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Biomedical subjects

M Turina

Publications and source records attributed to M Turina.

At least 271 records · Page 15Linked to original sources
PubMed1991

[Brain abscess as a complication of Osler's disease with lung involvement].

Eight months after sustaining a reversible left motor hemisyndrome, predominantly of the arm, a 47-year-old man known to have hereditary haemorrhagic telangiectasia (Osler's disease) again developed neurological symptoms (headache, vertigo, unsteady gait) with fever (up to 38.5 degrees C). Clinical features and findings on computed tomography indicated a cerebellar abscess. This was resected because it continued to enlarge despite antibiotic treatment with daily 2 g ceftriaxone and twice daily 0.5 g ornidazole. As another manifestation of Osler's disease further tests revealed an arteriovenous malformation (2.5 x 2.0 cm) in the right upper lobe of the lung, presumably the cause of the cerebral abscess. After wedge resection of the anterior upper lobe segment the further course was without complications.

Arteriovenous Malformations↗
PubMed1991

[Aortocoronary bypass surgery in patients older than 70 years].

From January 1981 to December 1990, 204 patients aged between 70 and 81 years underwent aortocoronary bypass surgery. Operative mortality (30-day mortality) was 6.8%. Actuarial survival rate at 1 and 5 years was 92% and 86% respectively. A higher incidence of postoperative complications was observed (arrhythmias in 19%, reoperation for bleeding in 5.4%, respiratory and neurological complications in 13% and 3% respectively, perioperative infarction in 4.4%). The mean follow-up was 25 months. Preoperatively most patients (71%) were in New York Heart Association (NYHA) functional class III and IV, and at the end of following-up in NYHA functional class I and II (95%) (p less than 0.001). A rapid rise in coronary artery surgery in the elderly is evident. It is associated with an increased but acceptable operative risk. Long-term results and postoperative improvement of functional status are very satisfactory.

Age Factors↗
PubMed1991

[Successful resection of a hypernephroma extending continuously into the right ventricle: utilization of extracorporeal circulation in general surgery].

We report the case of a 53-year-old woman with renal cell carcinoma extending into the inferior vena cava and through the tricuspid valve into the right ventricle. Successful total removal was performed with the aid of cardiopulmonary bypass. The rarity of this case prompted a review of the literature in which only the involvement of right atrium in this type of tumor was found. Review of our own experience with extracorporal circulation in non-cardiac procedures demonstrates that an aggressive therapeutic approach, requiring operations of escalating magnitude and multidisciplinary surgical treatment, can salvage patients who otherwise might not be considered for operation.

Carcinoma, Renal Cell↗
PubMed1991

[Vascular complications associated with aortic dissection].

Aortic branch occlusion may constitute the mode of presentation or become an important focus of treatment in patients sustaining acute aortic dissection. The optimal therapeutic approach in patients with acute aortic dissection complicated by cerebral, visceral and peripheral vascular problems, and the implications of such complications, are not well established. We review the outcome in 187 consecutive patients (149 males and 38 females, mean age 58 years) with acute dissection of the thoracic aorta who were admitted and operated on in our department over a 13-year period. We assess the incidence, consequences and specific management of significant stenotic and obstructive lesions of the aorta and its branches. Noncardiac vascular complications occurred in 59 patients (32%); of these complications, 38 were associated with type A dissection (incidence 28%) and 21 with type B dissection (incidence 48%). A trend towards decreasing overall surgical mortality was observed in the second part of the study (1983-1989) compared with the first part (1977-1982) i.e. 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, celio-mesenteric and renal circulation. Proximal aortic repair at the site of the intimal tear with obliteration of the false lumen may have restored 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) were necessary in 15 patients to restore adequate perfusion in the compromised area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Different interactions of platelets with arterial and venous coronary bypass vessels.

We studied the interaction of platelets with the wall of human internal mammary arteries and saphenous veins, suspended in organ chambers for measurement of isometric tension. Vessels were obtained during coronary bypass surgery and cut into 5 mm rings; in some the endothelium was chemically removed. Rings from several patients were randomly chosen for each experiment, and in each ring six concentrations of platelets (from healthy blood donors; 1-75 x 10(3)/microliters) were tested consecutively and concentration-response curves constructed; the areas under these curves were used for statistical comparisons. In rings of internal mammary artery contracted in response to noradrenaline, aggregating platelets induced endothelium-dependent relaxation which was prevented by apyrase (0.67 U/ml ADPase activity) and L-NG-monomethylarginine (1 mmol/l). By contrast, in saphenous vein rings contracted in response to noradrenaline, aggregating platelets induced only a further increase in tension. In quiescent vessels, the platelet-induced contraction did not occur in arteries with endothelium but that in veins was greater and facilitated by endothelium. Preincubation of platelets with aspirin (10 mumol/l) reduced the contraction in both vessels, but contraction was abolished only in the presence of both the thromboxane receptor antagonist SQ-30741 and the serotoninergic (5HT2) receptor antagonist ketanserin. These findings show that platelet-derived ADP causes release of nitric oxide by the endothelium of internal mammary artery but not of saphenous vein; thromboxane A2 and serotonin mediate contraction in vein but not artery with endothelium. These differences may contribute to differences in graft function and the clinical efficacy of antiplatelet drugs.

Apyrase↗
PubMed1991

Long-term follow-up of medical versus surgical therapy for hypertrophic cardiomyopathy: a retrospective study.

In a retrospective analysis 139 patients with hypertrophic cardiomyopathy were followed up for 8.9 years (range 1 to 28 years). Patients were divided into two groups: Group 1 consisted of 60 patients with medical therapy and Group 2 of 79 patients with surgical therapy (septal myectomy). Groups 1 and 2 were subdivided according to the medical treatment. Group 1a received propranolol, 160 mg/day (n = 20); Group 1b verapamil, 360 mg/day (n = 18); and Group 1c, no therapy (n = 22). Group 2a received verapamil, 120 to 360 mg/day, after septal myectomy (n = 17) and Group 2b had no medical therapy after surgery (n = 62). In Group 1, 19 patients died (annual mortality rate 3.6%) and in Group 2, 17 patients died (mortality rate 2.4%, p = NS). Of the patients who died, approximately one half to two thirds in both Groups 1 and 2 died suddenly and the other one half to one third died because of congestive heart failure. The 10 year cumulative survival rate was 67% in Group 1, significantly smaller than that in Group 2 (84%, p less than 0.05). In the subgroups, the 10 year survival rate was 67% in Group 1a, 80% in 1b (p less than 0.05 versus 1a) and 65% in 1c (p less than 0.05 versus 1b). The 10 year survival rate was 100% in Group 2a (p less than 0.05 versus 1a, 1b, 1c) and 78% in Group 2b (p less than 0.05 versus 2a). It is concluded that cumulative survival rate is significantly better in surgically than in medically treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[Triplegia in bilateral anterior-media watershed infarcts].

Deterioration of a neurologic deficit was observed in a 47-year-old patient with high-grade bilateral internal carotid artery stenoses. She presented monoplegia of the right leg with progression to triplegia (bicrural and left arm) following antihypertensive treatment of a suspected "hypertensive crisis". Triplegia is a very rare syndrome and highly suggestive of bilateral pathology of the carotid arteries. Antihypertensive treatment is contraindicated because sufficient blood pressure is needed for adequate perfusion of the brain, especially in the border zones between the great cerebral arteries. Allowing a high blood pressure and low head positioning led to slow recovery from the neurologic deficit, which continued after bilateral carotid endarterectomy. The patient became ambulatory without assistance and with minimal residual paraspasticity. Triplegia and other patterns of motor deficit in cerebrovascular disorders are discussed and the clinical picture of hypertensive encephalopathy is reviewed.

Arm↗
PubMed1991

Function and structure of the failing left ventricular myocardium in aortic valve disease before and after valve replacement.

Left ventricular (LV) cineangiography and endomyocardial biopsies were performed preoperatively in 49 patients (pts) with aortic stenosis (AS) and 35 pts with aortic insufficiency (AI). LV failure (group 1) was present in 15 pts with AS and 17 pts with AI. In these pts ejection fraction (EF) was less than 57% and either cardiac index was less than 2.5 L/min/m2 and/or LV end-diastolic pressure was greater than 20 mm Hg. Macroscopic LV hypertrophy was assessed by angiographic muscle mass (LMMI, g/m2). Morphometric evaluation of LV biopsies included the determination of muscle fiber diameter (MFD, mu), percent interstitial fibrosis (IF, %), volume fraction of myofibrils (VFM, %) and the calculation of LV fibrous content (FC, g/m2). Pts of group 1 and 2 were restudied 22.5 and 24.0 months, respectively, after successful aortic valve replacement. Preoperatively, group 1 pts had a significantly higher LMMI, MFD, and FC than did the patients in group 2 (non-failing group consisting of 34 pts with AS and 18 with AI). IF and VFM did not differ. After surgery EF increased significantly from 44% to 59% in group 1, whereas it remained unchanged in group 2 (66%). Although in both groups LMMI and MFD decreased significantly these quantities were increased after surgery in group 1 as compared to group 2. IF, VFM, and FC did not change significantly in group 1 after valve replacement. There was no difference in these latter three quantities between groups 1 and 2 after surgery. It is concluded that 1) macroscopic and microscopic hypertrophy is more marked in the failing than in the non-failing left ventricle, 2) left ventricular pump function is not related to percent interstitial fibrosis, and 3) at an intermediate time after aortic valve replacement pts with previously failing left ventricle show considerable improvement of ejection performance, but residual hypertrophy persists.

Angiography↗
PubMed1991

Perioperative myocardial perfusion scintigraphy at rest with technetium 99m methoxyisobutylisonitrile before and after coronary bypass operations.

Eighteen patients were examined at rest by technetium 99m methoxyisobutylisonitrile (99mTc-MIBI) myocardial scintigraphy 1 day before and 1 week after aorto-coronary bypass operation with planar and single photon emission tomography (SPET) imaging. One day postoperatively, a planar scintigraph in the intensive care unit (ICU) was done. Inter-observer variability was 3.8% for all examinations and for SPET alone, 3.9%. The quality of the planar images taken under emergency conditions in the ICU was quite comparable with those taken under routine conditions. The postoperative myocardial infarction in a patient who died 6 days later could clearly be demonstrated. In 16.2% of all segments which were hypoperfused at rest on preoperative scintigraphy, an amelioration of perfusion could be shown in the 1st week after the bypass operation. 99mTc-MIBI proved to be a useful agent to assess perioperative perfusion, in the ICU as well as under standard conditions.

Adult↗
PubMed1991

Perfusion without systemic heparinization for rewarming in accidental hypothermia.

We report on a patient with accidental deep hypothermia (23.3 degrees C) and cardiorespiratory arrest resulting from severe craniocerebral injury. Systemic anticoagulation was contraindicated, and the decision was reached to rewarm the patient with cardiopulmonary bypass without systemic heparinization using heparin-coated perfusion equipment. The patient was successfully rewarmed, was weaned from cardiopulmonary bypass, and recovered.

Adolescent↗
PubMed1991

Simultaneous revascularization for critical coronary and peripheral vascular ischemia.

Patients with coronary artery disease can exhibit substantial vascular involvement, and patients with vascular disease have a high incidence of coronary disease. Simultaneous coronary artery bypass grafting and treatment of vascular disease was performed in 32 patients with strong indications for surgical treatment of coronary artery disease and critical peripheral vascular ischemia operated on from 1980 until 1990. Overall hospital mortality was 3.1%; 1 patient died of myocardial infarction 2 days after urgent combined revascularization because of unstable angina pectoris and subacute occlusion of the aortoiliac bifurcation. Early mortality was 0% in patients undergoing elective operations. Eight-year actuarial survival was 87.5%. Combined procedures can be performed with acceptable risk and with encouraging long-term results in this special group of patients; they may improve prognosis in patients with diffuse atherosclerosis.

Adult↗
PubMed1991

Improved forceps for pulmonary embolectomy.

A malleable, nonocclusive forceps for surgical extraction of fresh pulmonary emboli is described. This device allows the performance of pulmonary embolectomy under direct vision with an unobscured peripheral field and reduces the potential for traumatic pulmonary artery laceration.

Equipment Design↗
PubMed1991

Dealing with dilated ascending aorta during aortic valve replacement: advantages of conservative surgical approach.

Five to fifteen percent of patients undergoing aortic valve replacement (AVR) will have an ascending aortic aneurysm requiring a concomitant surgical procedure. On the other hand, a dilated ascending aorta is known to be a potential source of complications after AVR. From 1972 to 1988, 2278 AVR, either isolated or combined with a second cardiac procedure, were performed in our institution. In the same time interval, a dilated ascending aorta was treated in additional 291 consecutive patients during AVR. Three different surgical options were employed: aortic remodelling and external wall support in 164 patients (56.4%), composite graft replacement in 81 patients (27.8%) and a supracoronary graft in 46 patients (15.8%). Early mortality was 4.8%. Aortic remodelling plus external wall support had the lowest early mortality (1.8%) and the best 8-year survival (89.6%). Supracoronary grafting had a higher early mortality (6.4%) and lower 8-year survival (73.2%). The results of the composite graft were least favourable: early mortality was 9.8% and 8-year survival 76.5%. The results point out the necessity for instituting the appropriate surgical procedure for a dilated ascending aorta during AVR. They show that conservative aortic surgery with preservation of endothelial lining gives excellent early and late results.

Actuarial Analysis↗
PubMed1991

Preoperative assessment of the likelihood of infection of the lower respiratory tract after cardiac surgery.

Lower-respiratory-tract infections are among the most frequent complications observed in the intensive care unit, leading to delayed postoperative recovery time and increased costs and mortality. We have tried to evaluate the prognostic value of perioperative bacteriology of tracheal aspirates in assessing the risk of such complications. In a prospective study aspirates of 100 patients undergoing cardiac surgery were taken immediately after intubation and were analysed for microorganisms by Gram-stain and microbiological cultures using standard procedures. All patients received perioperative antibiotic prophylaxis with a single dose of 2 g ceftriaxone intravenously. From 26 patients with bacteriologically positive tracheal secretion, 8 (30.7%) developed lower respiratory tract infection whereas only 1 of 72 patients (1.4%) with negative bacteriological results developed this complication. Smoking (p less than 0.01) and abnormal preoperative lung function (p less than 0.01) were significantly more frequent in patients developing postoperative pneumonia. Regarding the results of this study, the risk of developing pulmonary infection in the early postoperative course after cardiac surgery can be estimated from the tracheal aspirates.

Adult↗
PubMed1991

Experimental evaluation of heparin-coated cardiopulmonary bypass equipment with low systemic heparinization and high-dose aprotinin.

Cardiopulmonary bypass (n = 8 calves) with heparin-coated perfusion equipment, low-dose systemic heparinization (activated clotting time: ACT greater than 180 s) and high-dose aprotinin administration was evaluated in comparison to standard perfusion equipment with full-dose systemic heparinization (ACT greater than 480). All animals were perfused for 6 hours and similar values were observed for blood gases and mixed venous oxygen saturation in both groups. The heparin doses given in the study group before and during the 6 hours of perfusion totalized 14660 +/- 2553 IU as compared to 60833 +/- 5137 IU for the control group. No protamin was given in the study group whereas an equivalent of 27000 +/- 5805 IU was necessary to reverse heparin in the control group. There was no difference for prebypass hematocrit versus postbypass hematocrit in the two groups. Prebypass plasma hemoglobine was 8.4 +/- 2.1 mumol/L in the study group versus 10.0 +/- 3.8 mumol/L in the control group. After mixing with the priming volume, plasma hemoglobine was 8.6 +/- 2.5 mumol/L in the study group versus 6.7 +/- 1.6 mumol/L in the control group. The highest value was observed in the study group after 2 hours of perfusion (8.2 +/- 2.1 mumol/L) versus 5 hours of perfusion in the control group (7.4 +/- 3.6 mumol/L). Prebypass LDH levels of 1610 +/- 150 IU in the study group versus 1740 +/- 210 IU in the control group moved to 1870 +/- 200 IU in the study group at 24 hours after perfusion versus 2650 +/- 400 IU in the control group at 24 hours and decreased thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Predictability of aortic dissection as a function of aortic diameter.

The role of aortic diameter on the occurrence of type A dissection was investigated in 73 patients with dilated ascending aorta at the time of pre-operative evaluation. Using transthoracic echocardiography for diagnosis and measurements, 54 patients were identified with type A dissection (group 1) and 19 without dissection (group 2). The true mean aortic diameters were identical (6.0 +/- 1.3 cm in group 1 and 6.4 +/- 1.4 cm in group 2; mean +/- SD; ns) as were the indexed aortic diameters (ratio of diameter/body surface area; 3.2 +/- 0.8 cm.m-2 and 3.4 +/- 0.7 cm.m-2, respectively; ns). However, the individual diameters showed a pronounced scatter in both groups (range from 3.6 +/- 11.0 cm). Of the 73 patients, 66 had surgery (47/54 with and 19/19 without dissection) and seven patients were treated medically. Emergency surgery was performed in 45/66 patients (all with acute type A dissection) and elective repair in 21/66 (19 without and two with chronic type A dissection). In-hospital mortality was 18% in the emergency group, 5% in the elective group and 57% in the medical group. It is concluded that patients with dilated ascending aorta have a substantial incidence of acute dissection. Their clinical course is unpredictable: acute dissection occurs in some, and in others the ascending aorta continues to enlarge without dissection. Because patients with dissection often arrive too late for elective repair and have to be operated on as emergencies with a higher operative risk, we recommend elective surgery before the diameter of the ascending aorta has reached 6 cm.

Aortic Dissection↗
PubMed1991

Activity-sensing rate responsive versus conventional fixed-rate pacing: a comparison of rate behavior and patient well-being during routine daily exercise.

Rate responsive single chamber pacing (VVIR) may be the pacemaker of choice in patients who are not suitable candidates for a dual chamber system. Several studies, most of them performed in an exercise laboratory, have shown a significantly higher exercise capacity demonstrating an improvement in cardiac output and anaerobic threshold compared to conventional fixed rate pacing (VVI). Expressing our idea that stress testing in an "artificial environment" on a bicycle or motor driven treadmill has its limitations and may be difficult to extend into patient's daily life, we designed an outdoor study imitating patient's daily activity. Twenty-one patients with an activity-sensing rate responsive pacemaker performed in a double blind fashion in VVI and VVIR mode the following test circuit: walking 170 meters on flat ground, 210 meters incline, climbing a flight of stairs, and the same circuit in reverse order, and therefore "downhill". Heart rate behavior was recorded by Holter monitoring and patients subjective feelings of well-being, i.e. fatigue and dyspnea were also evaluated. VVIR pacing responded promptly to exercise, i.e., walking on a flat ground, but no further significant increase in pacing rate was observed in relationship to the strength of physical activity while walking inclined or climbing stairs. While patients became exhausted, a nonphysiological decrease in heart rate sometimes occurred. Despite these limitations 6 of 12 patients who had a paced-only rhythm while exercising in both VVI and VVIR mode reported feeling significantly better in the VVIR mode, expressing less dyspnea and fatigue. In contrast, two of nine patients having only intermittently paced rhythm preferred the VVIR mode. Patients with lower ejection fraction (EF) were more likely to show subjectively a benefit while exercising in VVIR mode, compared to those with less reduced or normal EF. Despite the technical limitations of using a piezo crystal for rate adaptation, VVIR pacing is an important option in paced-only patients, but it seems less beneficial in patients with only intermittent paced rhythm.

Activities of Daily Living↗