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Biomedical subjects

P A Ebert

Publications and source records attributed to P A Ebert.

At least 19 recordsLinked to original sources
PubMed1990

Methods for evaluation of medical care other than credentialing. Cost, experience, and results.

Unfortunately, the majority of studies proposed to evaluate a physician's capabilities, such as effectiveness programs, outcome research, and hospital evaluation, do not focus directly on the individual practitioner. The certifying process, although imperfect, still offers the best method of evaluation. The other evaluation methods will need additional refinement to be able to individually analyze a specific physician's performance and determine whether he or she is truly providing the highest quality care. Physicians are being asked to document the effectiveness of their clinical decision making. On the surface this seems so simple, and in some areas where the outcome is either life or death or a specific yes or no type of answer, many have the capability to come forth with some realistic documentation. However, today's society is focused on health and the perfect outcome, and many nonlife-threatening therapies are evaluated by a patient's unrealistic expectation. Thus, the same result may be interpreted differently in one geographic area or by patients with different expectations. The biggest mistake would be to believe that outcome studies can be used to reduce cost. There may be some initial reduction or delays in treatment that suggest an immediate reduction of cost, the so-called sentinel effect, but no information or evidence indicates that these effects can be expanded without actually reducing needed health care services. In fact, the delays or obstruction to entering the health-care system experienced by many individuals often lead to more costly and less effective care with suboptimal results.

Costs and Cost Analysis↗
PubMed1979

Operative correction of total left anomalous pulmonary venous return.

The evaluation, surgical repair, and follow-up are described in an asymptomatic 27-year-old man with unilateral total anomalous pulmonary venous return from the left lung through an innominate vein and a patent foramen ovale. The anomalous vein was divided and anastomosed directly to the left atrium using a vascular technique that produced an orifice larger than the vein diameter. Radionuclide scanning accurately identified the anomaly before operation and allows periodic noninvasive reevaluation after operation. Correction is recommended in all patients with unilateral anomalous pulmonary venous return because disease in the one normal lung could be fatal.

Adult↗
PubMed1979

Extracellular space, water, and ion concentration in the hypertrophied rat myocardium.

Extracellular space (ECS), water, and intracellular ion concentration were determined in the normal and hypertrophied rat myocardium. Theoretical measurements of myocardial ECS based on a mathematical model (9.31%) closely approximated the observed results in the normal myocardium (12.8%) and hypertrophied myocardium (11.7%). Observed results confirmed theoretical considerations of no change in ECS with hypertrophy. ECS and water content were higher in the right ventricle than the left ventricle, but intracellular electrolytes remained unchanged. Myocardial hypertrophy did not alter these relationships.

Animals↗
PubMed1979

Mild ventricular dysfunction following cold potassium cardioplegia.

The long-term effects of cold potassium cardioplegic arrest was examined in 40 patients who underwent myocardial revascularization. Comparisons between resting ejection fraction (EF), end diastolic volume (EDV), and segmental wall motion were made between the preoperative and postoperative catheterization (mean postoperative recatheterization, 6 months). A 2.93 graft per patient ratio was found in this group of patients, with 108/117 grafts visualized at the time of recatheterization. The EF was 60% +/- 3% before surgery and 62% +/- 3% after surgery. A correlation coefficient of 0.91 was determined for the entire series. The EDV was 151 +/- 16 cc before coronary artery bypass graft (CABG) and was unchanged post CABG at an end diastolic volume of 137 +/- 15 cc. Analysis of preoperative wall motion of 33 patients demonstrated 111 depressed segments, 68 normal, and 52 hypercontractile; at recathetrization, there were 100 depressed, 66 normal, and 65 hypercontractile segments. Although there was essentially no deterioration of myocardial function for 37 out of 40 patients, three demonstrated a reduction in EF, the largest reduction being 15%. These three patients had a cardioplegic arrest time greater than 70 minutes. An inverse relationship between percent change in EF and the length of cardioplegic arrest was observed, with an r value o - 0.57 (p less than 0.01). These data suggest that prolonged cardioplegic arrest times may be associated with mild dysfunction. Cold potassium cardioplegic arrest up to 70 minutes was associated with no change in EF, EDV, or wall motion in this series of patients.

Cardiac Catheterization↗
PubMed1979

Protection of myocardial function not enhanced by high concentrations of potassium during cardioplegic arrest.

Myocardial performance was evaluated intraoperatively in 20 patients undergoing myocardial revascularization when hypothermic potassium cardioplegic arrest was used. High concentrations of potassium (20 mEq/L) were compared to normal concentrations of potassium (5 mEq/L) in hypothermic cardioplegic solutions. The cardioplegic arrest period averaged 53 +/- 3 minutes in the high potassium group and 54 +/- 4 minutes in the low potassium group, Intraoperative calculation of ejection fraction and end-diastolic volume was accomplished by the technique of radiocardiography. All data were grouped according to end-diastolic volume index (EDVI) for both high (HK) and low (LK) potassium comparisons. Comparisons between high and low potassium groups demonstrated no significant differences in ejection fraction (HK = 66%, LK = 61%), cardiac index (HK = 2.74 L/min/m2, LK = 3.0 L/min/m2), stroke work (HK = 36 gm.m/m2, LK = 30 gm.m/m2), oxygen consumption as measured by left heart double product (HK = 9,438; LK = 9,209), and myocardial compliance (HK = 2.8 cc/torr, LK = 4.2 cc/torr at the post-cardioplegic arrest period). The role potassium plays in producing a rapid cardiac arrest is well accepted. Its protective effect on the preservation of high-energy phosphate stores is postulated, but its addition to perfusion hypothermia does not appear to enhance the protective effect observed with perfusion hypothermia alone.

Cardiac Surgical Procedures↗
PubMed1979

Management of symptomatic tetralogy of Fallot in the first year of life.

The surgical management of symptomatic tetralogy of Fallot in infants is debatable. The question of total correction versus palliation and the type of palliative procedure remain controversial. During the past 4 years, 30 infants, aged 1 day to 12 months (mean 5.6 months) with symptomatic tetralogy of Fallot underwent either total correction (21 infants) or palliation by relieving the pulmonary stenosis with a right ventricular outflow tract patch (nine infants). The ratio of diameter of the right pulmonary artery to diameter of the ascending aorta (PA/Ao ratio) was calculated from the anteroposterior cineangiogram of all patients. There were three operative deaths in the total correction group; two of these occurred in infants with PA/Ao ratios less than 0.3. One death occurred in the 19 patients undergoing total correction with PA/Ao ratios greater than 0.3 (mortality rate 5.3%). All nine infants undergoing right ventricular outflow tract patching had PA/Ao ratios less than 0.3, and one operative death occurred in this group. Four patients who had right ventricular outflow tract patching have had repeat cardiac catheterization 2 to 15 months postoperatively. All four have shown symmetrical enlargement of the pulmonary arterial tree and significant increases in their PA/Ao ratios.

Abnormalities, Multiple↗