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Biomedical subjects

B S Alpert

Publications and source records attributed to B S Alpert.

At least 109 records · Page 6Linked to original sources
PubMed1986

Pediatric digital subtraction angiography: intraarterial and intracardiac applications.

Intraarterial digital subtraction angiography (IA-DSA) was performed in 80 pediatric patients. Forty-four underwent arterial injections with digital filming techniques. Of the 130 injections, DSA imaging was good or excellent in 121, often allowing resolution of vessels 1 mm in size. Thirty-six of the 80 patients underwent cardiac evaluation with intra-cardiac injections. Improved contrast resolution with IA-DSA allowed the use of smaller catheters (3-4F) and smaller amounts of contrast material. Immediate availability of subtracted images (no film processing delay) resulted in shorter total procedure time. Outpatient studies are possible. IA-DSA provides several notable advantages for the pediatric patient.

Adolescent↗
PubMed1986

Soft-tissue swelling in two neonates during prostaglandin E1 therapy.

Two small neonates, one with hypoplastic right heart syndrome, and the other with tetralogy of Fallot and pulmonary atresia, were treated with intravenous prostaglandin E1 (Prostyn VR, Upjohn, Kalamazoo, Michigan) for 96 and 33 days, respectively. They developed limited cortical hyperostosis, but marked soft tissue swellings in all extremities. The changes were noted after PGE1 treatment for four weeks and one week, respectively. A skin biopsy was performed in one patient and revealed edematous changes and arteriolar wall abnormalities. We add this peripheral hard edema to the list of complications of PGE1 therapy, and speculate as to its pathophysiology.

Alprostadil↗
PubMed1986

Race and cardiovascular reactivity. A neglected relationship.

The magnitude of the cardiovascular response to stress has been implicated in the pathogenesis of cardiovascular disease. Psychological stress procedures have received increased usage as an alternative to expensive physical (exercise) stress procedures. In the present investigation, 213 healthy, black or white, male or female children between the ages of 6 and 18 years were exposed to the psychological stress of a video game. The video game challenge was administered by a black or a white experimenter and was played under three levels of increasing stress, 1) personal challenge, 2) experimenter's challenge, and 3) experimenter's challenge accompanied by a financial incentive, while blood pressure and heart rate were monitored. Results indicated that the video games provoked significant and incremental cardiovascular reactivity across the games. Black children demonstrated significantly greater reactivity than white children; the racial difference was more reliably observed for systolic and diastolic blood pressure than for heart rate. Furthermore, the race of the experimenter exerted a significant effect and often interacted with the race of the child, such that greater reactivity occurred in same-race pairings than in mixed-race pairings. These results suggest that reactivity is affected by an individual's race and social milieu and that reactivity may be one mechanism responsible for the greater prevalence of hypertension among blacks.

Adolescent↗
PubMed1986

Two-dimensional echocardiographic assessment of adequacy of pulmonary artery banding.

The goal of banding the pulmonary artery (PA) in children with complex heart disease is to reduce PA pressure and blood flow, relieve symptoms of circulatory congestion, and insure low pulmonary vascular resistance for future repair. To assess the hypothesis that two-dimensional echocardiography (E) measurements could be used to predict noninvasively the tightness of the PA band by measuring its diameter, we examined 15 patients with PA band. Of the 12 patients who underwent cardiac catheterization, nine with no symptoms of circulatory congestion had distal systolic PA pressure less than 0.5 systemic, and three symptomatic patients had distal PA pressure of more than 0.5 systemic. None had left ventricular outflow tract obstruction or pulmonary vascular disease. The E measurements were the internal diameter of the PA band (d), and PA annulus (D) in diastole. The d/D ratios correlated significantly with the ratios of measured distal to proximal PA systolic pressure (r = 0.98, P less than 0.001). Of the three patients not catheterized, one had a d/D ratio of less than or equal to 0.4 and two greater than 0.4. The former one had an excellent clinical improvement after banding, while the latter two remained in circulatory congestion. Doppler echocardiographic evaluation in five patients did not improve upon the data from the d/D ratios.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1985

"Absent" pulmonary valve with atrial septal defect and patent ductus arteriosus.

The case of a newborn with "absent pulmonary valve," atrial septal defect, and patent ductus arteriosus is reported. He underwent surgical repair at five weeks of age, with closure of the patent ductus arteriosus and porcine pulmonary valve insertion. The clinical course leads us to suggest that reduction of pulmonary artery pressure and pulmonary valve competence will lead to prompt improvement in tracheobronchial compression and respiratory symptoms; no pulmonary arterioplasty is needed.

Abnormalities, Multiple↗
PubMed1985

An unusual complication of a conduit-mounted homograft: valve leaflet fixation in the open position.

Surgical management of left ventricular outflow tract obstruction in patients with complete transposition of the great arteries and an intact ventricular septum is difficult. Direct resection of subpulmonary stenosis has not produced satisfactory results. Thus, relief of stenosis has been accomplished with valved conduits from the left ventricle to the pulmonary artery. Initially, conduit tissue valves were porcine in nature. More recently, human-origin conduit tissue valves have been employed. In this report, we describe an unusual complication in a child with complete transposition in whom a homograft valve conduit was placed from the left ventricle to the pulmonary artery to relieve subpulmonary stenosis. The leaflets became fixed in an open position. Thus, the conduit was converted to a functionally nonvalved communication. The subpulmonary stenosis regressed, allowing egress from both the natural outflow tract and the conduit.

Female↗
PubMed1985

Partial nail plate removal after digital replantation as an alternative method of venous drainage.

Partial nail plate removal, systemic anticoagulation, and the application of topical heparin to the exposed nail bed were used to provide and maintain venous drainage for 14 digital replantations in which an arterial repair but no venous repair was done ("artery only" replantation). In each case venous repair was not possible since no vein of an acceptable size could be found either because of a distal amputation level or because an avulsive or crushing injury had damaged the veins in the amputated part. The average operating time per "artery only" replantation was 2 1/2 hours. Ten of the 14 "artery only" replantations survived (71.4%). The active range of motion, sensibility, strength, activities of daily living, and hospitalization for this group of patients were comparable with replantations in which both arterial and venous anastomoses were done.

Adolescent↗
PubMed1985

Hand reconstruction for multiple amputations by double microsurgical toe transplantation.

Double microvascular toe transplant procedures were used to restore function in 16 mutilated hands. In eight hands, both opposing surfaces were reconstructed with the great toe or second toe used for the thumb and the contralateral second toe for the ulnar side of the hand. In eight hands in which the thumb was still present, two fingers were reconstructed with a second toe from each foot. All 33 transplanted toes survived. In all patients, hand function was substantially improved, with an average of 9.15 pounds of pinch strength between the transplanted opposing digits or the transplanted digit and a normal thumb. Adequate sensibility was restored. The two transplant procedures were done sequentially in six patients, while the two transplantations were performed simultaneously in 10 patients. Simultaneous reconstruction proved time- and cost-effective.

Adult↗
PubMed1985

Serial quantitative skin surface fluorescence: a new method for postoperative monitoring of vascular perfusion in revascularized digits.

Postoperative monitoring of vascular perfusion was performed in 72 revascularized/replanted digits in 40 patients. Sodium fluorescein (1.0 to 1.5 mg/kg) was administered intravenously every 2 hours for 36 to 48 hours beginning immediately after surgery. Quantitative fluorescence readings of each injured digit were obtained 10 minutes after fluorescein injection and were compared with readings from an uninjured (control) digit. A ratio between the fluorescence of the injured digit and that of the control digit was used for analysis. Viable digits had a fluorescein perfusion ratio of 86.4 +/- 16. Digits that did not survive had fluorescein perfusion ratios of 5.2 +/- 10 (p less than 0.001). The results of this study indicate that quantitative surface fluorescence assessment of revascularized/replanted digits is a minimally invasive, and reliable tool for monitoring vascular perfusion.

Child↗
PubMed1985

The Tweener maneuver.

A modification of standard microvascular anastomosis procedure is presented, which helps in training and improves clinical technique by conservation of motion. The speed of anastomosis is at least as rapid as the posterior wall technique on which it is based, and it has the advantage of having fewer unused penetrations of the vessel wall and better eversion of the edges.

Humans↗
PubMed1985

Free flap coverage of the hand.

The microvascular cutaneous transplant, or "free flap", suitable for hand resurfacing is described in detail. Anatomic and clinical indications are stressed, and the operative steps involved in the preparation and transfer of each flap are outlined.

Amputation Stumps↗
PubMed1984

Longitudinal exercise hemodynamics in children with sickle cell anemia.

To define further the natural history and causative factors in exercise-related cardiac dysfunction in children and adolescents with sickle cell anemia (SS), we studied the results of 74 patients' initial and follow-up exercise tests. The follow-up study was done one to three years after the first study in 36 children and four to seven years after initial testing in 38 children. Split-plot analysis of covariance did not show any temporal deterioration in exercise hemodynamic variables. Correlation analysis defined hemoglobin and hematocrit levels as critical determinants of cardiac functional reserve capacity in these patients. Several exercise ECG patterns, formerly considered abnormal in children with SS, are now considered to be variants of normal. Studies are presently in progress that should further define the nature and severity of the cardiac impairment during exercise in children with SS.

Adolescent↗
PubMed1984

Cardiac size and function in children with sickle cell anemia.

Cardiac size and function were studied echocardiographically in 124 children with sickle cell anemia. A group of 78 healthy black children served as control subjects. Sickle cell patients exhibited progressive chamber enlargement and progressively increasing left ventricular mass. Although contractility indices were normal, when the opposing influences of volume overload due to anemia and ventricular dysfunction were separated, abnormalities of systolic time intervals were identified. Left ventricular systolic time interval ratio and left ventricular preejection period were higher in the sickle cell group and became increasingly abnormal with growth, suggesting that left ventricular function deteriorated with time.

Adolescent↗
PubMed1984

Free microvascular transfer of second toe ray and serratus anterior muscle for management of thumb loss at the carpometacarpal joint level.

A 50-year-old machine operator suffered traumatic amputation of the thumb, ring, and small fingers. The thumb had been amputated at the carpometacarpal joint and was reconstructed 6 months later by microneurovascular transplantation of the second toe including the second metatarsal. Opposition was provided and the first web space was released at a second stage by reconstruction with the lowest two digitations of the serratus anterior muscle covered with a split-thickness skin graft.

Amputation, Traumatic↗