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Biomedical subjects

H Lindberg

Publications and source records attributed to H Lindberg.

At least 73 records · Page 4Linked to original sources
PubMed1989

Is cold, cardioplegic solution harmful to the lungs?

The effects of pulmonary flush with cold cardioplegic solution were investigated in 55 patients undergoing coronary artery bypass grafting. Extracorporeal circulation with bicaval cannulation was used in all cases, and single-dose cardioplegic solution was injected into the aortic root. In one of two randomly selected groups (n = 27) the cardioplegic solution was allowed to pass through the lungs and then evacuated via a left ventricular vent. In a second group (n = 28) the vent was first temporarily placed in the right atrium for evacuation of the cardioplegic solution, and the aortic root was vented later. Hemodynamic, metabolic, hematologic and radiographic changes were studied during the early postoperative period. No harmful effects of the pulmonary passage could be demonstrated. On the contrary, a protective effect was indicated, as the pulmonary vascular resistance index was reduced immediately and for 2 hours postoperatively. The ratio of left ventricular to right ventricular stroke work in the early postoperative period gave the same indication.

Cardioplegic Solutions↗
PubMed1989

Osteoporosis and heredity.

A retrospective epidemiological study was performed to determine whether postmenopausal osteoporosis is a hereditary condition. Frequency of fractures was calculated in women whose mothers had suffered vertebral fractures after a low-energy trauma three decades earlier. The frequency of fractures was compared to the frequency in an age-matched control group. The daughters of the osteoporotic women were not more prone to sustain fractures than the controls.

Aged↗
PubMed1988

Balloon dilatation of pulmonary artery banding in dogs: an experimental study.

The technique at our institution for banding of the pulmonary artery (PA) makes debanding by balloon dilatation theoretically possible. Previously we tested this hypothesis in an in vitro study (see previous article in this issue). This study describes balloon dilatation in dogs. Eight Labrador Retriever dogs had a PA band placed early in life, and when their body weight had doubled, they were restudied and debanded by balloon dilatation or surgical removal. One dog died of a virus infection before debanding and was excluded from the study. Five of the dogs (groups 1 and 2) underwent balloon dilatation with satisfactory relief of the gradient across the PA band. Two dogs (group 3) underwent surgical debanding without a plastic procedure on the PA, and this also produced satisfactory relief of the gradient. All dogs in group 2 and 1 dog in group 3 were studied 3 months later, and 1 dog in group 2 was also studied 6 months after the debanding procedure. The systolic pressure gradient fell from a mean of 54 to 18 mm Hg after the debanding procedure. There was no difference in the gradient after debanding in the balloon group compared to the surgical group.

Animals↗
PubMed1988

In vitro balloon dilatation of the banded pulmonary artery.

The pulmonary artery of unfixated human heart-lung specimens was banded by placing a Dacron tape around the artery and securing the tape with a 5.0 Prolene suture at selected circumferences. The banding was successfully dilated with a balloon catheter in 24 instances. The mean pressure necessary to burst the suture securing the tape was 2.4 atmospheres.

Catheterization↗
PubMed1988

Risk factors in surgically treated mitral valve disease.

Risk factors for operative mortality and long term survival were identified in 144 patients undergoing mitral valve replacement (MVR). The 3-year survival was 77% at a median follow-up time of 3.01 years, including an early mortality of 7.6%. Nineteen preoperative and perioperative variables were analysed by univariate and multivariate methods. The sole risk factor independently predictive of postoperative death was a poor functional class with a relative risk (RR) of 3.17 compared to patients with a better functional class. Independent risk factors of long term survival were; prior heart operation, presence of mitral regurgitation, age at operation and poor functional class. Estimation of the parameters of the Cox's model gave a predicted 3-year survival ranging from 95% to 11% for the most favourable and the less favourable risk factor combinations. Risk factors that affected late death were the presence of ischemic coronary etiology and poor functional class. Two modes of late death were identified each with its prognostic factor. The most common mode was cardiac-related death, its sole risk factor was the presence of ischemic coronary etiology. The RR ratio was 3.2 for patients with ischemic coronary etiology, compared to patients with other etiologies. Sudden cardiac death was the next, its independent risk factor was the age at operation with increasing hazard for younger patients. The RR ratio was 8.55 for a 35-year-old patient compared to a 60-year-old patient.

Age Factors↗
PubMed1988

Risk factors in surgically treated aortic and mitral valve disease.

Risk factors in simultaneous aortic and mitral valve replacement were studied in 78 patients. Risk factors for early mortality, according to a stepwise logistic regression model, were male sex, concomitant heart surgery and prior valve replacement. For low-output syndrome, the major morbid event, the risk factors were endocarditic etiology, concomitant heart surgery and prior valve replacement. Survival curves were used to estimate univariate risk factors for total mortality. With a multivariate procedure, using the Cox regression model, two covariates were pin-pointed as independent prognostic factors in total mortality, viz. mitral regurgitation and concomitant heart surgery. The Cox model also showed the two covariates ischemic heart disease and endocarditic etiology to be risk factors in late mortality. Predicted 3-year survival was estimated with different combinations of these risk factors. The results were compared with earlier reports.

Aged↗
PubMed1988

Surgical repair of aortico-left ventricular tunnel (ALVT).

ALVT is a very rare congenital malformation. Until 1983 a collective review reported only 37 cases published. A 5-month-old girl with a body weight of 5.5 kg was referred for cardiomegaly and cardiac murmur. 2D-echo revealed the diagnosis which was later confirmed by angiography. The child was then operated upon with extracorporeal circulation using deep hypothermia (20 degrees C). The aortic orifice of the tunnel was closed with 3 pledget reinforced sutures. Cross-clamp time was 17 min. Electromagnetic flowmetry suggested an insufficiency of 78% preoperatively, and postoperatively this was reduced to 6%. Angiography was performed two weeks postoperatively, revealing mild valvular aortic insufficiency. She was discharged from the hospital 15 days postoperatively. ALVT should be corrected surgically as soon as the diagnosis is made.

Aorta↗
PubMed1988

Human heart transplantation. Rejection risk factors.

The present analysis of risk factors in human cardiac transplantation is based on a review of 682 endomyocardial biopsies from 52 grafts in 51 recipients. Acute rejection was diagnosed in 149 biopsies (21.8%). The cumulative 1-year graft survival was 91.5 4%. Four out of seven patients died of irreversible rejection. An univariate analysis using the linearized rate of total rejection showed significantly higher frequency of acute rejection when donor and recipient differed for two HLA-DR antigens compared to zero or one HLA antigen disparity (p less than 0.01), as well as in patients treated with low dose steroids, Cyclosporine (CyA) and Azathioprine (p less than 0.01), compared to treatment with CyA high dose steroids. Other risk factors were graft ischemia extending 60 minutes (p less than 0.05) and patient age exceeding 40 years (p less than 0.05). A multivariate analysis using the competing risk hazard model for irreversible (= lethal) rejection was performed. The presence of two HLA-DR mismatches between donor and recipient was found to be an independent risk factor (relative risk = 8.9), and immunosuppression with CyA and high dose steroids without Azathioprine another (relative risk = 15.3). Potential risk factors such as donor and recipient sex, donor age, prior surgery and time on extracorporeal circulation were not of significant prognostic value neither in regard to rejection nor irreversible rejection.

Azathioprine↗
PubMed1987

Cerebral perfusion during major cardiac surgery in children.

Six children undergoing major cardiac surgery had extensive cerebral monitoring during cardiopulmonary bypass (CPB). The monitoring included continuous recording of arterial blood pressure (BP), central venous pressure (CVP), cerebral electrical activity by a cerebral function monitor (CFM), and middle cerebral artery (MCA) flow velocity by the transcranial pulsed Doppler (TCD) technique. Introduction of the precooled blood containing priming solution resulted in rapid fall in BP as well as MCA velocities in these children at the start of CPB. During steady-state CPB at 20 degrees C, MCA flow velocities were reduced in five of six children, range 45%-105% of pre-bypass value. These flow velocity values were recorded at cerebral perfusion pressures (CPP = BP - CVP) in the range of 14-26 mmHg. This reduced cerebral perfusion during steady-state CPB appears to be more than sufficient to meet the cerebral metabolic demands at the particular temperature. The reduced cerebral perfusion is in contrast to the enhanced perfusion found in adults during moderately hypothermic (28 degrees-30 degrees C) low-flow, low-pressure CPB previously reported. It was presumably due to the reduced temperature, reduced perfusion pressure, and less hemodilution. During periods of constant temperature, hematocrit, and partial pressure of carbon dioxide (PaCO2), MCA flow velocities varied passively with changes in CPP, demonstrating that cerebral autoregulation was not operative. Transcranial Doppler appears to be a suitable tool for investigating CPB techniques optimal with respect to cerebral circulation.

Blood Flow Velocity↗
PubMed1987

Femoral fracture following hip arthroplasty.

In 1,961 primary total hip arthroplasties performed during a 14-year period, 11 proximal ipsilateral femoral fractures occurred postoperatively. Seven were located distally to the tip of the femoral stem; none was a comminuted fracture. Six of the fractures were primarily revised with a long-stem prosthesis. The results after 5(1-8) years were good.

Aged↗
PubMed1987

Heavy labor and the occurrence of gonarthrosis.

The prevalence of primary gonarthrosis was investigated in 332 men, (average age, 66 years) who had been doing heavy work for more than 30 years. Only subjects who had had symptoms and clinical studies, including a knee roentgen examination, were considered. Using the criteria of Ahlbäck, the prevalence of primary gonarthrosis was 3.9% in the laborers. In the age-matched internal and external controls, the prevalence was 1.4% and 1.6%, respectively. Circumstantial evidence suggests an association between heavy work and the incidence of gonarthrosis.

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