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Biomedical subjects

M H Schatzlein

Publications and source records attributed to M H Schatzlein.

5 recordsLinked to original sources
PubMed1992

Cardiac isoenzymes following heart transplantation.

Creatine phosphokinase (CPK) isoenzymes are commonly obtained after heart transplantation (HT) to assess myocardial injury of the donor heart. This investigation retrospectively evaluated the utility of this practice. Fifty-six recipients of orthotopic heart transplants had at least two daily CPK-MB studies following HT. All patients were followed up for at least one year (or until death). Nineteen patients had entirely negative CPK-MB determinations (NEG). Eighteen patients had a single positive CPK-MB determination, and were considered to be equivocal (EQUIV). Nineteen patients had more than one daily positive CPK-MB determination (POS). To evaluate the influence of positive CPK-MB determinations on the outcome of HT, we compared the results in the NEG and POS groups. There was no difference in the donor organ ischemic times between the two groups. The duration of follow-up for the two groups was also similar (1,192 days vs 1,020 days). The NEG and POS groups had no significant difference in: 1 year survival (84 percent vs 74 percent); freedom from treated rejection episodes in 3 months (39 percent vs 42 percent); and freedom from coronary artery disease (CAD) at 3 years (83 percent vs 86 percent). Additionally, the ejection fractions of the donor hearts were similar at 1 year post-transplant for the 2 groups (64 percent vs 59 percent). We conclude that myocardial injury, as reflected by post-transplant CPK-MB levels, does not predict one-year mortality, predisposition to rejection, predisposition to coronary artery disease, or ultimate graft dysfunction. In an effort to perform HT more economically, we no longer obtain CPK-MB levels following HT.

Clinical Enzyme Tests↗
PubMed1991

Endarterectomy, vein patch, and mammary bypass of the anterior descending artery.

Occasionally the left anterior descending (LAD) coronary artery contains such diffuse calcific atherosclerosis that an area suitable for distal anastomosis with the internal mammary artery (IMA) cannot be found. Additionally, the LAD of some patients contains multiple areas of stenosis, which would prevent free outflow from the IMA graft. In these cases the potentially increased operative risk of LAD endarterectomy is justified to avoid leaving poorly revascularized areas of anteroseptal heart. In an effort to provide the long-term patency benefits of IMA grafting for these patients without the technical difficulty of a lengthy IMA to LAD anastomosis, we have combined saphenous vein patch reconstruction with IMA bypass when LAD endarterectomy is required.

Blood Vessel Prosthesis↗
PubMed1987

Cardiac transplantation: first-year experience in a community hospital.

The issue of decentralizing heart transplant services, formerly restricted to a few large medical centers, is currently under review by federal and state governments. We present the results of the first year of cardiac transplantation at a 385-bed community hospital. Twelve patients were selected according to generally accepted criteria from a pool of 24 referrals, all from within 75 miles of our institution. All patients were in New York Heart Association Class IV preoperatively. The one-year survival rate was found to be 82%, which is equivalent to that reported by established centers. All surviving patients were fully rehabilitated. Rates of infection and rejection were lower than expected, and costs were about half the national average. This series, in all likelihood, tests the limits to which the decentralization of cardiac transplant services can be taken. We conclude that cardiac transplantation can be accomplished at a community hospital with results, even for the first patients undergoing transplantation, comparable to those obtained by established programs at major medical centers.

Adult↗
PubMed1979

Gastroesophageal reflux in infants and children. Diagnosis and management.

Eighty-three infants and children underwent surgical correction of gastroesophageal reflux (GER) from 1973 to 1978. Fifty-four patients had coexistent brain damage (most commonly due to cerebral palsy), eight were previously treated for esophageal atresia, and four had gastroschisis or omphalocele repair. Clinical presentation included failure to thrive in 64 patients, vomiting in 59, and recurrent bouts of aspiration pneumonitis in 43. Barium roentgenography showed GER in 61 patients, whereas additional tests (particularly pH monitoring) were required for detection of GER in 22 patients. After failure of medical management, transabdominal Nissen fundoplication was performed in 80 cases and a Hill repair in three cases. The surgical mortality was zero, but there were five late deaths. Results were considered excellent in 54 patients, good in 22 patients, and poor in seven. Ten of 12 patients with preoperative stricture responded to dilation after fundoplication. Nissen fundoplication was a safe and effective antireflux procedure in 76 of the 83 cases.

Adolescent↗