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Biomedical subjects

L K Lacquet

Publications and source records attributed to L K Lacquet.

At least 19 recordsLinked to original sources
PubMed1995

Antegrade versus retrograde crystalloid cardioplegia: perioperative assessment of cardiac energy metabolism by means of myocardial lactate measurement.

The effects of retrograde and antegrade delivery of cold St. Thomas' Hospital cardioplegia were evaluated and compared in 21 patients who underwent elective myocardial revascularization. The patients were randomly separated into two groups: the antegrade group (n = 10), and the retrograde group (n = 11). Cardiac energy metabolism was monitored by evaluation of arterial and coronary sinus (CS) lactate concentration. There was an increase of the CS lactate concentration during aortic cross-clamp period in both groups. After release of the aortic cross-clamp, there was an increase of the CS lactate concentration in the antegrade group, and a decrease of CS lactate in the retrograde group. Analysis of the patients operated with antegrade delivery of cardioplegia showed an increase of the CS lactate concentration in 9/10 patients after aortic cross-clamp release. In the retrograde group, in 8/11 patients the CS lactate concentration decreased immediately after aortic cross-clamp release. Whereas the differences in the CS lactate concentration were not significantly different, the lactate extaction immediately after aortic cross-clamp release was significantly higher for the retrograde group (p = 0.034). This can be related to a faster reconsolidation of mitochondrial oxidative phosphorylation in the retrograde group. For the other registered parameters, hemodynamic recovery of cardiac function, release of creatine kinase MB isoenzyme, and clinical outcome, there was no significant difference between the groups. Based on this study we conclude that retrograde delivery of a cold non-oxygenated cardioplegic solution results in a better preservation of myocardial energy reserve than antegrade delivery.

Adult↗
PubMed1992

Early results with bilateral internal mammary artery grafting in coronary reoperations.

In recent years, use of the internal mammary artery (IMA) as first graft of choice has been expanded with bilateral and sequential grafts in primary myocardial revascularization. The use of bilateral IMA grafts in reoperation has seldom been reported. The experience and early results with bilateral IMA grafting in 47 patients undergoing coronary reoperation are described. Hospital mortality was 6.3%. Four patients had postoperative signs of low cardiac output, and 4 had a perioperative myocardial infarction. At follow-up (18 +/- 18 months), 2 cardiac-related, late deaths were noted. Thirteen patients (29%) improved 1 New York Heart Association class, and 28 (63%) improved > 1 class. In 1 of 44 surviving patients, operation did not result in a decrease in angina. On the basis of the early results, the bilateral use of the IMA in coronary reoperation appears justified.

Adult↗
PubMed1992

[Generalized sarcoidosis in combination with a malignancy in 3 patients; the value of mediastinoscopy].

Two male patients with a testicular carcinoma and a female with a mammary carcinoma, all associated with pulmonary sarcoidosis are described. This coincidence is very rare, but clinically relevant as enlarged mediastinal and hilar lymph nodes might suggest metastatic disease or metastasis after a curative treatment. The role of mediastinoscopy in obtaining a histological diagnosis is stressed. A causal relationship between sarcoidosis and malignant diseases has not yet been established.

Adult↗
PubMed1992

Pulmonary venous obstruction following correction for total anomalous pulmonary venous drainage: a challenge.

Pulmonary venous obstruction after surgical correction of total anomalous pulmonary venous drainage (TAPVD) is a serious condition. Pulmonary venous obstruction can be the result of a primary developmental error or is due to post-operative anastomotic stricture and is usually manifest within 6 months of surgery. Prompt restudy is indicated and if a stricture is present, urgent surgical relief is indicated. However, the results are often disappointing with a high early mortality and a significant chance of restenosis.

Constriction, Pathologic↗
PubMed1992

Pectus excavatum. A clinical study with long-term postoperative follow-up.

Between 1972 and 1987, 192 patients have been operated upon for pectus excavatum of which 152 patients were included in the study (79%). Mean age at operation was 15.3 +/- 5.5 years; 117 were male. Mean follow-up was 8.1 +/- 3.6 years. The deformity was noted before the age of 5 in 90%. Type I symmetrical and localized deformity was seen in 33.2%, type II symmetrical but diffuse depression in 23.7% and type III localized or diffuse asymmetrical deformity in 43.1%. It was considered severe in 68.9%, fair in 16.9% and mild in 14.2%. There were significantly more asymmetrical defects in the older age groups. The operation consisted of subperichondral chondrectomy, transverse sternotomy and division of the intercostal bundles at the outer limit of the chondrectomy and suturing the edge of this broad sheet of muscle and perichondrium to the anterior surface of the chest wall more laterally and under tension, elevating and stabilizing the sternum. Results were satisfactory in 83.6% (excellent 44.1%, good 39.5%). Results were not significantly influenced by age, sex, severity, type, symmetry, the extent of cartilage resection or follow-up. Results were inversely influenced by the occurrence of wound problems. The optimal age for operation is considered to be between 5 and 10 years. Both physical as well as psychological cosmetic factors may serve as an indication for operation.

Adolescent↗
PubMed1992

Evaluation of myocardial protection by combination of lidoflazine pretreatment and St. Thomas' Hospital cardioplegia in aorto-coronary bypass grafting.

The concept of pretreatment of the myocardium with a pharmacological agent protecting the cell against ischemic and reperfusion injury is very attractive. Lidoflazine, a calcium overload blocker, predominantly membrane stabilizing, is able to prevent cell damage during ischemic arrest and reperfusion. The purpose of this study was to determine whether the combination of lidoflazine pretreatment and St. Thomas' Hospital cardioplegia can provide, in clinical practice, better myocardial protection in aorto-coronary bypass grafting than St. Thomas' Hospital cardioplegia alone. As indices for myocardial protection, recovery of cardiac function, enzyme release, and clinical outcome were registered. Ninety-three patients undergoing aorto-coronary bypass surgery were studied. These patients were randomized into two groups in a double blind fashion. Patients in group A (n = 48) received lidoflazine 1 mg/kg intravenously over a period of 20 min before initiation of cardiopulmonary bypass. Group B (n = 45) receiving placebo, acted as a control group. Myocardial protection consisted of intermittent infusion of cold 4 degrees C St. Thomas' Hospital cardioplegia, topical slush ice, and systemic hypothermia (28 degrees C rectal). No significant differences between the two groups were noted in terms of recovery of cardiac function, enzyme release, incidence of myocardial infarction, low cardiac output, rhythm, and conduction disturbances. In conclusion, our data suggest that the combination of intravenous pretreatment with lidoflazine and St. Thomas' Hospital cardioplegia did not provide significant additional myocardial protection in the clinical situation.

Aged↗
PubMed1992

Retrograde coronary sinus cardioplegia in myocardial revascularization: hemodynamic evaluation of the influence on the right-ventricular function.

The problem of the efficacy of right-ventricular protection with retrograde coronary sinus cardioplegia is studied. Sixty patients undergoing myocardial revascularization were prospectively assigned to receive cold St. Thomas' Hospital cardioplegia into the aortic root (30 patients) or retrogradely in the coronary sinus (30 patients). The two groups were similar concerning preoperative and operative data. The hemodynamic recovery postoperatively was good in both groups, the increase of the heart rate, the decrease of the mean aortic pressure and the right-ventricular stroke-work index were not significantly different in the two groups. However, right atrial pressure increased significantly (p less than 0.001) in patients who received cardioplegia anterogradely and decreased, but not significantly, in the retrograde group. The data suggest that the decrease of the right-ventricular stroke-work index in the anterograde group is related to a depressed contractility and in the group with retrograde delivery of cardioplegia to a decreased preload. There were no differences between the groups with respect to clinical outcome. We conclude that retrograde delivery of cardioplegia results in an excellent protection of the right-ventricular function in elective myocardial revascularization.

Adult↗
PubMed1992

Cardiac herniation after pneumonectomy.

Cardiac herniation is a rare, lethal complication of intrapericardial pneumonectomy demanding urgent treatment. It usually occurs within the first 24 h postoperatively. We present a patient with late cardiac herniation, 28 h postoperatively, where the electrocardiographic changes were evident several hours before the clinical picture became clear. After the diagnosis was made, the patient was treated surgically and survived.

Carcinoma, Bronchogenic↗
PubMed1991

[Hemoptysis caused by a retained piece of chest drain].

We describe a patient with haemoptysis 13 and 22 years after thoracotomy for a leiomyoma of the oesophagus. Despite extensive evaluation we did not get a firm diagnosis. The findings at bronchoscopy and microscopy suggested the possibility of a bronchial adenoma. At exploratory thoracotomy we found an intrapulmonary torn-off tip of a pleural drain. In retrospect, this foreign body was recognizable on the lung tomogram, the computerized tomogram and the magnetic resonance image. We discuss the diagnostic approach of a patient with non-massive haemoptysis.

Adenoma↗