Biomedical subjects

R A Zeldin

Publications and source records attributed to R A Zeldin.

3 recordsLinked to original sources

PubMed1984

Postpneumonectomy pulmonary edema.

Postpneumonectomy pulmonary edema has become a worldwide problem. Study of data available from some of these patients implicates excessive perioperative volumes of intravenous fluid. A study done on dogs supports the clinical conclusion. The risk factors for this complication are right pneumonectomy, large perioperative fluid load, and high intraoperative and postoperative urine outputs. Patients undergoing pneumonectomy are at greater risk from intravenous fluid therapy than other types of patients.

Animals↗

PubMed1984

Assessing cardiac risk in patients who undergo noncardiac surgical procedures.

To confirm the usefulness of the cardiac risk index published by Goldman and associates in 1977, the author did a separate, prospective study of 1140 patients over the age of 40 years who underwent noncardiac surgical procedures. Four risk categories were defined (classes I to IV, low to high risk according to Goldman's point score). Percentages of postoperative cardiac events (life-threatening cardiac complications or cardiac death) were tabulated. The incidence of cardiac events for each risk category, classes I to IV, was 0.7%, 3%, 15% and 30%, respectively. Comparisons with Goldman's original study demonstrate that the cardiac risk index is a reliable, objective and valid method of assessing cardiac risk in patients who undergo elective surgery.

Adult↗

PubMed1982

A modified Sugiura procedure.

The Sugiura procedure for esophageal varices combines splenectomy with esophagogastric devascularization, which destroys the intraesophageal portacaval shunt but preserves periesophageal portacaval shunts. We have modified the total vagotomy and pyloroplasty and sutured esophageal anastomosis of the original operation. A single left thoracoabdominal incision is used. Esophagogastric devascularization is performed without dividing the main vagus trunks; only a proximal gastric vagotomy is done, thereby avoiding a pyloroplasty. The esophageal transection and reanastomosis are performed with the circular End-to-End Anastomosis stapler and protected with a loose-fundal wrap. Fifteen of 20 patients have had good to excellent results, with rapid recovery and no recurrent esophagogastric bleeding or any hepatic encephalopathy in follow-up of two months to two years. Four patients, who were bleeding massively at the time of operation and who were in Child's class C with gross ascites, muscle wasting, ad coagulopathy, died in the postoperative period. Conceptually, the operation is original and exciting because it preserves hepatic blood flow and the beneficial periesophageal shunt, while destroying the harmful intraesophageal shunt. Our early experience encourages us to continue using this operation, except in those patients who bleed massively and are in Child's C, end-stage, class.

Esophageal and Gastric Varices↗