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Biomedical subjects

P Satter

Publications and source records attributed to P Satter.

At least 91 records · Page 5Linked to original sources
PubMed1984

Hemodynamic equivalence of automated nitroglycerin- and nitroprusside-infusions combined with dobutamine for augmentation of cardiac output in patients following aorta coronary bypass-operation.

In low-output cardiac failure with hypertension developing early after aortocoronary surgery, the currently preferred vasodilators nitroglycerin and nitroprusside proved to be equally successful and safe for the closed-loop control of mean arterial pressure. With NP- and NTG-induced MAP reduction to the present level of 80 mm Hg cardiac index increased similarly from 2.0 +/- 0.35 to 2.4 +/- 0.3 l/min/m2 (p less than 0.05) and from 1.9 +/- 0.29 to 2.2 +/- 0.26 l/min/m2 (p less than 0.05), respectively. Once adequate blood pressure fall was obtained, the addition of dobutamine at 6 micrograms/kg/min resulted under maintenance doses of NP and NTG averaging 1.6 +/- 0.4 and 4.6 +/- 1.8 micrograms/kg/min, respectively. A further improvement of cardiac performance manifested itself by cardiac index rise to 3.4 +/- 0.4 l/min/m2 (p less than 0.005) and 3.3 +/- 0.3 l/min/m2 (p less than 0.001), respectively. The NP-Db and NTG-Db regimens induced comparable reductions of rate - pressure-products reflecting a decrease of myocardial oxygen demands and facilitation of myocardial work.

Aged↗
PubMed1984

Effects of the automated management of hypertension after open heart surgery. The relevance of the initial systemic vascular resistance as index for predicting hemodynamic response to computer-controlled nitroprusside infusion.

In the study of hemodynamics of hypertensive patients with low-output syndrome after open-heart surgery (the closed loop control of mean arterial pressure with nitroprusside, n = 14), evidence was obtained that the baseline SVR is a valuable index for predicting the response to vasodilation. Patients with markedly elevated SVR (n = 11) (1800 dyn. s. cm-5) responded favorably to vasodilation with SVR fall (from 2300 +/- 500 dyn X cm-5 to 1400 +/- 300 dyn X cm-5, p less than 0.005, -37%), cardiac index rise (from 2.1 +/- 0.3 to 2.4 +/- 0.4 l/min. m2, p less than 0.05 + 14%), or stroke volume index elevation (from 23.4 to 26.7 ml/m2, p less than 0.05, +14%). In patients with slightly raised SVR close to the normal range a mild SVR reduction (by 10%) occurred but no cardiac index increase with vasodilation alone. These patients derived their hemodynamic benefit from a combination of NP with preload augmentation and possibly direct inotropic stimulation. By assessing SVR before and during treatment with nitroprusside we were able to monitor more closely the course of automated afterload reduction and provide an additional important parameter for this regulation.

Adult↗
PubMed1984

[Hemodynamic and echocardiographic long-term results of closed mitral commissurotomy].

During recent years open mitral commissurotomy (OMC) has seemed to be more favorable than closed commissurotomy (CMC). Up to now only few long-term results including hemodynamic data of mitral valve reconstruction have been reported. 69 of the 103 patients who underwent CMC between 1973 and 1980 were followed over a mean period of 5.3 +/- 2.1 years after intervention. 5 patients died. In 8 (11%) a prosthetic valve replacement was necessary (restenosis 4, insufficiency 2, combined valve disease 2). 36 of the patients were clinically improved (at least 1 NYHA class), 21 (30%) maintained the same NYHA class, and 7 (10%) had deteriorated. The relative heart volume (HV) from supine chest X-rays decreased from 1010 ml/1.71 m2 to 906 ml/1.73 m2 (n = 42, p less than 0.01). The mitral valve area ( MOFL ; n = 25) increased from 1.2 cm2 (Gorlin formula) to 2.6 cm2 (2D-echo) (p less than 0.001). Mean pulmonary artery pressure ( MPAP ) at rest decreased by 29% (from 33.6 mm Hg to 23.8 mm Hg, n = 37, p less than 0.001) and during exercise by 36% (from 69.5 mm Hg to 44.8 mm Hg, n = 10, p less than 0.01). The reduction in PA pressures and the increase in mitral valve area did not correlate and showed no relationship to the intraoperatively estimated success of commissurotomy. Our findings reflect very satisfactory long-term results after closed commissurotomy, which are comparable with those of open valvotomy.

Adolescent↗
PubMed1982

Inotropic and electrophysiological effects of histamine on human ventricular heart muscle.

1. The effects of histamine were investigated on mechanical and electrophysiological parameters in isolated electrically driven human ventricular papillary muscles. The effects of cimetidine and propranolol on histamine responses were also investigated. 2. The effects of histamine were compared with those of noradrenaline, isoprenaline, dimaprit, a selective H2-receptor agonist, and a cyclic AMP derivative, 8-(4-chlorphenylthio) cyclic AMP. 3. The effects of histamine and dimaprit and the effects of cimetidine on histamine responses were also investigated in guinea-pig right ventricular papillary muscles in order to allow a comparison with human papillary muscles. 4. In human papillary muscles, histamine caused concentration-dependent increases in the force of contraction and reductions in both time-to-peak tension and time-to-half-maximal relaxation. Histamine simultaneously caused distinct changes in the action potential configuration with increases in the height and duration of the plateau phase and an increase in the over-all action potential duration. 5. Noradrenaline and isoprenaline produced similar responses to histamine, as did 8-(4-chlorphenylthio) cyclic AMP, consistent with the view that the effects of histamine as well as the beta-adrenoceptor agonists on human ventricle, were associated with cyclic AMP mediated increases in calcium-dependent slow inward current.

Action Potentials↗
PubMed1982

[Hemodynamic effects of computer-guided blood pressure-lowering with nitroprusside sodium during the postoperative phase after aortocoronary bypass operations].

The hypertension immediately after open heart surgery for coronary heart disease was chosen to evaluate the suitability of computer-controlled infusion sodium nitroprusside, to improve the circulatory state in heart failure by reducing the impedance to the left ventricular ejection. Sodium nitroprusside produced a prompt reduction of MAP to a preset level and a rise in cardiac index from an average of 2.1 +/- 0.3 to 2.4 +/- 0.4 when infused alone and to 3.1 +/- 0.5 1/min m2 (p less than 0.05, + 48%) after volume was infused to maintain LAP at a constant level to eliminate the effects of preload. The rise in cardiac index was associated with marked decrease in systemic vascular resistance from 2260 +/- 530 to 1415 +/- 280 and 1130 +/- 1130 +/- 270 dyns (p less than 0.005, 63%) respectively. The initial values of SVR correlated well with the fall of SVR (r = 0.78). Our results suggest that systemic vascular resistance is a strong indicator of the vascular responsiveness to vasodilation, the computer-controlled infusion of sodium-nitroprusside being suitable for the "titration" of the high systemic vascular resistance.

Adult↗
PubMed1980

Determination of maximal ischemic tolerance of the human heart by ultrastructural recording of preischemic degree of myocardial hypertrophy and degeneration.

Three biopsies were taken transmurally in different time intervals (before and after ischemia and during the reperfusion phase) from 20 patients undergoing open-heart operation for acquired valvular heart disease, and the myocardial cylinders were examined with the electron microscope. They were scrutinized to see if there is a relationship between the degree of hypertrophy and degeneration before ischemia and the extent of ischemic damage after a certain ischemia period, and between the damage before ischemia and the postoperative outcome of the patients. Our results show that the ischemic changes are not dependent on the preischemic extent of hypertrophy and degeneration. It seems that they are mainly dependent on the duration of ischemia because the degree of ischemic damage increases with prolongation of the ischemia interval. However, a good correlation was found between the preischemic changes and the postoperative outcome. Especially the combination of marked hypertrophy and the appearance of degenerative signs in the biopsy taken before ischemia seems to predestine a bad postoperative course. Therefore, it can be concluded that the total damage to the myocardial cells, which results from the sum of previous damage (hypertrophy and degeneration) and ischemic alterations, is responsible for the postoperative outcome.

Cardiomegaly↗
PubMed1979

[Chest injuries (author's transl)].

The mortality rate of chest injuries sustained during work or in road accidents stands now at 15-20%. The considerable force of the impact in road accidents is, in 60-80% of the cases, responsible for chest injuries which involve not only the chest wall but also the lungs. The extent and course of the lung damage must be assessed by repeated X-ray examinations, blood gas analyses and clinical observations. The decision to intubate and apply artificial ventilation should be made at an early stage. Fracture of a single rib needs only pain killers. If a rib is broken in several places or if several ribs are fractured instability of the chest wall is apt to develop in 15-20% of the cases. It manifests itself in paradoxical breathing and ensuing increase in the dead space. These cases require prompt "internal pneumatic splinting" in the form of positive pressure respiration and intubation. In recent years surgical stabilization of the chest wall has regained favour. Plate osteosynthesis, screw-less rib plates, self-gripping steel plates and steel splints are being used (Brunner, Hofmeister, Koncz). Primary osteosynthetic stabilization of the chest wall is indicated only if artificial ventilation has proved inadequate and there are other reasons for performing a thoracotomy. In these circumstances surgical intervention ensures that prolonged artificial ventilation and its attendent risks and complications and the demands made on the nursing staff are reduced to a minimum.

Accidents, Traffic↗
PubMed1978

Assays of cephalosporin antibiotics administered prophylactically in open heart surgery. Determination of serum and tissue levels before, during and after cardiopulmonary bypass.

Twenty-eight patients who underwent open-heart surgery were divided into three groups, each of which received a different antibiotic from the cephalosporin series (cephalotin, cefazolin or cefamandole) in order to prevent infection. All antibiotics were given via intravenous infusion in a dosage of 2 g prior to surgery. To clarify the question of antibacterial activity under operative conditions with the cardiopulmonary bypass, the serum and tissue levels were determined before, during and after the surgical procedure. The effectiveness of the cephalosporins against bacteria most frequently encountered in open-heart surgery was demonstrated and substantiated by the serum and tissue concentrations. It became apparent that, in view of the favorable serum and tissue levels during and after the cardiopulmonary bypass, cefamandole should be considered the antibiotic of choice in preventing infections during open-heart surgery.

Adult↗
PubMed1978

Surgical management of massive pulmonary embolism.

Between 1972 and 1976, 24 patients have been treated by open pulmonary embolectomy with the aid of cardiopulmonary bypass (CPB). In 17 (71 percent) acute pulmonary embolism occurred 3 to 60 days after a surgical procedure. The remaining seven (29 percent) patients had chronic medical diseases. The interval between clinical manifestation of acute pulmonary embolism and the performance of open embolectomy ranged from 8 to 36 hours. The definitive diagnosis in all patients was made by pulmonary arteriography. Candidates for pulmonary embolectomy were selected by assessment of hemodynamic stuides: shock, arterial Po2 less than 65 mm. Hg, acidosis, pulmonary artery pressure higher than 20 to 30 mm. Hg, and central venous pressure elevated (patients in Class III or IV according to the Greenfield classification). The definitive indication for embolectomy was occlusion of the main pulmonary artery of more than 50 percent as well as occlusion of the right or left pulmonary artery. Of the seven patients operated upon between 1973 and 1974, three (43 percent) died in the early postoperative period. Between 1975 and 1976 the operative mortality rate in 17 patients was 23 percent (four patients). Our results show that prompt diagnosis of acute massive pulmonary embolism and better selection of patients may improve significantly the survival rate after open pulmonary embolectomy with CPB.

Adult↗