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Biomedical subjects

A Harjula

Publications and source records attributed to A Harjula.

At least 37 records · Page 2Linked to original sources
PubMed1991

Pleural and pulmonary complications after bilateral internal mammary artery grafting.

The long-term patency of internal mammary artery (IMA) grafts in coronary bypass surgery is superior to that of saphenous vein grafts. To investigate if bilateral IMA grafting increases the complication rate, especially pleural problems, 100 patients with bilateral and 100 with unilateral IMA grafts were retrospectively studied. Preoperatively the groups did not differ in age, previous myocardial infarction, ejection fraction, NYHA classification or previous respiratory disease, but the coronary artery status was poorer in the bilateral IMA group. Postoperative pleural drainage was greater after bilateral IMA grafting (1074 vs. 497 ml, p less than 0.0001). Reoperation was required for bleeding in 10% of the patients with unilateral, and 20% of those with bilateral IMA grafting (p less than 0.05), and more blood was transfused in the latter group (5.9 vs. 4.7 units, p less than 0.01). Pleural effusion at discharge from hospital or 3 months postoperatively, pain in the sternotomy wound, pain on breathing and postoperative use of nitroglycerin did not differ significantly between the groups. Bilateral IMA grafting thus led to more bleeding and reoperations than single IMA grafting, but did not cause excessive pulmonary complications.

Blood Loss, Surgical↗
PubMed1991

Extracranial carotid artery aneurysms.

A material of eighteen patients with carotid artery aneurysms is presented. Mean age of the patients was 57.9 +/- 15.1 years. Most of the patients were asymptomatic or had only a pulsating mass on the neck. One patient had stroke and five TIA. Most common etiology was arteriosclerosis. Two patients got contralateral and two ipsilateral hemiparesis, one patient was unconscious immediately after the operation. Shunt was used on four of these patients. Three patients died, two for neurological reasons and one myocardial death. During the follow up time there were no carotid related diseases. Two patients died of cancer and two of heart attacks. Mean follow up time was 78.6 months. Eight patients attended the follow up studies which were performed by duplex scanning or angiography. They were free of neurological symptoms and their carotid arteries were patent.

Adult↗
PubMed1990

Surgery after heart transplantation.

Of 17 patients who underwent heart transplantation in 1985-1988, three were later operated for reasons unrelated to the transplant. Two of them had acute cholecystitis and one haemothorax, due to rupture of the internal mammary artery during endomyocardial biopsy. Cholecystectomy was performed in the first two cases and thoracotomy in the third, with uneventful recovery in all cases. Early diagnosis and adequate surgical treatment are necessary in these cases. Consideration of the immunosuppressive medication is important during and after operation.

Adolescent↗
PubMed1990

Single lung allotransplantation in pigs. A morphologic study of tissue preservation with modified Euro-Collins and fluorocarbon solutions.

In the present study the functional and morphologic effects of two pulmoplegic solutions are evaluated. Single left-lung allotransplantation with ligation of the right pulmonary artery was performed in 15 piglets (13-20 kg). The lungs were preserved after donor prostaglandin E-1 treatment with single pulmonary artery flush with either modified Euro-Collins solution (mECS) (9 pigs) or oxygenated fluorocarbon emulsion (FC-43) (6 pigs) and transplanted after 6-hr storage in cold Physiosol solution. Tidal volumes of 15 ml/kg x fr (18) with 40% inspired oxygen were used for ventilation during reperfusion. Function of the transplanted lung was monitored for 4 hr postoperatively by determining pa CO2 and pa O2 levels from arterial samples and by noninvasive monitoring of end-tidal CO2 values and arterial oxygen saturations. Sequential morphologic changes in pulmonary artery flow surface and lung tissue were studied after 6-hr storage and 4-hr reperfusion, using light, scanning, and transmission electron microscopy (LM, SEM, TEM). There was no mortality. After transplantation the mECS group experienced significant hypoxia and hypercarbia and had low end-tidal CO2 values as signs of defective oxygenation and gas exchange, whereas the FC-43 group was normoxic and normoventilated without disturbed elimination of carbon dioxide. After storage and reperfusion, LM showed signs of increased vascular permeability and reperfusion damage--more evident in the mECS group compared with the FC-43 group--while the lymphoid cell population was more intensely activated in the latter group. Electron microscopy after storage showed good overall preservation of structures in both groups. After reperfusion preservation of pulmonary artery flow surface and lung tissue was estimated to be moderate in the mECS group, whereas it was good-to-moderate in the FC-43 group by SEM (NS). TEM of lung tissue, however, showed significantly better-preserved alveolar epithelial lining in the FC-43 group compared with the mECS group. In conclusion, oxygenated fluorocarbon (FC-43) pulmoplegia gave better functional and morphologic preservation of lung grafts compared with modified Euro-Collins solution.

Animals↗
PubMed1989

Vasodilator properties of atrial natriuretic factor: a comparison with nitroglycerin, nitroprusside, and phentolamine during cardiopulmonary bypass.

Thirty-five patients scheduled for coronary artery surgery were studied during hypothermic cardiopulmonary bypass (CPB) to compare the arteriolar and venodilator properties of a bolus dose of atrial natriuretic factor (ANF), 100 micrograms, with those of nitroglycerin, 200 micrograms, sodium nitroprusside, 120 micrograms, phentolamine, 3 mg, and placebo. A decrease observed in mean arterial pressure was used as an indicator of a decrease in systemic vascular resistance (arteriolar dilation), while a decrease in reservoir blood volume of the CPB circuit was considered to indicate an increase in venous capacitance (venodilation). All vasodilators decreased mean arterial pressure, and there was no difference in the maximal decrease of the pressure between the drugs. However, the decrease caused by ANF appeared later than that caused by the other vasodilators and lasted longer than with nitroglycerin and sodium nitroprusside. Nitroglycerin and sodium nitroprusside decreased reservoir blood volume, while ANF and phentolamine had no effect. It is concluded that ANF is an arteriolar dilator with a time profile of its effect differing from those of nitroglycerin, sodium nitroprusside, and phentolamine. ANF seems to have no venodilator activity in patients undergoing hypothermic CPB.

Atrial Natriuretic Factor↗
PubMed1989

Intracellular-type solution flush for preservation of myocardium and coronary and pulmonary artery flow surface.

Modified Euro-Collins solution (ECS), which has been successfully used in kidney, liver and lung transplantation, was tested concerning myocardial and endothelial preservation in nine piglets. In six (group I), 1-hour cardiac arrest was induced with cold modified ECS, and in three (group II) heart-lung transplantation was performed, using modified ECS for graft preservation. In group I myocardial energy preservation was determined with biochemical assays for adenosine triphosphate, creatine phosphate, lactate and creatine 5, 15, 30 and 60 minutes after aortic clamping, and preservation of endothelium in the aorta and coronary arteries was studied with scanning electron microscopy. In group II electron microscopy was performed on endothelial samples from the ascending aorta and coronary and pulmonary arteries of the heart-lung block after excision, after 2 hours of ischemia, and after 1-2 hours of reperfusion. High-energy phosphates decreased progressively during the ECS cardioplegia in group I, and circulatory support was required during the post-transplantation reperfusion period in group II. The endothelial lining in all specimens was remarkably well preserved, however. Modified ECS flush thus was ideal for vascular endothelium but, because of its poor energy-preserving capacity, unsuitable for cardioplegia.

Animals↗
PubMed1989

Single-lung allotransplantation in pigs following donor pretreatment with intravenous prostaglandin E-1. Morphologic changes after preservation and reperfusion.

Single left lung allotransplantation with ligation of the right pulmonary artery was performed on 11 pigs after donor pretreatment with prostaglandin E-1 and pulmonary artery flush with modified Euro-Collins solution. Sequential morphologic changes in pulmonary artery flow surface and lung structure were studied after 6-hour storage and after 4-hour reperfusion, using light microscopy and scanning and transmission electron microscopy. Morphologic observations were compared with functional changes. After 6-hour preservation slight degenerative changes were found in the pulmonary artery flow surface and changes in lung tissue suggestive of increased vascular permeability and edema. During 4-hour reperfusion the changes progressed. Preservation was in general moderate. Lung tissue showed vascular congestion and slight inflammation. Localized areas of reperfusion damage could adjoin near-normal looking alveoli. Oxygenation and gas exchange, though low in the beginning of reperfusion, tended to improve during the reperfusion period. The method was concluded to afford good morphologic preservation of the graft after 6-hour storage, and moderately good morphologic and functional preservation after 4-hour reperfusion.

Animals↗
PubMed1988

Comparative evaluation of [123I]14-p-iodophenyl-beta-methyltetradecanoic acid and thallium-201 in the detection of infarcted areas in the dog heart using SPECT.

The concept of using beta-methyl-branched long-chain fatty acids for assessment of myocardial fatty acid uptake and perfusion was extended to the use of radioiodinated fatty acid with stabilization of iodine on the omega-phenyl ring. Beagle dogs were injected with thallium-201 and imaged 15 min after injection. The next day the dogs were infarcted by occluding the LAD, and 2 h later they were injected with [123I]14-p-iodophenyl-beta-methyltetradecanoic acid [123I]BMTDA and imaged for 90 min using a gated SPECT procedure. Maximum uptake of BMTDA in the heart was reached 2 min post injection and the activity level remained constant in the heart during the imaging period. The activity ratio of target to nontarget areas in the tomographic slices was significantly better for the BMTDA imaging compared to 201Tl (P greater than 0.01).

Animals↗
PubMed1988

Donor deep hypothermia or donor pretreatment with prostaglandin E1 and single pulmonary artery flush for heart-lung graft preservation: an experimental primate study.

Using cardiopulmonary bypass to cool the graft and flushing the lungs with cold crystalloid solution are the most popular methods for clinical cardiopulmonary preservation. Heart-lung transplantation was carried out in 11 cynomolgus monkeys. Donor cardiac preservation was achieved with cold crystalloid cardioplegic solution (10 ml per kilogram of body weight) in all animals. Lung preservation was achieved with a rollerhead pump and by cooling (12 degrees C) the donor in one group of 4 animals (deep hypothermia group) and infusing cold (4 degrees C) modified Euro-Collins solution (15 ml/kg X 4 minutes) into the main pulmonary artery of 7 donors pretreated with prostaglandin E1 (PGE1) (PGE1 group). PGE1 was given intravenously (0.5 to 4.0 micrograms/kg/min) beginning 15 minutes prior to aortic cross-clamping and was continued during administration of the pulmonary cooling solution. In the deep hypothermia group, no pharmacotherapy was used. Grafts were stored at 4 degrees C for about 6 hours. After heart-lung transplantation, arterial blood gases were measured on 40% inspired oxygen and 2 to 3 cm of positive end-expiratory pressure, and were significantly higher in the PGE1 group than the deep hypothermia group after 8 hours of reperfusion (p = 0.04). The partial pressure of arterial oxygen decreased significantly during the 8 hours of reperfusion in the deep hypothermia group (153 to 108 mm Hg; p = 0.01) and increased in the PGE1 group (189 to 218 mm Hg;p = 0.0002). Eighty-six percent of the animals in the PGE1 group survived more than 24 hours (p = 0.03). There were no survivors in the deep hypothermia group.(ABSTRACT TRUNCATED AT 250 WORDS)

Alprostadil↗
PubMed1988

Polydioxanone and polypropylene suture material in free internal mammary artery graft anastomoses.

An experimental study with six beagle dogs was conducted to evaluate a new monofilamentous absorbable suturing material--polydioxanone. Free internal mammary artery grafts, 3 cm long, were harvested via a median sternotomy and were implanted as arterial bypasses in femoral arteries (12 end-to-end anastomoses) and as arteriovenous shunts in the carotid artery-contralateral jugular vein position (12 end-to-side anastomoses). Twenty-four anastomoses were made with monofilamentous nonabsorbable suturing material, polypropylene (12 arterial, 12 shunts), to serve as control grafts. At 6 months the grafts and anastomoses were explanted and studied with light and scanning electron microscopes. Macroscopically, the polydioxanone sutures had disappeared. The major histologic finding was the foreign body reaction around the polypropylene sutures. In the electron microscopic study the endothelial line covered the anastomotic site and in the polypropylene anastomoses the suture material was bulging up from the anastomoses. No aneurysms or dilatations were seen. According to this study, polydioxanone is a suitable suturing material for small luminal arterial anastomoses and is superior to polypropylene suturing material because it causes no tissue or other late changes on the flow surfaces.

Animals↗
PubMed1988

Life-threatening complications of cardiac operations and occurrence of myocardial catecholamine bombs.

Myocardial catecholamine bombs (huge local intra-axonal accumulations of catecholamine, mainly norepinephrine, within cardiac tissue) were observed in (right auricular) myocardial biopsy specimens in 16 of 65 adult patients selected randomly from a series of elective cardiac operations. The occurrence of catecholamine bombs was in highly significant correlation (p less than 0.001) with the occurrence of life-threatening complications of cardiac operations (life-threatening arrhythmias [ventricular tachycardias, ventricular fibrillation, asystole], clinically evident perioperative myocardial infarction/postoperative low-output syndrome, death). There was a very close correlation between the occurrence of catecholamine bombs and life-threatening arrhythmias. Life-threatening arrhythmias occurred in 13 patients. Eight of them belonged to the group of 16 patients with catecholamine bombs and five belonged to the group of 49 patients with no bombs; the difference (8/16 versus 5/49) is very clear (p less than 0.001). It was our experience that dangerous arrhythmias related to catecholamine bombs may occur as late as during the second postoperative week. We believe our observations are of considerable clinical importance, because catecholamine bombs are easily identified by fluorescence microscopic examination of right auricular myocardial specimens retrieved intraoperatively, and patients at high risk can then be selected (during the operation) for more extensive and prolonged surveillance and possibly prophylactic treatment.

Adult↗