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M Turina

Publications and source records attributed to M Turina.

At least 325 records · Page 18Linked to original sources
PubMed1990

[Dangerous reduction of blood flow in the internal mammary artery in acute hypovolemia].

Internal mammary artery (IMA) flow patterns were analyzed in a dog model without interference with the coronary artery bed (n = 6, mean bodyweight: 21 +/- 4 kg) during the following conditions: a) baseline values and steady state: b) acute hypovolemia (withdrawal of 20% of circulating volume over 90 s): c) retransfusion (same volume over 90 s): d) progressive hypovolemia (withdrawal of the same volume over 240 s): e) bolus of nitrates (500 micrograms/kg over 60 s).

Animals↗
PubMed1990

[Cardiopulmonary bypass over 24 hours without systemic anticoagulation: new horizons?].

Open chest cardiopulmonary bypass was evaluated in eight canine experiments (mean bodyweight 37 +/- 7 kg) over 24 hours using either heparin surface coated equipment without systemic anticoagulation or standard equipment with systemic heparinization (ACT greater than 400 s). Mean duration of perfusion achieved was 23 +/- 2 hours in the group perfused without systemic anticoagulation versus 21 +/- 6 hours in the group with: [table; see text] These results show, that prolonged open chest perfusion by the means of heparin surface coated equipment without systemic anticoagulation can be performed with reduced blood trauma and without transfusion of blood products for 12 hours.

Animals↗
PubMed1990

[Cytomegalovirus (CMV) infection: a frequent and life-threatening complication in heart transplant patients].

We investigated the clinical relevance of cytomegalovirus infection in our heart transplant recipients (n = 48). There was a high incidence of CMV-infection in patients where IgG positive donor versus IgG negative recipient was present. A total of 5/8 patients (= 62.5%) showed severe clinical CMV-infection with pneumonitis, colitis or tonsillitis besides general malaise, requiring long hospital treatment (2 to 24 weeks). CMV-infection is a frequent and threatening complication in patients after heart transplant (HTPL). We discuss the various managements in diagnosis, prophylaxis and treatment.

Antibodies, Viral↗
PubMed1990

[Surgical and perioperative problems of heart transplantation].

Orthotopic heart transplantation is an established treatment for terminal cardiac diseases. Close cooperation and coordination with other clinics and laboratories is mandatory to transplant a good organ with minimal ischemic time. Accurate donor evaluation and treatment is essential for fast recovery after operation. Our series is 79 orthotopic heart transplantations form 9/85 to 10/89 in 78 patients. Average ischemic time is 38 minutes in organ procurement from table to table and rises distinctly in distal heart procurement (n = 33), but is usually under 120 minutes at organ procurement from any place in Switzerland. The transplantation is performed in the technique from Lower and Shumway. Immunosuppression with triple therapy (Cyclosporin A, Azathioprim, Prednisone) and initial cytolytic therapy is well tolerated. Consequent diagnosis and treatment for rejection and infections lead to good short and medium term survival. Prophylactic treatment is indicated in high risk constellation for cytomegalovirus and toxoplasmosis infection. Early mortality (less than 30 days) was two out of seven and caused by bacterial infections. Actuarial survival is 91% at one and two years and 85% at three years with good quality of life and NYHA class I.

Heart Diseases↗
PubMed1990

[The artificial ventricle as a bridge in heart transplantation].

Invasiv mechanical circulatory support is the approach for cardiogenic shock, either till recovery or as bridge to transplantation. The five most common ventricle assist devices including the total artificial heart have been used in more than 500 cases worldwide. The international registry reports 219 assisted cases with primary intention of transplantation. Heart transplantation was performed in 159 patients (73%) resulting in 99 (45%) hospital survivors. However, a broad armentarium of mechanical circulatory support systems is required to achieve improved clinical results.

Adult↗
PubMed1990

[Graft rejection reaction and immunosuppression following heart transplantation].

Acute rejection is the most important factor influencing mortality after heart transplant. Acute rejection occurs at least once in over 95% of the patients in the early phase after heart transplant. In the vast majority of episodes of acute rejection clinical symptoms are absent. The regular performance of endomyocardial biopsy after heart transplant allows histological diagnosis of rejection episodes as well as follow-up control of rejection treatment. This overview points to the major problems regarding acute rejection and immunosuppressive regimen in heart transplant recipients.

Graft Rejection↗
PubMed1990

Gluteal necrosis after acute ischemia of the internal iliac arteries.

Ligation of the internal iliac artery mostly remains without consequences because of the well established collateral network. In patients with compromised collateral circulation however, acute interruption of both hypogastric arteries during aorto-iliac surgery or transluminal embolisation can lead to necrosis of the gluteal muscles and other adjacent organs (rectum, bladder, lumbosacral plexus). Experience with 3 similar cases after aorto-iliac surgery demonstrates two main intraoperative mechanisms: 1. Embolisation, 2. Ligature of both internal iliac arteries in patients with compromised arteriosclerotic collaterals. Despite of adequate therapy, mortality is over 70%. The most important feature during aorto-iliac operations is to preserve at least one internal iliac artery by either reimplantation of the main stem or by an additional bypass to this artery.

Aged↗
PubMed1990

Long term cardiopulmonary bypass without systemic heparinization.

Cardiopulmonary bypass over 24-hours using heparin surface coated equipment, without systemic heparinization was analyzed in comparison to standard equipment with systemic heparinization in 8 open-chest canine experiments (37 +/- 7 kg). Mean duration of perfusion was 21 +/- 2 hours for the group perfused without versus 21 +/- 6 hours with systemic heparinization. The group without systemic heparinization could be perfused for 13 +/- 1 hours without transfusion of blood components whereas the pumpsucker was necessary during the whole procedure with systemic heparinization. Hematocrit dropped with systemic heparinization from 40 +/- 7% to 18 +/- 5% at 12 h versus a decrease from 38 +/- 4% to 15 +/- 1% without (with versus without: ns). Free plasma hemoglobin increased with systemic heparinization from 0.1 +/- 0.0 g/l to 1.4 +/- 1.2 g/l at 12 h compared with an increase 0.1 +/- 0.0 g/l to 0.3 +/- 0.1 g/l without (with versus without: p less than 0.05). Platelet levels dropped with systemic heparinization from 100 +/- 36% to 41 +/- 17% at twelve hours versus from 100 +/- 29% to 82 +/- 14 without (with versus without: p less than 0.05). Mean aortic pressure dropped with systemic heparinization from 73 +/- 12 mmHg to 53 +/- 4 mmHg at 22 hours whereas it remained at the same level without (83 +/- 6 mmHg). Improved hemostasis during long term open-chest cardiopulmonary bypass without systemic heparinization resulted in superior hemodynamics.

Animals↗
PubMed1990

[Toxoplasmosis in the heart transplant patient].

Toxoplasmosis is a well-known problem under immunosuppressive conditions in cardiac transplant patients. In our series 12% of the patients (8 of 65) had clinical and/or serological signs of active toxoplasmosis. Due to its serious prognosis once the clinical process has started we favor a generous diagnostic interpretation of the serological results and a broad indication to drug therapy.

Animals↗
PubMed1990

[Long-term follow-up after heart transplantation].

Actuarial survival rate two years after heart transplant in our patients is 90%. The most patients report excellent quality of life (NYHA I) and present definitely improved work load capacity as well as normal cardiac hemodynamic assessment two years after transplant. The major problems in the long follow-up of heart transplant recipients are accelerated coronary disease (graft atherosclerosis), arterial hypertension and renal function impairement.

Cause of Death↗
PubMed1990

[Injuries of the heart and para-cardiac large vessels].

Myocardial contusion is the most common manifestation of cardiac trauma; the true heart rupture or posttraumatic aneurysms are rare. Pericardial rupture can lead to cardiac strangulation; haemorrhagic pericardial effusion following trauma requires surgical drainage. Constrictive pericarditis occurs rarely after pericardial injury. Valve injury causes always the incompetence: traumatic aortic and mitral incompetence occur with both blunt and penetrating injury. In penetrating heart trauma a surgical revision is almost always necessary, to perform hemostasis and to decompress pericardial tamponade. Traumatic rupture of the descending thoracic aorta is amenable to immediate surgical treatment; end-to-end-anastomosis with simple aortic cross-clamping is the method of choice. Pump oxygenator is rarely necessary in treatment of cardiac trauma; emergency surgery--pericardial decompression, hemostasis and bilateral chest drainage--is performed in primary trauma center.

Adolescent↗
PubMed1989

[Long-term course of hypertrophic cardiomyopathy: drug versus surgical therapy].

139 patients with hypertrophic cardiomyopathy (HCM) have been followed up for 1-28 years (mean 8.9 years). Group 1 consisted of 60 patients (mean age 38 years) without indication for septal myectomy (SM) (no pressure gradient at rest in 8, pressure gradient less than 50 mm Hg in 52 cases); group 2 consisted of 79 patients (mean age 36 years) who had SM (pressure gradient at rest 70 mm Hg). Management in group 1 was the following: (1a) propranolol (n = 20) (160 mg/d), (1b) verapamil (n = 18) (360 mg/d) and (1c) no therapy (n = 22). 19 patients died in group 1 (mortality 3.6% year); 17 died in group 2 (mortality 2.4%/year). 10 year survival in group 1b was 80% and in groups 1a und 1c 67% and 65% respectively. Patients of group 1b had a higher survival rate (p less than 0.05) than the other subgroups. Surgery patients treated with verapamil (120-360 mg/d) (n = 17) had a 10-year survival rate of 100% compared to 78% for surgery patients (n = 34) without such treatment (p less than 0.05). In summary, it can be said that the overall survival rate after SM is better than that with medical treatment. Under verapamil, however, survival is not different from that after surgery. The most favorable outcome was observed in surgery patients under long-term therapy with verapamil, probably due to the reduction of systolic pressure overload (SM) and improvement in diastolic function (verapamil).

Adult↗
PubMed1989

[Results of the initial 50 heart transplantations in Zurich].

During the first 40 months of the new Heart Transplantation Program (September 1985 until December 1988) a total of a 160 patients were evaluated for transplantation at the University Hospital in Zurich. 50 patients eventually came to heart transplantation, while one patient underwent a heart-lung transplant. In the same period 9 patients accepted for transplantation died on the waiting list before transplantation. All 50 hearts were transplanted orthotopically. Follow-up treatment, immunosuppression and diagnostics for rejection are described. There was no operative mortality in this group. Two patients died early and three died late. For the first consecutive 50 heart transplant patients, showing a total of 732 patient months, actuarial survival was calculated at 90.1% at one and two years, and at 79.5% at three years. "Enlarged Heart Transplantation Program" describes some of the secondary activities spurred by the new Heart Transplantation Program.

Actuarial Analysis↗
PubMed1989

[Ventricular septal defect following myocardial infarct].

Surgery was performed for postinfarction ventricular septal defect (VSD) in 25 consecutive patients (14 men, 11 women; mean age 68 +/- 8 years). 9 patients were preoperatively in cardiogenic shock and required mechanical circulatory support by intra-aortic balloon pump (IABP) before surgery, whereas 11 acute patients underwent surgery without use of the IABP beforehand. The following procedures were performed: VSD patch closure in 25/25 patients, resection of infarct in 15/25, and patch enlargement of the left ventricle in 3/25. The overall 30-day mortality was 6/25 (24%). However, mortality was higher (4/9 [44%]) in the group with IABP support versus the group of acute patients without it (2/11 [18%]: p less than 0.05). In patients with significant postinfarction VSD, surgical closure appears to be mandatory.

Aged↗