Transmyocardial laser revascularization and coronary artery bypass grafting without cardiopulmonary bypass.
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Cardiopulmonary Bypass↗
Biomedical subjects
K Nordstrand
Publications and source records attributed to K Nordstrand.
Long term lipid-based parenteral nutrition causes pulmonary hypertension in pigs.
OBJECTIVE: To study pulmonary perfusion after long term intravenous lipid-based total parenteral nutrition (TPN). DESIGN: Open experimental study. SETTING: Teaching hospital, Norway. MATERIAL: 31 pigs. INTERVENTIONS: Infusion of TPN alone, TPN + pellets, or Ringer's solution alone through central venous catheters for 7 weeks. OUTCOME MEASURES: Haemodynamic variables during a standardised volume load, and measurement of plasma N-terminal pro-atrial natriuretic factor (ANF). RESULTS: Mean pulmonary artery pressure (PAP) was 12.9 (6.1) to 20.1 (3.0) mmHg in response to the volume load in control animals compared with 15.8 (8.5) to 25.4 (5.8) (p < 0.05) mmHg in those given TPN alone and 22.8 (10.3) (p < 0.05) to 28.0 (6.4) (p < 0.05) mmHg in those given TPN and pellets. Pulmonary vascular resistance index was also increased after TPN, but the plasma N-terminal pro-ANF concentration did not increase during infusion of TPN. CONCLUSION: Long term TPN caused moderate pulmonary hypertension, but not longstanding right-sided congestion.
Animals↗
The CarboMedics valve: midterm follow-up with analysis of risk factors.
BACKGROUND: This study examined the midterm results with the CarboMedics prosthetic valve. METHODS: From 1987 through 1991 a total of 569 patients received the CarboMedics prosthesis. RESULTS: Early mortality was 4.9% and related to emergency operation, presence of diabetes mellitus, coronary artery disease, preoperative New York Heart Association class, duration of cardiopulmonary bypass, and aortic cross-clamp time. Midterm follow-up with respect to mortality was 100% complete. All patients were followed up in the hospital after 1 year. In addition 86% of the patients responded to a questionnaire. Mean follow-up was 3 years (range, 0 to 5.6 years). Cumulative survival at 1 and 4 years was 91.2% +/- 1.2% and 83.7% +/- 1.8%, respectively. Five patients experienced obstructive valve thrombosis (0.3%/patient-year), 16 patients had major thromboembolic events (0.9%/patient-year), and 10 patients had major warfarin-related bleeding (0.6%/patient-year) requiring hospitalization or blood transfusions. Eight patients were reoperated on for paraprosthetic leak (0.4%/patient-year). Prosthetic valve endocarditis developed in 4 patients (0.2%/patient-year). No structural valve failure was observed. CONCLUSIONS: Midterm follow-up demonstrates that the CarboMedics mechanical prosthesis is reliable and has an acceptable rate of valve-related complications.
Adolescent↗
Development of granulomas and vascular fibrocellular proliferation in the lungs of pigs receiving long-term lipid-based parenteral nutrition.
The lungs of pigs receiving long-term total parenteral nutrition (TPN) have been studied. A total of 20 pigs were tentatively infused with TPN through central venous catheters for 7 weeks. To secure adequate nutrition and gastrointestinal absorbance of nutrients, an additional full oral diet was given to eight of these animals. Fifteen control animals received Ringer solution through central venous catheters in addition to the oral diet. All animals infused with TPN for 7 weeks developed lung granulomas, a finding not observed in control animals. No lung granulomas were seen in three TPN animals sacrificed after 3 to 5 weeks owing to illness. All TPN animals also developed tissue reactions suggesting long-standing lung vascular inflammation. Similar vascular changes were seen in seven control animals that had bacterial infection or endotoxemia. The total amount of neutral fat in lung homogenate tended to increase in animals given TPN, and the linoleic acid content was significantly increased. In conclusion, long-term TPN caused lung granulomas in pigs. Vascular damage seemed to be accelerated by bacterial infection as well as by the TPN. The tissue reactions presumably involved long-term activation of monocytes/macrophages.
Animals↗
Pericardio-peritoneal window for recurrent postoperative effusion. Case report.
A pericardio-peritoneal window was created to relieve cardiac tamponade by recurrent effusion after heart transplantation. The effect was echocardiographically evaluated. The technique is described. It requires no sternal splitting for pericardial access and no foreign materials such as drains or shunts. The method should be considered for immunologically compromised, infection-prone patients with heart transplantation.
Cardiac Tamponade↗
[Serious complications related to use of corn starch powder on surgical gloves].
Cornflour has been used as a lubricant on surgical gloves since 1947. Serious complications have been reported after deposition of cornflour powder in the human body. The best known complication is granulomatous peritonitis, but cornflour granulomas have also been found in the heart, the kidneys and the central nervous system. Maltesercross, when seen in polarized light in the microscope, is pathognomonic. Malignancy and other granulomatous inflammations are actual differential diagnoses. Nowadays gloves free of lubricating powder are commercially available.
Gloves, Surgical↗
Patency of the internal mammary artery used as sequential graft.
In 28 patients with the left internal mammary artery (IMA) used as a sequential coronary artery graft, clinical and angiographic evaluation was made 19-47 months postoperatively. Patency was 96% in the proximal anastomoses and 93% in all the anastomoses. Angiography, however, showed optimal function in only 75% of the distal graft ends. These observations indicate that routine use of left IMA as a sequential graft should be restricted to experienced surgeons. Clinical and angiographic findings did not always correlate, emphasizing that evaluation of IMA-graft patency should include angiography.
Adult↗
[Thrombolysis in acute tricuspid valve thrombosis].
The usual treatment of acute heart valve thrombosis is thrombectomy or heart valve replacement. During the last 20 years there have been a few reports of thrombolytic treatment for heart valve thrombosis. We report the successful treatment of two patients with a thrombosed tricuspid heart valve. Both patients received streptokinase. The diagnosis of heart valve thrombosis was based on the clinical status of the patients, cineradiology and echocardiography. Both patients received the combination of salicylic acid and warfarin after streptokinase treatment. Follow-up has shown well functioning heart valves in both patients.
Acute Disease↗
Intrapericardial left atrial aneurysm diagnosed by transoesophageal echocardiography and nuclear magnetic resonance imaging.
A case of intrapericardial left atrial aneurysm is described in a 38-year-old woman, who presented with invalidating paroxysmal atrial fibrillation. The diagnosis was suspected by 2D-echocardiography, and confirmed by transoesophageal echocardiography and magnetic resonance imaging. Chest X-ray, right and left ventricular and coronary angiography were normal. The aneurysm was surgically removed, and the patient has subsequently remained free from symptoms.
Adult↗
Organ changes in pigs after longterm parenteral nutrition.
When nutritional substrates used in clinical parenteral nutrition are given to rats a number of organ changes have been reported. These could be a species-related effect without significance outside the experimental laboratory. The reproduction of such organ changes in a large unrelated species would increase their importance. Longterm complete parenteral nutrition (CPN) was given to piglets. Nutritional substrates accepted in human parenteral nutrition were used, and the animals were parenterally fed for 6 and 12 weeks. Autopsy demonstrated an increased splenic weight. Epithelioid cell infiltration was found in the liver, spleen and lung. Osmiophilic fat droplets and vascular inflammation were seen in the pulmonary arteries. No signs of infections were found.
Journal Article↗
Effects of glucose-insulin-potassium infusion on glycogen levels in cardiac and skeletal muscles in rats.
The effects of loading with glucose-insulin-potassium on the glycogen contents of the heart and peripheral musculature were studied in rats. One group of animals was given intravenous infusion of high concentrations of glucose containing insulin and potassium for 3 days. A control group received the same volume of saline. The hearts and rectus femoris muscles were then analysed for levels of glycogen. It was found that loading with glucose-insulin-potassium induced a decrease in cardiac stores of glycogen while there were no changes in glycogen stores of peripheral musculature as compared to the control animals.
Journal Article↗
[Life-threatening central thromboembolisms. Removal by inflow occlusion].
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Adult↗
Effects of fasting and glucose-insulin-potassium on glycogen contents in heart, skeletal muscle and liver.
The effect of intravenous infusion of glucose, insulin and potassium (GIK) on the glycogen contents of the heart, skeletal muscle and liver was investigated in rats. One group of animals received intravenous infusion of GIK continuously for 3 days, and two other groups of rats were given the same amount of saline intravenously. The animals receiving GIK, and a control group of the rats, were fasted for 8 h before sacrifice, while a second control group of animals was given free access to water and pellets until sacrifice. The heart, rectus femoris muscle and liver were then analysed for glycogen contents. It was found that fasting caused a depletion of glycogen in skeletal muscle and liver, while it did not cause any changes in myocardial glycogen which remained similar to that in the fed animals. Infusion of GIK prevented the depletion of glycogen in skeletal muscle and liver, but, unexpectedly, it did not cause any significant changes in myocardial glycogen content.
Animals↗
Intraabdominal granuloma reaction in rats after introduction of maize-starch powder.
A total of 32 Wistar rats were given 1, 10, 100 and 1000 mg glove powder (Biosorb) intraperitoneally for 4, 11, 18 or 25 days. Four control rats received physiological saline. Examination of the abdominal cavity displayed granulomatous inflammation which was clearly dose-dependent in the experimental animal, but not in the controls. A biphasic time-sequence of the granulomatous reaction was observed in those rats receiving 100 and 1000 mg Biosorb with a minimum at day 18. The mean size of the granules (8.1 microns) within the inflammatory tissue was almost identical with the size of powder granules found on the external surface of the gloves (8.8 microns). X-ray microanalysis demonstrated maize-starch additives of magnesium and aluminium. The study indicates a foreign body reaction to maize-starch. In addition, immunological factors may play a role later in the development of the disease.
Animals↗
Mortality in rats on long-term parenteral nutrition.
The long-term effect of total parenteral nutrition (TPN) was studied in rats. A failure to thrive developed and all animals died within 40 days of TPN. Autopsy invariably demonstrated the increased weight and volume of the liver and spleen. Multiple fat emboli were found in the lungs of all animals, and multiple epithelioid cell granulomas in the liver of all and in the spleen of most animals. Chronical low grade infection could not be demonstrated. Microorganisms were not found in blood or tissue specimens and endotoxin could not be demonstrated in plasma samples.
Animals↗
Use of dextran to prevent pericardial adhesions caused by maize starch powder.
Maize starch powder, used as lubricant in surgical gloves, was administered into the pericardial cavity of rats and was found to induce granulomatosis with formation of pericardial adhesions. The effect of dextran 70 on the formation of these adhesions was investigated. It was found that intrapericardial dextran reduces the occurrence of pericardial adhesions.
Animals↗
Preservation of high energy phosphates during ischaemic cardiac arrest with glucose.
The possible myocardial protection by glucose-insulin-potassium infusion prior to cardioplegic ischaemic arrest was studied in rats. One group of animals was given intravenous infusions of high concentrations of glucose during 3 days. A control group received the same amount of saline. The isolated hearts were subjected to Langendorff perfusion followed by cardioplegic arrest at 15 degrees C for a period of 2 or 3.5 hours. The hearts were then subjected to reperfusion for a period of 45 min for those sustaining 2 hours of ischaemia and 60 min for those sustaining 3.5 hours of ischaemia. In the hearts that suffered 2 hours of ischaemia there were no differences in myocardial content of high energy phosphate compounds between the pretreated and controls, and there was no evidence of creatine kinase release. In the hearts exposed to 3.5 hours ischaemia, myocardial content of high energy phosphates was significantly higher in the pretreated than in the controls. The release of creatine kinase was also less, but this difference was not significant. The study indicates that preoperative treatment with glucose-insulin-potassium may improve myocardial tolerance to ischaemia.
Animals↗