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Biomedical subjects

H N Neufeld

Publications and source records attributed to H N Neufeld.

At least 145 records · Page 8Linked to original sources
PubMed1980

Aorto-coronary saphenous vein bypass grafting in a patient with a single coronary artery arising from the right aortic sinus.

A patient who presented with severe angina was found to have an ectopic origin of the entire left coronary system, the left main coronary artery arising from the proximal third of the right coronary artery. Atherosclerotic obstructive lesions were present in the right coronary artery, the left anterior descending artery, and the obtuse marginal branch of the left circumflex coronary artery. The three obstructed vessels were bypassed, using autologous saphenous veins. The patient continues to do well 24 months after his operation. We believe that coronary artery bypass should be carried out in symptomatic patients with abnormal coronary anatomy and atherosclerotic disease.

Angina Pectoris↗
PubMed1980

Exercise tests in patients with severe angina pectoris: an angiographic correlation.

Graded submaximal ergometric tests were peformed on 60 patients who suffered from clinically severe angina pectoris, and the results were correlated with their coronary angiograms. The test was positive in 44, negative in 9, and undetermined in 7 patients (defined as failure to reach the target heart rate without ischemic ST changes). Among patients with positive tests, 42 (95%) had obstruction of one to three coronary vessels. Among patients with negative tests, only 3 had significant coronary disease (sensitivity 93%). While all patients suffered clinically from severe "angina pectoris," 8 (15%) had insignificant CAD, and among them 6 had a negative and 2 a false-positive exercise response (specificity 75%). Although ST depression was a good indicator of CAD, its degree did not parallel the severity of the lesions. The peak heart rate on exercise of patients with ischemic ST changes was lower than their target heart rate, suggesting that the heart rate at which ST changes occur constitutes in itself a good indicator of severity. Among the 7 patients with undetermined tests, CAD was found in 6. In these patients the absence of ST changes may be ascribed to extensive myocardial fibrosis, and the only clue to CAD resides in the negative chronotropic response to exercise. Although exercise testing does not always distinguish between normal and CAD patients, it nevertheless constitutes a valuable noninvasive technique for the detection of the high-risk patients.

Adult↗
PubMed1980

Supravalvular aortic and peripheral pulmonary arterial stenoses. A report of eight cases in two generations.

Peripheral pulmonary arterial stenosis, either alone or in combination with supravalvular aortic stenosis, is described in two generations of one family. The last child born in the first generation ws the only fatal case and showed severe narrowing and thrombosis of the pulmonary arteries and significant narrowing of the descending aorta. Physical and mental development were normal in the seven surviving patients. Five had slight dyspnea on effort. Hemodynamic and angiocardiogrphic studies showed multiple peripheral pulmonary stenosis in six patients and supravalvular aortic stenosis or aortic hypoplasia in the last three of the first generation and in one of the second generation. The younger children were more severely affected. A marked systolodiastolic caliber variation of the main pulmonary arteries was noted angiographically in all those studied. We suggest that this finding can be used as an indirect sign of the presence of peripheral pulmonary arterial stenosis.

Aortic Valve Stenosis↗
PubMed1979

Complete heart block in an adult with corrected transposition of the great arteries treated with permanent pacemaker.

A 53-year-old patient with corrected transposition of the great arteries developed complete heart block with fainting episodes. After temporary pacing through the endocardium of the venous (anatomically left) ventricle, a permanent epicardial pacemaker was implanted. This case shows the progressive nature of the atrioventricular conduction disturbances, which are very common in association with this congenital cardiac anomaly.

Heart Block↗
PubMed1979

Steady-state serum quinidine concentration: role in prophylactic therapy following acute myocardial infarction.

Steady-state serum quinidine concentrations were monitored in 24 patients with acute myocardial infarction who were on a 1,300-mg daily dosing regimen. Mean serum concentrations spanned the therapeutic range, from 2 to 6 microgram/ml in 21 patients. In no patient was the level of 7 microgram/ml exceeded. Mean levels were similar in patients with congestive heart failure [3.6 +/- 1.5 (SD) microgram/ml] as in those free of failure (3.2 +/- 1.3 microgram/ml), and did not vary with impairment of renal function. There was a significant correlation between mean individual serum quinidine concentrations and the rate-normalized QT interval prolongation (r = 0.54, P less than 0.01); however, variability of the response was high. Variability of the mean serum quinidine levels among individuals was 41%. Variability within individual patients was only 18%. In the individual patient receiving prophylactic oral quinidine therapy, monitoring serum quinidine levels appears to be an accurate, reproducible and pharmacologically significant guideline to therapy.

Adult↗
PubMed1978

Right aortic arch with left descending aorta (circumflex aorta). Roentgenographic diagnosis.

Right aortic arch with retroesophageal segment is a rare anomaly with distinctive roentgenographic features. We present 2 patients, who on the barium oesophogram had an additional finding which has not previously been described. The typical features include an indentation on the right upper barium filled oesophagus (in the antero-posterior view), an oblique indentation descending from right to left (caused by the retroesophageal segment) and the left descending aorta. The oblique identation has not previously been described. The embryology and incidence of the lesion are briefly discussed.

Aorta, Thoracic↗