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Biomedical subjects

M Turina

Publications and source records attributed to M Turina.

At least 253 records · Page 14Linked to original sources
PubMed1992

Hemodynamic performance and myosin light chain-1 expression of the hypertrophied left ventricle in aortic valve disease before and after valve replacement.

Previously, we have reported on the selective accumulation of an atrial-like myosin light chain-1 (ALC1) in different forms of human ventricular hypertrophy. The present study involves the determination of ALC1 content in a control group and in patients with aortic stenosis or insufficiency before and 56 +/- 23 months after valve replacement and compares the hemodynamic and angiographic parameters. ALC1 was quantified densitometrically after two-dimensional electrophoretic resolution of biopsy specimens from the left ventricle and was expressed in percent of total ventricular light chain-1. The mean ALC1 content was 11.2 +/- 9.2% in preoperative aortic stenosis and 4.5 +/- 1.4% in aortic insufficiency, both being significantly (p less than 0.001) higher than the control value of 0.3 +/- 0.3%. After valve replacement, mean ALC1 content was lower than before, 4.2 +/- 3.3% (p less than 0.05) in stenosis and 3.4 +/- 3.1% (p = NS) in insufficiency. Left ventricular systolic pressure yields a significant (p less than 0.01) linear correlation (r = 0.45) with the ALC1 content in all preoperative and postoperative patients. Patient group averages of ALC1 content correlate directly with left ventricular systolic and end-diastolic pressure and wall thickness (r = 0.94-0.98) and, in an exponential fashion, with peak systolic circumferential wall stress (r = 0.98) but not with muscle mass or any other parameter. The ventricular ALC1 binds to myosin in proportion to its occurrence in the myocardium. The content of the endogenous ventricular light chain-1 did not change under pathological hemodynamics. The response in expression of the ALC1 to pressure and volume overload suggests an adaptational process.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Performance characteristics of hemofilters with heparin surface coating: an experimental study.

Heparin surface coated hemofilters and tubing sets were evaluated in comparison to identical but uncoated controls in 8 bovine experiments (74+/-6 kg). No heparin was given (neither systemically nor in the priming fluid). The hemofilters were primed with one liter of Ringer's lactate in both groups and the maximal filter performance (arterial line pressure 300 mmHg; transmembrane pressure (TMP) 500 mmHg) was measured over 6 hours or until filter occlusion. All coated and one control filter remained functional during the scheduled 6 hours. The mean filter patency was 360+/-0 minutes for coated versus 210+/-99 minutes for uncoated (p less than 0.01). Mean blood flow at 1 hour and 6 hours was 675+/-114 and 580+/-96 ml/min for coated versus 432+/-183 and 25+/-43 for uncoated (NS; p less than 0.01). Mean filter output during the 6th hour and total filter output over 6 hours was 4225+/-998 ml and 21779+/-4273 for coated versus 400+/-692 and 7717+/-9757 for uncoated (p less than 0.01; p<0.01). Mean lactatedehydrogenase (LDH) levels before and 30 minutes after hemofiltration were 1855+/-411 IU and 2007+/-635 for coated versus 2160+/-411 and 1945+/-500 for uncoated (NS; NS). The heparin coated hemofilters demonstrated improved thromboresistance resulting in superior filter performance. There was no evidence of increased blood trauma.

Animals↗
PubMed1992

[Prevention of cytomegalovirus infection following heart transplantation].

Cytomegalovirus (CMV) infection after heart transplantation (HTx) is a severe complication, which leads to long treatment and hospital stay. Even if prophylactic therapy with anti-CMV IgG antibodies is performed, there is a high incidence of infection, especially when the heart from a CMV positive donor is transplanted to a CMV negative recipient (high risk constellation). This study evaluates the prophylactic antiviral therapy with ganciclovir in CMV high risk constellation at HTx. Out of 108 HTx, 29 CMV negative recipients (IgG and IgM) received a heart from a CMV positive donor (IgG pos., IgM neg.). The control group (CO) (n = 8) was treated with anti-CMV IgG antibodies (Cytotect 2 ml/kg at day 0, 1, 2, 7, 14, 21,), whereas the study group (GAN) (n = 13) was treated with ganciclovir (7.5 mg/kg single dose n = 8, or 5 mg/kg in twice daily doses n = 5 from day 1 to 14). Urea, creatinine, white blood cell count and platelet count was controlled daily. No side effects on renal and bone marrow function were noted. Therapy was well tolerated. Both groups had similar immunosuppressive protocol (prophylactic cytolysis, prednisone, azathioprine and cyclosporin A) and were similar in age, sex, preoperative diagnosis and NYHA class. Seroconversion for CMV (IgM and IgG) was observed in 75% of CO and 31% of GAN (p less than 0.05). Clinical manifestations of CMV infection started in the second month after HTx with fever in both groups CMV-organ manifestations developed in 50% (or 67% of infected) in CO (enterocolitis 2, pneumonitis 3, tonsillitis 1), and in 15% (or 50% of infected) in GAN (pneumonitis 2, epididymitis 1) NS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Technique and organization of heart removal from the multi-organ donor].

The orthotopic heart transplantation is an accepted treatment for terminal cardiac disease. The technique of heart procurement and preservation is explained and the primary graft function in 108 subsequent heart transplantations is assessed. The mean ischemia time is 41 +/- 10 min in local, 98 +/- 19 min in distant (< 100 km) and 114 +/- 16 min in distant (> 100 km) organ procurement. Our method of preservation consists of cold cardioplegic arrest with potassium (30 mEq/L) cardioplegic solution. The incidence of the indication for high dose katecholamine-treatment after surgery and the maximal creatininekinase levels rose with ischemia time. All hearts recovered within a few days and the stay in the intensive care unit was not prolonged. We conclude that the heart preservation with cold cardioplegic arrest results in a good primary graft function. It is important to keep the ischemia time as short as possible.

Graft Survival↗
PubMed1992

[Malignant ventricular arrhythmia in congenital aneurysms of the left ventricle in adulthood].

Congenital aneurysms of the left ventricle (ALV) are rare cardiac lesions. Beyond that an association with malignant ventricular arrhythmias (MVA, symptomatic ventricular tachycardia--VT or ventricular fibrillation--VF) is reported only in sporadic cases. Since 1988 we had the opportunity to study 5 patients (pts) with MVA (4 sustained VT, 1 VF; 1 female, 4 males; mean age 38 years) without cardiovascular risk factors, history of myocardial infarction, trauma or inflammatory disease. Left ventricular contrast angiography and echocardiography disclosed ALV's. At programmed electrical stimulation clinically documented MVA (4 VT, 1 resuscitated VF) were reproducible in all 5 cases, the respective VT was located in the area of the ALV in 4 cases. In 2 pts aneurysmectomy combined with subendocardial resection and cryotherapy (1 apical, 1 posterobasal ALV) was performed. In both pts histopathology confirmed a congenital disorder, without evidence of inflammatory lesions. In 2 pts MVA was controlled with antiarrhythmic therapy. The pt with VF and an ALV adjacent to the anulus of the aortic valve received an implantable cardioverter defibrillator. In congenital aneurysms of the left ventricle complicated by malignant ventricular arrhythmias surgical intervention offers a potential cure in selected cases.

Adolescent↗
PubMed1992

[Valve replacement in patients over 80 years of age].

Between January 1983 and October 1990, 20 patients age 80 years or older (mean 82 +/- 1.5 year, range 80 to 87 years) underwent valvular surgery at Clinic for Cardiovascular Surgery Zurich. The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a bioprosthesis in one. There were 15 elective operations, 2 urgent, and 3 emergency operations. Four of these patients had aortic valve replacement plus coronary artery bypass grafting. The operative mortality rate was 15% (3 patients). All patients were preoperative in NYHA classes III and IV. All survivors remained in NYHA classes I or II. The survivors have been followed from 6 to 70 months (mean 20 +/- 8 months). The actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. Valvular replacement can be performed with increased but acceptable mortality and morbidity. Long-term results are encouraging.

Aged↗
PubMed1992

[Resorbable pericardial replacement--an experimental study].

The resorbable pericardial substitute: In modern heart surgery every patient undergoing cardiac surgery will eventually require a second operation including resternotomy. To reduce the risk of damage to the heart it has been recommended to close the pericardial sac primarily. Unfortunately there is no ideal pericardial substitute yet available. This experimental study summarizes our experience with the use of Gore-Tex Surgical Membrane and Vicryl-Collagen mesh as pericardial substitutes which have been implanted orthotopically in 12 rats. After a mean follow-up of 86 days we evaluated macroscopically the pericardial adhesions, the closure of the pericardial defect and histologically the inflammatory reaction. At explanation we found that both pericardial substitutes produce little adhesion. But in rats with Vicryl-Collagen mesh as a pericardial substitute there were only a very few inflammatory cells and total closure of the pericardial defect was in 4 out of 6 rats present. These findings suggest that Vicryl-Collagen mesh seems to be a superior pericardial substitute and also allows formation of a neopericardium.

Animals↗
PubMed1992

[Surgical indications of pulmonary arteriovenous fistulae in Osler disease].

Hereditary hemorrhagic teleangiectasia (HHT) is known to be associated in 15% with pulmonary arterio-venous fistulas (PAVF). Symptoms and complications of these fistulas are: hemoptysis, dyspnea, hemothorax, cerebral embolization and brain abscess. We studied a family with 7 members known to have HHT. 3 had PAVF. Patient 1 died of a hemothorax and pleural empyema. PAVF were diagnosed at autopsy. Patient 2 (nephew) suffered from a cerebellar abscess. The fistula-bearing part of the lung was removed by wedge resection. Patient 3 (son of the former) had no symptoms, but the arterial PO2 was 6.7 kPa. In order to prevent complications like in his father, the patient was operated. A lobar resection was necessary to remove the fistula. The postoperative course was eventless in patients 2 and 3. We conclude, that periodical thorax X-ray studies are indicated for all members of families with HHT in order to find PAVF before complications occur. The classical treatment is resection of the fistula with as little lung tissue as possible. Good results have been reported lately with embolization of PAVF, but this method is not generally available yet.

Adolescent↗
PubMed1992

[Surgery of infectious pericarditis].

Between 1980 and 1990 34 patients (pat.) (21 male, 13 female) were operated for infectious pericarditis (P.) at a mean age of 48 years (min. 2, max. 70 years). The infection was acute in 12 pat. (7 bacterial, 4 Tbc, 1 viral). A chronic constrictive P. was found in 22 pat. (15 history of Tbc, 7 history of viral P.). The preoperative mean NYHA class was 3.0. Cardiac catheterization was performed in 22 pat. and confirmed restrictive pericardial disease in all cases with elevated and equalized diastolic pressures in all 4 cardiac chambers. Mean cardiac index was 2.7 l/min m2 and the ejection fraction 53%. Pericardectomy (Pe.) was performed through an anterolateral left thoracotomy in 31 pat. and through a sternotomy in 3 pat. Total and partial Pe. were performed in 31 and 3 pat., respectively. Total mortality was 3/34 pat. (8.8%) with no operative death (one early and two late deaths). There were two recurrent P. (1 Tbc, 1 viral) and no recurrent constriction. Long-time follow-up of 31 surviving pat. is known in 28 cases with a mean follow-up of 4.6 years (min. 1 month, max 10.5 years). At the end of the follow-up the mean NYHA class ist 1.3 (p less than 0.005). Actuarial survival after Pe. is 97% after 30 days and 90% after 5 and 10 years. In our retrospective study we conclude that Pe. is a safe treatment for infectious P. with low mortality and excellent long-time results with improvement of cardiac function. Pe. should be performed early for purulent or constrictive P. There is no conservative treatment for progressive myocardial constriction and the resulting cardiomyopathy. After total Pe. there is a low rate of recurrent P. or constriction.

Adolescent↗
PubMed1992

[Treatment strategy of vascular complications of acute aortic dissection].

Aortic branch occlusion may constitute the mode of presentation or become an important focus of treatment in patients sustaining acute aortic dissection. We reviewed the outcome of 187 consecutive patients (149 males and 38 females, mean age 58 yrs) with acute dissection of the thoracic aorta who were admitted and operated in our clinic during a 13-year period. We assessed the incidence, the consequences and the specific management of stenotic and obstructive lesions of the aorta and its branches. Noncardiac vascular complications occurred in 59 patients (32%); out of these complications, 38 were associated with dissection type A (incidence 28%) and 21 with dissection type B (incidence 48%). Trend towards decreasing overall surgical mortality was observed in the second part (1983-1989) of the study when compared with the first part (1977-1982): it was 28% versus 12%. Although aortic rupture and cardiac tamponade were the strongest correlate of morbidity and mortality, death specifically related to vascular complication was more common when such malperfusion occurred in the carotid, coelio-mesenteric and renal circulation. Proximal aortic repair at the site of the intimal tear with obliteration of the false lumen may have restore adequate distal circulation in 27 patients in whom improvement of the visceral or peripheral ischemia was observed after the thoracic aortic repair. Additional procedures (immediately after the thoracic repair or later on) were necessary in 15 patients to restore adequate perfusion in the compromised area. Early aggressive thoracic aortic repair followed in selected patients by additive vascular procedures can save some patients with compromise visceral or peripheric circulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Retroperitoneal approach in selective surgery of the infrarenal aorta].

In recent years, there has been a resurgence of interest in the retroperitoneal approach to the aorta; however, there has been only few prospective studies in the literature and the results are controversial. For this reason, we assessed peri- and postoperative problems associated with both procedures and compared the results of each one in a prospective study. Between 1989 and 1990, 163 patients underwent operative procedure because of an aortic or aorto-iliac lesion. 121 were operated on through the "classical" transperitoneal method (87 had aortic aneurysm, 34 aorto-iliac occlusive disease) whereas in 42 patients, retroperitoneal approach of the aorto-iliac bifurcation was performed (28 because of aortic aneurysm and 14 because of occlusive disease). Early mortality was 0 in the group with retroperitoneal approach, despite the fact that 66% of these patients were classified as high-risk patients (American Society of Anesthesia risk classification III or IV); it was 0.8% in the group with classical approach. Retroperitoneal group demonstrated significant decrease in blood (630 vs 1300 ml) and crystalloids (1700 vs 3250 ml) requirement, shorter nasogastric intubation time (1.6 vs 4.4 d) and quicker peroral intake. Significant pulmonary and cardiac complications were less often observed in the group of patients after retroperitoneal approach to the abdominal aorta. Mean postoperative hospital stay was significant shorter when compared with the transperitoneal group (8.5 vs 13.9 d). Our results confirm that retroperitoneal approach is an excellent alternative to the transperitoneal method for elective reconstructive surgery of the abdominal aorta. It is associated with better tolerated incisional pain, decrease in cardiac and pulmonary complications and thereby decreased hospitalization time.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Abdominal↗
PubMed1992

[Intestinal ischemia following replacement of the infrarenal aorta and aorto-iliac bifurcation].

Intestinal ischemia following abdominal aortic surgery is a rare but dreaded complication and is associated with a high postoperative morbidity and mortality. Based on a review of the literature the incidence was noted between 2% to 10% of patients undergoing reconstruction of the abdominal aorta. From January 1980 to March 1991, 1017 patients were operated on the abdominal aorta or aorto-iliac bifurcation; the diagnosis was either abdominal aortic aneurysm (AAA) or chronic occlusive disease (COD). There were 819 patients with AAA (80.5%, mean age 67.9 years), and 198 patients with COD (19.5%, mean age 62.2 years). In 134 cases (122 for AAA, 12 for COD) the inferior mesenteric artery (IMA) was reimplantated into the graft. The incidence of postoperative intestinal ischemia after AAA repair was 2.8% (23/819 patients) after AAA repair and 0.5% (1/198 patient) with COD. 66% of the patients who have developed intestinal ischemia were operated emergently. However 2/134 (1.5%) patients presented intestinal ischemia despite reimplantation of IMA. Early explorative laparotomy or early postoperative colonoscopy could demonstrate ischemia in the majority of cases, whereas diagnosis of intestinal ischemia was confirmed at autopsy in 2 patients. In our experience with more than 1000 patients operated on the infrarenal aorta during a 10-year period suggests that a postoperative intestinal ischemia is caused mainly by a misbalance of the blood supply of the left hemicolon and rectosigmoid and may be prevent by reimplantation of IMA. Our actual policy consider reimplantation in presence of patent and large IMA with weak backflow, especially in patients with previous colonic disease or by missing collaterals at preoperative angiogram.

Aged↗
PubMed1992

Improved biocompatibility of heparin surface-coated ventricular assist devices.

Heparin surface coated ventricular assist devices (VADs) and cannulas were evaluated in comparison to uncoated VADs in 10 bovine experiments (body weight 77 +/- 6 kg). All systems were primed with cristalloid solution. No systemic heparin was given. Left ventricular assist was started with a blood flow of 4.2 +/- 0.4 l/min and maintained over 6 hours. Besides hemodynamic monitoring, blood samples were taken at regular intervals for blood gas, hematological, biochemical and coagulation studies. All animals in the study group (coated) were assisted for the scheduled 6 hours without device failure. In the control group, however, total occlusion occurred in 1 VAD after 1 hour of left ventricular assist whereas the other 4 VADs remained functional throughout the protocol. Mixed venous oxygens saturation was preassist 56 +/- 12% for coated versus 63 +/- 11% for uncoated and the final value at 60 minutes after weaning was 58 +/- 16% versus 59 +/- 5% (NS). Mean hematocrit dropped from a baseline value of 33 +/- 4% for coated versus 29 +/- 8% for uncoated to 29 +/- 7% versus 30 +/- 5% (NS) after 6 hours of assist. There was no significant difference between the baseline values (5.7 +/- 3.0 mumol/l for coated versus 4.6 +/- 3.1 mumol/l for uncoated) and the 6-hour values (3.8 +/- 3.7 mumol/l versus 7.6 +/- 6.4 mumol/l) for mean plasma hemoglobine. The normalized platelet levels dropped after 10 minutes of assist to 91 +/- 21% for coated versus 94 +/- 49% for uncoated (NS) and 89 +/- 29% versus 65 +/- 44 at 6 hours (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

[Blood substitution in aorto-iliac surgery].

To determine the amount of blood substitution required we evaluated in a retrospective analysis 68 consecutive patients that were operated on the infrarenal abdominal aorta 1990, 60 men with a mean age of 66 years (40-87) and 8 women, aged 73 years (62-85). Indications for treatment were: aneurysm (55) and occlusive disease (13). 21 aneurysms (45%) were ruptured and had to be operated as an emergency. Early lethality (less than 30 days) in this group was 19% (n = 4). In the other 47 patients there was no early mortality. Mean blood products transfusion requirements in patients with ruptured abdominal aortic aneurysm was: 18 (9-34) units of concentrated red cells, 16 (3-43) units of fresh frozen plasma (FFP) and 5 (0-19) units of concentrated red cells, 2 (0-7) units of FFP in the elective group. Main determinants of blood loss in the elective group were: the number of anastomoses and the preoperative status of the coagulant system. We conclude that in elective surgery of the infrarenal aorta homologous transfusion can be virtually eliminated if an entire autologous transfusion concepts is applied (predonation, intraoperative salvage, hemodilution and plasmapheresis).

Aged↗
PubMed1992

[Mycotic aneurysm of the infrarenal aorta: surgical possibilities and results].

Between 1973 and 1990 eleven patients with mycotic aneurysm of the abdominal aorta underwent surgery. Extra-anatomic axillobifemoral bypass with aortic ligation and aneurysm excision was performed in 5 patients, and in situ reconstruction in 6. There were 3 early and 3 late deaths. Regardless of the type of operation, surgery of mycotic aneurysm is followed by severe postoperative complications with high the early and the late mortality rates.

Aged↗
PubMed1992

[Surgery of the suprarenal subdiaphragmatic aorta: early and long-term results].

Surgery of the suprarenal segment of abdominal aorta is characterized by specific problems of operative techniques and of circulatory support during operative procedure. Ischaemic time of kidneys and other viscera has to be limited and use of femoro-femoral bypass allows perfusion of distal aortic branches during performance of the proximal anastomose. Replacement of the suprarenal abdominal aortic segment was performed in 57 consecutive patients (45 with aneurysm and 12 with para- or suprarenal atherosclerosis). Emergent operation was performed in 10 patients (9 with aortic rupture and 1 with acute renal failure by occlusion of the pararenal aortic segment) with early mortality of 50%. Elective operation was much safer with early mortality of 4.3% (2/47 patients). Following procedures were performed to revascularize the kidney and the other visceral arteries: direct replantation with or without endarterectomy (80%), bypass with prosthetic material or saphenous vein (15%), other procedures (5%). Nephrectomy was done in 3 patients. Overall 6-year survival was 64% in patients with aneurysm and 48% in patients with aortic atherosclerosis. 6-year survival was significant (p less than 0.01) higher in patients with normal renal function postoperatively than patients with persisting creatinine value over 200 micromol/l 3 months after operation (68% vs 15%).

Aged↗
PubMed1991

[Late results following surgical repair of aneurysm of the descending thoracic aorta].

A consecutive series of 74 patients was analyzed after repair of descending thoracic and thoracoabdominal aortic aneurysms. After hospital discharge there were 13/71 deaths (18%) during a mean follow-up of 60 +/- 20 months (range: 28-107). Actuarial analysis showed a mean survival rate of 89% after 1 year, 78% after 5 years and 71% after 9 years. During the same time period there were reoperations of the aorta in 10/71 patients (14%). Actuarial analysis showed freedom of reoperation in 97% after 1 year and in 80% after 5 years. Elective repair of these aneurysmal lesions can be recommended.

Actuarial Analysis↗