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Biomedical subjects

M Sopher

Publications and source records attributed to M Sopher.

7 recordsLinked to original sources
PubMed1997

Early tracheal extubation after liver transplantation.

OBJECTIVE: To assess the value and safety of tracheal extubation in the operating room at the end of liver transplantation. DESIGN: Retrospective chart review. SETTING: University Medical Center. PARTICIPANTS: Eighteen adult patients extubated in the operating room at the end of liver transplantation (study patients) compared with 17 patients who were not extubated and had < or = 3 U of blood transfused during liver transplantation (control patients). INTERVENTIONS: Data collected include severity of preoperative liver disease, anesthetic technique, use of venovenous bypass, surgical time, intraoperative blood replacement, core temperature and arterial blood gases on admission to the intensive care unit (ICU), times to discharge from ICU and the hospital. MEASUREMENTS AND MAIN RESULTS: Except for age (43.9 +/- 2.7 in study patients v 52.4 +/- 2.5 years; p = 0.03), patients were similar with regard to preoperative Child's-Pugh class and liver function tests. Study patients received more crystalloid in the OR (5,306 +/- 561 v 3,771 +/- 454 mL; p = 0.04), were warmer (36.6 degrees C +/- 0.2 degree C v 35.6 degrees C +/- 0.3 degree C; p = 0.01), had a lower arterial pH (7.29 +/- 0.01 v 7.36 +/- 0.02; p = 0.003) and higher arterial carbon dioxide tension (45 +/- 1 v 35 +/- 2 mmHg; p < 0.001) on admission to ICU than controls. There were no significant differences between groups with regard to discharge times from the ICU (50.6 +/- 2.7 hours in the study group v 61.2 +/- 4.7 in control group; p = 0.06), or discharge from the hospital (14.8 +/- 1.6 in the study group v 21.3 +/- 3 days in control group; p = 0.06). CONCLUSIONS: Tracheal extubation of selected patients at the end of liver transplant surgery in the operating room is safe but did not result in decreased ICU or hospital stay.

Adult↗
PubMed1997

Initial clinical experience with an implantable human atrial defibrillator.

Low energy biatrial shock is an effective means of restoring sinus rhythm in patients with atrial fibrillation (AF). Ventricular proarrhythmia is avoided provided that shocks are well synchronized to R waves that are not at closely coupled intervals or preceded by long-short cycles. Based on these principles, an implantable atrial defibrillator has been developed and was implanted in three patients with drug refractory paroxysmal AF. The device detects AF via an actively fixed right atrial and a self-retaining coronary sinus defibrillating leads, and delivers 3/3 ms biphasic shocks up to 300 V synchronized to the R wave. The mean implant threshold (ED50) was 195 V (1.8 J). and minimum voltage at conversion during follow-up assessments at 1, 3, and 6 months were 260 V, 2.5 J. 250 V, 2.3 J, and 300 V, 3.0 J respectively. Detection of AF was 100% specific and shocks were 100% synchronized, although only a proportion of synchronized R waves were considered suitable for shock delivery primarily because of closely coupled cycles. Three patients had 9 spontaneous AF episodes, 8/9 (89%) successfully defibrillated by shocks of 260-300 V. Sedation was not used in 4 out of 9 (45%) episodes. Backup ventricular pacing was initiated by the device in 6 out of (67%) episodes. One patient had more frequent AF after lead placement, which subsided after a change of medication. There was no ventricular proarrhythmia. It is concluded that an implantable atrial defibrillator is a viable therapy for selected patients with paroxysmal AF. The device is capable of accurate AF detection, R wave synchronization and ventricular support pacing after successful defibrillation of AF.

Adult↗
PubMed1982

Arden contrast sensitivity testing in glaucoma.

Two hundred sixteen eyes (164 patients) were studied with the Arden printed contrast gratings to test Arden's hypothesis that an abnormal score would distinguish between eyes with and without glaucoma. Ninety-five eyes were normal and 75 eyes were glaucomatous; 46 eyes suspected of being glaucomatous were also studied to determine whether such eyes would score differently than eyes with normal intraocular pressures. No age-dependent trend in scoring was found in the different diagnostic categories, except with the age group younger than 40 years, which had consistently better contrast sensitivity. The tests were demonstrated to be reproducible over time and showed little or no intertester variability. Decreased contrast sensitivity was found in the glaucomatous eyes compared with normal eyes. The scores of the eyes suspected of being glaucomatous fell between the scores of the glaucomatous and normal eyes. Overlapping distributions among the three groups, however, limit the diagnostic value of the test.

Adult↗