Search PubMed⌕ Search

Biomedical subjects

J Nissinen

Publications and source records attributed to J Nissinen.

31 records · Page 2Linked to original sources
PubMed1995

Magnesium substitution in elective coronary artery surgery: a double-blind clinical study.

Magnesium may be beneficial in the control of ventricular ectopy and supraventricular tachyarrhythmias after coronary artery bypass graft (CABG) surgery, but it is not known whether a high-dose magnesium regimen is superior to a regimen keeping the patient normomagnesemic. A prospective randomized and double-blind clinical comparison was performed in 81 elective CABG patients in order to assess the effects of two different magnesium infusion regimens on electrolyte balance and postoperative arrhythmias. Forty-one patients (high-dose group, H) received 4.2 +/- 0.7 g (mean +/- SD), of magnesium sulfate before cardiopulmonary bypass, followed by an infusion of 11.9 +/- 2.8 g of magnesium chloride until the first postoperative (PO) morning, and a further 5.5 +/- 1.0 g until the second PO morning. Forty patients (low-dose group, L) received magnesium sulfate only after bypass to a total of 2.9 +/- 0.5 g at the first, and 1.4 +/- 0.1 g at the second PO morning. A blood cardioplegia technique was used in both groups, including bolus doses of magnesium chloride to a total of 2.4 +/- 0.6 g and 2.3 +/- 0.6 g to H and L patients, respectively. Continuous Holter tape-recording was used for 12 to 15 hours preoperatively, and for 48 hours postoperatively. Serum magnesium peaked in H patients on the first PO morning at 1.60 +/- 0.25 mmol/L, whereafter it declined to the normal level on the third PO morning. Patients in the L group were normomagnesemic, except after the start of bypass.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1995

Amino acid-enriched glucose-insulin-potassium infusion improves hemodynamic function after coronary bypass surgery. A double-blind study in patients with unstable angina and/or compromised left ventricular function.

OBJECTIVE: The goal of this study was to assess the effects of a combination of glucose-insulin-potassium (GIK) and the amino acids aspartate and glutamate upon perioperative hemodynamics in coronary surgery patients with unstable angina and/or compromised left ventricular function. DESIGN: Prospective, randomized, and double-blind clinical study. SETTING: Operating theatre and intensive care unit (ICU) of a university hospital. PATIENTS: 44 coronary artery bypass graft (CABG) patients with unstable angina and/or compromised left ventricular function. INTERVENTIONS: 22 patients (group A) were given 1l of an infusion with 250g glucose, 100 I.U. fast-acting human insulin, 72 mmol potassium, 32 mmol magnesium, 20 mmol phosphate, 65 mmol aspartate, and 65 mmol glutamate, while another 22 patients (group C) were given 1l of an infusion with 50 g glucose, 72 mmol potassium, 32 mmol magnesium, and 8 mmol phosphate. The infusion rate was 1.2 ml/kg/h from the anesthesia induction onward to the commencement of cardiopulmonary bypass, when it was reduced to 0.8 ml/kg/h. When 11 had been infused, but not later than 4 a.m., the infusion was continued by giving 10% glucose at the same rate to both groups. Additional insulin (median: 14.2 I.U., range: 0-41.5) or saline was given during bypass to the A and C patients, respectively. A blood cardioplegia technique containing aspartate and glutamate was used in both groups. RESULTS: At aortic cannulation, the cardiac index (CI) had increased from the pre-anesthetic level by 15.3% (mean) (SD: 31.7%) in group A and decreased by 7.7% (15.1%) in C patients, p = 0.0069. Also the changes in stroke index (SI; p = 0.022), left (LVSWI; p = 0.0037) and right ventricular stroke work index (RVSWI; p = 0.0097) were more favorable in group A. Despite longer aortic cross-clamp, p = 0.031, and perfusion times, p = 0.042, in A patients, the change in cardiac index was also better in this group after bypass: At decannulation, the difference between mean values was 31.8%, p = 0.0001, and at arrival in the ICU it was 16.1%, p = 0.028. The same was also seen 8 h postoperatively and on the 1st and 2nd postoperative mornings; p = 0.034, 0.040, and 0.037, respectively (Wilcoxon test). Favorable changes were seen for the A patients also regarding SI at decannulation (p = 0.0002) and after 8 h (p = 0.017); LVSWI at decannulation (p = 0.0002), at arrival in the ICU (p = 0.0023), and after 8 h (p = 0.0011); and RVSWI at decannulation (p = 0.0027), at the ICU (p = 0.021), after 8 h (p = 0.014), and on the 1st postoperative morning (p = 0.039). However, the response to a hemodynamic loading test (6% hydroxyethyl starch 5 ml/kg) was similar in the 2 groups, and there was no difference in the need for inotropic support. CONCLUSIONS: Amino acid-enriched GIK infusion improves hemodynamic function in CABG patients with unstable angina and/or compromised left ventricular function.

Aged↗
PubMed1994

Segmental mediolytic arteritis--electronmicroscopic and immunohistochemical study.

We examined specimens of human gastroepiploic artery aneurysm from a patient having several visceral aneurysms using electronmicroscopic and immunohistochemical techniques. The histopathological and ultrastructural findings confirmed the diagnosis of segmental mediolytic arteritis. Arterial smooth muscle cells from the gastroepiploic artery contained cytoplasmic vacuoles, media was thin and the internal elastic membrane showed distortion. X-ray microanalysis revealed calcium deposits in the medial extracellular space. Antigenic determinants of human immunoglobulins, fibrinogen, complement C3a and factor VIII were demonstrated in the injured artery wall, suggesting that immunocomplexes deposited in the artery wall may be associated with local injury. These findings support the role of autoimmune disorders in the pathogenesis of segmental mediolytic arteritis.

Aged↗
PubMed1994

Spontaneous intraabdominal haemorrhage caused by segmental mediolytic arteritis in a patient with systemic lupus erythematosus--an underestimated entity of autoimmune origin?

We describe the sixth known case of segmental mediolytic arteritis and the third in a survivor. A 70-year-old woman had intraabdominal bleeding due to a ruptured aneurysm of the omental artery. Interestingly, this patient also had a systemic lupus erythematosus. This report gives further support to the role of immune abnormalities underlying segmental mediolytic arteritis.

Aged↗
PubMed1994

Perioperative glucose-insulin-potassium infusion in elective coronary surgery: minor benefit in connection with blood cardioplegia?

OBJECTIVE: The goal of this study was to examine the metabolic and hemodynamic effects of a glucose-insulin-potassium infusion in elective coronary surgery, when blood cardioplegia was used for cardiac protection. DESIGN AND PATIENTS: A prospective, randomized, open, clinical comparison was performed between 2 perioperative infusion regimens in 40 elective nondiabetic coronary artery bypass graft (CABG) surgery patients. SETTING AND INTERVENTIONS: 20 patients (glucose-insulin-potassium-GIK-group) received glucose 0.2 g/kg/h, insulin 0.12 U/kg/h, potassium 0.15, magnesium 0.032 and phosphate 0.024 mmol/kg/h from anesthesia induction to the start of bypass, when infusion rate was reduced to 30%, and after bypass increased to 50% of the initial rate. The infusion was continued until the first postoperative morning. Another 20 patients (control-R-group) received glucose 0.05 g/kg/h, potassium 0.075, magnesium 0.016 and phosphate 0.008 mmol/kg/h from the end of bypass to the next morning. Pump prime was glucose-free and a blood cardioplegia technique was used for cardiac protection. RESULTS: The GIK patients needed less dopamine support in the intensive care unit (ICU) (p < 0.05). No difference was found between the groups with regard to myocardial injury, the MB-fractions of serum creatine kinase (CK-MB) being elevated to a similar degree in both groups. Likewise there were no significant differences in hemodynamic changes or duration of ICU stay. Although the glucose infusion was continued during bypass in the GIK patients, there was a considerable risk of hypoglycemia (due to insulin and hemodilution) after the onset of bypass: in 5 GIK patients (25%; 95% confidence interval 8.7 to 49.1%) blood glucose was less than 2 mmol/l. However, the hypoglycemia was of short duration and no detrimental effects were seen. CONCLUSIONS: Perioperative GIK infusion entailed a slight decrease in the postoperative need for dopamine support, but was connected with a considerable risk of hypoglycemia.

Adult↗
PubMed1994

Myocardial release of malondialdehyde and purine compounds during coronary bypass surgery.

BACKGROUND: Free radicals and lipid peroxidation have been suggested to play an important role in the pathophysiology of myocardial reperfusion injury. The purpose of the present study was to monitor myocardial malondialdehyde (MDA) production as an index of lipid peroxidation during ischemia-reperfusion sequences in patients undergoing elective coronary bypass grafting. There has been a lot of debate on the role of xanthine oxidase as a potential superoxide anion generator and thus lipid peroxidation in human myocardium. To evaluate the activity of xanthine oxidase pathway, we measured the changes in the transcardiac concentration differences in adenosine, inosine, hypoxanthine, xanthine, and uric acid. METHODS AND RESULTS: The coronary sinus-aortic root differences (CS-Ao) of MDA, oxypurines, and nucleosides were measured by a recently developed ion-pairing high-performance liquid chromatographic (HPLC) method. Fifteen patients were included in the study, and 13 of them demonstrated a more than 10-fold increase in net myocardial production of MDA on intermittent reperfusion during the aortic cross-clamp period. In 2 patients, MDA was not detectable in any of the CS or Ao samples. Before aortic cross-clamping, the CS-Ao concentration differences in adenosine, inosine, hypoxanthine, xanthine, and uric acid were 0.59 +/- 0.19, 0.23 +/- 0.05, 0.89 +/- 0.36, 0.58 +/- 0.32, and 11.4 +/- 4.9 mumol/L, respectively. After aortic cross-clamping, the sum of the transcardiac differences of these compounds increased up to 2.8-fold and then gradually decreased after declamping of the aorta. There was a weak positive correlation between transcardiac concentration differences of MDA and xanthine plus uric acid (r = .48, P < .01). The postoperative functional recovery or leakage of cardiac enzymes was not affected by the level of MDA net release during the aortic cross-clamp period, however. CONCLUSIONS: We conclude that myocardial lipid peroxidation, estimated as MDA formation, is common during intermittent ischemia-reperfusion sequences in coronary bypass surgery, although some patients may be better protected. Xanthine oxidase appears to be operative in human myocardium, and free radicals generated in this reaction might also be involved in the observed lipid peroxidation process. Increased degradation of myocardial adenine nucleotides and concomitant lipid peroxidation may play a specific role in the development of reperfusion injury. In this study, however, more extensive lipid peroxidation was not associated with impaired functional recovery.

Adenosine↗
PubMed1994

Long-term outcome after renovascular surgery. Comparison between thoracoretroperitoneal/saphenous vein and transabdominal/Dacron prosthesis bypass grafting.

The outcomes of 16 patients operated on for renovascular hypertension (RH) are analyzed. Eight had undergone surgery by the thoracoretroperitoneal approach with saphenous vein bypass grafting, and 8 by the transabdominal approach with a Dacron prosthesis. Distinct differences in favour of the former group were found after an average of 6 years of follow-up.

Abdomen↗
PubMed1993

Efflux of adenosine and its catabolites during cold blood cardioplegia.

Levels of myocardial high-energy phosphates decrease during cardioplegia for open heart operations, with a subsequent increase in the level of adenosine and its metabolites. It has been demonstrated in experimental models that the effluent concentrations of purines can be used as a measure of the average myocardial energy state. Net adenylate loss and myocardial energy state were evaluated here by determining aorta-coronary sinus differences in levels of adenosine catabolites in 17 patients during cold blood cardioplegia for elective coronary artery bypass grafting. Repeated blood samples were taken before cross-clamping of the aorta, when cardioplegic solute was infused into the aortic root and grafts after five distal anastomoses, and after declamping of the aorta. The aorta-coronary sinus differences in levels of total purines increased 4.7-, 7.5-, 7.1-, 7.8-, and 10.2-fold (from the preclamp level of 1.7 +/- 0.7 mumol/L; p < 0.001) for grafts one through five anastomosed at an average of 19, 34, 50, 63, and 76 minutes after the aortic cross-clamp, respectively. Hypoxanthine and xanthine were present in the highest concentrations. Vasodilatory adenosine concentrations of 1 to 2 mumol/L were observed in the coronary sinus while the aorta was cross-clamped. There was a linear positive correlation between the aorta-coronary sinus purine differences and corresponding cross-clamp time (r = 0.62; p < 0.001). The metabolite differences settled at a more negative level after declamping of the aorta than that prevailing before placement of the cross-clamp, suggesting continuous washout of adenosine and its catabolites during the 30-minute postclamp observation period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine↗
PubMed1991

Rectus abdominis muscle flap with microvascular anastomoses for repair of recurrent sarcoma.

After radical resection of a recurrent leiomyosarcoma, the thoracic wall was stabilized with a Gore-Tex graft. The skin and soft tissue defect was repaired with a large rectus abdominis flap in which the circulation was secured by end-to-end microvascular anastomosis of the inferior epigastric artery to the internal mammary artery, which had to be cut during tumor removal.

Anastomosis, Surgical↗
PubMed1989

Surgery of thoracoabdominal aneurysms.

Seventeen patients with thoracoabdominal aneurysms, including 5 ruptured aneurysms, were operated upon using a left diaphragm-splitting thoracoabdominal incision and the retroperitoneal route. A temporary shunt was used in 13 patients, femorofemoral perfusion in 1 and cold perfusion cooling of the kidneys in 3 patients. The step-by-step reattachment technique into ready-made limbs or holes in the Dacron graft ensured that visceral and renal ischaemic times remained within acceptable limits. The mean renal and proximal clamping times were 44 and 77 min, respectively. One patient with a ruptured aneurysm (6%) died of diffuse bleeding. The others recovered without paraplegic, renal or other severe complications. During the follow-up period, mean 44 months and range 10-116 months, 3 patients died of lung cancer and 2 of coronary disease giving a late mortality of 29%. The remaining 11 patients are alive and well. The cumulative 2- and 5-year survival is 87% and 62% respectively. The patency rate of the grafts was 100% and that of the 30 individually revascularised arteries 80%. We recommend elective surgery for thoracoabdominal aneurysms using a temporary shunt or cold perfusion cooling of the kidneys as a protective measure against perioperative ischaemia.

Adult↗
PubMed1987

Infection prophylaxis in pulmonary surgery: a randomized prospective study.

A prospective randomized study to evaluate the efficacy of antibiotic prophylaxis against postoperative infections was carried out on 120 patients undergoing pulmonary operations. The patients were randomized into two groups of 60 patients each. One group received doxycycline (deoxytetracycline) prophylaxis for five days, and the other received cefuroxime (a second-generation cephalosporin) for one day. The groups were comparable with regard to age, sex, common risk factors, diagnosis, and operative procedures. A reduction in the infection rate was noted in the cefuroxime group (10/60) compared with the doxycycline group (19/60), but the difference was not statistically significant (p = 0.055). In major infections (empyema and pneumonia) there was no difference between the groups (4/60 in the cefuroxime group and 5/60 in the doxycycline group), but a significant (p less than 0.05) reduction was noted in minor infections (6/56 and 14/55, respectively) such as lower respiratory tract infections and prolonged fever. There were no wound infections in the two study groups. There were significantly (p less than 0.05) fewer postoperative fever reactions (axillary temperature greater than 37.5 degrees C) in the cefuroxime group (30/60) compared with the doxycycline group (44/60). Both antibiotics were effective in preventing wound infections, but cefuroxime may also be beneficial in preventing minor respiratory infections. The bactericidal effect of cefuroxime may explain this finding.

Cefuroxime↗