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Biomedical subjects

M M Kirsh

Publications and source records attributed to M M Kirsh.

At least 19 recordsLinked to original sources
PubMed1979

Esophageal atresia. A 41-year experience.

Since the first attempted repair in 1935, a total of 365 infants have undergone treatment for esophageal atresia with or without tracheoesophageal fistula. To evaluate the improvement in our results, we have divided our patients into four, approximately equal, time periods. The overall late survival has indeed improved during each of the four decades from between 36% and 53% to 68% in the last ten years. During this past decade, the group A risk infants (35 patients) had a 3% mortality, the group B (20 patients) had a 5% mortality, but the group C babies (22 patients) had a 41% mortality due to associated anomalies or severe prematurity. Anastomotic leaks and recurrent fistulas were each encountered in approximately 5% of the cases in all decades. Postoperative stricture has been encountered in 20% of the entire series and no esophageal replacements have been required.

Abnormalities, Multiple↗
PubMed1979

Effects of methylprednisolone in cardioplegic solution during coronary bypass grafting.

The effects of adding 500 mg. of methylprednisolone to each liter of cardioplegic solution were studied in patients undergoing coronary artery bypass grafts. Patients were randomly assigned to control (12 patients) or steroid-treated groups (10 patients). The cardioplegic solution was identical in the two groups except for the added methylprednisolone. Contractile element velocity (VCE and left ventricular end-diastolic pressure (LVEDP) were recorded immediately before and after perfusion in the operating room. There were no differences between the two groups with respect to these two variables or the postoperative courses. Thus this study fails to demonstrate a beneficial effect of methylprednisolone when added to cardioplegic solutions.

Coronary Artery Bypass↗
PubMed1979

Endotoxin-induced intravascular coagulation (DIC) and its therapy.

Anticoagulants in the form of heparin, dipyridimole, steroids, prostaglandin E1, Macrodex, and antithrombin III were administered in separate experiments prior to endotoxin infusion in the dog. The pattern of disseminated intravascular coagulation (DIC) developed consistently when endotoxin alone was administered. Heparin dosages from 1 to 10 mg/kg did not influence the appearance of thrombocytopenia but effectively eliminated the decrease in fibrinogen levels ordinarily found. Antithrombin III (AT III), obtained from the National Red Cross, administered in a dose designed to provide a doubling of the circulating AT III, reduced the fibrinogen utilization to a similar degree as heparin without affecting the platelet loss. Dipyridimole, as administered, was ineffective in this model, and did not alter the development of thrombocytopenia or the hypofibrinogenemia. Steroids, Macrodex, and prostaglandin E1 had minimal effect on the coagulopathy. Our finding would suggest that the endotoxin effect on dog platelets id direct, and not mediated by thrombin, and that the role of heparin in the clinical management of DIC should be considered only in instances in which renal complications exist.

Animals↗
PubMed1979

Clinical presentation and management of patients with carcinoma of the lung: a 14-year experience.

Carcinoma of the lung has been steadily increasing since World War II, and the family physician can now expect to see a greater incidence of the disease in women and persons under age 50 years. The clinical manifestations of carcinoma of the lung are described, based on a 14-year experience at the University of Michigan. Diagnostic procedures are outlined. The preferred treatment for carcinoma of the lung is pulmonary resection, combined, in appropriate situations, with mediastinal lymph node irradiation. Survival is dependent to some degree on the tumor cell type as well as the extent of metastasis. A new immunotherapeutic adjunct to resection and irradiation is being developed. Five to ten-year survivors of resections for lung cancer and normal persons serve as lymphocyte donors. Transfer factor is extracted from these lymphocytes and injected into selected patients who have recently had resections for lung cancer. It is too soon to evaluate the results of this experiment, but it is hoped that immunotherapy using transfer factor will be of help to patients with carcinoma of the lung.

Carcinoma, Bronchogenic↗
PubMed1979

Valve replacement for Ebstein's anomaly of the tricuspid valve.

The role of valve replacement in the treatment of Ebstein's anomaly of the tricuspid valve remains controversial. Between 1965 and 1977, five patients with Ebstein's anomaly ranging in age from 11 to 57 years (mean 29) underwent tricuspid valve replacement in our institution. All of the patients were cyanotic but one, three were in Functional Class III, and two were in Class IV (New York Heart Association classification). The valve was placed above the coronary sinus. Plication of the atrialized portion of right ventricle was required in only one patient. Four patients had additional closure of an atrial septal defect. There were no deaths. On follow-up (range 1 to 13 years), four patients are in Functional Class I and one is in Class II. None is cyanotic. Four patients are in sinus rhythm and one has a pacemaker because of postoperative complete heart block. We conclude that valve replacement and, when necessary, plication of the atrialized right ventricle produce excellent clinical improvement.

Adolescent↗
PubMed1978

Effects of cardioplegic solution on human contractile element velocity.

A technique for measuring the maximum contractile element velocity (Vpm) of the myocardium was developed, verified, and employed in patients to allow accurate intraoperative assessment of the adequacy of myocardial protection. Four groups of patients were studied. Ten patients had coronary artery bypass grafts (CABG) with cardioplegia; 13 had CABG with coronary perfusion, ventricular fibrillation at 28 degrees C, and aortic clamping for distal anastamoses; 6 had aortic valve replacement (AVR) with cardioplegia; and 7 had AVR with coronary perfusion to the beating heart. For cardioplegia, a solution of 5% dextrose in 0.2% saline at 4 degrees C with 25 mEq of potassium chloride and 12.5 gm of mannitol was infused initially, followed by 500 ml every 30 minutes. Clinically all patients did well, and there were no deaths. Patients having CABG with intermittent coronary perfusion during ventricular fibrillation had significant (p less than 0.01) depression of Vpm from 38.3 to 30.8 sec-1 while Vpm in patients having CABG with cardioplegia was unchanged. Patients having AVR with continuous coronary perfusion or with cardioplegia (average anoxia time, 70.4 minutes) had no significant change in Vpm. We conclude that this cardioplegic solution provided adequate protection of myocardial function for up to 105 minutes of continuous aortic clamping in humans. The depression in Vpm observed following CABG with intermittent coronary perfusion is consistent with previous suggestions that this combination is detrimental because of maldistribution of coronary blood flow during ventricular fibrillation.

Aortic Valve↗
PubMed1978

Myocardial revascularization in patients receiving long-term propranolol therapy.

Twenty-seven patients receiving long-term propranolol therapy underwent myocardial revascularization to relieve stable or unstable angina. The patients were randomly divided into two groups, one (Group 1) in which propranolol was discontinued 48 hours prior to operation and one (Group 2) in which patients received a final dose of propranolol 1 to 2 hours prior to operation. Several physiological variables were compared, and there was no statistically significant difference between the groups except for a slower pulse rate in Group 2 patients. Although the patients in Group 1 showed a greater frequency of hypertension before bypass, the incidence of postoperative complications and perioperative myocardial infarction was the same for both groups. The findings of this study indicate that myocardial revascularization is safe even if propranolol is administered up to 1 or 2 hours before operation.

Adult↗
PubMed1978

The effect of glucagon in animals on chronic propranolol therapy.

Eleven adult mongrel dogs were divided into two groups. Group 1 animals served as controls and Group 2 received propranolol (6 mg/kg/day) orally in divided doses for 15 to 21 days. Prior to cardiopulmonary bypass, cardiac output, first derivative of left ventricular pressure (dp/dt), peak systolic pressure, heart rate, and central venous pressure were recorded. The animals were then placed on cardiopulmonary bypass and subjected to 30 minutes of global ischemia at the myocardial temperature of 32 degrees C. Following cessation of cardiopulmonary bypass the baseline studies were repeated. In Group 2 animals following the repeat studies, glucagon was administered at a rate of 0.13 microgram/kg/min. The cardiac index and dp/dt were decreased by 43.3% (p less than 0.001) and 40.5% (p less than 0.001) in comparison to Group 1 animals. In Group 2 dogs, after bypass and glucagon infusion, cardiac index increased by 38% (p less than 0.02), dp/dt rose by 78% (p less than 0.05), and peak systolic pressure increased by 24.8% (p less than 0.05). These studies show the benefit of glucagon in the treatment of low cardiac output in the presence of beta-adrenergic blockade.

Animals↗
PubMed1978

Treatment of caustic injuries of the esophagus: a ten year experience.

The methods of managing 32 patients sustaining caustic injuries to the esophagus are assessed. Treatment of these patients must be individualized according to the type of caustic ingested, the degree of burn and other clinical signs. While an aggressive approach is favored for second and third-degree burns in the form of early esophago-gastrectomy with subsequent colon interposition, operation is not necessary. In all patients, particularly those with first-degree burns. The use of antibiotics is recommended as soon as the diagnosis of esophageal injury is established. The efficacy of steroids in preventing stricture formation, especially with third-degree burns, is questioned.

Adult↗
PubMed1978

Late spontaneous disruption of a porcine xenograft mitral valve. Clinical, hemodynamic, echocardiographic, and pathological findings.

A case is presented of failure of a Hancock porcine xenograft mitral prosthesis secondary to disruption of the prosthetic leaflets. Clinical, hemodynamic, and echocardiographic evidence of prosthetic dysfunction has been correlated with operative, pathological, and ultrastructural findings. Other instances of dysfunction of this prosthesis have been reviewed. Echocardiography should be routinely employed when the diagnosis of xenograft dysfunction is entertained.

Animals↗
PubMed1978

Management of unusual traumatic ruptures of the aorta.

Blunt injuries to the ascending aorta and branches of the aortic arch are unusual but must be considered in any victim of a high speed decelerating injury. Because there are no characteristic clinical or roentgenographic findings, aortography is the only definitive method of establishing the diagnosis. Aortography should therefore, be performed upon any patient who has had a high speed decelerating injury, regardless of the clinical or the roentgenographic findings. An early operation will prevent exsanguination.

Adolescent↗
PubMed1978

Technique for insertion of apicoaortic conduit.

A technique for insertion of an apicoaortic prosthesis is described. It provides a hemostatic aortic and ventricular anastomosis and can be performed with a minimum of bypass time and without interruption of coronary circulation. The technique requires no special instruments.

Animals↗
PubMed1978

Nitroglycerin infusion during infrarenal aortic cross-clamping in dogs: an experimental study.

The effects of an intravenous infusion of nitroglycerin on cardiac index and peripheral vascular resistance during infrarenal aortic cross-clamping were determined in normal animals and in animals subjected to low cardiac output state. Both groups of untreated animals demonstrated progressive fall in cardiac index with a rise in total peripheral resistance during infrarenal aortic cross-clamping. The infusion of nitroglycerin during the period of aortic cross-clamping prevented the increase in total peripheral resistance and therefore prevented the progressive fall in cardiac index that occurred in untreated animals. In the animals with depressed myocardial function, the infusion of nitroglycerin produced a 44% increase in cardiac index during aortic cross-clamping. The results of this study showed that the infusion of nitroglycerin during abdominal aortic cross-clamping can prevent adverse cardiovascular sequelae from occurring and should be used in patients undergoing abdominal aortic resection, especially those with impairment of left ventricular function.

Animals↗