frequent than in patients undergoing similar operations for the first time. The late functional result was good in the majority (73%) of survivors.

Adolescent↗
PubMed1975

Letter: SI units.

Explore the source record for details and available documents.

Diagnostic Errors↗
PubMed1970

Sinus bradycardia treated by long-term atrial pacing.

A technique for long-term atrial pacing is described. It uses the system whereby power from an external pulse-generator (including battery) is transferred through the intact skin by inductive-coupling. Once installed, there is no requirement for further surgery to effect battery changes, and the patient can control his heart rate over a wide range to suit his needs. It is suggested that pacing by such means may offer a preferable alternative to drug therapy in the treatment of low cardiac output due to pathological sinus bradycardia. Two patients successfully treated in this way are reported.

Arrhythmia, Sinus↗
PubMedDate not supplied

An operation for the treatment of intractable peptic stricture of the esophagus.

The current management of severe strictures of the esophagus resulting from reflux esophagitis is unsatisfactory. A new operation comprising esophagoplasty and intrathoracic fundoplication is described. This preliminary report records the results of this operation in 10 patients. There was one operative death. Of the nine survivors, followed for six months to three years, seven are completely free of symptoms. The remaining two have mild residual symptoms, but no dysphagia.

Aged↗