R McCloy — Page 2 | Search PubMed

PubMed1976

A comparison of cardiovascular effects of dobutamine and isoprenaline after open heart surgery.

In a cross-over study, the cardiovascular effects of dobutamine were assessed in 11 patients who had undergone operation for replacement of the mitral or aortic valve approximately four hours earlier. In 9 of these the effects of isoprenaline were assessed for comparison. Dose-response curves were obtained using four dose levels of dobutamine in the range 1.25-10 mug/kg per min and of isoprenaline in the range of 0.005-0.04 mug/kg per min. Both drugs produced similar dose-dependent increases in heart rate and cardiac output and a dose-dependent decrease in peripheral resistance. Mean arterial pressure was only slightly increased by either drug. The positive inotropic effect of dobutamine was confirmed, but the chronotropic effect was not significantly different from that of isoprenaline. This contrasts with the findings of previous studies, and possible reasons for this are discussed.

Adolescent↗

PubMedDate not supplied

Minimal access surgery--the renaissance of gastric surgery?

Peptic ulcer surgery has been revitalized by the introduction of minimal access techniques for surgery of chronic and perforated peptic ulcer. A wide range of vagotomies, including truncal vagotomy, anterior lesser curve seromyotomy with posterior truncal vagotomy and proximal gastric vagotomy, have been performed laparoscopically. Short-term (two-24 month) follow-up of laparoscopic anterior seromyotomy with posterior truncal vagotomy cases has been promising, but long-term follow-up is required to confirm these early good results. Laparoscopic repair of perforated peptic ulcers has also been described. Initial reports of laparoscopic gastrojejunostomy and Billroth II partial gastrectomy have also appeared. These procedures are technically very demanding and are currently being performed in only a few "centers of excellence" around the world. Cost-benefit analyses of medical treatment with proton-pump inhibitors versus laparoscopic vagotomy are necessary to determine which form of treatment is more economical in the long run. Criteria for patient selection need to be defined and substantiated by audit of outcome.

Humans↗