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Biomedical subjects

T Mattila

Publications and source records attributed to T Mattila.

69 records · Page 4Linked to original sources
PubMed1983

Perioperative myocardial infarction in coronary bypass surgery.

Thirteen of 199 consecutive patients undergoing coronary artery bypass surgery revealed definite perioperative myocardial infarction (PMI) in electrocardiography (ECG). The occurrence of PMI was not higher in the group of 44 patients who had intermittent aortic cross-clamping than in those patients treated with cold chemical cardioplegia. In 83 patients serum MB isoenzyme of creatine kinase (CK) and LD1 isoenzyme of lactic dehydrogenase were determined. Patients with unchanged ECG had peak CK-MB levels of 0 to 49 U/l (mean 18.7 U/l +/- 2.6 SEM) at 18 hours postoperatively while patients with PMI showed CK-MB levels of 64-350 U/l (mean 207 +/- 53 U/l); the difference was significant (p less than 0.01). In patients with unchanged ECG, LD1 was 139 +/- 19 U/l and 594 +/- 95 U/l in those with PMI (p less than 0.01). Risk factors for PMI were: age greater than or equal to 60 years, coronary endarterectomies, or cardiopulmonary bypass time greater than or equal to 100 minutes. One patient died of PMI while the remaining patients had postoperative courses comparable to those patients without PMI.

Adult↗
PubMed1983

Cardioplegia versus topical cooling for cardiac protection during open-heart surgery. An electron microscopic and histochemical study of right atrial biopsies.

The effectiveness of topical cooling and cold cardioplegia for cardiac protection in the course of open-heart surgery was studied by electron microscopy and fluorescence microscopy of right atrial biopsies. In 20 patients with topical cooling, no changes or minimal changes were observed in 15 cases, more pronounced changes in 3 cases, and severe destruction in 2 cases. In the group of 20 patients with cold cardioplegia the range of the changes was significantly narrower: no specimen remained completely intact; on the other hand, very severe destruction was not observed. Fluorescence microscopy revealed that the neural noradrenaline stores were relatively resistant to ischaemia. Electron microscopy showed certain failure of the protective procedure, resulting in injury of myocardial cells and neural elements. Even "spot-like" destruction noted in the nerve terminals may interfere with the peripheral neuro-neuronal interaction, resulting in nonhomogenous spread of the excitation wave front and electrical instability of the heart. Therefore cardiac nerve damage should also be taken into consideration when evaluating the effectiveness of different methods for cardiac protection.

Aortic Valve↗
PubMed1983

Serum CK-MB isoenzyme after aortic and mitral valve replacements.

A release of the MB fraction of creatine kinase (CK) enzyme into the serum due to myocardial manipulation and trauma occurs in patients undergoing cardiac surgery. Thus, the appearance of CK-MB activity as such is not sufficient to indicate of perioperative myocardial infarction. The mean (+/- SD) serum CK-MB isoenzyme level was 95 +/- 103 U/l 18 hours after aortic or mitral valve replacement in 76 patients. Thirteen patients undergoing closure of an atrial septal defect served as controls. They had a significantly lower (p less than 0.01) isoenzyme level postoperatively: 45 +/- 39 U/l. Two patients had the ECG changes of definite myocardial infarction after valve replacement and they also showed high CK-MB values, while the other patients with high enzyme level had no ECG signs suggesting acute infarction. CK-MB values correlated with the aortic cross-clamping time (r = 0.39, p less than 0.001) and weakly with the precordial ECG voltage of SV1 + RV5 (r = 0.25, p less than 0.01). While these findings may reflect the sensitivity of a thick myocardial wall to ischaemia during surgery, the postoperative recovery was not related to the serum CK-MB level.

Adult↗
PubMed1980

Effect of combined cold and pharmacological ischaemic cardioplegia on myocardial intrinsic sympatho-adrenergic system during coronary bypass surgery.

The effect of combined cold and pharmacological ischaemic cardioplegia on the structural integrity and the degree of the functional activity of the inbuilt intrinsic sympatho-adrenergic nervous system was studied by means of fluorescence microscopy of atrial myocardial biopsies obtained in the course of coronary bypass surgery on 8 consecutive patients. The specimens were taken 1) before starting extracorporeal circulation (controls), and 2) at decannulation (i.e. after cold cardioplegic ischaemic asystole and subsequent coronary reperfusion). The cardioplegia was induced by perfusing the coronary arteries via the aortic root with cold "cardioplegic solution" after starting extracorporeal circulation, venting the left ventricle and cross-clamping the ascending aorta. The specimens were processed for semi-quantitative fluorescence histochemical analysis. No changes were observed. Thus, it is concluded that the procedure of the combined cold and pharmacological ischaemic cardioplegia obviously preserves well the neural noradrenalin of the heart, a vital means of compensating for decreasing myocardial contractility. As the clinical parallelism, all patients made a smooth convalescence.

Adult↗
PubMed1978

Cardiac disturbances after pneumonectomy--the value of prophylactic digitalization.

The incidence of postoperative cardiac disturbances and the value of prophylactic digitalization were studied retrospectively in 143 patients undergoing pneumonectomy for carcinoma of the lung. Cardiac arrhythmias occurred in 29% and tachycardia episodes in 30% of the patients. The incidence of myocardial infarction was 2%. Operative mortality was 4%. The cardiac disturbances developed more often after left than after right pneumonectomy. The age of the patients, a history of angina pectoris or hypertension did not markedly increase the incidence of cardiac disturbances, neither did operative factors, such as pericardiotomy, left atrial resection, major bleeding nor postoperative empyema. Prophylactic digitalization significantly reduced postoperative cardiac disorders, their frequency being 33% in the group of patients who received prophylactic digitalis compared with 65% in the group that did not.

Adult↗
PubMed1977

The effect of digoxin on the contractility of transplanted heart.

The effects of digoxin on the contractility of orthotopically transplanted heart was studied in dogs. Intravenously administered digoxin produced a fall in the rate and output of the transplanted heart without any change in stroke volume, whereas the output of the intact heart was slightly improved due to a small increase of stroke volume. This difference was thought to be due to the action of digitalis which is mediated via the nervous pathways, which are interrupted in the transplanted heart.

Animals↗
PubMed1977

Traumatic diaphragmatic hernia. Report of 50 cases.

The writers report a clinical series of 50 patients with traumatic diaphragmatic hernia. There were 36 hernias on the left side and 14 on the right. Stab or bullet wound was the cause of the hernia in 27 cases. The other 23 cases were due to traffic accidents or other blunt injuries. Immediate operative repair was done in 30 cases; in 20 cases the operation was carried out after a time interval of 11.5 years post trauma on an average. Plain chest X-ray, barium meal or enema and pneumoperitoneum were the most valuable diagnostic tools. Visceral injuries were discovered in 53% of cases caused by traffic accidents. The omentum, stomach, colon and spleen were the organs most frequently herniated. In two cases perforation of the stomach occurred before the operation. There were three cases of pericardial rupture associated with the diaphragmatic hernia in the series. The repair was done via thoracotomy in 28 cases, via laparotomy in 4 cases; and both thoracotomy and laparotomy were carried out in 18 cases. The hospital mortality was 2%. One of the patients died of peritonitis and renal failure following perforation of the stomach and intestines on the 9th postoperative day. Recurrence of the hernia occurred twice in one case. Re-examination revealed striction of the diaphragmatic movement in 11 cases. The clinical features, diagnosis and operative treatment are discussed.

Adolescent↗
PubMed1976

Mitral valve replacement with ball and tilting disc valve prosthesis. A clinical and haemodynamic study.

A survey is presented on the results of 100 consecutive patients who underwent mitral valve (78 patients) or mitral and aortic and/or tricuspid valve replacement (22 patients) with ball or disc valve prosthesis. The patients were followed-up from 6 to 54 months postoperatively. The mortality for mitral valve replacement was 13 (17%) early deaths (up to one month from operation) and 5 (6%) late deaths. The corresponding figures for multiple valve replacements were 9 (41%) and 3 (14%). A direct correlation was found between early mortality and preoperative functional class IV of the New York Heart Association (30% dead). Pulmonary hypertension combined with multiple valve disease resulted in an early mortality of 42%. No significant differences in early mortality figures after MVR were found between ball and disc valve prostheses. Predominant complications were respiratory infection and atelectasis (13%), acute myocardial infarction (11%) and haemorrhage (9%). Haemolysis was found in 9 patients and three other patients had haemolytic anaemia attributable to paravalvular leak which in two indicated the reapplication of the prosthesis. The main causes of death were heart failure, 8 early and 4 late deaths, and myocardial infarction, 5 and 4 respectively.

Adolescent↗
PubMed1975

Congenital posterolateral diaphragmatic hernia in the adult.

Five adult patients with the Bochdalek type of congenital diaphragmatic hernia are presented. Four of the hernias were on the left side and one on the right. One of the patients was asymptomatic, while 3 of them had gastrointestinal symptoms. In 2 of these 3 cases, the symptoms became worse when the patients were lying down. One patient complained mostly of dyspnoea, and also had a patent ductus arteriosus. The other anomaly, in addition to hernia, was diaphragmatic pulmonary sequestration. All the patients were operated on transthoracally. In one case, laparotomy was also performed. There was no strangulation in any of the cases. No operative or postoperative complications occurred. A complete roentgenologic examination including chest X-ray, barium meal, barium enema, and sometimes pneumoperitoneum may be needed in order to make an accurate diagnosis preoperatively. Because of the strangulation danger operation is recommended whenever the diagnosis is made.

Adult↗
PubMed1975

Surgical treatment of hernia through the foramen of Morgagni.

A series of 25 surgically treated patients with the Morgagni type of diaphragmatic hernia is presented. Twenty-two of the patients were female and three were male. The hernia was on the right side in all of them. Five of the patients had symptoms which were predominantly gastrointestinal. The remainder of the patients were asymptomatic and were admitted to hospital because of an abnormal finding at chest X-ray. All but one were operated transthoracically. In one case an abdominal approach was used because cholecystectomy was performed simultaneously with the hernial repair. In 3 cases the hernail sac contained a portion of transverse colon and in 9 cases, omentum. In 12 there was an accumulation of adipose tissue in the hernial sac, and in 2 cases it was empty when operated. There were no serious complications and no mortalities.

Adult↗
PubMedDate not supplied

Pseudoaneurysm of the left ventricle following mitral valve replacement. Report of two cases and review of the literature.

Two cases of left ventricular (LV) pseudoaneurysm following mitral valve replacement (MVR) are presented. In one patient the false aneurysm developed after an initially successful correction of intraoperative left ventricular wall rupture while the other case resulted from an apparently uncomplicated MVR performed because of staphylococcal endocarditis. Both cases were detected by combined 2-dimensional and Doppler echocardiography. The operative treatment was similar in both patients. After extirpation of the old prosthesis, the orifice of the pseudoaneurysm was closed from inside the heart, either with a Dacron patch or using interrupted sutures supported by a teflon pledget. One of the patients died one month postoperatively but the other one recovered and is clinically well 6 months after repair. She has, however, a residual communication between the LV and the pseudoaneurysm.

Adolescent↗