A severe complication of pulmonary vein angiography.
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Angiography↗
Biomedical subjects
B S Alpert
Publications and source records attributed to B S Alpert.
Spontaneous closure of small ventricular septal defects: ten-year follow-up.
The natural history of small ventricular septal defect (VSD) was studied in 50 infants for up to 10.5 years. The VSD closed spontaneously in 34 patients. Life-table analysis of the data showed that by 10 years of age, 75% of small VSD will close spontaneously; the figure is higher for defects in the muscular septum (83%).
Child↗
Multilating multidigital injuries: use of a free microvascular flap from a nonreplantable part.
In severe hand injuries, all usable parts should be salvaged from amputated nonreplantable areas. A case is presented in which a free flap taken from an amputated finger was used to reconstruct a severely injured but viable remaining digit. This was done as part of the primary reconstructive effort and provided a well vascularized protective cover for the surviving injured digit.
Adult↗
Replacement of damaged arteries and veins with vein grafts when replanting crushed, amputated fingers.
Two cases are presented in which multiple vein grafts were used to revascularize several digits in hands injured by severe crushes. One case had partial amputations of 4 digits, and the other had 4 complete amputations. After debriding the damaged parts of the vessels, we interposed vein grafts in both the arterial and venous circulations to the digits. Seven of 8 revascularized digits survived. In crushing injuries, it is essential to debride the vessels proximally and distally to where the intima has not been injured. To bridge the gaps, vein grafts can be used successfully where other methods are undesirable or impossible.
Adolescent↗
Spontaneous closure of small ventricular septal defects. probability rates in the first five years of life.
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Age Factors↗
Discrete subaortic stenosis after successful treatment of congenital aortic valve stenosis.
Two cases of discrete subaortic obstruction which developed in a previously normal left ventricular outflow tract of patients with congenital valvar aortic stenosis are described. These examples emphasize the need for careful scrutiny of the etiology of recurrent postoperative left ventricular outflow tract obstruction.
Aortic Valve Stenosis↗
The contributions of microvascular surgery to emergency hand surgery.
Microvascular surgery has revolutionized the field of emergency hand surgery in the areas of replantation and microvascular transplantation. Amputated parts from as small as a distal phalanx to the entire extremity can now be successfully replanted and unreplanted, or missing parts can be restored and reconstructed with immediate microvascular transplants (MVTs). MVTs can be used to cover exposed vital structures and replace missing complex parts. Part or whole digits can be reconstructed, with up to 4 toe transplants. Joints, bones, and muscles can be replaced with osteocutaneous and neuromyovascular transplants. Using the same approach for multiple replants, teams of 4 to 6 surgeons operating simulatneously and sequentially around the clock can accomplish multiple microvascular transplants in the acute setting. The classical principle of hand surgery, "preserve length and function", can now be modified to "restore length and function."
Amputation, Traumatic↗
Complications of ergometer exercise in children.
To determine the frequency of significant complications of exercise testing in children, we reviewed 1,730 studies performed over a 9-year period, 1973 to 1982. The protocol used a graded, continuous test to maximal effort on a cycle ergometer. The overall incidence of complications was 1.79%, similar to the 1.7% previously reported by Freed [4]. No deaths occurred. Complications were classified into 4 groups with their frequency of occurrence as follows: chest pain (0.69%), dizziness or syncope (0.29%), decreased blood pressure (0.35%), hazardous arrhythmias (0.46%). These data confirm that exercise testing in children has low morbidity and mortality. We believe that the safety of stress testing should encourage physicians to expand its use in the assessment of functional ability.
Adolescent↗
Thermodilution Qp/Qs: an indicator dilution method.
The pulmonary-to-systemic blood flow ratio (Qp/Qs) is critical in the appraisal of the need for surgery in patients with left-to-right shunts. Because of the drawbacks present with conventional Fick, indicator dilution, and radionuclide techniques of Qp/Qs measurement, we sought to determine whether an extension of thermodilution technology could accurately predict Qp/Qs. We studied 30 children with clinically suspected or postoperative atrial or ventricular septal defects. The thermodilution temperature curves from the pulmonary artery were printed on a strip chart recorder after right atrial injection of iced solution. Gamma variate curve fitting and area analysis were used to determine Qp/Qs. The correlation between Fick and thermodilution Qp/Qs values was excellent (r = 0.95). The thermodilution technique was rapid, and did not require either arterial entry, radiation after venous catheter placement, or multiple sampling.
Cardiac Catheterization↗
Steroid-induced hypertrophic cardiomyopathy in an infant.
This report describes a 14-month-old boy receiving high-dose steroids for hypsarrhythmia and infantile spasms in whom the echocardiographic diagnosis of hypertrophic cardiomyopathy was made. Family studies were negative for hypertrophic cardiomyopathy, but positive for mitral valve prolapse. The steroid dosage was progressively decreased and finally discontinued; the echo was normal within 12 months. In infants receiving long-term steroid therapy, echocardiograms should be performed to monitor myocardial structure and function.
Cardiomyopathy, Hypertrophic↗
Exercise in hypertensive children and adolescents: any harm done?
Hypertensive children and adolescents are frequently arbitrarily excluded from sports or exercise because of the fear of possible complications, such as stroke or myocardial infarction. No hypertensive children have had exercise-related morbidity or mortality in the reviewed literature. No restriction from dynamic exercise seems warranted; training has led to reductions in blood pressure in hypertensive youth. Isometric exercise is more hotly debated. Because no complications of exercise have been reported, the author prefers to allow participation if no target organ damage is present. Life-long maintenance of habitual physical activity may help prevent adult-onset essential hypertension.
Adolescent↗
Microvascular tissue transfer in paediatric patients: analysis of 106 cases.
We report a series of 106 microvascular transplants performed in paediatric patients between 1973 and 1989. Eighty-eight percent of these flaps were successful. Two of the 13 failed flaps (1.9%) in this series were lost because of small vessel size. Otherwise, success rates (93% in the last 5 years) and complications were comparable to our adult cases. No growth-related complications were noted either in recipient or donor sites. We conclude that microvascular transplantation is a reliable procedure in children.
Adolescent↗