Core cooling remains the most effective technique of extended heart-lung (HL) preservation: further experimental evidence.
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Animals↗
Biomedical subjects
R Pillai
Publications and source records attributed to R Pillai.
Leukocyte depletion ameliorates free radical-mediated lung injury after cardiopulmonary bypass.
Activated leukocytes and oxygen free radicals have been implicated in the pathogenesis of lung injury associated with cardiopulmonary bypass. To determine whether leukocyte depletion could prevent this injury, we used a dog model simulating routine cardiac operations. Mongrel dogs (11 to 17 kg) were subjected to cardiopulmonary bypass with a bubble oxygenator and cooled to 27 degrees C. After aortic crossclamping and cardioplegic arrest for 90 minutes, control animals (n = 5) were rewarmed and weaned from bypass, and their condition was then stabilized for 90 minutes. Leukocyte-depleted animals (n = 5) had a leukocyte filter incorporated in the bypass circuit. During bypass, circulating leukocyte counts decreased by 60% in control dogs, and by 97% in leukocyte-depleted animals. Free radical generation (estimated by spectrophotometric assay of plasma conjugated dienes) was significantly reduced by leukocyte depletion during and after bypass. Total hemolytic complement activity and the titer of C5 decreased markedly immediately after the onset of bypass in both the control and leukocyte-depleted animals. Pulmonary function after bypass was better preserved in leukocyte-depleted animals. These data suggest that depletion of circulating leukocytes contributes to lung injury during cardiopulmonary bypass and is associated with increased oxygen radical activity, pulmonary edema, and vasoconstriction. Leukocyte depletion substantially reduced the pulmonary injury seen after cardiopulmonary bypass.
Animals↗
Amantadine and the end-stage dementia of Alzheimer's type.
Significant improvement of mental status was noted with amantadine therapy in three patients in whom autopsy subsequently showed Alzheimer's disease. Two patients showed a dramatic improvement during the treatment. Their mute, immobile states were reversed and they were able to speak a few coherent words. Their mental status deteriorated when the drug was withdrawn. Transient clinical improvement was noted when amantadine was reinstituted. In all patients EEG showed typical repetitive periodic sharp waves (PSW) similar to those seen in Creutzfeldt-Jacob disease. Alterations of PSW accompanied the initial clinical improvement. We speculate that amantadine acts as a central stimulant by enhancing the release of central endogenous dopamine and possibly other neurotransmitters.
Aged↗
Adrenal carcinoma with reactive plasmacytosis.
An 18 year old boy presented with anaemia, congestive cardiac failure and a 'renal mass'. Preoperative and post-operative investigations demonstrated "reactive plasmacytosis" with antibodies directed against a non-functioning adrenal carcinoma. Existing literature on reactive plasmacytosis and anti-tumour antibodies is summarised.
Adolescent↗
Neuromuscular transmission studies in preeclamptic women receiving magnesium sulfate.
The purpose of the study was to evaluate the neuromuscular transmission defect in preeclamptic women receiving intravenous magnesium sulfate and to study the correlation of the degree of defect with serum magnesium and calcium levels. The study population included: group 1, 14 preeclamptic women receiving magnesium sulfate and undergoing induction of labor; group 2, six preeclamptic women studied in the postpartum period while receiving magnesium sulfate; and group 3, 10 normotensive women undergoing induction of labor. The neuromuscular transmission studies were performed with standard techniques before and during the administration of magnesium sulfate. During magnesium sulfate therapy patients in groups 1 and 2 showed abnormal responses characterized by an initial low-amplitude muscle action potential followed by a progressive increase in the amplitudes of the successive responses. There was significant correlation between the degree of the neuromuscular transmission defect and serum magnesium levels, serum calcium levels, and the magnesium/calcium ratio in groups 1 and 2. All studies were normal in group 3. The findings confirm the occurrence of abnormal neuromuscular transmission in preeclamptic women receiving magnesium sulfate, and the intensity of the defect correlates significantly with increased serum magnesium levels and decreased serum calcium levels.
Adult↗
Ventricular septal rupture complicating myocardial infarction: is earlier surgery justified?
Fifty-five consecutive cases of ventricular septal rupture following myocardial infarction were reviewed in order to ascertain clinical and haemodynamic determinants of in-hospital mortality. Factors associated with a poor prognosis included clinical evidence of a poor haemodynamic state or biochemical evidence of impaired renal function. Twenty-six patients managed before 1982 (group 1) were then compared with 29 managed subsequently (group 2) when a policy of earlier surgical intervention had been adopted. Patients in group 2 were more haemodynamically compromised and had greater impairment of renal function. The surgical mortality in group 1 was 3 of 18 patients (17%) which was not significantly different from that in group 2 (7 of 22 patients, 32%). Earlier surgical intervention in ventricular septal rupture is frequently undertaken in critically ill patients whose prognosis is poor. However their surgical risk is not significantly increased and such an approach can therefore be justified as it may salvage some patients who otherwise would not survive.
Adult↗
Tracheopathia osteochondroplastica. A cause of unexpected difficulty in tracheal intubation.
A 60-year-old man presented for aortocoronary saphenous vein grafting; tracheal intubation was found to be difficult before surgery. Bronchoscopy at the time suggested tracheal carcinoma, but subsequent biopsy of the trachea demonstrated tracheopathia osteochondroplastica. The condition is described and its implications for anaesthetists are discussed.
Humans↗
Results of surgical repair for dissection of the ascending aorta.
Between 1970 and 1986, 40 patients had surgical treatment for dissection of the ascending aorta at the London Chest Hospital. The overall hospital mortality was 27.5%. Preoperative renal impairment and age greater than or equal to 60 years were both associated with a significantly increased hospital mortality. In the long term one patient was lost to follow up. There have been two late deaths among the remaining 28 patients (mean follow up 4.4 years). The functional state of the survivors is good, with only three having any cardiac disability.
Adolescent↗
Ostium primum atrioventricular septal defect: an anatomical and surgical review.
The results of surgical repair of ostium primum atrioventricular septal defect show continued improvement. This improvement reflects the advances in open-heart surgery in general and, in particular, the better understanding of the anatomy of the conduction tissue and the morphology and function of the left atrioventricular valve. We have corrected this defect in 84 patients over a ten-year period. There were 2 early deaths (2.4%) and 2 late deaths (2.4%). Two patients had problems related to conduction. Our surgical approach has been to place the interatrial baffle in such a way as to avoid the displaced atrioventricular node and thereby leave the coronary sinus in the left atrium. Our approach to repair of the so-called cleft in the left atrioventricular valve (in reality the space between the ventricular components of the bridging leaflets), is based on the unequivocal triple-leaflet morphology of this valve.
Adolescent↗
Intracardiac metastases from malignant teratoma of the testis.
Cisplatin-based chemotherapeutic regimens are highly successful at controlling testicular teratomas, returning tumor markers to normal in 76% of patients. However, bulky residual disease persists in 24%, and surgical excision of these deposits is becoming increasingly common. This approach is justified, because the histologic characteristics of such deposits gives valuable prognostic information, allowing a decision to be made regarding additional therapy, and relapse of apparently stable disease may occur. Excision of residual bulky disease may be achieved safely. We have recently successfully excised an intracardiac metastasis in a patient with no demonstrable extrathoracic disease and normal serum marker levels.
Adult↗
Surgical management of adults with cyanotic congenital heart disease.
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Adolescent↗
Endarterectomy of the left coronary system. Analysis of a 10 year experience.
Between January, 1971, and June, 1981, 278 patients undergoing coronary artery bypass grafting had additional endarterectomy to the left coronary system. This constitutes 28% of all patients undergoing bypass grafting. Additional endarterectomy of the left anterior descending was performed in 250 and of the circumflex in 75 (an average of 1.2 endarterectomies to the left coronary system per patient). Five hundred thirty-six additional grafts to other vessels were performed, for a total of 861 grafts (three grafts per patient). There were 11 (4%) early and 29 (10%) late deaths. The actuarial survival rate was 93% at 3 years and 80% at 6 years. The incidence of perioperative myocardial infarction was 12%. Of the survivors, 94% were either asymptomatic or improved. Two hundred forty-three grafts (75%) were restudied early (2 weeks to 1 year). The early patency rate of the grafts to the left anterior descending was 83% (156/188) and to the circumflex 75% (41/55). In 75 patients (81 grafts), restudied 1 year or more after operation, the patency rate was 75% (61/81). The runoff of grafts to the left coronary system was judged to be good in 76%, moderate in 14%, and poor in 10%.
Adult↗
Relief of superior vena caval syndrome with autologous femoral vein used as a bypass graft.
Two patients presenting with superior venal caval syndrome have been treated surgically. In one patient the obstruction was caused by benign idiopathic mediastinal fibrosis; in the other it was secondary to carcinoma. In both cases venous decompression was achieved by using a segment of autogenous femoral vein to bypass the obstruction.
Adult↗
Surgical treatment of subpulmonary obstruction in transposition of the great arteries by means of a left ventricular-pulmonary arterial conduit. Late results and further considerations.
Between January, 1976, and June, 1983, 16 patients with transposition of the great arteries and fixed subpulmonary obstruction underwent repair by means of a combined Mustard procedure and placement of a conduit between the left ventricle and main pulmonary artery. Their mean age and weight were 5.3 years and 19 kg. Ten patients had an intact ventricular septum and six had a ventricular septal defect, which because of its size or location precluded a Rastelli repair. A fibromuscular tunnel was the most common type of subpulmonary obstruction (10/16, 62%). There were three early deaths and one late death. Early cardiac catheterization (mean interval from operation, 45 days), performed in 10 of 13 survivors, showed a significant decrease in the mean left ventricular-pulmonary arterial gradient from 66 to 8.5 mm Hg. Late cardiac catheterization (mean interval from operation, 4 years) showed continuing relief of the subpulmonary obstruction with a mean increase in peak systolic transconduit pressure gradient of 6.4 mm Hg. This procedure is an option to direct relief in the management of severe fixed subpulmonary obstruction in patients with transposition and intact ventricular septum or in the presence of a ventricular septal defect when a Rastelli repair is precluded.
Blood Pressure↗
Thymolipoma in association with Hodgkin's disease.
Thymolipomas are rare mediastinal tumors. They have been described with a variety of systemic diseases. To our knowledge they have never been described in association with Hodgkin's disease. The significance of this association is unknown.
Adult↗
Malalignment of the interventricular septum with atrioventricular septal defect: its implications concerning conduction tissue disposition.
Malalignment of the interatrial and interventricular septal structures is rarely seen associated with atrioventricular septal defects. Such malalignment gives rise to an anomalous disposition of the conduction tissue specifically in regard to the siting of the atrioventricular node. Recognition of this abnormality prior to (or at) surgery is important if post-operative rhythm problems are to be avoided.
Abnormalities, Multiple↗
Elective femoro-femoral bypass for operations on the heart and great vessels.
Femoro-femoral bypass with "circulatory arrest" is no longer used in routine cardiac operations. Its use today is normally limited to operations wherein access to the arch of the aorta is required or the thoracic aorta is to be temporarily occluded. We have recently encountered three patients presenting with complications of previous operations. In all three, the use of this technique allowed us to approach the defect safely.
Adolescent↗
Surgical correction in mirror-image atrial arrangement or left atrial isomerism with systemic venous return to the left-sided atrium.
We have recently encountered three patients with the hemodynamics of complete transposition accompanied by unusual atrial arrangements. The flow patterns produced all required correction by means of a "mirror-image" Mustard operation. Two of the patients had left atrial isomerism as evidenced by the finding of bilateral atrial appendages of morphologically left type. In both patients the systemic venous return was to the left-sided atrium and the pulmonary venous return to the right-sided atrium. The major effect of the isomerism was to reduce the volume of the left-sided chamber. This initially produced concern, since we now try to avoid enlargement of the pulmonary venous atrium when performing Mustard's operation. However, despite the small volume, it was possible to place the baffle without producing postoperative pulmonary or systemic venous obstruction. The other significant effect of left atrial isomerism is to deviate the position of the sinus node, but thus far we have not encountered any postoperative rhythm problems. The third patient had a mirror-image arrangement of the atrial chambers and the venous connections (situs inversus), and the anatomy was corrected by straightforward mirror-image reversal of our current technique for Mustard's procedure.
Child↗