Biomedical subjects
Publications and source records attributed to M J Levy.
A 16-year-old patient with Behçet's syndrome had massive hemoptysis due to a ruptured aneurysm of a segmental artery of the left lung. Emergency left lower lobectomy was performed. The patient is well 12 months after operation. There have been no further episodes of hemoptysis.
During an 11-month period, 4 patients underwent surgical removal of a mobile, pedunculated left ventricular thrombus. All 4 patients had a history of myocardial infarction. Two of the 4 patients had systemic emboli, and in the 2 others, the ventricular thrombi were removed to prevent emboli. The thrombus was removed during the acute phase of myocardial infarction in 2 patients and one and two years, respectively, following the infarct in the remaining 2 patients. Concomitant coronary artery bypass grafting was performed in 3 patients. There were no early or late deaths, and none of the patients had clinical or echocardiographic evidence of recurrent thrombi or emboli at follow-up 3 to 15 months later. These results indicate that left ventricular thrombectomy might be an effective treatment for patients with mobile, pedunculated, left ventricular thrombi. However, additional experience is required to compare surgical and medical treatment.
The hazards related to ten patients who underwent 11 urologic surgical procedures during a 36 month period were taken into consideration. Electrocautery was used in all instances and there were no complications. All of the pacemakers were preset for ventricular pacing and sensing inhibited or multiprogrammable and were reprogrammed during the operation to ventricular pacing fixed rate mode or magnet mode, with very satisfactory outcome. To avoid life-threatening situations arising from pacemaker inhibition or ventricular fibrillation during cautery for transuretheral resection, three basic factors were considered: 1, appropriate type of pacemaker; 2, the proper grounding of all medical electronic equipment used during the procedure, and 3, the directing of the complete flow of the electrocautery circuits substantially below the level of the pacemaker unit.
Dissection of the young women without Marfan disease is related, in most instances, to pregnancy. The structural changes in the arterial wall that occur during pregnancy may predispose women to this complication of pregnancy. In this study, two young women, who had none of the characteristics of Marfan's syndrome, were operated upon for dissection of the ascending aorta. The first patient was in the 35th week of gestation and a cesarean section was performed prior to replacement of the ascending aorta. In the second patient, diagnosis of dissection and severe aortic regurgitation occurred in the postpartum period. Knowledge of this albeit relatively rare complication of pregnancy may assist the clinician in diagnosing and referring patients early for surgical treatment that, in most instances, may save the lives of both mother and fetus.
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The method of continuous catheter drainage for pericardial tamponade as used in 108 patients is described. The efficacy of this procedure in relieving tamponade resulting from a variety of diseases is demonstrated. Blood clot in the pericardium probably constitutes a contraindication to catheter drainage.
A 37 year old man with Behçet's disease who was maintained on prolonged corticosteroid therapy, developed diabetic ketoacidosis and pneumonia. Secondary infection with mucor intervened with abscess formation cured by pneumonectomy. The association of Behçet's disease and mucormycosis has not been previously reported, although diabetes mellitus was almost certainly the predisposing cause. Surgical treatment offers the best chance of survival in similar cases.
Coarctation of the aorta was surgically treated in 28 infants (16 male, 12 female) aged 2 days-3 months, with 19 younger than 1 month. Body weight at operation was 1.6-4.2 (mean 2.8) kg. 3 infants had coarctation alone, 10 had a wide patent ductus arteriosus as the only associated anomaly and 15 had a variety of other anomalies. Resection with end-to-end anastomosis was performed in only one case, while 21 underwent subclavian flap aortoplasty and six patch graft aortoplasty. Additional procedures were banding of the pulmonary artery in five cases and open aortic commissurotomy in one case. The early mortality was 10.7% (3 infants) and three more died later. Further cardiac surgery was subsequently performed on four of the infants. Of the 22 survivors, two had significant recurrence of coarctation which, however, was successfully corrected in one case. The blood pressure was within normal limits in all survivors, except those with recoarctation.
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Proton NMR spectra of met-aquo-myoglobin have been recorded in whole dark muscle from yellowfin tuna for the first time; in addition, spectra of the met-aquo, met-cyano, and deoxy forms were recorded in solution. The number of resolved methyl resonances in the met-aquo and met-cyano derivatives of the purified protein indicates a molecular heterogeneity, with the two species present in a ratio of approximately 3:2. These same two species, in very similar environments, are found in whole muscle. Upon reconstitution of the protein, the ratio of the two species is approximately 1:1. Specific isotope labeling in the met-cyano form reveals an interchange of 5-methyl and 8-methyl environments that is characteristic of heme orientational disorder about the alpha, gamma-meso axis. Incubation of the met-cyano protein at 37 degrees C shows that the two species are interconvertible, with the minor component declining to about one-eighth of that of the major component. This indicates that one of the two orientations is favored thermodynamically. The rate of equilibration for the met-aquo protein is exceedingly slow (half-life greater than 30 days), some 10(2) slower than for the analogous sperm whale derivative. The "reversed" heme orientation is therefore present in muscle as a kinetically trapped or metastable species, suggesting that the last step in the biosynthesis of myoglobin is similar to that of in vitro reconstitution. The presence of both heme orientations in myoglobin in whole muscle proves that heme orientational disorder is a physiological phenomenon.
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Of 16 patients with bronchial adenoma who were operated on at Beilinson Medical Center from 1967 to 1980, only three presented the "triad" of cough, hemoptysis, and recurrent pulmonary infections. In two patients the tumor was diagnosed incidentally and in five patients histological evidence of adenoma was made during bronchoscopy. One patient died of myocardial infarction following reoperation for bleeding, and one patient was lost to follow-up. The remaining 14 patients were followed for 4 to 17 years without evidence of local recurrence or distant metastases. We conclude that the long-term prognosis of patients with bronchial adenoma is excellent, and limited surgical procedure should be the treatment of choice whenever possible.
The isolation, purification, and characterization of metmyoglobin reductase from yellowfin tuna (Thunnus albacares) is described. The enzyme has been purified 120-fold. Characterization of the enzyme includes molecular weight, isoelectric point, substrate specificity, enzyme kinetics, chromatographic behavior, and sensitivity to inhibitors. The physical and catalytic properties of the tuna enzyme are compared to those of bovine and blue-white dolphin metmyoglobin reductase.
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Pacemaker carriers are at risk when undergoing operations involving the use of diathermy. The Shaw Scalpel utilizes a method by which the cutting edge of the blade is heated to a selected temperature that seals blood vessels as they are cut. No electrical currents are passed to or through the patient and there is no sparking or electrical arcing to the tissue. This apparatus was used as the sole method of thermal coagulation in 20 patients undergoing replacement of pacemaker batteries.
The course of 22 pregnancies in 11 women undergoing heart valve replacement with a porcine xenograft is reported. All of the pregnancies treated with warfarin were interrupted by induced abortion. Of the 11 pregnancies treated with dipyridamole which were not interrupted by induced abortion, fetal wastage occurred in five. There was no fetal wastage among three patients who were not treated by any kind of anticoagulant. A review of the literature revealed that fetal complications among patients with the mechanical prosthetic valve are significantly higher compared with patients with bioprosthetic valves. There was no maternal hemorrhagic or thromboembolic event in patients with bioprosthetic valves. Delivery after porcine xenograft insertion is safe provided that the patient is in good cardiac condition and does not require warfarin treatment.
A discrepancy observed in electrophoretic mobility of human atrial and ventricular myosin heavy chains permitted the determination of these protein isoforms in myocardial biopsies. In ventricular biopsies we found only the heavy chain specific to this tissue whereas in atrial specimens we sometimes detected an extra heavy chain comigrating with the ventricular species. The peptide mapping of such preparations revealed peptides unique to ventricular heavy chain. Patients suffering from pressure overload expressed ventricular heavy chain at a higher frequency than those suffering from coronary heart disease (66% VS.29%), but this disparity was not found statistically significant (0.1 greater than P greater than 0.05).