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Biomedical subjects

L Gilbert

Publications and source records attributed to L Gilbert.

At least 109 records · Page 6Linked to original sources
PubMed1984

A decade of nuclear pacing.

In April, 1973, a decade-long study was begun on nuclear-powered pacemakers. The first 15 of these were designed by the Numec Corporation under a contract from the United States Atomic Energy Commission. Altogether 151 units powered by the isotope plutonium 238 were implanted in 131 patients; the pacemakers of 4 different manufacturers were used. The last nuclear pacemaker was implanted in January, 1983. The actuarial survival at 10 years was 92%, meeting the original performance goal of the Commission of 90%. Ninety pulse generators are still in service today; 25 patients have died and 36 pulse generators have been replaced with non-nuclear units. The most common indication for replacement was an inappropriate pacing mode. This high reliability and superior performance suggest that continued use of a radioisotopic power source is justified, particularly if combined with the electronic circuits of today's dual-chambered, multiprogrammable, and multifunctional pacemakers.

Equipment Design↗
PubMed1978

Symptomatic unilateral cannon "a" waves in a patient with a ventricular pacemaker.

A 64-year-old woman was referred because of intermittent pulsations of the left side of the neck, face, and scalp that were first noticed after the insertion of a ventricular pacemaker. The pacemaker had been inserted because of symptomatic 2:1 atrioventricular block. Right cardiac catherization showed cannon "a" waves, and phlebographic studies revealed stenosis of the right innominate and internal jugular veins. The symptoms were abolished by conversion to an atrial synchronous pacing system. Comments are offered on the hemodynamic findings, the "pacemaking syndrome", and the use of atrial synchronous pacing.

Brachiocephalic Veins↗
PubMed1978

Facilitation of class-inclusion performance in mildly retarded adolescents: feedback and strategy training.

Two experiments were conducted to explore the feasibility of training mildly retarded adolescents to solve class-inclusion problems. In Experiment 1, the effects of training consisting primarily of feedback were investigated. In Experiment 2, training with feedback alone vs. training with feedback plus a counting strategy was compared. Both experiments assessed the generality of training effects to specific training and/or posttest formats. Results suggested that training was generally effective in improving performance with untrained class-inclusion problems on immediate and delayed posttests. Feedback training with pictorial stimuli appeared to be effective regardless of posttest format. The effects of the other training method/format combinations varied according to posttest format.

Achievement↗
PubMed1976

Vascular complications of intra-aortic balloon pumping.

Vascular injury or occlusion from intra-aortic balloon pumping (IABP) that results in actual or potential limb ischemia occurs more frequently than reported. In a series of 79 IABP patients, 36 lived long enough to have the balloon catheter removed; thirteen (36%) of them had vascular complications. The complications were in three patients with an injury at the insertion site, eight patients with arterial thromboses, and two with arterial occlusion by the large balloon catheter. Local artery revision, thrombectomy alone, or thrombectomy with femorofemoral cross-over grafting was required in 11 patients. Femorofemoral crossover graft was utilized when arterial occlusion would have ordinarily required premature balloon removal or when immediate arterial occlusion by the catheter was recognized at the time of balloon insertion. This was preferable to transferring, replacing, or discontinuing IABP, since the same factors that led to thrombosis in the first place would have eventually come into play again. Patients should be observed frequently and have Doppler limb pulse determinations every four hours to avoid ischemic catastrophies. Proper IABP weaning and the use of a Fogarty catheter at the time of balloon removal is mandatory to prevent complications. Femorofemoral crossover graft is indicated for ischemic limbs when IABP must be continued.

Adult↗
PubMed1976

Endarterectomy of the left anterior descending and mainstem coronary arteries: a technique for reconstruction of inoperable arteries.

The proximal left anterior descending coronary artery (PLAD) is an area of predilection for such severe and diffuse calcific arteriosclerosis that reconstruction of these vessels often is impossible. The branches of this segment include the septal perforators, median artery, the left anterior descending coronary artery, and its first and second diagonal branches. Successful endarterectomy, therefore, would revascularize large areas of the left ventricle and interventricular septum. We have performed 45 such operations during the past 13 months. Following endarterectomy there are several methods of reconstructing the endarterectomized vessel, the preferable technique being the addition of a saphenous vein bypass to the endarterectomized segment. Patients selected for this operation were mostly in the fair (58%) and poor risk (42%) categories; there were no good risk patients. Diffuse arterial disease was the rule. The average ejection fraction was 0.48. The operation was successful with respect to graft patency, bypass flow rates, and symptomatic relief. The operative mortality rate in the entire group was 15%, including the 19 poor risk patients in six of whom elective preoperative use of an antra-aortic balloon pump was required. Most of the surviving patients (92%) were either symptom free or greatly improved. Only two patients were clinically unchanged. There was one late sudden death. This operation is indicated when there is extensive involvement of the life main, the proximal left anterior descending coronary artery and its major branches. It is the only possible way to revascularize otherwise inoperable arteries.

Aged↗
PubMed1975

Fibrinous uremic pleuritis: a surgical entity.

Fibrosing uremic pleuritis is a newly recognized late complication of uremia. Extreme incarceration of the lining and chest wall can occur with disabling restriction of pulmonary function. Decortication of the chest wall and the lung can be carried out safely with minimal bleeding and restoration of pulmonary function.

Adult↗
PubMed1975

Followup of implanted pacemakers: an evaluation of surveillance methods.

A waveform analysis clinic augmented by telephone transmission of pacemaker interval in the late stages of pacemaker life will yield a considerable amount of information and will permit elective replacement of pacemakers in about 90 per cent of cases. The clinic has an advantage over other surveillance systems in the accuracy of the diagnosis, the identification of abnormalities that do not require pacemaker replacement, and the multiple benefits of a direct doctor-patient relationship. No system of surveillance can be recommended over all others in all circumstances. It is sufficient here to indicate the merits of each system and to allow the various centers to develop according to their own particular needs and desires. There is no objection to telephone monitoring alone as long as one realizes that only about 80 per cent of the problems can be detected and that there will be an irreducible percentage of false negative and false positive diagnoses. The danger of errors of this type is not great, but it does exist and should be avoided if possible. Other methods of pacemaker followup, such as simple examination and an electrocardiogram in a doctor's office or changing the pacemaker on the basis of the manufacturer's prediction, are relatively unsatisfactory. It should be stressed that pacemaker surveillance of some type is essential to satisfactory patient care because it provides for maximum utilization of the pacemaker, for replacement only if and when necessary, for detection of 90 per cent of pacemaker problems, and for protection of the patient against unexpected pacemaker failure.

Costs and Cost Analysis↗
PubMed1975

Clinical experience with nuclear pacemakers.

Approximately 1,400 nuclear pacemakers have been implanted in patients since April, 1970, without a single battery failure; 64 of these have been implanted at the Newark Beth Israel Medical Center. All except four of the 64 pulse generators were attached to transvenous electrodes, 39 to pacing wires already in place. Fifty-nine of the 64 units are in service and continue to function normally in a follow-up period of up to 2 years. In the total worldwide experience, 70 pacemakers are out of service, approximately half because of the patient's death, and the rest for infection or lead problems, and only three or four because of difficulties with components. The first 15 ARCO pacemakers implanted 2 years ago continue to function well. Of the 15 control pacemakers implanted at the same time, one unit has failed. We have concluded that a nuclear pacemaker should not be used in a patient with limited life expectancy or in an infant, but for the otherwise healthy young or middle-age individual, it should be the unit of choice.

Arrhythmias, Cardiac↗