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Biomedical subjects

E B Diethrich

Publications and source records attributed to E B Diethrich.

At least 109 records · Page 6Linked to original sources
PubMed1988

Symptomatic sinus node dysfunction after heart transplantation.

When donor hearts are studied systematically after transplantation, by programmed electrical stimulation, sinus node dysfunction has been found to be common though data regarding symptoms related to this phenomenon are not available. In this case report we describe a heart transplant recipient who experienced serious symptomatic sinus node dysfunction associated with transient atrial fibrillation 17 days after cardiac transplantation; there was no evidence of donor heart rejection. Intracardiac electrophysiology testing confirmed sinus node dysfunction of the donor heart, but only with relatively rapid atrial pacing rates.

Adult↗
PubMed1987

Postoperative complications necessitating right lower lobectomy in a heart-lung transplant recipient with previous sternotomy.

Heart-lung transplantation for treatment of end-stage cardiopulmonary disease continues to be plagued by many problems. Three primary ones are the technical difficulties that can be encountered, particularly in those patients who have undergone previous cardiac operations, the additional restriction on donor availability imposed by the lack of satisfactory preservation techniques, and the need for lung size compatibility. Two of these difficulties and others surfaced postoperatively in a heart-lung transplant recipient who presented a series of unique operative and therapeutic challenges. A 42-year-old woman with chronic pulmonary hypertension and previous atrial septal defect repair underwent a heart-lung transplantation in August 1985. The operative procedure was expectedly complicated by bleeding from extensive mediastinal adhesions from the previous sternotomy and bronchial collateralization. Excessive chest tube drainage postoperatively necessitated reoperation to control bleeding from a right bronchial artery tributary. Phrenic nerve paresis, hepatomegaly, and marked abdominal distention caused persistent atelectasis and eventual right lower lobe collapse. Arteriovenous shunting and low oxygen saturation necessitated right lower lobectomy 15 days after transplantation, believed to be the first use of this procedure in a heart-lung graft recipient. Although oxygenation improved dramatically, continued ventilatory support led to tracheostomy. An intensive, psychologically oriented physical therapy program was initiated to access and retrain intercostal and accessory muscles. The tracheostomy cannula was removed after 43 days and gradual weaning from supplemental oxygen was accomplished. During this protracted recovery period, an episode of rejection was also encountered and successfully managed with steroid therapy. The patient continued to progress satisfactorily and was discharged 83 days after transplantation. She is well and active 20 months after discharge.

Adult↗
PubMed1985

Comparison of various oculoplethysmography modalities.

This article compares the accuracy of commonly used oculoplethysmography (OPG) equipments--OPG/Gee, OPG/Kartchner, and OPG/Zira--in the detection of significant carotid stenosis. The first 200 patients (400 carotid arteries) with readily available carotid arteriograms were selected from each of the following categories: OPG/Kartchner, OPG/Gee, and OPG/Zira, making a total of 600 patients. The radiologic findings were divided into two categories: the first included patients with normal carotid arteries or vessels with less than 50% stenosis, and the second included patients with carotid stenosis greater than or equal to 50%. The results of OPG/Zira, OPG/Kartchner, and OPG/Gee are listed respectively: diagnostic sensitivity of 88.88%, 92.6%, and 96.0%; diagnostic specificity of 86.77%, 90.7%, and 91.8%; false positive rate of 6.0%, 5.1%, and 3.6%; false negative rate of 22.7%, 13.0%, and 8.9%; overall diagnostic accuracy of 88.25%, 92.0%, and 94.8%; and accuracy in determining bilateral carotid stenosis of 66.0%, 79.0%, and 89.5%. We concluded that the three machines were valuable in the diagnosis of normal carotid arteries and significant unilateral carotid stenosis. However, the OPG/Gee had slightly better overall accuracy and was more valuable in the diagnosis of significant bilateral carotid stenosis. The OPG/Kartchner had the advantage of being applicable in patients with extreme hypertension and cardiac arrhythmias. The OPG/Zira was limited in the diagnosis of bilaterally significant carotid stenosis.

Arterial Occlusive Diseases↗
PubMed1982

Successful reversal of brain damage from iatrogenic air embolism.

During an aortocoronary bypass procedure, the patient suffered an air embolism arising from technical difficulties with the extracorporeal circulatory device. Initial emergency treatment included a loading dose of thiopental concomitant to a one hour period profound hypothermia. A modified protocol for treating patients with acute head injuries was the initiated. It combined moderate hypothermia with continuous barbiturate coma for 96 hours. Brain activity in this patient returned on the third postoperative day. She recovered completely, with no detectable neurologic damage.

Brain Diseases↗
PubMed1981

Simplified operative procedure for proximal subclavian arterial lesions: direct subclavian-carotid anastomosis.

An operative approach to treatment of proximal subclavian occlusive lesions was used in 11 patients with claudication of the arm, vertebrobasilar insufficiency or subclavian steal syndrome. Through a supraclavicular incision, the subclavian artery is isolated proximal to the vertebral origin, dissected from the periarterial tissue into the mediastinum and then clamped above the atherosclerotic lesion. The artery is transected and the proximal end closed. The distal portion of the subclavian is then anastomosed end-to-side to the common carotid either in front of or behind the internal jugular vein. This procedure, applicable to right or left subclavian occlusive or ulcerative lesions, is particularly advantageous since it avoids major thoracotomy and the use of prosthetic bypasses in the neck. Postoperative noninvasive and angiographic evaluation in this series of patients indicates that the technique is simple, effective and without complications, making it preferable to existing procedures.

Aged↗
PubMed1980

Doppler testing in peripheral vascular occlusive disease.

One hundred and twenty-five patients received both lower limb arterial Doppler ultrasonics examinations and arteriographic tests. From the 250 limbs, 963 segments--iliofemoral, femoral, popliteal and popliteal trifurcation--were measured. Arteriography confirmed 649 of the 673 normal ultrasound results, while of the 290 abnormal ultrasound tests, 261 were documented by arteriography. Combining all segments, 910 were accurately defined by the Doppler ultrasonic technique for a reliability factor of 95 per cent. This simple, inexpensive, noninvasive technique was judged to be highly reliable in detecting and assessing occlusive lesions of the peripheral arterial system, making it a valuable adjunct to the evaluative procedure for patients with peripheral vascular occlusive disease.

Adult↗
PubMed1979

Doppler ultrasound in evaluating the localization and severity of peripheral vascular occlusive disease.

We studied 150 arterial Doppler examinations on 150 patients by obtaining segmental pressures and the analogue wave tracings, and comparing the ankle/arm index to the arteriograms. Each limb was divided into iliofemoral, femoral, popliteal, and trifurcation segments. Of the 793 segments interpreted as normal by arterial Doppler, 758 were confirmed, with 96% true-negative and 4% false-negative results. Of 364 segments shown by arterial Doppler to be abnormal, 328 were confirmed by the arteriogram, ie, 90% true-positive and 10% false-positive results. Thus, a total of 1,157 segments were studied, with 94% correlation with the arteriogram in localizing the peripheral vascular occlusive disease. The ankle/arm index is helpful in determining the severity of the disease. The majority of patients with an ankle/arm index of 0.6 to 0.8 have significant disease. An index of less than 0.6 is indicative of severe disease.

Adult↗
PubMed1979

Treatment of microemboli of the upper extremity.

A patient with microembolism of the left hand from an ulcerated lesion in the proximal part of the left subclavian artery was treated by a simple procedure for removing the embolic source from the arterial circulation. Through a supraclavicular approach, the subclavian artery was divided from the aorta distal to the lesion and anastomosed to the left common carotid artery. This technique was effective not only in restoring unobstructed distal circulation but also in avoiding the use of the more complicated thoracotomy.

Aorta, Abdominal↗
PubMed1979

Left atrial myxoma: association with acute coronary embolization in an 11-year-old boy.

An 11-year-old boy had clinical signs of an acute inferior wall myocardial infarction. On echocardiography, a left atrial myxoma was demonstrated. Coronary artery embolization from myxoma was confirmed by selective coronary arteriography. The tumor was removed 12 days after acute coronary embolization. The clinical value of echocardiography is demonstrated in this report of a successful surgical excision of left atrial myxoma in a child with a myocardial infarction due to tumor embolization.

Child↗
PubMed1977

Pseudoaneurysm of atrioventricular groove. A late complication of mitral valve replacement.

This report describes an unusual late complication of mitral valve replacement in which a false aneurysm of the atrioventricular groove produced compression on the circumflex coronary artery and myocardial infarction. The cause of this condition is not well explained, but its potential is present whenever there is early separation of the mitral anulus from the fibrous skeleton of the heart. Early hematoma formation resulting in frank perforation and hemorrhage has been reported, but late pseudoaneurysm formation after initial mitral valve replacement appears to be a rare occurrence.

Adult↗
PubMed1975

Transmyocardial left-to-right shunt complicating acute inferior wall myocardial infarction after aortocoronary bypass.

A 61-year-old woman suffered an inferior wall myocardial infarction on the third day following aortocoronary bypass surgery. Her condition subsequently deteriorated and she was not responsive to vigorous conventional therapy. On the twenty-first postoperative day, selective coronary arteriography revealed a patent circumflex bypass graft and an occluded right coronary artery bypass graft. Left ventricular injection showed slight dilation of the ventricle and a reduced ejection fraction. A dissection from the left ventricular cavity into the myocardium, across the septum near the apex of the left ventricle with rupture into the right ventricle, was seen functioning as a left-to-right shunt with a step-up in oxygen saturation at that level. This was corrected by operation on the twenty-ninth postoperative day and, 9 months after operation, the patient remains asymptomatic and has normal exercise tolerance.

Cardiac Catheterization↗