Successive measurements of cardiac myosin light chain I (MLC), creatine kinase isoenzyme MB (CKMB), and the titer of antimyosin antibody (AMA) were performed prospectively in 19 patients following open heart surgery. Seven of these patients showed the postpericardiotomy syndrome (PPS). No differences in serum concentrations of MLC or CKMB were observed between the patients with and without PPS, and all patients in both groups had abnormal MLC values after surgery. However, only patients with PPS had significantly elevated AMA titers. The maximum AMA titer was significantly correlated with the severity of the effusion. These data suggest that PPS is unrelated to the severity of myocardial injury during operation. Furthermore, the AMA titer may be useful as one of the indicators for determining the patient's clinical condition.

Adolescent↗

PubMedDate not supplied

Influence of preoperative nutritional state on inflammatory response after surgery.

To investigate whether the preoperative nutritional state influences the postoperative inflammatory reaction and immunity, we grouped patients whose postoperative nutritional support was performed by total parenteral nutrition into the good nutritional state group (group I) and the latent protein-calorie malnutrition suggested group (group II) based on the preoperative rapid turnover protein (RTP). Nutritional markers markedly decreased after surgery and recovered almost to preoperative levels on postoperative day (POD-) 7 in groups I and II. Nutritional markers on POD-7 in group II were significantly lower than those in group I (RTP, P < 0.001; albumin, P < 0.05). After surgery, levels of interleukin-6 (IL-6), C-reactive protein (CRP), and polymorphonuclear (PMN-) elastase were higher in group II than in group I (P < 0.01). In groups I and II, IL-6 and interleukin-8 (IL-8) rose before the remarkable elevation of CRP and PMN-elastase. In group I, all the nutritional markers showed a negative correlation with CRP and PMN-elastase. Further, a positive correlation was observed between IL-6 and CRP and between IL-8 and PMN-elastase. In conclusion, evaluation of the preoperative nutritional state appears to be very important for the prediction of postoperative complication.

Aged↗

PubMedDate not supplied

Superior vena caval placement of a temporary filter: a case report.

Placement of permanent filters in the superior vena cava (SVC) for preventing pulmonary embolism (PE) arising from thrombi superior to the right atrium has rarely been performed. The authors report the first case of temporary filter insertion in the SVC because of upper extremity thrombosis accompanied with PE. After thrombectomy, the temporary filter was successfully removed. It is recommended to use a temporary filter, especially in young patients with upper extremity thrombosis requiring temporary prophylaxis against PE.

Adult↗

PubMedDate not supplied

Clinical experience with temporary vena cava filters.

An experience with temporary filter placement, which seems to be safe and effective for temporarily preventing pulmonary embolism, is reported. Since October 1997, six patients had temporary filters. There were two men and four women, with a mean age of 37 years. Three filters were placed at the infrarenal inferior vena cava, two at the suprarenal inferior vena cava, and one at the superior vena cava. All filters were placed before various surgical interventions. During filter placement, anticoagulation therapy was routinely performed. There were no complications at and during filter placement. No pulmonary emboli occurred during surgical intervention. All filters were successfully removed, two of which were exchanged for permanent filters. All patients are alive and well without recurrent deep vein thrombosis and/or pulmonary emboli during a follow-up period of 11 to 25 months. Although this experience is small, temporary filter placement is safe and effective for short-term prevention of pulmonary emboli even in older patients or those with malignant disease. Veins of the upper part of the body may be more favorable than the femoral vein for insertion of a temporary filter. Temporary filters can be safely placed not only at the infrarenal inferior vena cava, but also at the suprarenal inferior vena cava or superior vena cava.

Adolescent↗

PubMedDate not supplied

A new experimental model for simultaneous evaluation of aortic and pulmonary allograft performance in a composite graft.

A model was developed in pigs for simultaneous evaluation of aortic and pulmonary allograft performance in a composite graft. The composite graft consisted of vascular prosthesis and aortic and pulmonary allografts. Following antibiotic preservation, it was anastomosed to the recipient's thoracic descending aorta by an extrapleural approach without using cardiopulmonary bypass. Aortic blood flow was completely diverted into the composite graft. All 12 recipient pigs recovered well, 4 of which were assigned for the initial study to design the suitable experimental schedule. Calcification readily occurred in the aortic allografts and aneurysmal dilatation without calcification developed in the pulmonary allografts. These morphological findings were consistent with those of previous reports. This model has several benefits. First, aortic and pulmonary allograft conduits can be implanted and evaluated simultaneously under the same conditions by making a composite graft. Second, the magnitude of the operation is minimum, and postoperative circulatory and respiratory management is uncomplicated. Third, wound infection rarely occurs, because the skin incision is made on the back. These preliminary studies suggest that this model will allow future study concerning aortic and pulmonary allograft conduits under different conditions.

Aneurysm↗

PubMedDate not supplied

Technique for procurement of heart, liver and kidneys from a single donor for transplantation.

The purpose of this report is to present a safe, simple technique for procurement of the heart, liver, and kidneys from a single donor with no warm ischemic time. Twenty mongrel dogs were divided into 5 groups of 3 recipients and 1 donor each. Liver and kidney mobilization was performed when the core temperature of the liver reached 27 degrees C, a result of ice slush in the abdominal cavity. As the core temperature of the liver reached 20-22 degrees C, the aorta and inferior vena cava were clamped just above the diaphragm. After excision of the liver and kidneys, another team harvested the heart as it continued to beat. The heart and liver were transplanted orthotopically after simple preservation for 12 and 6 hours, respectively. The kidney was transplanted heterotopically after simple 12-hour preservation. The maximum survival time was 7 hours for heart transplantation and 16 days for liver transplantation. Kidney homogenate ATP levels decreased to 19% of baseline after preservation and were restored to 68% one hour after reperfusion. Our method is simple and safe for harvesting the heart, liver, an kidneys for transplantation and may offer a definite possibility for clinical application.

Animals↗

PubMedDate not supplied

Surgery for total anomalous pulmonary venous drainage in adults. Case reports and review of eight Japanese patients over 40 years of age.

In the majority of cases, total anomalous pulmonary venous drainage (TAPVD) results in death in infancy or early childhood, with very few cases surviving until adulthood. We report here the surgical correction of TAPVD in two adult patients, a 43-year-old male and 51-year-old female. The postoperative course was uneventful in the two patients, both of whom showed marked improvement of clinical features. The six other surgical corrections of TAPVD in patients over 40 years of age that have been reported in Japan are also reviewed. The favorable results in these cases were associated with the following common factors: 1) unobstructed forms with large drainage veins, 2) large interatrial communication, 3) normal pulmonary vascular resistance with normal or slightly elevated pulmonary artery pressure, 4) low grade, delayed cyanosis, and 5) the supracardiac type of TAPVD.

Adult↗

PubMedDate not supplied

Simultaneous retrieval of the heart and liver from a single donor: an evaluation through preservation and transplantation.

The simple, safe, and feasible procurement technique for the heart and liver with no warm ischemic time is reported. Fifteen mongrel dogs were used to form two recipients and one donor combination in each experiment. A midline incision is extended from the suprasternal notch to the pubis, and a catheter is advanced into the aortic root by means of the brachiocephalic artery for monitoring systemic arterial pressure and later for coronary vascular washout with a cold cardioplegic solution. Liver mobilization is carried out first when the core temperature of the liver reaches 27 degrees C, obtained with ice slush in the abdominal cavity. As the core temperature of the liver reaches 20 degrees to 22 degrees C, the aorta and inferior vena cava are clamped just above the diaphragm. After excision of the liver a second team harvests the heart while it continues to beat. The heart and liver were transplanted orthotopically after simple preservation into a cold solution for 12 and 6 hours, respectively. The maximum survival time was 7 hours in heart transplantation and 16 days in liver transplantation. Our method is a simple, safe, feasible technique for acquiring the heart and liver or other visceral organs for transplantation and may have broad clinical application.

Adenosine Triphosphate↗

PubMedDate not supplied

Disseminated intravascular coagulopathy associated with thromboexclusion for dissecting aortic aneurysm.

Disseminated intravascular coagulopathy (DIC) was demonstrated in a patient who underwent surgical thromboexclusion by blood flow reversal for dissecting aortic aneurysm. Large clots in the descending thoracic aorta and extra-anatomic bypass grafting might have been causative factors of the consumption coagulopathy. Low-dose heparin together with fresh-frozen plasma was effective; however, extreme caution should be adopted with such patients to minimize the development of DIC, because the factors responsible for the coagulation abnormalities are not removed in patients who undergo the surgical treatment of thromboexclusion.

Aortic Dissection↗

PubMedDate not supplied

A multipurpose grasping forceps for retrieval of an embolized catheter fragment.

Transjugular removal of an embolized catheter fragment from the right atrium of a 6-month-old infant was successfully performed using a multipurpose grasping forceps. All procedures for the retrieval were completed in only 10 minutes without complications or difficulty.

Cardiac Catheterization↗

PubMedDate not supplied

Duplication of the tricuspid valve (a rare congenital cardiac anomaly).

Explore the source record for details and available documents.

Adult↗

PubMedDate not supplied

Rejection of the colon in multi visceral organ transplantation in pigs.

We studied the rejection of the colon by performing multiple visceral organ transplantation in non-inbred Large White Duroc pigs. The rejection of the colon was graded as follows: Grade I, infiltration by lymphocytes and/or plasma cells in the mucosa on days 7-8 (the day of transplantation = day 0). Grade II, more intense infiltration in the mucosa and/or submucosa and scattered epithelial sloughing and cryptitis in the mucosa on days 10-14. Grade III, transmural infiltration and complete mucosal destruction on days 18-21.

Animals↗