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Biomedical subjects

W Goldstein

Publications and source records attributed to W Goldstein.

At least 19 recordsLinked to original sources
PubMed1996

Nonthoracotomy implantation of cardioverter defibrillators: preliminary experience with a defibrillation lead placed at the right ventricular outflow tract.

UNLABELLED: Although morbidity and mortality associated with defibrillator implantation using a nonthoracotomy approach have decreased as compared with a thoracotomy approach, defibrillation thresholds have been higher and fewer patients satisfied implant criteria. It may be possible to improve on the success of nonthoracotomy defibrillator implantation by the placement of a right ventricular (RV) outflow defibrillation lead. Implantable cardioverter defibrillator implantation data of 30 consecutive patients with clinical VT or VF were reviewed. Three defibrillation leads were routinely used. When either pacing threshold at the RV apex was inadequate (n = 2) or 18-J shocks were not successful in terminating VF in 3 of 4 trials (n = 8), the RV apex lead was positioned to the RV outflow tract attaching to the septum. Defibrillation testing was first performed with the RV apex lead in combination with CS, SVC, and/or subcutaneous leads. Twenty patients satisfied implant criteria with a defibrillation threshold of 13.5 +/- 3.6 J. In 7 of the 10 patients, whose RV lead was repositioned to the RV outflow tract, this lead in combination with SVC, CS, or subcutaneous leads produced successful defibrillation at < or = 18 J or in 3 of 4 trials. This approach improved the overall success of nonthoracotomy implantation of defibrillators from 69% to 90%. After a follow-up of 27 +/- 6 months, there was no dislodgment of the RV outflow tract defibrillation leads. CONCLUSIONS: This article reports the preliminary observation that placement of defibrillation leads to the RV outflow tract in humans was possible and without dislodgment. RV outflow tract offers an alternative for placement of defibrillation leads, which may improve on the success of nonthoracotomy defibrillator implantation.

Adult↗
PubMed1995

The purposes, formation, and legal implications of PHOs.

In response to rapid changes in the health care delivery system, hospitals and physicians are exploring collaborative efforts. One of these efforts is the physician hospital organization (PHO). This article explores the purposes for forming PHOs, their actual formation, and related legal issues.

Antitrust Laws↗
PubMed1994

Histopathologic changes in the aging human cricoarytenoid joint.

Detrimental effects of the natural aging process on the human cricoarytenoid joint have been hypothesized as a possible etiology for the voice changes seen in the aging population. Cellular events occurring at the histologic level, such as cricoarytenoid joint erosion or arthritis may lead to alterations in laryngeal structure which ultimately affect its function and performance. Seven normal human larynges of varying ages ranging from 29 to 69 years of age were examined histopathologically for changes in the cricoarytenoid joint. The synovium, joint space, periarticular muscle, and respiratory epithelium were evaluated for the presence of inflammatory changes or edema and degree of vascularity. The location and amount of ossification, elastin, and collagen formation were also noted. There were no appreciable changes noted in the synovium or joint space itself with increasing age. No differences were observed in the degree of elastin or collagen formation. However, there was progressive cricoid and arytenoid ossification and periarticular muscular atrophy and fibrosis. These findings suggest that other laryngeal changes may play a greater role in determining senescent vocal quality rather than changes within the cricoarytenoid joint itself.

Adult↗
PubMed1992

Pulmonary resection and contralateral anomalous venous drainage: a lethal combination.

A 72-year-old acyanotic woman had development of acute right heart failure with systemic hypotension 2 hours after a curative right intrapericardial pneumonectomy for primary lung cancer. A postoperative pulmonary angiogram revealed a major left to right shunt through previously unsuspected partial anomalous venous drainage of the left upper lobe of the lung.

Adenocarcinoma↗
PubMed1990

Concentrations of teicoplanin in serum and atrial appendages of patients undergoing cardiac surgery.

The concentrations of teicoplanin in sera and heart tissues of 49 patients undergoing coronary bypass were measured. Each patient received a 6- or 12-mg/kg dose of teicoplanin administered in a slow intravenous bolus injection over 3 to 5 min beginning at the time of induction of anesthesia. Mean +/- standard error of the mean concentrations in serum were, for the two doses, respectively, 58.1 +/- 1.7 and 123.3 +/- 7.4 micrograms/ml 5 min after administration and 22.2 +/- 0.7 and 56.5 +/- 2.8 micrograms/ml at the time of removal of atrial appendages. Mean +/- standard error of the mean concentrations in tissue were 70.6 +/- 1.7 and 139.8 +/- 2.2 micrograms/g, respectively, giving mean tissue/serum ratios of 3.7 +/- 0.3 and 2.8 +/- 0.2, respectively. Teicoplanin penetrates heart tissue readily and reaches levels in the serum far in excess of the MICs for most pathogens that have been found to cause infections following open heart surgery.

Anti-Bacterial Agents↗
PubMed1989

Hoarseness secondary to left atrial myxoma.

A 62-year-old woman presented with a history of hoarseness. Although stable for ten years, she recently showed signs of deterioration. Investigations revealed left vocal cord paralysis and a large left atrial tumor displacing the left pulmonary artery under the arch of the aorta. The lesion was removed and the normal aortopulmonary window on computed tomography (CT) scan was restored. On review of the literature, this case appears to be the first to suggest that myxomas cause recurrent laryngeal nerve palsy through direct effects.

Female↗
PubMed1986

Submammary skin incision as a cosmetic approach to median sternotomy.

Median sternotomy is the incision of choice to allow access to the anterior mediastinum, heart, or both lungs. The vertical skin incision leaves an unsightly scar for many female patients. A bilateral submammary horizontal skin incision with dissection of a flap including the subcutaneous tissue and breasts allows exposure of the sternum so that a median sternotomy can be performed. Since November 1981, we have used this incision 40 times in female patients undergoing open heart surgery. The exposure of the mediastinum was excellent, and there were no difficulties in cannulating the ascending aorta for cardiopulmonary bypass. Complications associated with this incision are insignificant if close attention is paid to details.

Adolescent↗
PubMed1986

Effect of Pseudomonas aeruginosa proteases on human leukocyte phagocytosis and bactericidal activity.

The effect of Pseudomonas aeruginosa alkaline protease (AP) and elastase (Ela) on neutrophil phagocytosis and bactericidal activity was examined. It was found that both proteases reduced the phagocytic activity of the leukocytes against P. aeruginosa, whereas they had little effect on the phagocytosis of S. aureus. AP and Ela at concentration of up to 250 micrograms per ml (much higher than the levels detectable under in vivo conditions) did not interfere with the bactericidal activity of the leukocytes against both test organisms. Inhibition of phagocytosis by AP and Ela without effect on the bactericidal activity suggests that the P. aeruginosa proteases most probably exert their effect on the cell surface perhaps by proteolytic cleavage of the cell receptors which are necessary for phagocytosis.

Blood Bactericidal Activity↗
PubMed1986

Lysosomal enzymes from polymorphonuclear leukocytes and proteinase inhibitors in patients with cystic fibrosis.

In serum and sputum samples from 15 patients with cystic fibrosis (CF) suffering from chronic Pseudomonas aeruginosa lung infections, concentrations and/or activities of elastase derived from polymorphonuclear leukocytes (PMN), cathepsin G, myeloperoxidase (MPO), and superoxide dismutase (SOD), as well as concentrations of the proteinase inhibitors alpha 1-proteinase inhibitor (alpha 1-PI) and alpha 2-macroglobulin (alpha 2-M), were determined. High enzyme concentrations compared with those in normal control subjects were found for PMN elastase (mean, 96.1 +/- 91.7 micrograms/ml), cathepsin G (mean, 5.9 +/- 6.0 micrograms/ml), and MPO (mean, 138.0 +/- 177 micrograms/ml) in patients' sputum samples. Superoxide dismutase was not detectable in any of the sputum specimens (below 1 ng/ml). Proteinase inhibitor concentrations were elevated in serum samples (alpha 1-PI: mean, 3,457 +/- 1,084 micrograms/ml; alpha 2-M: mean, 4,835 +/- 1,334 micrograms/ml). Means of 61 +/- 38 micrograms/ml alpha 1-PI and 29 +/- 31 micrograms/ml alpha 2-M were present in the sputum specimens. Both proteinase inhibitors were functional in the serum samples. However, sputum alpha 1-PI was proteolytically degraded, as shown by western blot technique, and was not able to bind 125I-labeled PMN elastase, as shown by autoradiography. Only 10.9 +/- 8.5% of the total alpha 1-PI in the sputum samples was complexed to PMN elastase and 3.6 +/- 3.2% to cathepsin G. On the other hand, 96.2 +/- 96.8% of the total PMN elastase and 78.0 +/- 100% of cathepsin G were unbound in the sputum samples. The study suggests that the imbalance between PMN proteinases and their inhibitors is due to inactivation of alpha 1-PI in the sputum caused by proteolytic or oxidative attack from PMN enzymes.

Blood Proteins↗
PubMed1986

Elastase from polymorphonuclear leucocytes: a regulatory enzyme in immune complex disease.

In sputa of 21 cystic fibrosis patients suffering from chronic Pseudomonas aeruginosa lung infections, activities of lysosomal proteases released from polymorphonuclear leukocytes (PMN) and immune complexes were quantitatively determined. The results showed that low immune complex values correlated with high protease activities and vice versa. In a longitudinal study fluctuating, reciprocal changes of the parameters were observed. Therefore, the hypothesis was investigated as to whether PMN elastase cleaves immune complexes and regulates inflammation. It was shown that treatment of immune complex-positive sputa with PMN elastase decreased IgG and IgA immune complex values and lead to cleavage of the immunoglobulins in the hinge region. PMN elastase-treated samples were not able to stimulate the oxidative burst of PMN. Cleavage of in vitro built immune complexes did not lead to liberation of bound antigen. Western blot analysis of one sputum sample revealed split products of the IgG heavy chain. The results suggest that PMN elastase splits off the Fc portion of immunoglobulins in immune complexes and thus regulates inflammation by a feedback mechanism leading to cyclic inflammatory states.

Antigen-Antibody Complex↗
PubMed1985

Ionescu-Shiley pericardial xenografts: follow-up of up to 6 years.

The results of valve replacement with the Ionescu-Shiley pericardial xenograft compare favorably with results obtained with other bioprostheses. From March, 1977, to July, 1983, 497 Ionescu-Shiley pericardial valves were implanted in 463 patients at the University of Ottawa Heart Institute. There were 292 patients who had aortic valve replacement (AVR), 140 with mitral valve replacement (MVR), 28 with double valve replacement, and 3 with triple valve replacement. The survivors were followed regularly. Actuarial analysis of late results indicates an expected survival of 71% at 6 years for patients who underwent AVR and 72% at 3 years for patients who had MVR. The only valve-related deaths were due to endocarditis, which occurred at a rate of 3.9% per patient-year for aortic valves and 0.6% per patient-year for mitral valves. Despite a low usage of formal anticoagulation, embolic complications occurred at a rate of 1.4% per patient-year for aortic valves and 4.0% per patient-year for mitral valves. Five valves were removed for intrinsic failure after 36 to 72 months of follow-up. New York Heart Association Functional Class improved an average of 1.28 classes per patient.

Actuarial Analysis↗
PubMed1985

Role of Pseudomonas aeruginosa exoenzymes in lung infections of patients with cystic fibrosis.

We investigated the role of Pseudomonas aeruginosa exoenzymes in cystic fibrosis lung infection in the presence and absence of specific serum antibodies. In sputa of 21 cystic fibrosis patients, concentrations of P. aeruginosa proteases and exotoxin A were determined by sensitive radioimmunoassays. In all sputa, detection of exoenzymes was negative (less than or equal to 10 ng). Positive serum antibody titers to bacterial exoenzymes were found in the majority of patients. Purified immunoglobulin G (IgG) preparations from the sera of two patients revealing specific antibody titers to the bacterial proteases neutralized these enzymes at ratios of 1,000:1 to 5,600:1 (wt/wt). Above the neutralizing capacity of IgG, proteases caused cleavage of IgG; below that level, no enzymatic activity was observed. In vitro incubation of P. aeruginosa elastase, alkaline protease, or exotoxin A with elastase derived from polymorphonuclear leukocytes showed that polymorphonuclear leukocyte elastase: (i) was cleaved by bacterial elastase, (ii) was not inactivated by alkaline protease, and (iii) inactivated exotoxin A. The results suggest that soon after the onset of P. aeruginosa lung infection in cystic fibrosis patients, bacterial proteases, but not exotoxin A, become important virulence factors. The results also suggest that exoenzymes do not directly contribute to lung damage after immune response to bacterial antigens has begun.

Cystic Fibrosis↗
PubMed1985

Mitral valve replacement with Hancock porcine bioprostheses: up to 7-year follow-up.

From February 1976 to May 1981 at the University of Ottawa Heart Institute, 137 mitral valves were replaced with the Hancock porcine bioprosthesis. This study concerns 111 patients (55 men, 56 women) who had single-valve replacement. The average age of the patients was 53.0 years. The predominant lesion in the 102 patients who were receiving their first substitute valve was stenosis in 46% and regurgitation in 42%. Preoperatively, 82% were New York Heart Association (NYHA) class III or IV. Additional procedures were performed in 44 patients (39.6%). The 26 patients who had multiple valves replaced were considered only for durability studies. Hospital mortality was 8.9% for isolated replacement and 22% for replacement associated with aortocoronary bypass grafting. At the time of discharge, 50% of patients were in atrial fibrillation, 14% were taking warfarin and 82% antiplatelet agents. Follow-up was available for a total of 374 patient-years (average of 5.4 years per patient). The mean symptomatic improvement was 1.6 NYHA classes per patient. Actuarial analysis indicated a survival rate of 70% at 8 years. Of the 18 late deaths, 4 (22%) were valve-related. The rates of endocarditis and thromboembolism were 1.1% and 5.8% patient-year respectively. In the 137 prostheses at risk, intrinsic failure occurred at the rate of 4.7% patient-year for a cumulative rate of 35% at 8 years. The authors conclude that the Hancock porcine bioprosthesis provides good relief of symptoms in the mitral position with an acceptable rate of thromboembolism even without anticoagulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Bioprosthesis↗
PubMed1980

Direct revascularization of the septal artery.

Between July 1, 1976 and May 1, 1979, 21 patients underwent coronary artery grafting of the first septal artery. Blood flow in the septal bypass averaged 60.2 ml/min and the diameter of the distal anastomoses averaged 2.1 mm. Among the 20 survivors, 13 were subjected to angiography at an average of 7 months after the operation (from 2 weeks to 2 years). The bypass graft to the first septal artery was patent in 84% of the patients (11 of 13) and 90% of the grafts were open (57 of 63). The authors believe that if a patient has an important stenosis in the first septal artery, direct revascularization may be carried out. However, because of technical difficulties during dissection and anastomosis it is wise to select an artery at least 2 mm in diameter which supplies a large area.

Adult↗
PubMed1980

First septal artery: direct or indirect grafting.

We retrospectively analyzed the revascularization of the septal artery achieved either directly through a coronary artery bypass graft (CABG) to the first septal artery (S1), or indirectly through endarterectomy and CABG of the anterior descending coronary artery (LAD). From July 1, 1976 to May 1, 1979, 21 84% (11 of 13). During the same period, 15 patients with a large S1 received endarterectomy and CABG of the LAD. Six of these 15 patients (40%) had an excellent flow into S1 as seen on the postoperative angiogram, whereas nine (60%) showed no improvement. The vein graft was patent and considered normal in 14 patients and the distal flow in the LAD was adequate in 10 patients (66%). We conclude that better revascularization of S1 is achieved by direct CABG. However, endarterectomy of the LAD allows revascularization of arteries that could not be grafted otherwise because of severe diffuse disease.

Adult↗