Cardiopulmonary bypass and renal function in open heart surgery.
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Animals↗
Biomedical subjects
T K Larmi
Publications and source records attributed to T K Larmi.
Mesenteric infarction.
The most common etiologies of mesenteric infarction in fifty-one patients were arterial thrombosis (in 42 per cent), bowel infarction without major vessel occlusion (in 28 per cent), and arterial embolus (in 22 per cent), but the etiology also included some very rare vascular diseases--two cases of the malignant atrophic papulosis of Degos. In the group of forty-four operative patients the mortality was 70 per cent. All the patients treated medically died. Mesenteric infarction should be suspected in all elderly cardiac patients with symptoms of acute abdomen. The value of an early diagnosis, fast resuscitation, and aggressive operative treatment cannot be overstated. Bowel resections yielded the best results in this series. However, the operative treatment of the mesenteric infarction should be individual, depending on the etiologic factors and the time which has elapsed from the onset of the symptoms.
Adult↗
Calcium microemboli and microfilters in valve operations.
Fatal microemboli occurred in 3 of 100 consecutive patients having aortic valve replacement; 2 occurred during perfusion before the microfilter era, and 1 occurred intraoperatively despite the use of in-line filters. In all 3 patients cerebral symptoms were present immediately postoperatively, and each died of severe brain damage. On postmortem examination cerebral calcium microemboli were verified in only 2 patients, although the brain of each patient contained minute infarctions. However, calcium particles were found in the kidneys of all 3 patients. Thus the kidneys proved to be the best place for detection of calcium emboli on postmortem examination. Although the microfilters currently available effectively prevent microemboli during extracorporeal circulation, the surgeon should be aware that embolization can also occur immediately after discontinuation of perfusion. The means of protecting the patient from this are discussed.
Aortic Valve↗
Intra-operative ascending aortic flowmetry.
Intra-operative flowmetry was carried out before and after cardiopulmonary bypass in 34 patients who underwent aortic root surgery. Most of the patients had either aortic or combined aortic and mitral valve replacement. Flowmetry performed before and after the procedure proved to be a very useful diagnostic tool, particularly in evaluating the immediate postoperative haemodynamic performance of the replaced aortic valve and the completeness of the correction.
Adolescent↗
Surgical treatment of axial hiatal hernia-reflux complex by Nissen fundoplication. A cineradiologic and manometric study.
This study was undertaken to review our result in the surgical treatment of the axial hiatal hernia-reflux complex with Nissen fundoplication using cineradiologic, manometric, and endoscopic studies and an analysis of objective symptoms of the patients as criteria in evaluation. During the period 1966-1975 86 patients underwent Nissen fundoplication at Oulu University Central Hospital. In 50 of the 86 patients it was possible to carry out thorough pre- and postoperative examinations and a long-term follow-up using the aforementioned methods. There was some discrepancy between objective and subjective postoperative results. During the 10-year follow-up period, mean 5 years, the recurrency frequency was 14% (7/50), but 22% (11/50) of the patients considered the postoperative result subjectively to be poor. On the other hand, 3 patients with a definite recurrence considered the end result subjectively to be good. On the basis of these findings we were able to conclude that the objective postoperative examinations in themselves are not sufficient for thorough, long-term evaluation of postoperative results, but that the patient's subjective postoperative symptoms and his opinion of the success or failure of the operation should also be taken into consideration.
Adult↗
Myocardial protection by continuous coronary perfusion during aortic valve replacement.
The coronary perfusion system used at Oulu University Central Hospital is described and the importance of physiological coronary perfusion stressed. Our method of protecting the myocardium from ischemic injury during aortic valve replacement included the following: phasic constant-pressure coronary perfusion, maintenance of coronary perfusion pressure larger than or equal to 80 mmHg, maintenance of the heart in a beating, empty, oxygenated state, and the use of the largest possible coronary canula. Under these circumstances, autoregulation of the coronary vascular bed was maintained. When small coronary cannulae were used a significant pressure drop occured across the tubing system, especially at high flow rates. Flow measurements recorded by an on-line electromagnetic flowmeter proved reliable.
Adolescent↗
Renal blood flow and intrarenal oxygen tension in haemorrhagic hypotension.
The changes occurring in renal cortical and medullary tissue oxygen tensions and in renal total blood flow (RBF) were studied during haemorrhagic hypotension in six dogs. The flow was measured with an electromagnetic flowmeter, and tissue oxygen tension with IBC (Ineternational Biophysics Corporation, USA) oxygen electrodes. Haemorrhagic hypotension led to a considerable decrease in cortical tissue oxygen tension. The decrease in the medullary tissue oxygen tension was smaller, while the renal total flow decreased considerably during haemorrhage. The role of perfusion pressure alone in the redistribution of renal blood flow during haemorrhagic hypotension is discussed.
Animals↗
Celestin tube palliation of unresectable esophageal carcinoma.
Celestin tube intubation was performed in 108 patients with unresectable carcinoma of the esophagus and cardia, in 83 per cent as the initial operation and in 17 per cent after exploration. The hospital mortality rate was 16 per cent, including a 7.4 per cent mortality rate from technical causes. The most frequent causes of death were perforations of the esophagus and cardia and aspiration pneumonia. Nonfatal complications occurred in 13 per cent of surviving patients, obstruction and dislodgment of the tube being the most common. All patients were able to swallow at discharge, and 91 per cent of them could take food by mouth until the time of death. In 9 per cent, additional palliation, usually esophagoscopy or gastrostomy, was required. Ninety-one patients survived one to 21 months (average 5.8 months). The 6 month survival rate was 44 per cent and the one-year survival 9 per cent.
Aged↗
Carcinoma of the oesophagus and cardia.
234 patients, 146 with carcinoma of the oesophagus and 88 with carcinoma of the cardia are reported. There were 82 females and 152 males, mean age 62 years. The overall operability and resectability of the whole series was 38% and 23%. In cardiac carcinoma operability was 50% and resectability 32%, while in oesophageal carcinoma it was 31% and 18% respectively. 54 patients underwent resection, 44 received irradiation, and in 136 patients only palliative treatment was possible. The overall hospital mortality after resection was 15%, after oesophageal resection 12%, after cardiac resection 18%, and after palliative procedures 14%. Anastomotic leakage occurred in 9 patients (17%), four of whom died. The overall 5-year survival rate for the whole series was 4%, after resection 11%, and after radiotherapy 4%. No patient in the palliative group survived for 2 years. The mean survival time after irradiation was 11.5 months and after palliative procedures 5.5 months. The 5-year survival rate after oesophageal resection was 13% and after cardiac resection 6%.
Cardia↗
A simple cannulation technique for perfusion problems in advanced aortic dissection.
A simplified left atrial-distal aorta bypass for operative treatment of extensive dissecting. Type III, aneurysms of the distal thoracic aorta is reported. In this technique the lower part of the body is perfused through a large cannula placed into the true lumen of the several distal aorta. The indications and advantages of the method are discussed.
Aorta, Thoracic↗
Nontraumatic perforations of the small intestine.
The etiology of nontraumatic small bowel perforations in 24 operated patients was as follows: strangulation in five, diverticulum in four, foreign bodies in four, idiopathic in three, Crogn's disease in two, malignant atrophic papulosis of Degos (MAP) in two, and tuberculosis, carcinoid tumor, radiotherapy, and iatrogenic in one. The high mortality rate in these patients appeared to be a funciton of the disease process rather than of the means of treatment. In favorable circumstances, as in strictly localized lesions with well known etiology and otherwise normal bowel, a simple closure of perforation is warranted. In more far advanced cases operated upon early enough, we still consider bowel resection and primary anastomosis as the best method of treatment, though it yielded poor results in procedures are advisable to protect the anastomosis.
Adolescent↗
Effect of metoclopramide on the lower oesophageal sphincter. An experimental study in dogs.
Oesophageal, lower oesophageal sphincter and gastric fundal pressures were measured with a triple lumen, open tip-infused catheter in dogs before and after intravenous injection of metoclopramide. The mean basal value of the lower oesophageal sphincter pressure was 5.3+/-2.7 mmHg. Metoclopramide injection caused a significant increase in this pressure. The effect of metoclopramide started immediately and disappeared about one hour after intravenous injection.
Animals↗
Bronchial resection. Feasibility and surgical considerations in lung surgery.
Four patients who had bronchial resection for benign and malignant bronchial lesions are reported. The aims were to salvage as much as possible of functioning lung tissue, especially in patients with benign lesions. In all but the patient with a pulmonary carcinoma, the long-term airway result was excellent. Bronchoplastic procedures are suitable and recommended for patients with benign, localised intrabronchial lesions.
Adult↗
Surgical treatment of cardiac myxoma. A case report.
A patient with a left atrial myxoma operated on successfully three years ago is reported. The symptomatology and diagnosis of the tumour and surgical considerations are briefly discussed, and the necessity of a long follow-up period is stressed.
Female↗
The profunda femoris artery in reconstructive vascular surgery.
Thirty patients with 43 ischaemic limbs were treated by profundal revascularization. 10 patients had impending gangrene preoperatively; the limbs were saved in 8 cases, and four have not had postoperative claudication symptoms. None had postoperative rest pain. In 53% of the whole material the results were evaluated as excellent with no ischaemic symptoms, and in 30% as good with only slight claudication. Profundal revascularization is a valuable method of saving pregangrenous limbs in advanced arteriosclerosis and a worthwhile alternative to femoro-popliteal bypass in suitable cases.
Adult↗
Intraoperative hemodynamic evaluation of the Björk-Shiley tilting disc aortic valve.
Intraoperative cardiac output and aortic and left ventricular pressures were measured simultaneously in 15 consecutive patients before and after aortic valve replacement (AVR) with the Björk-Shiley tilting disc valve. The predominant lesion in these patients was aortic stenosis. The following hemodynamic indices were calculated: aortic valve area (AVA), determined by Gorlin's formula, effective orifice area, and effective area index. Their applicability as hemodynamic criteria of the immediate hemodynamic performance of the replaced valve is discussed. By every criterion, AVR greatly improved the hemodynamic performance. The effective area index seemed more suitable than the other indices for the intraoperative hemodynamic evaluation of the replaced aortic valve.
Adult↗
Trauma to the liver: twelve years experience.
54 patients operated upon for liver injuries are reported. Hemoperitoneum, estimated blood loss and transfusions given in volumes more than 4 000 ml, and four or more associated injuries, worsened the prognosis markedly. It is also important to make a careful search for possible associated injuries at the operation for liver trauma, in order to decrease mortality and morbidity.
Adolescent↗
Surgical treatment of peptic oesophageal stricture with Nissen fundoplication and intraoperative dilatation.
6 patients whose peptic oesophageal stricture caused by reflux oesophagitis was treated surgically with Nissen fundoplication and oesophageal dilatation are reported. In 5 patients oesophageal dilatation was performed intraoperatively and in one postoperatively 2 months after Nissen fundoplication. One patient whose stricture had been treated for 12 years with repeated dilatation required several dilatations postoperatively as well, but now, 6 months after operation, the need and frequency of dilatations are definitely decreasing. Our results of the Nissen fundoplication operation and simultaneous oesophageal dilatation are very promising. We feel that in the surgical treatment of benign peptic oesophageal stricture, particularly if the aetiology of the stricture isgastro-oesophageal reflux, more conservative operations of this type will displace other procedures consisting of resection of the stricture with or without intestinal interposition.
Aged↗