Transcaval posterocranial resection of the liver as treatment of the Budd-Chiari syndrome.
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Adult↗
Biomedical subjects
A Senning
Publications and source records attributed to A Senning.
Cardiac pacing in retrospect.
As precursors of permanent pacemakers, Lidwill (1929) and Hyman (1932) introduced temporary pacemakers for resuscitation. Callaghan (1950) intravenously paced the sinus nodal region for bradycardia in hypothermic dogs. Zoll (1952) used external electrodes to treat Adams-Stokes attacks, and Lillehei (1957) fixed stainless steel electrodes to the myocardium, successfully treating iatrogenic total atrioventricular block with a percutaneous pacemaker. Since 1951, by experimental and clinical use of ventricular fibrillation to obtain a functional cardiac standstill during open heart surgery, we used all known methods of stimulation to treat asystole or bradycardia after defibrillation. Since 1957, percutaneous stimulation by Adam-Stokes attacks has been performed. The most serious complication is infections along the electrodes causing death from sepsis. The solution of the problem was the implantation of the pacemaker and its energy supply. Percutaneous leads were used to study the different parameters for electric stimulation and to find the lowest frequency (to spare energy) with the best variation of cardiac output. In October 1958 in Stockholm a fixed rate pacemaker was implanted by thoracotomy. At present, the patient is living with his 23rd pacemaker. Four additional patients had pacemaker implantations until 1960. In 1961, Chardack and Greatbach successfully implanted pacemakers with mercury batteries. Johanson and Lagergren connected the pacemaker to an intravenous electrode to avoid thoracotomy. The enormous development in the electronic field made more elaborate pacemakers possible, and eliminated the risk of the fixed rate (interference, repetitive firing, and ventricular fibrillation).
Adult↗
[Angio-follicular lymph node hyperplasia (Castleman's lymphoma)].
Two patients with angio-follicular lymph node hyperplasia are described, and the literature is reviewed. In one symptom-free man, the chest x-ray showed a tumour of the upper mediastinum the size of a fist (which is known to have been present for 20 years), in another man there was a 4 cm. node in the right hilum, which was shown by computer tomography not to be due to vessels. In each case the tumour was removed. Histologically they proved to be a hyaline-vascular type of angio-follicular lymph node hyperplasia. This is probably an inflammatory-reactive process.
Adolescent↗
Surgical treatment versus medical treatment in hypertrophic obstructive cardiomyopathy.
Sixty-three patients operated upon for HOCM and 49 patients selected for non-surgical treatment have been followed-up for 15 years. Pre-operatively, surgical patients had a higher left ventricular outflow tract gradient at rest and, on the average, more severe symptoms than non-surgical patients. Septal myectomy relieved the pressure gradient and symptoms more consistently than long-term treatment with beta-blockers or verapamil. Within an average observation time of 7 1/2 years, there was late deterioration or death in almost half of the non-surgical patients but in less than one-quarter in the operated patients. The 10 year mortality rate was 80% in the surgical series and 71% in the non-surgical series. In operated patients, pre-operative symptomatic status was significantly related to early and late mortality. In medically treated patients, mortality was unrelated to symptoms; however, it was significantly lower in patients receiving long term treatment with beta-blockers or verapamil. In conclusion, a high basal pressure gradient associated to limiting symptoms is a clear-cut indication for surgery. Other indications are more debatable. In medically treated patients, long-term administration of beta-blockers or verapamil is beneficial even without symptoms as it appears to improve prognosis.
Adolescent↗
Left ventricular relaxation at rest and during handgrip in aortic valve disease before and after valve replacement.
In 14 patients (pts) with aortic valve disease (AVD) left ventricular (LV) relaxation was assessed by the time constant (T) of LV pressure (tipmanometer) fall before and 19 months after successful aortic valve replacement (AVR). 12 control pts (CO) were studied by the same technique. Preoperative LV ejection fraction in AVD (64%) and in CO (69%) did not differ. In AVD T was increased (60 ms) as compared to the CO (38 ms, P less than 0.05). During handgrip (HG) there was a similar increase of LV peak systolic pressure (LVSP), heart rate and peak measured contractile element velocity of shortening in AVD and in the CO. LV end-diastolic pressure varied minimally in both groups. T decreased during handgrip in CO (38 to 33 ms, P less than 0.01) and remained unchanged in AVD. Following AVR T at rest decreased insignificantly to 52 ms, but remained increased (P less than 0.025) as compared with CO. During postoperative HG however, a decrease to 47 ms (P less than 0.05) was noted. Postoperative angiographic LV muscle mass (105 g/m2) and LVSP at rest (137 mmHg) remained elevated (P less than 0.02) as compared to CO (72 g/m2; 119 mmHg). It is concluded that (1) in AVD with normal ejection performance LV relaxation at rest is prolonged and the reaction of relaxation to HG is abnormal despite preserved contractile response, (2) following AVR the response of LV relaxation to HG becomes normal and (3) elevated postoperative T at rest appears to be related to residual hypertrophy and probably also to the still increased LVSP rather than to intrinsic disturbances of myocardial relaxation.
Adult↗
Different sensitising acrylic monomers in Napp printing plate.
3 chemically pure fractions were isolated from Napp printing plate and subsequently identified by means of nuclear magnetic resonance, infrared spectrophotometry and elemental analysis. 1 of the fractions elicited positive test reactions in 3 Napp-allergic printers, and another fraction also elicited a positive test reaction in 1 of the printers. The 2 allergens were 2-hydroxyethyl methacrylate and N,N'-methylene-bis-acrylamide. The 1st of the 2 allergens was also demonstrated in another printing plate, Nyloprint WD.
Acrylamides↗
Chemical feasibility studies concerning potential prodrugs of acetylsalicylic acid.
A rationale is developed for aspirin prodrugs based on non-acidic latentiated derivatives. Knowledge of the gastro-intestinal liabilities and pharmacological profile is required for this approach whereby aspirin is built into a common ortho ester function of the type 2-substituted 2-methyl-4H-1,3-benzodioxin-4-one with latentiated carboxyl and acetoxy groups. Twelve compounds of this type, ten substituted with various alkoxy and aryloxy groups and two with arylthio groups, have been isolated and characterized. A new synthetic route, comprising the reaction of 2-acetoxybenzoyl chloride with TMS derivatives of the corresponding alcohols and phenols, has been devised for the preparation of some of the compounds while others were prepared according to known methods. Subsequently, the prodrug candidates have been subjected to non-enzymatic hydrolysis for a first rapid screening in vitro. Only 2-tert-butoxy-2-methyl-4H-1,3-benzodioxin-4-one is observed to act as a true proaspirin, releasing aspirin, under these conditions, but analogous compounds with tertiary substituents may display the same behavior, and this chemical approach to aspirin modification may offer a viable rationale for aspirin prodrugs with reduced gastric irritancy or for making "superaspirins".
Aspirin↗
[Indication and early results of carotid endarterectomy].
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Arteriosclerosis↗
[Experiences with the extracardial conduit in the reconstruction of the right ventricular outflow tract].
Operative correction of certain congenital cardiac malformations with discontinuity between the right ventricle and pulmonary artery is technically possible today with satisfactory late results. The atretic or hypoplastic outflow tract can be bridged by an external tubular graft containing a valvular prosthesis. Of 22 patients operated upon from 1978-1981, 16 survived the operation and perioperative period. There was one late death. Routine cardiac catheterization was performed in 6 non-selected patients between 7 and 22 months after surgery. No hemodynamically important gradients were found. The extracardiac conduit between the right ventricle and pulmonary artery has become an important tool in correcting certain forms of congenital heart disease.
Adolescent↗
[Is the aorto-coronary bypass operation useful in patients with advanced coronary sclerosis and poor ventricular function?].
The prognosis and long term results in 56 patients with coronary artery disease and impaired left ventricular function (EF less than or equal to 40%) who underwent aortocoronary bypass surgery (all cases) and aneurysmectomy (26 cases) between 1972 and 1980 were compared with those in 47 equally ill patients treated medically. Survival was significantly higher in the surgical than in the non-surgical group, the survival rate being 80% and 58% respectively at 41 months after study entry (p = 0.012). No difference in survival was observed between grafted patients and patients in whom additional aneurysmectomy was performed. 26 patients were recatheterized postoperatively and this revealed an increase in left ventricular ejection fraction at rest from 33 +/- 5% to 44 +/- 11% (p less than 0.001) and a decrease in left ventricular end-diastolic pressure from 18 +/- 8 mm Hg to 14 +/- 8 mm Hg (p less than 0.025). Postoperatively the patients had less angina and physical working capacity increased. At restudy the average NYHA class had decreased in the surgical group from 2.9 +/- 0.7 to 2.1 +/- 0.9 (p less than 0.001) but was unchanged in the non-surgical group (2.6 +/- 0.6 and 2.6 +/- 0.7 respectively). It is concluded that aortocoronary bypass surgery improves survival, left ventricular function and symptoms in patients with coronary artery disease and severely impaired myocardial function.
Adult↗
[Relaxation of the left ventricle in aortic stenosis before and after aortal valve replacement].
In 14 patients with aortic valve disease (AVD) left ventricular (LV) relaxation was assessed by the time constant (T) of LV pressure (tipmanometer) fall before and 19 months after successful aortic valve replacement. 12 control patients were studied by the same technique. Preoperative LV ejection fraction in AVD (64%) and in controls (69%) did not differ. In AVD T was increased (60 ms) as compared to the controls (38 ms. p less than 0.05). During handgrip there was a similar increase in LV peak systolic pressure (LVSP), heart rate and peak measured contractile element velocity of shortening in AVD and in the controls. LV enddiastolic pressure varied minimally in both groups. T decreased during handgrip in controls (38 to 33 ms, p less than 0.01) and remained unchanged in AVD. Following aortic valve replacement resting T decreased insignificantly to 52 ms but remained increased (p less than 0.025) as compared to the controls. During postoperative handgrip, however, a decrease to 47 ms (p less than 0.05) was noted. Postoperative LVSP at rest (137 mm Hg) and LV muscle mass (105 g/m2) remained elevated (p less than 0.02) as compared to the controls (119 mm Hg; 72 g/m2). It is concluded that (1) in AVD with normal ejection performance LV relaxation at rest is prolonged, (2) the reaction of relaxation to handgrip is abnormal despite preserved contractile response, (3) following aortic valve replacement the response of LV relaxation to handgrip becomes normal and (4) elevated postoperative T at rest appears to be related to still increased LVSP postoperatively and residual hypertrophy rather than to intrinsic disturbances of myocardial relaxation.
Aortic Valve↗
[Aortic valve replacement in older patients].
From 1971 to 1976, 72 patients over 60 years old underwent aortic valve replacement. At the moment of the operation 6 patients were older than 70 (8%), 25 patients were between 65 and 69 (35%) and 41 patients between 60 and 64 years old (57%). The early postoperative mortality was 5.5% and the late postoperative mortality 12.5%. The average observation period was 34 months. The frequency of death was comparable in the three age groups. The operative risk and functional postoperative recovery are unrelated to the age of the patients. The patients with combined aortic disease have the best prognosis.
Age Factors↗
The ascending aortic aneurysm: replacement or repair?
Between 1971 and 1980, 100 patients underwent operation for ascending aortic aneurysm. Acute dissection was present in 29, chronic dissection in 11; 56 had dilatation only, and 4 had inflammatory disease of the ascending aorta. Four different operative procedures were applied independent of the type of disease: repair and reduction aortoplasty (21), reduction aortoplasty reinforced by nylon net (17), supracoronary graft replacement (42), and composite graft replacement with reimplantation of both coronary ostia (20). Early mortality was 10%, and late mortality was 12% after a mean follow-up of 45 months. Retrospective comparative analysis of the four operative methods led to the following conclusion: reduction aortoplasty supported by a tightly wrapped synthetic net is a suitable method in patients with a normal sinus of Valsalva and without dissection or inflammatory disease. Particular attention needs to be drawn to the proximal anchor stitches to avoid late net displacement. Compared with supracoronary or composite graft replacement, this method carried a lower complication rate, particularly in regard to cerebrovascular accidents and myocardial infarction. For patients with acute and chronic dissection with intact aortic root, supracoronary graft replacement is preferred, whereas in those with annuloaortic ectasia with dilated sinus of Valsalva and in all patients with Marfan's syndrome, composite graft replacement has become the procedure of choice.
Adolescent↗
Congenital aortic stenosis. Early and late results of aortic valvulotomy.
Between 1962 and 1979, 87 patients with congenital aortic stenosis (11 infants from 4 days to 5 months, and 76 patients from one year to 24 years) underwent open aortic valvulotomy; in 14 patients an additional subvalvular membraneous ring or hypertrophic subaortic stenosis was resected. There were 3 early deaths (3%), all in infants less than one year of age. A second operation was necessary 3 months to 10 years (mean 6.3 +/- 4 years) after the initial procedure in 12 of the 84 survivors. In 9 patients an aortic valve replacement and in 3 patients a second valvulotomy was performed without perioperative mortality: in the latter group valve replacement had to be performed later. There were 5 late deaths (6%). The causes of death were endocarditis (2), thrombosis of the prosthesis (1), accident (1) and sudden death (1). The overall actuarial survival curve shows a 5-year survival of 90% and a 10-year survival of 87%; 87% are reoperation-free after 5 years and 75% after 8 years. At present 7 patients are scheduled for surgery because of recurrence of stenosis; 61 patients are symptom-free. It is concluded that aortic valvulotomy has immediate and long-term benefit in the large majority of patients. Operative mortality and morbidity are low in patients older than one year of age. Nevertheless aortic valvulotomy, which should not be performed too late, represents a palliative treatment and will lead to reoperation in approximately 25% of patients after 8 years.
Actuarial Analysis↗
Bioprosthetic replacement of the tricuspid valve.
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Adult↗
Tricuspidal annuloplasty. Results and complications.
Between 1976 and 1979, 76 patients underwent tricuspid annuloplasty (TA) for predominant tricuspid regurgitation (TR). The TR was functional (secondary to mitral valve disease) in 70, postrheumatic in 4, posttraumatic in one and secondary to myxomatous degeneration in one. The mean preoperative functional class was 3.05 and cardiac index 2.15 +/- 0.53 l/min/m2. All but 8 were in atrial fibrillation. Pulmonary vascular resistance over 250 dyn x sec x cm-5 was present in 28 patients. The original de Vega technique was applied in 55, a modified annuloplasty technique was used in the remaining 21 cases. There were 3 early and 6 late deaths, none being related to annuloplasty. One early and 2 late complications were attributable to tricuspid annuloplasty. At control after 6 months, 64 of 72 patients had improved at least one functional class. Three presented moderate TR on clinical examination. Mean observation time now averages 30 months (20 to 48 months). De Vega annuloplasty is a safe and effective method for the treatment of functional TR. It is of particular value during the early postoperative period in preventing right ventricular overload.
Adolescent↗
[Spurious aneurysm after myocardial infarct].
False aneurysms of the left ventricle after myocardial infarction arae the result of perforation, which usually require early surgical treatment. The clinical features are not characteristic. The chest x-ray may provide important evidence for the diagnosis. Non-invasive diagnosis is possible by means of echocardiography and computer tomography; it is confirmed by angiocardiography. The authors experience with nine cases is described.
Adult↗
Myocardial function and structure in aortic valve disease before and after surgery.
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Aortic Valve↗