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Biomedical subjects

R Arcas

Publications and source records attributed to R Arcas.

At least 37 records · Page 2Linked to original sources
PubMed1988

Does desmopressin acetate reduce blood loss after surgery in patients on cardiopulmonary bypass?

It has been suggested that desmopressin acetate (DDAVP) administration reduces blood loss after cardiac surgery. We have investigated the effect of DDAVP administration in a double-blind, randomized, prospective trial including 100 patients placed on cardiopulmonary bypass during surgery. Fifty patients received 0.3 micrograms/kg DDAVP and 50 patients received a placebo administered in a 50 ml saline solution over 15 min when cardiopulmonary bypass had been concluded. Results showed no significant differences either in total blood loss per square meter (458 +/- 206 ml in the DDAVP group vs 536 +/- 304 ml in the placebo group) or in necessity for red cell transfusions (1642 +/- 705 ml in the DDAVP group vs 1574 +/- 645 ml in the placebo group) in the first 72 hr after surgery. Only intraoperative blood loss per square meter was significantly lower (p less than .02) in the DDAVP group (131 +/- 106 ml) as compared with the placebo group (193 +/- 137 ml). The prolongation of bleeding time and the decrease of factor VIII:C and factor VIII:von Willebrand factor 90 min after treatment were significantly lower (p less than .001) in the DDAVP group as compared with the placebo group. We conclude that the administration of DDAVP in patients placed on cardiopulmonary bypass during surgery does not reduce total blood loss and is only effective in reducing intraoperative bleeding.

Blood Transfusion↗
PubMed1986

201Tl myocardial imaging in a cardiac rejection episode.

Serial myocardial imaging using thallium Tl 201 was performed in the early follow-up of two patients with orthotopic cardiac transplantation. In one patient, non-homogeneous uptake, small defects and an irregular myocardial edge were observed during a moderately acute rejection crisis revealed by endomyocardial biopsy. The abnormal gammagraphic findings and histological changes were coincident and exhibited a parallel reversal. We emphasize the connection between these two events. The mechanisms which could explain these phenomena are discussed.

Acute Disease↗
PubMed1986

[Alpha 1-antitrypsin deficiency and atresia of the bile ducts].

A newly-born male affected by extrahepatic biliary atresia with an alpha-1 antitrypsin pi ZZ deficiency is presented. Parents, Pi MZ, showing no signs of affection either in liver or lungs. His two brothers and one sister died at nine months, 7 years and 22 months respectively. Two brothers showed cirrhosis of the liver, the sister showed extrahepatic biliary atresia, and in all three patients there was an alpha-1 antitrypsin deficiency. Authors want to emphasize the presence of extra-hepatic biliary atresia in both brother and sister who had also an alpha-1 antitrypsin deficiency because this is an infrequent association which requires different treatment.

Biliary Atresia↗
PubMed1985

[Valve replacement associated with aorto-coronary bypass in ischemic mitral insufficiency].

26 cases of ischaemic mitral regurgitation (MR) were treated by combined surgery: mitral valve replacement (MVR) and coronary bypass grafting (CBG). This type of operation is not common (1.3 p. 100 of all operations) and is usually reserved for men (21 cases) of middle age (average 59 years). A half of the cases had suffered previous myocardial infarction (MI), an average 5 months before surgery (range 20 days to 2 years). The other half had severe angina or ECG changes of myocardial ischaemia. 23 patients were in Class IV (15 patients) or Class III (8 patients) of the NYHA classification. 6 of the cases required intraaortic balloon pumping. Mitral regurgitation was severe () in half of the cases with a raised pulmonary capillary (mean V wave = 52 mmHg) and systolic pulmonary artery pressures (mean = 47 mmHg: exceeding 60 mmHg in 7 cases). The coronary lesions were severe in 18 patients (12 cases of double and 6 of triple vessel disease including 2 cases of left main stem stenosis). Ruptured chordae were found in 11 cases and papillary muscle necrosis in 4 cases. Surgery comprised MVR with 12 bioprostheses and 14 mechanical prostheses. 33 CBG were performed (anterior wall: 15 cases, posterior wall: 11 cases). In addition, one tricuspid annuloplasty and 3 ventricular aneurysmectomies were carried out. The hospital mortality was 15.4 p. 100. The main causes of morbidity were low output states and postoperative MI (2 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

[Nutritional and immunologic state of patients undergoing heart valve surgery].

A series of 60 consecutive patients treated by heart valve replacement surgery under extracorporeal circulation were reviewed. Poor nutrition was assessed in 28% of these cases, the cardiac index in these patients being significantly smaller than in operated patients with normal nutritional states (2.07 +/- 0.8 as against 2.46 +/- 0.7, p less than 0.01). Furthermore, 58% of those with poor nutrition presented postoperative complications: mediastinitis, wound infection, ventricular arrhythmias or secondary pulmonary infection. One death occurred in this group. Postoperative complications in patients with normal nutritional states developed in only 6% and there were no deaths. Duration of hospital stay was significantly longer in patients with poor nutrition (p less than 0.05). Apart from immunoglobulin levels, all immunologic parameters underwent postoperative modifications related to nutritional state. Physiopathologic hypotheses are proposed as well as a programme for increasing nutritional intake in patients in a precarious metabolic state which predisposes them to complications.

Adult↗
PubMed1982

Aortico-left ventricular tunnel: a case report and review of the literature.

A 5-year-old child was operated on for aortico-left ventricular tunnel (ALVT). Postoperative cardiac catheterization revealed obliteration of the aortic end of the tunnel, normalization of systemic pressure and mild residual aortic valvular insufficiency. A review of the literature carefully considers the anatomical and clinical findings from previous reports involving 27 other patients, along with suggestions for appropriate surgical management of ALVT.

Journal Article↗
PubMed1981

[Clinico-biological effectiveness of triflusal during the postoperative period of patients with chronic ischemic syndrome of the extremities].

A group of 15 patients, suffering of chronic ischaemia of the lower limbs, were treated with triflusal, a new antiaggregant and antithrombotic agent, at the dose of 300 mg/day, during the first 90 days after artery by-pass grafting. Clinical exploration of patients included: physical inspection, pulses palpation, intermittent claudication (in metres), arteriography before surgery, and postoperative evolution of oscillometric and Doppler indexes. Determinations of platelet aggregation, induced by ADP, epinephrine and collagen, as well as of prothrombin time, platelet adhesiveness, and of thromboelastography parameters in PRP ane PPP were also carried out. Biochemical and hematological data were determined; gastric tolerance and other side effects were written down. Results show a clear improvement of all patients due to surgery, but with triflusal, it has been possible to maintain a prophylactic effect without thrombosis of the graft or of the distal vessel of patients, during the postoperative period. Actually, lower limbs temperature and pulses were maintained, with a good capillary content and with an improved walking distance. No changes in prothrombin time an platelet adhesiveness, have been observed. Five patients showed a clear hypoaggregant tendency, and thromboelastography in PRP indicates a statistically significant increase of R and K parameters as well as a decrease of am. It must be noticed the absence of gastric, hepatic, renal or metabolic side effects and no haemorrhagic lesions were observed. In conclusion, the treatment of these patients with triflusal prevents the otherwise frequent appearance of postoperative thrombosis in this kind of arterial surgery.

Adult↗
PubMed1980

Surgical treatment for chest pain in mitral valve prolapse.

The case of a 40-year-old woman with mitral valve prolapse and severe atypical chest pain is presented. The diagnosis was confirmed by phonocardiographic, echocardiographic, and angiocardiographic studies. The electrocardiogram revealed an ischemic pattern of ST-T on the anterior and inferior wall. Coronary angiographic studies showed normal coronary arteries. The patient's long-standing, prolonged, disabling atypical chest pain could not be relieved with medical therapy, despite the administration of beta-adrenergic blocking agents, calcium antagonists, and short-acting nitrites during a 30-month period. Thus, the prolapsed mitral valve was replaced with a Hancock xenograft. After 12 months the patient is totally free of symptoms, without any treatment and with a normal ECG. This excellent surgical result could be explained on the basis of the valvular theory of chest pain in mitral valve prolapse, suggesting that pain is promoted probably by a regional imbalance between oxygen availability and consumption, because of the excessive papillary muscular stretching produced by the prolapse. To our knowledge, this is the first published report of successful surgical treatment of chest pain in mitral valve prolapse.

Adult↗