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Biomedical subjects

M Paneth

Publications and source records attributed to M Paneth.

At least 19 recordsLinked to original sources
PubMed1991

Complement activation during bypass in acquired C1 esterase inhibitor deficiency.

Serial complement estimations during cardiopulmonary bypass are reported in a patient with acquired C1 esterase inhibitor deficiency. Although the extent of classic and alternative pathway activation appeared appropriate, exaggerated common pathway activation with massive increase in the C3d:C3 ratio occurred. A fatal hemostatic disorder, pulmonary edema, and circulatory collapse ensued despite prophylaxis and therapy.

Aged↗
PubMed1990

Omental transfer in acute and chronic sternotomy wound breakdown.

Median sternotomy is complicated by deep infection in 1-5% of cases. Internal mammary artery grafting (especially bilateral) may increase incidence and severity. Mediastinitis accompanied by sternal necrosis has a reported mortality up to 30%. The defect resulting from removal of dead bone requires reconstruction and skin cover. Twelve patients are presented in whom this defect was abolished by omental transposition. There were no deaths. Seven had chronically infected wounds (median time to operation 100 days) with very large defects following multiple debridements resulting in total sternectomy; these were treated by omental transposition and meshed split-skin grafting. Five were treated 'acutely' (median time to operation 28 days p less than 0.02) using smaller omental flaps and direct myocutaneous closure, despite total sternectomy being required in 4. One was bleeding from an infected aorto-saphenous anastomosis following povidone-iodine irrigation. Median total hospital stay in the acute group was 49 vs. 82 days in the chronic group (p less than 0.01) who also had 4 major complications (p NS). All wounds healed but further surgery was required to stabilise the chest wall in 1 of the 'Chronic' group. It is concluded that for severe sternal infection early radical removal of necrotic tissue, omental transposition, and direct closure reduces morbidity and hospital stay. In one patient bleeding from a septic aortic erosion we consider the procedure to have been life-saving.

Aged↗
PubMed1990

Open valvotomy for critical aortic stenosis in infancy.

Over a 5 year period open valvotomy was performed on 13 patients under the age of one year with critical aortic stenosis. All 13 survived operation. There were two late deaths--one 38 days after operation, associated with an unrelated neurosurgical procedure and the other 2 years 6 months after when aortic root enlargement and replacement of the aortic valve were performed. During this period two other infants presented with aortic stenosis. One, who was very ill before transfer, died before operation could be performed. The second patient had a hypoplastic left ventricle with a small mitral valve ring and was, therefore, considered to be part of a different subgroup. All the surviving children have been followed up (median length of follow up 2 years and 11 months, range 7 months-5 years). Left ventricular function, in terms of percentage systolic wall thickening, was shown to be significantly impaired in all age groups. Peak diastolic thinning was abnormal in those children aged from 3 to 5. The aortic valve gradient, as assessed by peak instantaneous continuous wave Doppler, was less than 40 mm Hg in five patients and between 40 and 70 mm Hg in seven patients. One patient, with appreciable restenosis, has undergone successful percutaneous balloon dilatation of the aortic valve.

Aortic Valve↗
PubMed1989

Effect of temperature on rate of left ventricular pressure fall in humans.

The time constant (T) of left ventricular pressure fall is widely used as an index of ventricular "relaxation". It is not known whether its rate limiting step is deactivation, an enzymic energy consuming reaction whose rate is therefore sensitive to temperature, or elastic recoil. To distinguish between these possibilities, the time constant was measured by simple logarithmic (Tlog) and exponential (Texp) methods in 12 patients during cooling before coronary artery grafting. Ventricular loading conditions were altered by transfusion from bypass to maintain arterial and left atrial pressures constant in individual patients, though heart rate fell from 86 (8.4) to 68 (10) beats/min. Tlog increased from 49 (10) ms mean (SD), at 37 degrees C to 86 (15) ms at 31 degrees C, and Texp from 63(14) at 37 degrees C to 112 (23) ms at 31 degrees C with intermediate values at 34 degrees C. Texp proved sensitive to "noise" at low temperatures, but the overall change in Tlog with temperature was 9% per degree C--considerably less than that observed experimentally for the rate of tension decline of isolated myocardium, and possibly itself an overestimate because of the concomitant fall in heart rate. The relatively small effect of temperature on Tlog in humans, associated with a considerable load sensitivity appearing under hypothermic conditions, does not favour simple dependence on deactivation as the rate limiting step of left ventricular pressure fall, but suggests that its determinants may be complex.

Adult↗
PubMed1988

Angina pectoris treated by ventricular plication.

Objective analysis of the left ventricular angiogram in a patient with angina but normal coronary arteries showed an appreciable disturbance of regional wall movement. Because of persistent symptoms refractory to medical treatment left ventricular plication was undertaken. This resulted in a return to normal of a series of disturbances of left ventricular wall motion commonly found in patients with obstructive coronary disease, and a striking improvement in the patient's symptoms. The patient remains symptom free five years after operation.

Angina Pectoris↗
PubMed1988

Pulmonary embolectomy for acute massive pulmonary embolism: an analysis of 71 cases.

Between 1964 and 1986 a total of 71 pulmonary embolectomies were performed for acute massive pulmonary embolism. All patients were severely compromised haemodynamically. Sixteen (64%) of 25 patients who had sustained significant periods of cardiac arrest before operation died. The principal cause of death in this group was severe neurological damage. Five (11%) of the 46 who had not had a cardiac arrest died. The 50 (70%) patients who survived did so largely without morbidity during their hospital admission and in the follow up period. Most were not treated with long term anticoagulants and only two had another embolism. When a patient with acute massive pulmonary embolism is too ill to be given thrombolytic treatment, or when thrombolysis is either contraindicated or too slow in producing benefit, pulmonary embolectomy remains an effective alternative treatment with an acceptable mortality.

Acute Disease↗
PubMed1987

Angina pectoris in a case of Takayasu's disease: revascularization by coronary ostioplasty and bypass grafting.

A young man with Takayasu's disease had severe right and left coronary ostial stenoses. Severe angina was relieved by operation at which the right coronary ostium was enlarged by a pericardial patch extending across the stenosis from aorta to coronary artery; the aortic end of a vein graft to the left coronary artery was attached to this patch. This technique may reduce the risk of recurrence of ostial stenosis or of stenosis at graft origins.

Adult↗
PubMed1984

Elective femoro-femoral bypass for operations on the heart and great vessels.

Femoro-femoral bypass with "circulatory arrest" is no longer used in routine cardiac operations. Its use today is normally limited to operations wherein access to the arch of the aorta is required or the thoracic aorta is to be temporarily occluded. We have recently encountered three patients presenting with complications of previous operations. In all three, the use of this technique allowed us to approach the defect safely.

Adolescent↗
PubMed1983

Sleeve lobectomy (lobectomy and bronchoplasty) for bronchial carcinoma.

We present a series of 90 patients who underwent sleeve lobectomy for malignant bronchial tumors at the Brompton Hospital, London, between 1964 and 1974. The operative mortality was low (1%), and technical complications were infrequent. Bronchial stenosis, which occurred in 6% of patients, was due to recurrence of tumor in 4% and cicatrization in 2%. The majority of patients had squamous cell carcinomas of the upper lobe (76/90). In this group, the 5-year survival was 71% when the hilar lymph nodes were clear of tumor at the time of operation and 17% when the hilar lymph nodes were involved. Because these 5-year survival figures suggest that tumor-free survival is not significantly compromised by this conservative approach, we believe that sleeve lobectomy rather than pneumonectomy should be considered the operation of choice for squamous cell carcinomas of the upper lobe orifice involving the main bronchus.

Adult↗
PubMed1983

Chordal rupture. I: aetiology and natural history.

Between 1970 and 1981, 12% of patients undergoing mitral valve surgery were found to have chordal rupture. Spontaneous or primary rupture accounted for 74.6% of patients (primary group); in the remainder (secondary group) chordal rupture complicated chronic rheumatic valvular disease (8.9%), bacterial endocarditis on both normal (8.5%) and rheumatic valves (4.7%), ischaemic heart disease (2.3%), acute rheumatic fever (0.5%), and osteogenesis imperfecta (0.5%). Isolated posterior rupture was seen most frequently (54%), with anterior rupture in 36% and rupture of both mitral cusps in 10% of patients. A short symptomatic history of acute mitral regurgitation was rare, occurring in only 4% of patients in either the primary or secondary groups, suggesting that mitral regurgitation due to ruptured chordae is a progressive disease. In contrast to previous reports the clinical presentation did not help to differentiate the aetiology of the chordal rupture.

Adolescent↗
PubMed1983

Chordal rupture. II: comparison between repair and replacement.

During the period 1970-81, 183 patients underwent mitral valve surgery for chordal rupture. Of these, 82 (45%) patients were treated by mitral valve repair and 101 (55%) by mitral valve replacement. Mean age at surgery was 57 years. The early mortality was nine of 183 (4.9%) patients, of whom five had undergone replacement and four repair. During the follow up period (mean 3.6 years, range 0.8-12.2 years) a further 27 patients died; 23 of these had undergone mitral valve replacement and four mitral valve repair. Cerebrovascular events accounted for 35% of the deaths after mitral valve replacement and none of those after mitral valve repair. In 11 patients repair was technically unsatisfactory, and mitral valve replacement was undertaken at the same operation; a further five patients required late replacement (mean 1.4 years) for pronounced mitral regurgitation. Actuarial curves predict a six year survival of 68 +/- 5.7% (mean +/- SD) for all patients after mitral valve replacement compared with 88 +/- 6.9% (mean +/- SD) after repair (p less than 0.01). Actuarial survival curves favour mitral valve repair as the procedure choice for chordal rupture, and in isolated posterior cusp repair breakdown of the repair is a rare occurrence.

Adolescent↗
PubMed1983

Metastatic renal carcinoma presenting with profuse haemorrhage at cardiac surgery.

A 62-year-old man undergoing coronary artery bypass grafting sustained profuse unexplained haemorrhage during sternal diathermy before sternotomy. Histology of tissue from the sternum suggested metastatic renal carcinoma. A primary renal tumour was subsequently identified. Sternal metastases are rare, often highly vascular, and arise particularly from thyroid or renal tumours. In the absence of angiographic evidence of an eroding aortic aneurysm, sternal metastases represent the most likely cause of unexplained haemorrhage during sternotomy.

Bone Neoplasms↗
PubMed1983

Pulmonary aspergilloma: analysis of prognosis in relation to haemoptysis and survey of treatment.

From 1956 to 1980 85 patients were admitted to the Brompton Hospital, London, with pulmonary aspergilloma. The mean follow-up period was 8.7 years and 85% of patients were followed for five years or until death if this was earlier. There were 41 deaths, 27 from respiratory causes: 11 from pneumonia, six from chronic respiratory failure, seven after surgery for aspergilloma, and three from haemoptysis. Medical treatment alone was given to 36 patients, of whom three died of haemoptysis. Systemic antifungal treatment was given to 18 patients without benefit. Intracavitary antifungals were helpful in three out of 10 patients. Surgical resection was performed in 41 patients, of whom three (7%) died after operation and a further six (15%) developed major complications. Cavernostomy was performed in nine patients considered unfit for resection; four died after operation. Haemoptysis was absent or minor in 40 patients, of whom 19 were treated medically and 18 by resection, with similar five-year survival rates of 65% and 75%. Frank or major haemoptysis occurred in 45 patients, of whom 17 were treated medically and 23 by resection, with five-year survivals of 41% and 84% (p less than 0.02). The better survival of the surgical group in this retrospective survey may have been due to the selection of patients with better lung function and more localised pulmonary disease. Our observations suggest that surgical resection for aspergilloma should be restricted to patients with severe haemoptysis and adequate pulmonary function. In patients unfit for resection cavernostomy is hazardous.

Adolescent↗