Biomedical subjects
Publications and source records attributed to E T Gelfand.
A 33-year-old woman, 6 years after placement of a Wada-Cutter prosthesis, suffered from free mitral regurgitation secondary to the dislodgement of the disc occulder into the left atrium. She was operated on approximately 14 hours after the onset of symptoms and survived; this patient is the third reported survivor following dislodgement of a Wada disc.
Hypothermic asanguineous perfusion has been used to arrest 170 hearts at the beginning of 1/2 to 2 hours of intraoperative coronary ischemia. This method of producing cardioplegia has facilitated valve replacement and coronary artery bypass operations. Inadequate myocardial protection has not been experienced since we began using this method of arresting the heart for cardiac operations.
A bullet migrated from the heart to the left femoral artery in a youth ten days after he sustained a gunshot wound to the right chest. The bullet apparently traversed the pulmonary venous system at the time of the injury and lodged in the interior of the left ventricle. The production of an embolism in the systemic circulation was a delayed and unanticipated event.
A case of accidental pneumatic rupture of the thoracic esophagus in a 6-year-old boy is reported. Early operation with transthoracic esophageal repair resulted in survival of the patient, and follow-up at 18 months has demonstrated normal esophageal function and anatomy. A search of the literature has yielded 11 similar cases.
A melanotic malignant schwannoma of the right atrium occurring in a 14-year-old girl is described. No previous such tumors in this location have been reported.
The cases are described of two patients with pulmonary eosinophilic granuloma who presented with spontaneous pneumothorax. Prolonged air leak and recurrence of the pneumothorax after initial re-expansion of the lung occurred in both patients. In one of the patients the pneumothorax was simultaneously bilateral and almost complete.Thoracotomy, with aggressive and total pleurodesis, is recommended in the management of these patients to prevent recurrence and complications. Lung biopsy should be performed in all patients undergoing thoracotomy for recurrent pneumothorax.
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A 17-year-old boy presented with severe chest pain which partially subsided on anti-inflammatory medication. Five week later he was admitted with fully developed cardiac tamponade. Within five days surgical exploration revealed an nonresectable right atrial tumour. Management of angiosarcoma of the heart is discussed.
A total of 228 Omniscience cardiac valve prostheses were implanted in 210 patients at two hospitals in Canada from November, 1979 to August, 1984. The 184 operative survivors were followed for a mean duration of 28.5 months (maximum 62.7 months) and for a total of 438 patient-years. Actuarial analysis for AVR, MVR, and all patients showed survival probabilities at five years of 97.2%, 98.9%, and 97.0% respectively. The five-year actuarial probabilities of remaining free of any thrombotic complications were 96.9% for AVR, 96.4% for MVR, and 95.7% overall. When considering only serious thrombotic complications (thromboembolism with deficit or valve thrombosis), the event-free rates are 100% for AVR, 98.9% for MVR, and 98.6% for the overall patient group at five years. These rates for survival and freedom from thrombotic complication demonstrate the clinical safety and effectiveness of the Omniscience prosthesis. In addition, there were no cases of structural failure or intrinsic mechanical malfunction of the prosthesis.
A computer-assisted system has been developed to store, retrieve and analyze medical and surgical data on patients undergoing coronary bypass surgery. The analysis ranges from a simple summary tabulation to a more advanced prognostic evaluation of the risk of coronary bypass in an individual candidate for the operation. Data can be displayed on the terminal's screen or printed in a hard copy and used for clinical or administrative purposes. The system can be operated with no knowledge of computers or programming and requires only minimal typing skills.