Biomedical subjects

M Turina

Publications and source records attributed to M Turina.

At least 577 records · Page 32Linked to original sources

PubMedDate not supplied

Optimized veno-venous bypass with the affinity pump.

Veno-venous bypass (VVBP) is increasingly used to avoid acute venous hypertension and low cardiac output after clamping the vena cava. Air embolism upon accidental decannulation of the inflow line and endothelial damage due to suction of the blood collecting cannula to the vessel wall are known complications specific to the currently used roller and centrifugal pumps, because they generate negative pressure at the inflow site of the pump. The Affinity pump has a unique chamber design with an occlusive segment, that collapses in low filling states preventing negative pressure at the inflow site of the pump chamber. This device was tested for VVBP in three pigs (each weighing 52.3 +/- 5.1 kg) with hepatic vascular exclusion. Blood was pumped from the femoral and portal veins to the external jugular vein and perfusion was maintained for 6 hours. The hemodynamic state of the animals was assessed by recording heart rate; systolic, mean arterial, and diastolic pressure; as well as central venous pressure. Mean pump flow during the experiment was 1,629.3 +/- 372.2 ml/min. After clamping, the inflow line of the pump mean arterial pressure significantly decreased (from 69.5 +/- 4.4 to 43.1 +/- 3.5 mm Hg), and mean pressure in the femoral vein increased significantly (from 16.1 +/- 2.6 to 26.8 +/- 5.9 mm Hg), whereas the mean pressure in the internal jugular vein did not significantly change (from 6.0 +/- 1.7 to 5.0 +/- 2.1 mm Hg). There was no suction by the blood collecting cannula on the vessel wall, and neither bubbles nor air emboli were detected and no operator intervention was needed. In conclusion, the Affinity pump eliminates device related complications due to negative pressure generated at the inlet, and guarantees stable hemodynamics. Its application is simple and safe and minimal operator intervention is needed, making the Affinity pump particularly suited for veno-venous bypass.

Animals↗

PubMedDate not supplied

Extended follow-up after atrial repair for transposition of the great arteries: a younger age at surgery improves late survival.

BACKGROUND: Surgical treatment for transposition of the great arteries (TGA) usually involves anatomic repair, although atrial repair is used in cases with special coronary artery patterns. METHODS: Records of all 239 patients surviving at least 30 days after atrial correction of TGA between 1962 and 1987 at the University Hospital in Zurich were reviewed. The mean length of follow-up time was 13.7 years (median 14.9 years; range from 0.05 to 30.1 years). The average age at surgery was 45.7 months (range from 7 days to 24.4 years). One hundred twenty-one patients had a simple TGA, whereas the remaining 118 had a complex TGA. RESULTS: The surviving patients were in NYHA class I at time of follow-up. The most common reasons for death were systemic right ventricular dysfunction and sudden rhythm disturbances. There was a major risk for late cardiac event in patients over 3 years old at operation (p = 0.02) and also in patients with complex TGA (p = 0.03). However, date of surgery, previous surgery, or the postoperative requirement for a pacemaker did not greatly affect late cardiac mortality. CONCLUSIONS: Although the procedure of choice for TGA is the arterial switch operation, the promising findings of the current long-term study, which reports the longest follow-up to date, indicate that the atrial switch operation is a good alternative procedure for the rare cases where the use of arterial switch procedures is limited.

Adolescent↗

PubMedDate not supplied

Heat shock protein upregulation lowers cytokine levels after ischemia and reperfusion.

OBJECTIVE: Studies showed that the expression of heat shock protein 70 (HSP70) by whole-body hyperthermia or warming of the heart is associated with protection against ischemia/reperfusion injury. The aim of this study is to determine a time-related response of HSP70 expression through topical cardiac warming with correlation to cytokine production. METHODS: 30 rats were divided into three groups: no heat shock, heat shocked, and controls. Heat shock was performed with 42 degrees C saline solution applied to the heart for 5, 30, and 60 min. HSP70 and cytokines were measured. RESULTS: Heat shock treated animals showed a 1.2-fold increase after 5 min (NS) in HSP70 expression, a 2.0-fold increase (p < 0.02) after 30 min, and a 2.3-fold increase (p < 0.012) after 60 min compared to controls. The IL-1beta levels decreased from 14.3 pg/ml (normal controls) to 7.1 pg/ml after 5 min, to 1.6 pg/ml after 30 min (p < 0.002), and to 1.4 pg/ ml after 60 min of heat shock treatment (p < 0.002). The TNF-alpha levels also decreased, but not significantly. CONCLUSIONS: Upregulation of HSP70 through this novel method is instant and detectable within hours. The amount of HSP70 expression induced is time dependent, showing an indirect correlation with cytokine levels. These results suggest that the protective effect of HSP70 is immediate and might be explained by reduced cytokine levels. No prior recovery period is needed.

Animals↗

PubMedDate not supplied

Congenital coronary fistulas in children and adults: diagnosis, surgical technique and results.

Coronary artery fistula is a very rare congenital malformation with an abnormal coronary-cameral communication that may involve any chamber and any or all coronary artery branches. We present our experience with 11 consecutive patients (mean age 16.6 years, ranging from 4 to 64 years); 9 of them were treated surgically, spontaneous closure of the fistula was observed in 1 patient and 1 patient is still under observation. Nine patients were under 17 years of age at the time of operation whereas only 2 patients were older (56 and 64 years). Fistulas originated from the right coronary artery in 4 patients and drained either into the right (n = 3) or into the left system (n = 1). In 8 patients, the origin of the coronary artery from the aorta was normal and the fistulous communications developed with the right cardiac structures only. In 2 patients, both coronary arteries were involved in the pathological drainage and 2 patients were demonstrated to have multiple drainage from the left coronary artery. Additional congenital cardiac malformations were found in 2 patients: severe tricuspid valve regurgitation in 1 and ventricular septal defect in another patient. Surgical closure of the fistula was successful in all operated patients (in 1 case treatment was possible without cardiopulmonary bypass). Simple ligation of the fistula was performed in 1 patient, intracardiac closure of the fistula was combined with different reconstructive procedures in the other patients. No hospital mortality nor severe complications occurred in this small group of patients. The mean follow-up interval was 39.4 months and all patients were in NYHA functional class I, except 1 with moderate tricuspid and mitral valve regurgitation. In the presence of symptoms of congestive heart failure, significant left-to-right shunt and arrhythmias, elective closure of coronary fistula is generally accepted, whereas the indication is more controversial in asymptomatic patients. Considering the low perioperative morbidity, we recommend surgical closure of coronary fistulas with significant shunt and/or increased coronary artery diameter.

Adolescent↗

PubMedDate not supplied

Patency of external and internal carotid artery in the presence of an occluded common carotid artery: noninvasive evaluation with combined cerebrovascular Doppler examination and sequential computertomography.

The patency of the external carotid artery (ECA) and internal carotid artery (ICA) in the presence of an occlusion of the common carotid artery (CCA) was evaluated in 7 patients with a symptomatic CCA occlusion by the combined application of cerebrovascular Doppler examination (cv-Doppler) based on continuous-wave equipment and sequential computertomographic scans with intravenous bolus injection of contrast material (sequential CT-scans). Occlusion of the CCA was demonstrated by cv- Doppler and sequential CT-scans and confirmed by routine angiography. A patent ECA was found in all 7 patients by the combined method, but could not be demonstrated by routine angiography in one of these patients. A patent ICA was found in 2 patients by the combined method, while routine angiographic findings concerning the patency of the ICA were equivocal. An occluded ICA was found in 5 patients by the cv-Doppler-sequential CT-scans method, where routine angiographic findings also were equivocal. Operation to restore blood flow in the CCA was performed in 5 patients and successful in 3 patients in whom blood flow from the CCA to the ECA could be achieved in 2 patients, and to the ECA and ICA in one patient, as predicted by the combined cv-Doppler-sequential CT-scans method. Thus, the patency of the ICA in the presence of a CCA occlusion can be reliably evaluated by the combined diagnostic procedure. The method may help to decide for further diagnostic work-up, e.g., specific selective injections and projections in more than two plans during cerebral angiography, and/or successful surgical intervention in a given patient with a CCA occlusion, even if angiographic findings are equivocal.

Adult↗

PubMedDate not supplied

Effects of left heart bypass on cardiac performance following myocardial ischemia.

A series of nine dogs underwent 20 minutes of myocardial ischemia by cross clamping the aorta while total cardiopulmonary bypass. The four dogs that did not have subsequent left bypass all showed a deterioration of ventricular function curve 30 minutes after restarting the heart beat when compared to their own preischemic values. The five animals which were supported for 30 minutes in left heart after bypass all showed essentially unchanged cardiac function after bypass. This study suggests that an improvement of myocardial performance after ischemic damage can be achieved with left heart bypass.

Animals↗

PubMedDate not supplied

Orthotopic heart transplantation: an efficient treatment in a young boy with doxorubicin-induced cardiomyopathy.

We present the case of a boy who underwent orthotopic heart transplantation at the age of 14 years because of doxorubicin-induced cardiomyopathy 9 years after treatment of a Wilms tumor of the left kidney. Three years after heart transplantation the patient enjoys a normal daily life. Invasive studies show normal cardiac hemodynamic results and in spite of previous nephrectomy and long-term cyclosporine treatment, renal function is only slightly impaired. So far no secondary neoplasia has occurred under chronic immunosuppression.

Adolescent↗

PubMedDate not supplied

Improved life expectancy after coronary artery bypass grafting in elderly.

From 1981 to 1990, 204 patients (165 male, 35 female) aged 70 years and older (mean 72.4 +/- 2.4 years [+/- SD], range, 70 to 81 years) underwent isolated coronary artery bypass surgery with an average of 3.8 +/- 1.2 grafts per patient. Seven patients (3.5%) were in NYHA functional class I, 52 (25.5%) were in class II, 1237 (62%) were in class III, and 18 patients (9%) were in class IV preoperatively. The operative mortality (30-day mortality) was 6.8% (14 patients). The NYHA class improved in these patients from a mean preoperative value of 2.8 +/- 0.65 to 1.4 +/- 0.6 postoperatively (p < 0.0001). The actuarial survival (+/- SD) of the entire group was 92 +/- 2% and 86 +/- 4% at 1 and 5 years, respectively, and of the patients surviving operation, excluding those who died in the hospital, it was 98.5 +/- 1.0% and 93 +/- 3.5% at 1 and 5 years, respectively. We concluded that coronary artery bypass grafting in elderly patients can be performed with acceptable operative mortality and good late results.

Aged↗

PubMedDate not supplied

Echocardiographic evaluation of left ventricular wall motion before and after heart transplantation.

Forty transplanted hearts were retrospectively investigated before, immediately after, and 15 +/- 12 months after heart transplantation by two-dimensional echocardiography for the presence and course of left ventricular myocardial wall motion abnormalities. Fourteen heart donors who were brain dead because of subarachnoid hemorrhage formed group 1 (mean age, 35 years); 21 heart donors who were brain dead because of head injury formed group 2 (mean age, 29 years), and five heart donors who were brain dead because of head injury with an additional chest trauma formed group 3 (mean age, 28 years). Myocardial wall motion was examined in six different myocardial segments (inferior, septal, anterior, posterior, posterolateral, apical) and was quantitatively assessed by a modified score index system (score index 0 = normal wall motion; score index 1 = diffuse hypokinesia). Overall, 27 of the 40 heart donors showed mild to severe (9 of the 40) wall motion abnormalities, which improved shortly after heart transplantation (score index: 0.36 vs 0.18, p < 0.01), and remained improved 15 months after heart transplantation (score index: 0.15). Among the different study groups, a significant improvement occurred in the myocardial wall motion score index on a short-term and long-term basis in all the groups, except for group 2, regarding the long-term follow-up. This study concluded that brain-dead, potential heart donors often reveal mild-to-severe left ventricular wall motion abnormalities, which are readily detected and semiquantitated by two-dimensional echocardiography.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Repair of anomalous origin of the left coronary artery from the pulmonary artery without early and late mortality in 9 patients.

An anomalous origin of the left coronary artery from the pulmonary artery is a very rare congenital malformation. We examined the early and late results of 9 patients (4 males and 5 females, mean age at operation: 6.5 years +/- 6 years). Eleven operations were performed in these 9 patients. The following types of operation were performed: ligation of the left coronary artery close to the pulmonary artery in one case, coronary artery bypass grafting in 3 patients, reimplantation of the LCA into the aorta in 3 patients and interpulmonary artery tunnel repair ("tunnel operation") in 4 instances. These operations were combined with plastic reconstruction of the mitral valve (1 patient) or aneurysmectomy of the left ventricle (3 patients). There was no intra- or early operative mortality. After a mean follow-up of 7.3 years, all patients are alive and in New York Heart Association functional class I, except one patient suffering from dyspnoea during moderate exercise. In two patients complications requiring reoperations occurred after 4 and 100 months respectively: stenosis of the distal anastomosis after coronary artery bypass grafting using saphenous vein and thrombosis of the intrapulmonary tunnel. We conclude that an anomalous origin of the left coronary artery from the pulmonary artery is best operated by reimplantation of the vessel into the aorta at any age of life. Concomitant pathology may be corrected simultaneously, without increasing operative mortality.

Adolescent↗

PubMedDate not supplied

Late neutrophil infiltration of canine endothelial cell seeded Dacron grafts.

Neutrophil infiltration is known to affect the endothelial monolayer of seeded vascular grafts. The aim of this study was to develop an in vitro system allowing the monitoring of neutrophil (PMN) adherence after graft implantation. Dacron prostheses were seeded with autologous canine microvascular cells from omental adipose tissue and implanted for 35 days. In vitro, mature monolayers of canine homologous venous endothelial cells (CHVENC) were exposed to heparinized whole blood samples taken at days one and four postoperatively, followed by weekly tests. PMNs adherent to the CHVENC were counted per culture area. Results showed the feasibility of PMN monitoring, and demonstrated a late PMN adhesion, reaching its maximum about 20 days after implantation and decreasing to normal values after five weeks. It is concluded that in vitro tests can be used for noninvasive studies of host plasma factors and leukocyte activation.

Animals↗

PubMedDate not supplied

Coronary artery-right ventricular fistula in a heart transplant patient.

Routine coronary angiography 2 years after heart transplantation in a 48-year-old patient revealed a fistula from a septal branch of the left anterior descending artery to the right ventricle. This finding was not present at coronary angiography 1 year before. This coronary-ventricular fistula is most probably the result of repeated endomyocardial biopsies.

Angiography↗

PubMedDate not supplied

A compliant small-diameter vascular prosthesis lined with functional venous endothelial cells.

The long-term patency of small-diameter vascular grafts is still unsatisfactory. In contrast to native arteries, they are inelastic and lack active antithrombogenicity. To improve long-term patency, a new 4 mm internal diameter prosthesis was developed which is compliant and lined with functional endothelial cells (ENC). The wall of this prosthesis consists of a microporous polyurethane-siloxane copolymer reinforced with a polyester network. It displays compliance (13.2 x 10(-4) mmHg-1) comparable to native arteries, is nonkinkable (minimum radius of curvature = 5 mm), burst resistant, and easily suturable. Using a lining procedure, coverage of prostheses by ENC was in excess of 95%. The ENC populations were found to be highly pure (by factor VIII-related antigen, DilAcLDL uptake) and to produce about 0.3 ng prostacyclin per cm2. In vitro tests of shear stress resistance demonstrated that ENC monolayers on the new elastic prosthesis remain intact for 3 hr in physiologically pulsating culture medium (Vmax = 50 cm/sec). Lined prostheses implanted for 24 hours in mongrel dogs as an arteriovenous shunt demonstrated the antithrombogenicity of the cultured ENC. The results suggest that small-diameter vascular prostheses which are compliant, porous, and actively antithrombogenic are feasible.

Animals↗

PubMedDate not supplied

Perioperative antimicrobial prophylaxis in cardiovascular surgery. A prospective randomized trial comparing two day cefuroxime prophylaxis with four day cefazolin prophylaxis.

In a randomized prospective study, two different regimens of antibiotic prophylaxis have been tested: four-day cefazolin prophylaxis (Kefzol 0.5 gr every 6 h) compared with two-day cefuroxime administration (Zinacef 1.5 gr every 12 h). A total of 569 patients in the two groups were studied in a 10 month period. Haematological, liver function, serum creatinine and urea measurement were made preoperatively and repeated daily for the first four days and after one week. At least five chest X-rays were taken during the hospitalisation. Body temperature was measured regularly every two hours in the ICU and a least twice a day 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 taken for bacteriological examinations as also blood cultures in any suspected septicaemia. Of the 569 patients three had to be withdrawn from the study. Of the assessable ones 285 received cefuroxime and 281 were given cefazolin. Seven patients (1.2%) died 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. Septicaemia occurred in 0.5% of the cases. Pneumonia occurred in 11 (1.9%) patients; 1.5% in the cefazolin and 2.5% in the cefuroxime group. Seven patients (1.2%) developed a urinary tract infection; 1.4% in the cefazolin group and 1.1% in the cefuroxime group.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗

PubMedDate not supplied

Tetralogy of Fallot: to patch or not to patch?

Angiograms of 11 patients with Tetralogy of Fallot were reviewed before and after total repair, and analyzed with respect to growth of the pulmonary valve annulus. At the operation none of the patients was more than 5-years-old, none received a transannular patch and all were asymptomatic at the last visit. The radiologic diameter of the pulmonary valve annulus was compared to the descending thoracic aorta at the level of the diaphragm. Preoperative ratio averaged 1.09 +/- 0.22 and increased postoperatively to 1.35 +/- 0.20 (p less than 0.02). A "catch-up" growth of small annuli could be demonstrated.

Child, Preschool↗

PubMedDate not supplied

Disappearing obstructions in extracranial cerebral arteries.

Between 1973 and 1978 spontaneous lysis of obstructions in an external cerebral artery was detected in seven out of 3500 patients who suffered from symptoms of cerebrovascular failure in the territory of the internal carotid or vertebral artery. All patients underwent our routine cerebrovascular Doppler ultrasound examination. In the seven patients a high grade obstruction in the internal carotid artery (six cases) or in the brachiocephalic trunk (one case) was found by Doppler and/or angiography 1-3 days after the onset of the symptoms. On a second examination 4-30 days later these obstructions were no longer present either in the Doppler examination and on the angiograms, or in the surgically exposed vessel. These findings suggest that spontaneous lysis of the obstructions must have occurred. Furthermore vascular surgery should not be delayed more than 3-7 days without another reliable vascular examination.

Adult↗

PubMedDate not supplied

Irreversibility of cyclosporine-induced renal function impairment in heart transplant recipients.

The use of cyclosporine therapy for heart transplant recipients has been associated with a significant improvement of graft survival. Renal function impairment is a frequent finding in patients chronically treated with cyclosporine. The purpose of this prospective randomized study was to establish renal function in a group of heart transplant recipients receiving chronic cyclosporine treatment and to test the hypothesis of reversibility of cyclosporine-induced nephropathy by late reduction of cyclosporine. A total of 28 patients who underwent operation at least 18 months before this study began were randomly assigned to either group A (n = 14), in which the whole-blood polyclonal cyclosporine target trough level was reduced from 400 to 600 micrograms/L to 200 to 400 micrograms/L, and group B (n = 14), in which the level was maintained at 400 to 600 micrograms/L. Renal and cardiac function were assessed by paraaminohippuric acid, inulin and lithium clearances and heart catheterization, respectively, at entry and 4 months later. Cellular rejection in the transplanted heart was monitored by at least four endomyocardial biopsies every 14 days with the histologic Texas scale (grading: 0 to 10). In heart recipients renal blood flow (592 +/- 202 ml/min/1.73 m2) and glomerular-filtration rate (74 +/- 33 ml/min/1.73 m2) were significantly lower (p < 0.01), and mean arterial blood pressure (109 +/- 13 mm Hg) and renal vascular resistance (22.4 +/- 9 mm Hg/dl/min/1.73 m2) were significantly higher than the corresponding values in normal controls (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

[The ilio-caval confluence syndrome].

UNLABELLED: The venous confluence syndrome is the clinical consequence of the flows obstruction which are the main tributary of the deep venous system. The cava confluence syndrome is different from the aortic obstruction at the level of its bifurcation. Its causes are congenital abnormality, extrinsic, intrinsic and intramural compression. CLINICAL PICTURE: collaterization of the int. vertebral plexus of the Azigos and hemiozygos veins as well as episgastric and thoracic veins, in chronic cases. On the other hand, in acute cases, significant renal insufficiency, ascites and bilateral phlegmasia caerulea make up the clinical picture. In acute stage, surgery requires thrombectomy and endovascular prothesis whereas in chronic stage, surgery will tend to remove the cause with only a palliative action on external symptoms. In both cases, abnormalities bring about a surgical issue.

Acute Disease↗