Histocompatibility in the dog.
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Animals↗
Biomedical subjects
E Bos
Publications and source records attributed to E Bos.
Detailed analysis of aortic valve endocarditis: comparison of precordial, esophageal and epicardial two-dimensional echocardiography with surgical findings.
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Adult↗
Gradient echo MRI for measurement of the pulmonary autograft diameter after transplantation to the aortic root: validation and comparison with ultrasound.
The purpose of this study was to s the value of MRI for measurement of pulmonary autograft diameters after transplantation to the aortic root in adults. Thirty-eight adults underwent this operation. MRI and transesophageal echocardiography (TEE) were performed in 30 and 27 patients, respectively, after a mean follow-up period of 2.8 years. For internal validation of MRI, measurements at the diastolic short and long axes of the sinus level were used. Pulmonary autograft diameters were measured and compared with MRI and TEE at five different levels: the subannular region (1), annulus (2), sinus (3), sinotubular junction (4), and the distal part of the autograft (5). The correlation coefficient (r2) between long- and short-axis measurements for corresponding sinuses was .97. Diameters obtained with MRI were 1 to 3 mm larger than those obtained with TEE (P < .05), except for the annulus at systole (P > .3). Cine gradient echo MRI is an appropriate technique to evaluate pulmonary autograft diameters during follow-up. Concordance with TEE was good, apart from a systematic difference of approximately 2 mm.
Adult↗
Echocardiographic diagnosis of overriding tricuspid valve in a child with Ebstein's anomaly.
The M-mode echocardiographic diagnosis of overriding tricuspid valve rests on the ability to demonstrate simultaneously two atrioventricular valves with no intervening septal echo [6, 13]. When scanning inferiorly toward the body of the ventricles, a distinct septal echo at the level of the midportion of the tricuspid valve can be detected. Here we report a case of Ebstein's anomaly, pulmonary stenosis, and ventricular septal defect (VSD), in which the echogram falsely indicated an overriding tricuspid valve.
Child, Preschool↗
Intraoperative epicardial echocardiography: early experience with a newly developed small surgical transducer.
To test the feasibility of performing intraoperative echocardiography with a specially designed epicardial transducer, 20 adult patients were studied. All patients were undergoing coronary bypass surgery and had structurally normal intracardiac anatomy. The surgical transducer has 48 elements and a size at the tip of 10 x 12 x 5 mm. The scan plane has been set at 90 degrees to the cable axis to allow scanning from lateral positions. The terminal 10 cm of the cable has been reinforced to act as a malleable and steerable handle. Good quality images were obtained with the new transducer, and many different imaging planes were identified compared to imaging with the standard transducers. These include the right ventricular apex, the right and left lateral aspects of the heart, the aortic arch, and the pulmonary artery and its branches. The limitation of the probe was the difficulty in obtaining left ventricular apical views because of ventricular arrhythmias sustained when the transducer was placed between the left ventricular apex and the diaphragm. We conclude that this new transducer has a promising future in the application of intraoperative epicardial echocardiography.
Adult↗
Reproducibility of color Doppler flow quantification of aortic regurgitation.
The preferred method for quantification of aortic regurgitation severity with color Doppler echocardiography is the assessment of the ratio of jet diameter to left ventricular outflow tract diameter and jet area to left ventricular outflow tract area. However, the reproducibility of these measurements is not known and may limit its clinical application. This study was performed to identify sources of variability and reproducibility of the echocardiographic data. We examined 62 color Doppler echocardiographic examinations of patients showing isolated aortic regurgitation after human tissue valve implantation. The mean differences with standard deviations between paired measurements were calculated. The interobserver, intraobserver, and interframe variability showed a close agreement for the jet diameter and left ventricular outflow tract diameter measurements. The agreement for jet area and left ventricular outflow tract area measurements showed a small bias, but a large variance. The reproducibility of jet-left ventricular outflow tract diameter is better than the jet-left ventricular outflow tract area measurement and is more accurate to assess the severity of aortic regurgitation from color Doppler images.
Adult↗
Cardiorespiratory and metabolic effects of profound hypothermia.
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Blood Pressure↗
Cardiorespiratory and metabolic effects of profound hypothermia.
At operation the body temperature of mechanically ventilated infants was initially decreased to 25--22 degrees C with surface cooling and further lowered to 16 degrees C by total body perfusion. During circulatory arrest, averaging 40 min, repair of complex intracardiac deformities was carried out. Rewarming to 36 degrees C was achieved by 35--65 min of total body perfusion. Of 29 infants, 23 under 10 kg survived their correction; normothermic ventilation without added CO2 was given throughout the cooling period. The following measurements were made: gas exchange, lung mechanics, heart rate, arterial pressure, right atrial pressure, cardiac output (Qt), ECG, core and nasopharyngeal temperature, as well as biochemical determinations. During surface cooling O2 consumption (VO2), CO2 production (VCO2), endtidal CO2 (PETCO2) and PaCO2 decreased proportionally and linearly with body temperature. Inspiratory resistance, total compliance, physiological dead space (VD/VT), and the single breath CO2 curve did not reveal disturbed lung function. Mean arterial pressure was 98, 90, and 70 mm Hg and heart rate was 141, 107, and 76 beat/min, at temperature 35, 30, and 25 degrees C, respectively. Cardiac index was 2.2 +/- 0.2 liter/min/m2 (mean +/- SEM, n = 25) 2 hours after surgery. Arterial lactate reached peak values of 4.1 +/- 0.3 mM/liter (n = 17), during rewarming but returned to normal. Respiratory alkalosis caused by hyperventilation during cooling caused no apparent harm. No neurological damage was observed. It is concluded that surface cooling performed with normothermic ventilation under guidance of core temperature, VO2, PETCO2, and VCO2, is a safe method.
Body Temperature↗
Lung mechanics in patients undergoing mitral valve replacement. The value of monitoring of compliance and resistance.
Measurements of compliance, resistance of the respiratory system, and left atrial pressure were made before, during, and after mitral valve replacement in 30 patients. Postoperatively left atrial pressures decreased, resistance decreased and compliance increased significantly. Monitoring and recordkeeping of lung mechanics were found to be useful in predicting the feasibility for extubation and as indicators of impending disasters, e.g., due to bleeding in the thoracic cavity.
Airway Resistance↗
Social support and the persistence of complaints in chronic fatigue syndrome.
BACKGROUND: Several studies suggested that the surroundings of chronic fatigue syndrome (CFS) patients are of importance in the persistence of complaints. Contrary to what was expected, participation in support groups has not led to clinical improvement. The purpose of the present study was to describe social support in CFS patients as compared with other fatigued and non-fatigued groups. Further, changes in social support and the influence of social support on the course of CFS over a period of more than 1 year were studied in patients with and without treatment. METHODS: Baseline data were assessed in 270 CFS patients, 150 disease-free breast cancer patients, 151 fatigued employees on sick-leave and 108 healthy subjects using the Social Support List and Significant Others Scale. CFS patients were followed in cognitive behaviour therapy (CBT), guided support groups and natural course at 8 and 14 months. RESULTS: CFS patients and fatigued employees reported more negative interactions and insufficiency of supporting interactions than cancer patients and healthy controls. No differences in frequency of supporting interactions were found. Negative interactions decreased significantly after treatment with CBT, but did not change in support groups or natural course. In the natural course, higher fatigue severity at 8 months was predicted by more negative interactions at baseline. CONCLUSIONS: In CFS patients and fatigued employees, social support is worse than in disease-free cancer patients and healthy controls. Lack of social support was identified as a new factor in the model of perpetuating factors of fatigue severity and functional impairment in CFS.
Adolescent↗
Criteria for early extubation after intracardiac surgery in adults.
Of 142 adult patients undergoing open-heart surgery, 123 were extubated either in the operating room or within 3 hours after admission to the recovery room, to avoid the discomfort and risks of prolonged mechanical ventilation. The remaining 19 patients, who had impaired cardiac function, were mechanically ventilated for 1 to 7 days postoperatively. The most important criteria for cardiopulmonary malfunction indicating the need for continued mechnical ventilation were a low mixed venous O2 saturation (SVO2) of less than 60% and a high left atrial pressure (greater than 20 torr). Of the 123 patients, 118, had an uneventful postoperative recovery and 5 needed reintubation, 2 because of low SVO2 and 3 because of complications unrelated to respiratory management. Most adult patients can spontaneously breathe adequately immediately after or within 3 hours of completed open-heart surgery, but a thorough physiologic and clinical evaluation should precede extubation, to identify those who need prolonged mechanical ventilation in the postoperative phase. Criteria for selection of patients for early extubation are presented.
Adolescent↗
Automated data collection and presentation in the operating room.
An 'Operating Room Data Integration System', is described which is used to collect, present and archive all important physiological parameters during open heart surgery. The system requires very little attention, and provides an easy to understand and coherent interface to the user. The system is adaptable to a large extend and thus data can be presented to the user in a manner, with which he or she is already familiar. Simple drivers can be written to enable connection of the system to almost any other piece of medical equipment, if the latter provides an analog or digital, output signal. Automatic logging of the acquired signals is then possible.
Computer Systems↗
Effect of cryopreservation and HLA-DR matching on the cellular immunogenicity of human cardiac valve allografts.
The cellular immunogenicity of fresh and cryopreserved human cardiac valve leaflets was measured in a lymphocyte proliferation assay. One fresh leaflet and a cryopreserved leaflet derived from the same valve were cut into 2 mm diameter pieces and incubated with responder peripheral blood mononuclear cells, matched or mismatched for HLA-DR. The tritiated thymidine incorporation into the lymphocytes measured after 7 days, was expressed as stimulation index. Fresh, HLA-mismatched valve pieces induced high stimulation index in all cases (median 9, range 4 to 117). The cryopreservation procedure resulted in a significantly lower stimulation index (p = 0.002, Wilcoxon), with a median stimulation index of 2 (range 0 to 9). In the instances where HLA-DR matched combinations were studied, cryopreservation was also associated with lower stimulation index. HLA matching itself was able to reduce the stimulation index both with cryopreserved and fresh valve pieces as stimulator, resulting in a median stimulation index of 4 (range 2 to 117) for the HLA-DR-mismatched and 1 (range 0 to 5) for the matched lymphocytes (p = 0.006, Wilcoxon). In conclusion, human cardiac valves are able to stimulate immune competent cells in vitro, even after cryopreservation. The cellular allogeneic response in vitro could be an explanation for valve allograft degeneration observed in the clinic. Matching for HLA-DR may reduce these effects.
Cryopreservation↗
Coronary artery disease after heart transplantation: timing of coronary arteriography.
The increasing numbers of long-term survivors after heart transplantation make yearly coronary arteriography, used by most centers to study the development of transplant coronary artery disease, less practical. Therefore the prevalence and clinical relevance of coronary artery disease in 119 one-year survivors of heart transplantation were studied. Visual analysis revealed two main patterns of vascular changes: abnormalities of the epicardial vessels and their major branches and abnormalities of the tertiary branches. The prevalence of all abnormalities in the coronary vascular tree increased from 34% after 1 year to 79% after 5 years. The prevalence of anatomically significant lesions (more than 50% stenosis in the epicardial branches or abrupt ending/proximal occlusion of tertiary branches) was only 11% after 5 years. During follow-up of 25 to 87 (median, 43) months, no significant coronary artery disease developed in the 101 patients who showed normal epicardial vessels or abnormal tertiary branches only at their first year angiography, and none of the patients died of ischemic heart disease. Of the 18 patients with abnormal epicardial vessels, three patients died of ischemic heart disease; one of these patients was treated with atherectomy and is alive at the moment of this report, and two patients showed progression of discrete lesions without evidence of ischemia until now. Based on these findings, a schedule for timing of arteriography was developed depending on the first-year coronary findings.
Adolescent↗