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Biomedical subjects

B S Alpert

Publications and source records attributed to B S Alpert.

At least 127 records · Page 7Linked to original sources
PubMed1984

Composite metacarpophalangeal joint reconstruction in great toe-to-hand free tissue transfers.

he recommended technique of skeletal fixation of great toe-to-hand free tissue transfers for thumb reconstruction is related to the length of the first ray present. When the entire first metacarpal is intact, fusion of the disarticulated great toe proximal phalanx to the metacarpal head has been described. Another possibility in this selected situation with cartilage present on the metacarpal head is to reconstruct a new metacarpophalangeal (MP) joint from a cuff of collateral ligaments and plantar plate on the proximal phalanx, anchored to the metacarpal head. In a series of 45 great toe-to-thumb transfers, eight were done with a composite MP joint reconstruction technique. A description of this technique and clinical results are presented. Based on the results in these patients, this technique should be considered as an alternative to joint fusion when the entire first metacarpal is intact.

Adult↗
PubMed1984

Resolution of prostaglandin-induced cortical hyperostosis in an infant.

Prostaglandin E1 (PGE1) has been used to preserve patency of the ductus arteriosus in various forms of congenital heart disease. Long-term PGE1 therapy often leads to the roentgenographic findings of cortical hyperostosis, similar to those seen in infectious or metabolic diseases. These periosteal reactions regress after cessation of PGE1 therapy and should not prompt further diagnostic evaluation.

Adult↗
PubMed1983

Exercise-induced cardiac dysfunction in sickle cell anemia. A radionuclide study.

Cardiac performance was studied by radionuclide angiography at rest and during exercise in 22 adolescents with sickle cell (SC) anemia and the results were compared with those in 12 control subjects. At rest, cardiac contractility was normal; cardiac output and end-diastolic volume were increased. At maximal exercise, heart rate, cardiac output response, and work capacity were reduced; the reduction was related to the degree of anemia. Left ventricular end-diastolic volume decreased with exercise most markedly in patients with ischemic exercise electrocardiograms. An abnormal ejection fraction response to exercise occurred in 4 patients; electrocardiographic signs of ischemia developed in all 4, and wall motion abnormalities in 2. Those patients who had electrocardiographic signs of ischemia had a significantly lower heart rate, ejection fraction, and cardiac output response to exercise, and a lower hematocrit level than subjects with normal results on exercise electrocardiography. The increase in cardiac output was not sufficient to maintain a normal level of exercise. The decrease in end-diastolic volume suggests that diastolic function was abnormal during exercise. Cardiac dysfunction was manifested by an abnormal ejection fraction response, wall motion abnormalities, and incomplete left ventricular filling during exercise.

Adolescent↗
PubMed1983

An evaluation of five indices of physical working capacity in children.

The purposes of this study were 1) to analyze race, sex, and body surface area (BSA) differences in the mean work to exhaustion index, maximal endurance index, rate-pressure product, maximum power, and physical working capacity index (PWC) of 383 healthy children, ages 5-16 yr, by using an alternative method of statistical analysis than has been used in previous studies of this type; and 2) to determine which index best measures relative physical working capacity in children. As a result of a three-way analysis of variance test, strong interaction effects were found among race, sex, and BSA on all but one of the indices. In general, the results indicated that the differences between males and females and between blacks and whites in physical working capacity were not consistent across all BSA groups. This suggests that normal values for these indices should be separated into race, sex, and BSA groupings. Based on correlation coefficients, it was also found that all the indices except PWC were biased by age and height differences. In addition, PWC was the only working capacity index to discriminate properly among underweight, normal, and overweight children. It was concluded that of the five indices tested, PWC was the best index of relative physical working capacity for use with children.

Blood Pressure↗
PubMed1983

Replantation of the upper extremity.

In recent years, the functional results after replantation surgery have improved with increased experience. Stiffness remains as the single greatest postoperative problem. Improvements in this area are now possible with aggressive and closely supervised postoperative hand therapy and splinting. The efficiency of the replantation effort itself has increased dramatically in the hands of a number of surgeons experienced in replantation working together as a team. Once vascular flow to an amputated part has been reestablished, the injury is converted to a complex upper extremity injury that would be treated aggressively by many surgeons trained in this discipline. The stigma associated with the amputated part as being one to which function may never be restored has largely been eliminated. One thing is certain ... missing digits never function.

Adult↗
PubMed1982

Responses to exercise in children with sickle cell trait.

To determine whether responses to exercise in children with sickle cell trait (AS) are different from those of normal children, we performed dynamic cycle ergometer stress testing in 48 children with AS, aged 4 to 21 years. We compared these data with those obtained from 184 healthy black children. No subject with AS demonstrated definite ischemia on the exercise ECG, but four (8.3%) had equivocal ischemia. Population statistics derived from Z score values showed that the subjects with AS had lower exercise values for heart rate and work load than the controls. The BP response to exercise was normal in subjects with AS. Since no ischemia or complications occurred, exercise in subjects with AS appears to be safe. Further studies are needed to define the mechanism for the impaired pulse rate and work load variables.

Adolescent↗
PubMed1982

Automated blood pressure measurement during ergometer exercise in children.

The measurement of systolic and diastolic blood pressure during exercise is often difficult to perform due to patient motion and environmental noise. We evaluated an automated system of blood pressure determination in 121 children undergoing cycle ergometer stress testing. The system (Critikon Model 1165) utilized acoustic transduction, with electrocardiogram gating and microprocessor signal filtering. One observer measured the blood pressure values from the same arm as the automated system; this observer was blinded to the readout of the system. The correlation coefficients for systolic blood pressure at rest, during exercise, and during recovery were all greater than 0.91, and improved with the use of a stethophone adapter. This system can eliminate intraobserver variation as well as the necessity for the technician or physician to direct attention away from the electrocardiogram and patient during stress testing.

Adolescent↗
PubMed1982

Exercise-induced ventricular tachycardia.

Exercise tests were done on all patients referred to us because of ventricular premature beats. Exercise-associated ventricular tachycardia was seen in three of these patients. Once therapy for the arrhythmia was begun in two patients, we performed serial exercise tests, attempting to provoke the arrhythmia again. In the third patients, who was pregnant, we advised against strenuous physical activity and will exercise her post partum to determine whether therapy is warranted. We have shown that exercise testing can be used successfully in unmasking ventricular arrhythmias not detectable on resting evaluation.

Adolescent↗
PubMed1982

Responses to ergometer exercise in a healthy biracial population of children.

To determine normal values for the exercise variables heart rate, blood pressure, maximal workload, physical working capacity index, J point displacement, and ST segment slope, we stress tested 405 healthy children. We analyzed the data for four body surface area-determined groups, to discover whether there were any racial differences between healthy white children and black children. There were numerous racial differences in blood pressure, maximal workload, and physical working capacity index; there were no differences in the heart rate values. The incidence of false-positive J point displacement was less than or equal to 3% when the PR isoelectric line method was used. The ST segment slope in healthy children was always greater than zero at maximal exercise. Thus, norms for exercise variables must be expressed in relation to both sex and race. The nomograms presented in this report provide an easy-to-use set of normative data for cycle ergometer stress testing in children.

Adolescent↗
PubMed1982

Free latissimus dorsi muscle flap with split-thickness skin graft cover: a report of 16 cases.

Use of the latissimus dorsi free muscle flap was split-thickness skin graft for coverage of large defects has advantages over the musculocutaneous flap. The flap is less bulky, and contouring at the recipient site is facilitated. The donor site is less conspicuous. This method has been useful in treating large scalp and lower-extremity wounds even when there has been chronic infection.

Adolescent↗
PubMed1982

Surgical treatment of the totally avulsed scalp.

Scalp avulsion is associated with significant physical and psychological morbidity. In the past, extended hospitalizations and multiple procedures to achieve coverage were the rule and the chronic morbidity of partial thickness coverage was high. Microvascular surgery now allows an initial chance for successful replantation or a subsequent one-stage reconstruction with well-vascularized tissue with a 90 per cent chance of success. The use of the free latissimus dorsi muscle has been a significant advance in this regard. When progress in immunologic research allows allotransplantation with little morbidity, scalp transplantation may become a useful reconstructive tool.

Female↗
PubMed1982

Prostaglandins and the management of congenital heart disease.

Either continued patency or closure of the ductus arteriosus is needed to improve survival of infants with certain kinds of congenital heart disease. In many of these infants, the use of prostaglandin (PGE1) or a prostaglandin synthetase inhibitor (indomethacin) permits clinical stabilization in preparation for surgery or makes surgery unnecessary. Although these forms of therapy carry some risk, the risk does not outweigh that of the untreated congenital defects.

Age Factors↗