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Biomedical subjects

M Inberg

Publications and source records attributed to M Inberg.

At least 19 recordsLinked to original sources
PubMed1996

Composite graft in annulo-aortic ectasia. Nineteen years' experience without graft inclusion.

OBJECTIVE: The original Bentall procedure for the surgery of annulo-aortic ectasia (AAE) includes the risk of leakage and pseudo-aneurysm formation in the coronary anastomosis. To avoid the complications mentioned above we have used the open technique without the graft inclusion. In this study we evaluate our early and late results. MATERIAL AND METHODS: One hundred consecutive patients with annuloaortic ectasia underwent surgical repair with composite graft between December 1975 and February 1994. In all cases the aneurysmal tissue was radically resected and the origins of the coronary arteries were directly reimplanted to the tube prosthesis. No wrapping was used. Twenty-two patients met the clinical criteria of Marfan syndrome. Thirteen of the patients underwent an emergency operation, because of a rupture of aneurysm in 2 cases and an acute dissection in 11 cases. Additional procedures were performed in 16 patients: mitral valve replacement in 2, coronary artery bypass grafting in 12 patients and in 2 cases the tube prosthesis included aortic arch, too. RESULTS: The overall hospital mortality was 3.0% (3/100). In the elective group there was one hospital death (1/87; 1.1%). In the emergency group two patients died in the operation room (2/13; 16.7%). There have been 13 late deaths among the 97 hospital survivors (13.4%). Four of the late deaths were surgery related. Routine control angiography was performed in all patients 6 months after surgery. Sixty patients who had lived at least 3 years after surgery were called to reangiography and 53 of them came. No pseudo-aneurysm or leakage at distal anastomosis or coronary anastomosis could be seen. A slight dilatation of one or both coronary origins was observed on 15 patients; 9 of whom had Marfan syndrome. CONCLUSIONS: The open technique is simple and can be used in all anatomical variations of the annulo-aortic ectasia. The early and late results are at least comparable with those achieved by other techniques.

Adolescent↗
PubMed1995

Results of cardiovascular surgery in the Marfan syndrome. A retrospective study of 49 patients.

To evaluate the outcome of cardiovascular surgery in the Marfan syndrome, the records of 49 patients (median age 35 years) who underwent 60 operations were reviewed. Primary surgery was elective in 39 patients and emergency in ten. Non-dissecting aneurysm with diameter 4-19 cm was present in 34 cases and distal, isolated aneurysm in four. In eight cases there was type A acute aortic dissection with median diameter 5.0 cm. One patient was operated on for mitral valve insufficiency, one for ventricular septal defect and one (acute) for endocarditis. Composite grafts were used for aortic root reconstruction. Operative complications occurred in 24% of the patients. The 30-day survival was 92%. There were five (10%) late deaths. Survival after a median of 8 years postoperatively was 82%. The early and late results of cardiovascular surgery in the Marfan syndrome thus are concluded to be generally favourable. As late reoperation frequently is needed, however, close monitoring is advocated even after successful primary surgery.

Adolescent↗
PubMed1994

Combined cardioplegia delivery offers no advantage over antegrade cardioplegia administration in coronary surgical patients with a preserved left ventricular function.

The effects of antegrade and of combined antegrade and retrograde cardioplegia were compared in 101 patients undergoing elective coronary artery surgery. The patients were randomly allocated to two groups: antegrade cardioplegia was administered in 53 patients and combined cardioplegia in 43 patients. The patients of the two groups were similar in age, sex and left ventricular ejection fraction. Aortic clamping time and the number of coronary bypasses were equal in the groups. The ventricular septal temperature was measured continuously during cardioplegia administration, after each distal anastomosis accomplished, and continuously after aortic declamping. Serum CK-MB activities were serially measured for up to 3 days postoperatively. Electrocardiograms (ECG) were taken preoperatively, as well as on the first, second and eighth postoperative days. The left ventricular function was evaluated with a volume load test preoperatively and on the first postoperative morning. The two groups were similar with respect to myocardial cooling, response to volume loading, the number of patients with perioperative myocardial infarctions, cardiac arrhythmias or atrioventricular conduction blocks and clinical outcome. However, the CK-MB activities were lower in the antegrade group suggesting better myocardial protection in an unselected group of patients undergoing coronary artery bypass grafting.

Analysis of Variance↗
PubMed1992

Quality of life during rehabilitation after coronary artery bypass surgery.

The effect of a three-phase comprehensive rehabilitation programme on the quality of life during the first postoperative year after coronary artery bypass surgery was studied in 205 male patients randomly allocated into a rehabilitation (R) and a hospital-based treatment (H) group. The rehabilitation programme included physical exercise, relaxation training, psychological group sessions, dietary advice and discussions about postoperative treatment of coronary disease. There was no difference between R and H groups in the frequency of postoperative complaints, number of hospital admissions and satisfaction of sexual life. An almost significantly greater number of subjects in R group than in H group perceived their health as good 12 months after surgery. The Beck Depression Index score decreased significantly in R group but not in H group during follow-up. A greater increase in hobby activities was observed in R group than in H group. More subjects in R group than in H group considered rehabilitation important for recovery, whereas more patients in H group considered support by the spouse and family, the subjective mental strength and a secure income as important.

Adult↗
PubMed1992

Exercise habits and physical performance during comprehensive rehabilitation after coronary artery bypass surgery.

The effects of training as part of a comprehensive rehabilitation programme on exercise capacity and habits was studied in 171 male coronary artery bypass surgery patients randomized into a rehabilitation (R) (n = 93) and a reference, hospital-based treatment (H), group (n = 78). The rehabilitation programme started with a 2-day informative course before surgery and continued with a 3-week exercise-based course 2 months after surgery followed by a 2-day refresher 8 months post-operatively. The percentages of subjects having regular exercise were 22% and 10% pre-operatively, 42% and 38% 6 months and 46% and 38% 12 months after surgery in the R and H groups, respectively. The changes in the proportions observed in R and H groups were not significantly different. Total work during a bicycle exercise test increased from 38.9 +/- 24.3 kJ pre-operatively to 64.0 +/- 31.4 kJ 6 months (P less than 0.001) and to 70.0 +/- 35.7 kJ 12 months (P less than 0.001) post-operatively in group R and from 40.8 +/- 25.6 kJ to 57.3 +/- 26.6 kJ (P less than 0.001) and to 60.4 +/- 30.8 kJ (P less than 0.001) in group H, respectively. The increase from the pre-operative value was greater in group R than in group H both 6 (P = 0.03) and 12 months (P = 0.02) after surgery. Respective changes occurred in maximal work load, but the increase was significantly greater in group R than in group H only 12 months post-operatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Comparison of somatostatin and vasopressin in bleeding esophageal varices.

Somatostatin (ST) and vasopressin (VP) infusions were compared in the treatment of actively bleeding esophageal varices. Fifty-four patients with liver cirrhosis were included in the study. Thirty-two were given ST 4.2 micrograms/min, and 22 patients were given VP 0.4 IU/min for 72 h after endoscopic diagnosis. The role of alcoholic cirrhosis was similar in both groups. Initial control of bleeding was achieved significantly more often (p = 0.0281) when ST was used (84.4%) than during VP treatment (57.1%). Rebleeding occurred in 18.8% and 4.8%, respectively. Side effects of treatment were significantly more common when VP was used than during ST treatment (p = 0.0021). Overall mortality was high in both groups, being 34% in the ST group and 36% in the VP group. ST infusion seems to be more effective and safer than VP in the treatment of acute variceal bleeding. However, the high frequency of rebleeding during ST treatment means that, after primary hemostasis with ST infusion, other methods, such as surgery or sclerotherapy, are needed to prevent the serious complications of rebleeding.

Adult↗
PubMed1989

Fatty acid composition of serum lipids in patients with a coronary bypass operation.

The fatty acid composition of serum phospholipids and cholesteryl esters was analysed in 71 male patients with angiographically defined three-vessel coronary artery disease (CAD) selected for a coronary bypass operation. Their 71 control subjects were matched according to age, sex, smoking, relative weight, and absence of CAD. The concentrations of fatty acids, 14:0, 16:0 and 16:1 of the serum phospholipids, were significantly (P less than 0.01, P less than 0.05 and P less than 0.01, respectively) higher in CAD patients than in the controls. On the other hand, linoleic (18:2 omega 6), linolenic (18:3 omega 3) and arachidonic (20:4 omega 6) acids were at a significantly lower level in the patients when compared to the controls. The polyunsaturated/saturated fatty acids (P/S) ratio in serum phospholipids was significantly (P less than 0.01) lower in the patients than in the controls. In the cholesteryl ester fraction the results paralleled those of the phospholipids. Significant correlations were obtained between the polyunsaturated fatty acids and the high density lipoprotein cholesterol or apolipoprotein A-I in the control subjects but most of these correlations were absent in the patients. Our present results further support the importance of linoleic acid in the protection against atherosclerosis. However, no unequivocal evidence on the possible beneficial effect of long-chain omega 3-fatty acids in comparison with omega 6-acids was obtained.

Adult↗
PubMed1987

Serum group I pepsinogens during insulin and pentagastrin tests in unoperated and vagotomized duodenal ulcer patients.

The level of serum group I pepsinogens (PG I) has been studied during the conventional insulin-pentagastrin test in 29 duodenal ulcer (DU) patients before and 2 months after proximal selective vagotomy (PSV) and in 31 unoperated DU patients. The mean basal serum PG I level was 191.6 +/- 15.4 micrograms/l (mean +/- SEM) before and 143.7 +/- 24.0 micrograms/l after PSV. A significant increase in mean serum PG I above the initial value was found both in unoperated DU patients and in patients after PSV 1 h after insulin injection. In 29 PSV patients the mean serum PG I showed a paradoxical decrease during the 2nd h after insulin injection, and the mean postvagotomy serum PG I 2 h after insulin injection was significantly (p less than 0.01) lower than the respective preoperative value in the same patients, and the value was close to the basal serum PG I. The low level of serum PG I 2 h after insulin injection in vagotomized patients may reflect the deprivation of the reduced store of PG I in the absence of normal vagal tone. Both the basal serum PG I and serum PG I response during insulin-induced hypoglycaemia showed an overlap between unoperated and vagotomized DU patients. Therefore, serum PG I analyses during the insulin test cannot replace acid secretion tests in the assessment of the completeness of vagotomy.

Adult↗
PubMed1987

Vagotomy and gastroenterostomy for stenosing duodenal ulcer.

Vagotomy and gastroenterostomy (V-GE) was performed in 41 patients with chronic stenosing duodenal ulcer and gastric retention in the years 1965-84. There was no mortality and no severe complication occurred. One patient was reoperated for dysfunction of an antecolic stoma. After a follow-up of 1-16 (mean 8) years 30 patients were interviewed and gastroscopy was performed in 21. One recurrence of ulcer was found at endoscopy. Visick classification gave the following overall results: grade I 40%, grade II 13%, grade III 30% and grade IV 17%. One case of gastric carcinoma was found five years after operation. It was concluded that V-GE is a simple and safe method and will give satisfactory early and long-term results.

Adult↗
PubMed1986

Levels of serum lipids, apolipoproteins A-I and B and pseudocholinesterase activity and their discriminative values in patients with coronary by-pass operation.

Serum lipids and apoproteins A-I and B were measured in 115 male patients and serum pseudocholinesterase activity (PChE) was determined in 83 patients with 3 vessel coronary artery disease (CAD). The control subjects were matched according to sex, smoking, relative weight and age and were free from heart disease. The CAD patients had significantly higher serum VLDL cholesterol and triglyceride levels and lower HDL cholesterol and apo A-I levels and lower HDL to total cholesterol ratio than the controls. The concentrations of serum total cholesterol and LDL cholesterol were only slightly (6.4% and 8.8%, on an average) higher in CAD patients than in controls. The apo B levels of CAD patients were also slightly lower in patients than in controls. The CAD patients had slightly higher PChE activities than controls. The ratios of apo A-I to PChE and HDL cholesterol to PChE were significantly (about 30%, P less than 0.001) lower in patients than in controls. In discriminant analysis between the groups HDL cholesterol and apo A-I showed the best (74% success in reclassifying the patients to correct groups), and total cholesterol, triglycerides, LDL cholesterol and apo B remarkably weak discriminating power among the single variables of serum lipids and lipoproteins. In discriminating analysis the apo A-I/PChE and HDL cholesterol/PChE ratios showed relatively high (77.1 and 71.1% success from the patients to correct groups) and serum PChE activity weak discriminating power. These results indicate that low levels of HDL cholesterol and apo A-I and the low ratio of HDL cholesterol to total cholesterol are the most potent metabolic risk factors for 3 vessel coronary artery disease in a population with relatively high serum total cholesterol level. The determinations of apo A-I/PChE and HDL cholesterol/PChE ratios may be an additional, valuable tool in discriminating the risk for CAD.

Adult↗
PubMed1984

Clinical findings and return to work after heart valve replacement.

One hundred and thirteen patients operated during the years 1971 to 1976, were re-examined at an average of 26.3 months after heart valve replacement. The functional capacity assessed by the NYHA-classification improved in about 40% of the patients. About 80% considered their symptoms and well-being to have improved after the operation. At the re-examination, heart size was most often enlarged in patients with mitral valve replacement. The average work load measured in bicycle ergometer test was higher in patients with aortic valve replacement compared to those with mitral valve replacement. Patients with aortic valve replacements were working more often (54%) than those with mitral valve replacements (37%). The mean age of patients who were working was significantly lower than in patients who were retired. There was a statistically significant relation between the physical working capacity and the working status. The employability assessed by history and clinical findings corresponded well to the actual work situation in individual patients.

Aortic Valve↗
PubMed1984

Morphology and function of the parietal cells after proximal selective vagotomy in duodenal ulcer patients.

The effects of proximal selective vagotomy (PSV) on parietal cell morphology and the degree of gastric inflammation were investigated and correlated with changes in gastric acid secretion and serum gastrin concentrations in 17 duodenal ulcer patients. Endoscopy, acid secretion tests, and blood sampling were performed preoperatively and 2 months, 1 year, and 3 years postoperatively. The mucosal biopsy specimens obtained at endoscopy were analyzed both light- and electron-microscopically. Five healthy persons also underwent gastroscopy and biopsy for comparison. Preoperatively, the duodenal ulcer patients differed significantly from this control group, 33% of whose parietal cells appeared 'secretory'; the corresponding figure for the duodenal ulcer patients was 47%. Two months after the operation the number of secretory parietal cells had fallen to 30%, after which the percentage increased slightly again to 35% 3 years after PSV. A similar phenomenon was observed in the acid secretion capacities, which were maximally depressed 2 months postoperatively and recovered slightly but significantly during the 3-year follow-up period. There was a significant increase in the degree of gastric inflammation after the operation.

Adult↗
PubMed1982

Desmosines in aneurysms of the ascending aorta (annulo-aortic ectasia).

Amino acid chromatography was used for determination of the elastin-specific amino acids desmosine and isodesmosine in acid hydrolyzates of intima-medial samples taken intraoperatively from aneurysms of human ascending aorta. Elastin concentration of the specimens was also estimated by hot alkali extraction followed by nitrogen determination of the extracted material and the insoluble residue. All patients studied had annulo-aortic ectasia i.e., dilatation of the aortic annulus and the ascending aorta. Two patients with the Marfan syndrome had low aortic elastin concentration determined by both methods. A third Marfan syndrome patient, youngest of the three, also had a slightly reduced concentration of elastin in the aorta. Aortic samples were studied from five patients who did not have the classical Marfan syndrome. Two patients of those five had decreased aortic elastin concentration. The change in elastin concentration was accompanied by high hydroxyproline/proline or hydroxylysine/lysine ratios which indicates that the proteins of the aneurysmatic aortic wall contained more collagen than the proteins of the control aortic wall. These findings point to a change in the structure or metabolism of elastin in the aortic wall in the Marfan syndrome and at least in some other patients with annulo-aortic ectasia.

Adolescent↗
PubMed1981

Serum oncocity and myocardial oxygen balance during haemodilution in open-heart surgery.

In the first part of the present study the colloid-oncotic properties of degraded gelatin and dextran 70 were compared with each other during moderate normovolemic and extreme haemodilution. Serial serum analyses of colloid oncotic pressure and albumin concentration were performed on 39 open-heart surgery patients. The profile of albumin changes during the 24-hour period beginning with preanaesthetic measurements was identical in both colloid-groups. The data obtained strongly support the supposition that the gelatin solution easily escapes from the circulation due to gelatin's low number average molecular weight. On the other hand the oncotic and haemodynamic effects of dextran 70 may continue for many hours; dextran 70 seems therefore to be an ideal colloid for haemodilution. The second part of the study comprised an investigation of the effects on myocardial oxygen and lactate balance of moderate and extreme haemodilution with dextran 70 on 11 patients undergoing coronary bypass surgery. To compensate fully for the observed decrease in the blood O2-capacity during normovolemic haemodilution (Hct fell from 44 to 32), the coronary blood flow should have been increased by 24% in addition to the increase observed in the myocardial oxygen extraction. The compensation was considered adequate, because no myocardial ischaemia, as judged by the unchanged myocardial lactate balance, developed. The coronary sinus blood samples are, however, a poor reflection of local myocardial metabolic changes in those areas, where coronary flow is most severely restricted.

Blood Physiological Phenomena↗