Search PubMed⌕ Search

Biomedical subjects

M Turina

Publications and source records attributed to M Turina.

At least 415 records · Page 23Linked to original sources
PubMed1985

Cefuroxime versus ceftriaxone prophylaxis in cardiovascular surgery.

In a randomized, prospective study a 2-day course of cefuroxime prophylaxis (Zinacef, 1.5g every 12 h) was compared with 2-day ceftriaxone prophylaxis (Rocephin, 2g i.v. plus 1g i.v. after 24 h). To date 512 patients undergoing cardiac (n = 418) and major vascular surgery (n = 94) entered the study: 258 in the cefuroxime and 254 in the ceftriaxone group. The one-month lethality rate was 1.0%. The total infection rate was 4.7% (12 patients in the cefuroxime and 12 in the cefuroxime group. Septicaemia occurred in 1-4% (cefuroxime n = 4; ceftriaxone n = 3); pneumonia in 2% (5 vs 5 patients). One patient developed diarrhoea due to Clostridium difficile. Plasma concentrations of ceftriaxone were measured (HPLC method) over the first 24 h in 110 patients undergoing cardiac surgery. Plasma concentrations 24 h post-injection were 25.4 +/- 12.7 micrograms/ml. Prophylaxis with either cefuroxime or ceftriaxone was highly effective. The mean plasma levels of ceftriaxone achieved are far in excess of the MICs for the microorganisms commonly associated with infection following cardiovascular surgery, with the exception of Bacteroides and Pseudomonas. A single dose of ceftriaxone should therefore provide adequate prophylaxis for most patients undergoing major cardiovascular surgery.

Adolescent↗
PubMed1985

[Acute aneurysm with prerupture of the left ventricle following inferior infarct].

A large infero-posterior aneurysm of the left ventricle following myocardial infarction is reported, which still showed the echo- and angiocardiographic criteria of a true aneurysm. Because of concomitant pericardial effusion a prerupture was suspected. A resection showed that the wall of the aneurysm was composed of epicardium and thrombi only.

Angiocardiography↗
PubMed1985

[Regression of heart hypertrophy in patients with operated aortic valve diseases].

In 33 patients with aortic stenosis (AS), 27 with combined aortic valve lesion (AS + AI) and 23 with chronic aortic insufficiency (AI) left ventricular angiographic muscle mass (LMMI) was determined before and after successful valve replacement. Preoperative age in the three groups was 51, 47 and 42 years (P less than 0.05 vs. AS) respectively; recatheterization was carried out 17, 20 and 21 months postoperatively (not significant). In all three groups angiographic mass decreased (P less than 0.001) following surgery: In AS from 167 to 117, in AS + AI from 200 to 127 and in AI from 192 to 142 g/m2. Left ventricular end-diastolic wall thickness decreased from 1.22 to 1.02 (P less than 0.001) in AS and from 1.19 to 1.03 cm (P less than 0.001) in AS + AI. No change of wall thickness occurred in the patients with AI. Left ventricular ejection fraction (EF) increased from 61 to 68% (P less than 0.01) in AS, from 58 to 68% (P less than 0.005) in AS + AI and from 52 to 59% (P less than 0.02) in AI. The postoperative EF in the patients with AI was smaller (P less than 0.05) than in AS, AS + AI and in controls (EF = 68%, n = 18). Postoperative normalization of LMMI (less than or equal to 120 g/M2) occurred in 22/33 (67%) patients with AS, in 14/27 (52%) with AS + AI and in 8/23 (35%) with AI. The age of the patients and the time interval between surgery and recatheterization had no influence on postoperative normalization or non-normalization of LMMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Insufficiency↗
PubMed1984

[Heart surgery in patients older than 70 years].

Between 1980 and 1983, 103 patients over the age of seventy (average 72.5 years) underwent cardiac surgery. It comprised 41 aortic valve replacements, 11 mitral valve operations, 7 aortic and mitral valve procedures, 18 valve replacements with concomitant coronary artery bypass grafting, 17 coronary revascularizations, 7 operations for VSD after acute myocardial infarction and 2 procedures for dissecting aneurysm of the ascending aorta. Early mortality was 7.8% and late mortality 10% after a mean follow-up of 29.3 months. Preoperative NYHA-class IV is an incremental risk factor for early and later cardiac death. Early and late results are very satisfactory in patients with isolated valvular lesion, with or without concomitant coronary artery disease, and for isolated coronary atherosclerotic heart disease, whereas there is a high risk of early and late death in patients with multiple valvular lesions or VSD after acute myocardial infarction.

Age Factors↗
PubMed1984

[The course of endomyocardial fibrosis following surgical endocardial decortication].

Between 1971 and 1983 the authors observed 10 patients with left ventricular (n = 3) and biventricular (n = 7) endomyocardial fibrosis (7 women and 3 men). Seven of the 10 patients underwent open heart surgery with endocardial decortication of the left (n = 5) or left and right (n = 2) ventricle combined with mitral (n = 6) and tricuspid (n = 2) valve replacement. In 1 patient left ventricular endocardial decortication was performed without valve replacement. Three of the 10 patients were treated medically because functional limitation was only mild. One of the medically treated patients died 4 years later from congestive heart failure. Postoperative follow-up was 4.4 years. Two of the 7 patients who had undergone surgery died due to recurrence of endomyocardial fibrosis with blood eosinophilia of 46% (Löffler's endocarditis) in one, and due to severe left ventricular heart failure in the other. Annual mortality was 6.4%. NYHA classification was 3.4 pre- and 2.0 (p less than 0.005) postoperatively. Four patients were recatheterized 10 months after surgery: left ventricular end-diastolic pressure had decreased significantly from 24.6 to 13.6 mm Hg, cardiac index had increased slightly from 1.9 to 2.4 l/min/m2, left ventricular end-diastolic volume had increased from 69 to 84 ml/m2 (ns) and left ventricular ejection fraction remained unchanged pre- and postoperatively (59% and 57% respectively). It is concluded that endomyocardial fibrosis involves both ventricles in 70% of all patients, and that women are affected more frequently than men. Endocardial decortication with AV-valve replacement is regarded as the therapy of choice.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Plasma levels of ceftriaxone in cardiovascular surgery.

In 512 patients undergoing major cardiovascular surgery, this prospective, randomized study compared the effectiveness of perioperative prophylaxis with either ceftriaxone or cefuroxime. In the ceftriaxone group, 254 patients received a single 2 g dose given intravenously at the start of anesthesia followed by a 1 g dose 24 hours later. In the cefuroxime group, 258 patients received 1.5 g at the start of anesthesia, followed by 1.5 g given intravenously every 12 hours for 2 days postoperatively. Postoperative infectious complications developed in only 12 patients in each group (4.7 percent). In 53 patients the mean serum concentration of ceftriaxone 24 hours after administration of the 2 g dose was 37.4 micrograms/ml, a level far in excess of the minimal inhibitory concentrations of usual cardiovascular pathogens with the exception of Bacteroides species and Pseudomonas species. We conclude that a single 2 g dose of ceftriaxone given at the time of cardiovascular surgery should provide adequate prophylaxis.

Bacterial Infections↗
PubMed1984

[Aorto-intestinal fistulas. 4 case reports].

Four cases of aorto-enteric fistula are reported. The two primary types occurred after rupture of an aneurysm of the abdominal aorta into the duodenum and as a consequence of tumor infiltration of both the aorta and the intestinal wall in a woman with metastatic ovarian cancer. The two secondary types developed as a late complication of reconstructive surgery of the abdominal aorta. The condition was diagnosed or suspected on the basis of endoscopic findings in two cases. The pathogenetic role of graft infection in the development of secondary aorto-enteric fistula is emphasized. The generally poor prognosis can be considerably improved if prompt resection of the graft is combined with axillo-bifemoral anastomosis.

Aged↗
PubMed1984

[Cerebrovascular Doppler studies--a potent tool in neuroangiology].

Cerebrovascular disease is caused in about half of the patients by obstructions in the extracranial cerebral arteries. In the other half, stroke is due in roughly equal proportions to obstructive intracranial arterial lesions, emboli from the heart, or intracranial hemorrhage. Half of the patients with major ischemic stroke had previous warning signs in the form of transient ischemic attacks (TIA), reversible ischemic neurologic deficit (RIND) or infarction with only minor residual deficit not limiting daily activity, professional skills, and quality of life. Investigation of patients with warning signs of impending ischemic stroke is mandatory in order to prevent other events with possible major disability, but also, in patients with acute infarction, in order to choose the appropriate early therapy and rehabilitation. Routine cerebrovascular Doppler examination based on continuous-wave equipment has been successfully used to detect extracranial arterial obstructions. In the authors' experience of more than 12000 patients this noninvasive diagnostic tool makes it possible-in conjunction with the patient's history and the results of the clinical examination-to differentiate between obstructions needing surgery and lesions small enough to warrant medical treatment. Minor lesions which do not disturb blood flow locally, or accessible to available continuous-wave Doppler equipment, can be detected with real-time ultrasound imaging systems, i.e. B-mode or B-mode-Doppler-(duplex) systems in addition to routine Doppler examination. These complex systems also serve to follow-up patients with minor lesions which are not treated, or treated medically, in regard to deterioration, possible invariability, or even regression of a lesion.

Adult↗
PubMed1984

[Coronary reoperation--yes or no?].

From 1979 to April 1984, 51 patients were reoperated on for postoperative angina pectoris. Three patients died early and 4 late. The cause of death was cardiac in all cases. After the second operation the mean observation period was 24.2 months and the mean functional class 2.0. These results were somewhat worse than was to be expected after the first operation. The single significant risk factor was an ejection fraction reduced below 50%. The indication for reoperation should therefore be confined to patients with severe angina, good left-ventricular function, bypassable coronary arteries and sufficient graft material available (saphenous vein, internal mammary artery).

Adult↗
PubMed1984

[A prospective, randomized comparative study between cefazolin and cefuroxime as perioperative antibiotic prevention in cardiovascular surgery].

In a randomized prospective study, two different regimens of antibiotic prophylaxis have been tested: 4-day cefazolin prophylaxis (Kefzol, 0.5 g every 6 h) compared with 2-day cefuroxime administration (Zinacef, 1.5 g every 12 h). A total of 569 patients in the two groups were studied over a 10 months' period. Hematological, liver-function, serum creatinine and urea measurements were performed preoperatively and repeated daily for the first four days and after one week. At least five chest X-rays were taken during the hospitalization. Body temperature was measured regularly every two hours in the ICU and at least twice daily thereafter. The wounds were examined daily and the patients were carefully observed for other infections. Bacteriological examinations of the tips of all inserted catheters and pacemaker wires were undertaken on removal in the first four months of the trial. Swabs of any tracheal or wound secretion or pus were taken for bacteriological examinations, and blood cultures were performed for any suspected septicemia. Of the 569 patients, 3 had to be withdrawn from the study. Of the assessable patients, 285 received cefuroxime and 281 were given cefazolin. Seven patients (1.2%) died intra- or postoperatively. The total infection rate was 5.5%; 5.7% in the cefazolin group and 5.3% in the cefuroxime group. The overall wound infection rate was 1.8%; 2.5% in the cefazolin group and 1.1% in the cefuroxime group. Septicemia occurred in 0.5%, pneumonia in 11 patients (1.9%); 1.5% in the cefazolin and 2.5% in the cefuroxime group. Seven patients (1.2%) developed a urinary tract infection; 1.4% on the cefazolin group and 1.1% in the cefuroxime group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Diastolic stiffness and myocardial structure in aortic valve disease before and after valve replacement.

Passive diastolic properties were determined in 10 control patients and 21 patients with aortic valve disease before and 17.5 months after successful valve replacement. Ten patients had severe aortic stenoses (AS), five had combined aortic valve lesions (AS + aortic insufficiency [AI]), and six patients had severe AI. Left ventricular endomyocardial biopsies were obtained before and after surgery in patients with AS, AS + AI, and AI. Simultaneous echocardiographic and high-fidelity pressure measurements were made in all patients, and left ventricular chamber stiffness was calculated from a viscoelastic pressure-circumference relationship and left ventricular myocardial stiffness from a viscoelastic stress-strain relationship. The constant of chamber stiffness, beta', was slightly although not significantly increased in patients with AS (0.27 before and 0.24 after surgery), but was normal in those with AS + AI (0.22 before and 0.17 after surgery) and slightly decreased in those with AI (0.18 before and 0.16 after surgery) when compared with in control subjects (0.21). The constant of myocardial stiffness beta was normal in patients with AS (13.2), AS + AI (11.5), and AI (11.7) before surgery compared with in the control group (12.5). beta increased, however, significantly in those with AS (25.2; p less than .02), but not in those with AS + AI (16.3; NS) and AI (12.8; NS) after surgery. Myocardial morphologic characteristics showed a significant decrease in muscle fiber diameter in patients with AS, AS + AI, and AI, as well as a significant increase in interstitial fibrosis from 15% to 26% (p less than .05) in those with AS and a slight increase from 15% to 22% (NS) in those with AS + AI and from 19% to 24% (NS) in those with AI. Left ventricular fibrous content (left ventricular muscle mass index multiplied by interstitial fibrosis) remained, however, unchanged in all three groups after aortic valve replacement. In conclusion, left ventricular chamber stiffness is increased in AS but decreased in AI, whereas LV myocardial stiffness is normal in patients with aortic valve disease before surgery. After surgery, left ventricular myocardial stiffness increased significantly in AS patients but remained unchanged in those with AI. Postoperative changes in myocardial structure were characterized by a decrease in muscle fiber diameter and a relative increase in interstitial fibrosis, whereas fibrous content remained unchanged. Thus, regression of myocardial hypertrophy in aortic valve disease is accompanied by an increase of myocardial stiffness in concentric hypertrophy that is not seen in eccentric hypertrophy.

Adult↗
PubMed1984

[Lipoma of the left ventricle and insulinoma of the pancreas].

In a 59-year-old woman with cerebral attacks a left ventricular tumor was detected by two-dimensional echocardiography and confirmed by angiocardiography. The tumor was considered a source of embolism and resected. It proved to be a lipoma. Recurrent cerebral attacks finally led to the diagnosis of an insulinoma of the pancreas. After resection the cerebral attacks ceased.

Adenoma, Islet Cell↗
PubMed1984

Left ventricular function and myocardial structure in aortic valve disease before and after surgery.

47 patients with aortic valve disease were studied by left ventricular micromanometry and cineangiography before and 18 months after successful valve replacement. There were 27 patients (17 with aortic stenosis, ten with aortic insufficiency) with moderate hypertrophy (angiographic mass less than 180 g/m2) and 20 patients (ten with aortic stenosis, ten with aortic insufficiency) with severe hypertrophy (angiographic mass greater than or equal to 180 g/m2). In the patients with moderate hypertrophy ejection fraction was slightly although not significantly smaller than in 14 controls. Peak systolic circumferential wall stress was, however, significantly increased. In the patients with severe hypertrophy ejection fraction was significantly decreased although afterload was similar to that in the patients with moderate hypertrophy. This indicated a depressed contractile state in the patients with mass exceeding 180 g/m2. After surgery peak systolic wall stress returned to normal levels in both groups. Among the patients with severe preoperative hypertrophy only the patients with aortic stenosis showed a normal ejection fraction after surgery, whereas in the patients with aortic insufficiency ejection fraction improved but remained depressed compared to the controls. In a second study, comparison of left ventricular function with myocardial structure (endomyocardial biopsies) was carried out in 30 patients with aortic valve disease (group 1: 18 with aortic stenosis, group 2: twelve with aortic insufficiency). Both groups were restudied 18.8 and 17.4 months, respectively, following successful aortic valve replacement. Preoperative biplane ejection fraction (60 and 57%), angiographic mass (183 and 186 g/m2), muscle fibre diameter (31.1 and 30.8 mu), interstitial fibrosis (17.1 and 17.4%) and left ventricular fibrous content (31.0 and 32.2 g/m2) were similar in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Stenosis, Subvalvular↗