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Biomedical subjects

T Salerno

Publications and source records attributed to T Salerno.

At least 19 recordsLinked to original sources
PubMed2001

Myocardial revascularization on the beating heart after recent onset of acute myocardial infarction.

OBJECTIVE: Coronary artery bypass grafting (CABG) after the recent onset of acute myocardial infarction (AMI) is associated with high morbidity and mortality. Myocardial revascularization without cardiopulmonary bypass (CPB) has been proposed as an alternative technique to treat these patients in an attempt to decrease the operative risks. METHODS: From January 1995 to June 1999, 518 patients underwent CABG after the recent onset of AMI (1-20 days): 421 patients were revascularized on-CPB and 97 patients off-CPB. Preoperative risk factors (redo operations, congestive heart failure, stroke, extensive calcification of the aorta, and dialysis) were significantly higher in the off-CPB group (p-value < 0.05). Preoperative use of intra-aortic balloon pump (IABP) (off-CPB 5.2% versus on-CPB 2.4%, p-value = NS) and emergent operations (off-CPB 5.2% versus on-CPB 2.6%, p-value = NS) were similar in both groups. Mean number of grafts per patient was 3.46 in the on-CPB group versus 1.82 in the off-CPB group (p-value < 0.005). RESULTS: Actual mortality was 2.9% in the on-CPB group versus 6.2% in the off-CPB group (p-value = NS). Morbidity was comparable in the two groups. Multivariate analysis showed that advanced age, preoperative hemodynamic instability, and left ventricular hypertrophy were independent risk factors for death. Global ischemic time and preoperative hypertension were independently related to postoperative AMI. At univariate and multivariate analysis, CPB was not related to mortality or major postoperative complications. CONCLUSION: Multivariate analysis demonstrates that CABG can be performed safely with or without CPB in patients with recent AMI. CPB is not independently related to mortality or major adverse outcomes.

Aged↗
PubMed2001

Reoperative coronary artery bypass grafting with and without cardiopulmonary bypass: determinants of perioperative morbidity and mortality.

BACKGROUND: This retrospective study evaluates perioperative results of reoperative coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass (CPB). METHODS: From January 1995 to March 1999 reoperative CABG was performed on 581 patients: 307 (52.84%) patients were operated upon on-CPB and 274 (47.16%) off-CPB. Median sternotomy was used in all patients on-CPB. Median sternotomy or alternative surgical approaches were used in the off-CPB group. Data was retrospectively reviewed. To identify the variables independently related to perioperative mortality and adverse outcome, multivariate analysis was performed in the overall population of 581 patients. RESULTS: Preoperative risk factors were comparable in the two groups. Critical lesions of the right and left circumflex coronary artery were more common in the on-CPB group (p < 0.005). A total of 2.7 grafts/patient was performed in the on-CPB group versus 1.3 grafts/patient in the off-CPB group (p = NS). Freedom from postoperative complications was higher in the off-CPB group (72% versus 90.9%, p < 0.005). Perioperative stroke and respiratory failure rates were more common in the on-CPB group (3.9% versus 0.7% and 5.9% versus 2.2% respectively, p < 0.005). Actual mortality was 5.9% in the on-CPB group and 3.6% in the off-CPB group (p = NS). Risk adjusted mortality was 2.2% and 1.3% in the on-CPB and off-CPB groups respectively. Although CPB was found to be independently related to adverse outcome (odds ratio (OR) = 2.89, p-value < 0.005), no correlation was found between mortality and CPB. CONCLUSIONS: Avoidance of CPB independently reduces adverse outcomes in reoperative CABG without affecting mortality rate.

Adult↗
PubMed2000

Posterior thoracotomy for reoperative coronary artery bypass grafting without cardiopulmonary bypass: perioperative results.

BACKGROUND: This retrospective study evaluates morbidity and mortality of reoperative coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) using a posterior thoracotomy to revascularize the lateral aspect of the heart. METHODS: From January 1995 to July 1999, reoperative CABG without CPB was performed on 67 selected patients using a left posterior thoracotomy approach. Preoperative risk factors, postoperative mortality, and major complications were derived from the New York State database. RESULTS: All patients were operated on without CPB. A total of 1.3 grafts per patient were performed. Freedom from major complications was 95.5%. There were no postoperative cerebro-vascular accidents (CVA) or new neurological deficits. Two patients (3%) had a perioperative acute myocardial infarction. The actual mortality rate was 4.5% (3/67), the expected mortality was 5.1% and the calculated risk adjusted mortality was 2.1%. CONCLUSIONS: Reoperative CABG without CPB to revascularize selected coronary artery targets can be safely performed using a posterior thoracotomy approach.

Aged↗
PubMed1994

The effects of hypothermic and normothermic cardiopulmonary bypass on glyceryl trinitrate activity.

Glyceryl trinitrate (GTN) is used to control arterial blood pressure during cardiopulmonary bypass (CPB) procedures, but its effects are often decreased during the period of extracorporeal support. The plasma and urine concentrations of GTN and glyceryl-1,2-dinitrate (1,2-GDN) and glyceryl-1,3-dinitrate (1,3-GDN) for male and female patients who received GTN during hypothermic CPB, and male and female patients who were given GTN during normothermic CPB, were measured by gas-liquid chromatography. During hypothermic CPB, the male and female subjects experienced significant decreases in GTN clearance (P < 0.05), 66% and 52%, respectively. Neither the males nor the females who underwent normothermic CPB experienced any significant change in GTN clearance. These results suggest that the lower core temperature during hypothermic CPB may decrease the biotransformation of GTN to GDNs and nitric oxide, thereby resulting in less dilation of blood vessels. Furthermore, the males in the hypothermic CPB group had significantly greater urinary concentrations of 1,3-GDN and 1,2-GDN than the females (P < 0.05), and the normothermic CPB males had a significantly greater urinary concentration of 1,2-GDN than the females in that group. The normothermic CPB males also had significantly higher plasma concentration of GTN at two time points, and 1,3-GDN at one time point, than the females. These data suggest that there may be a gender difference in GTN biotransformation.

Aged↗
PubMed1994

Successful removal of an unusual cystic mass of the heart.

A patient presented with a very unusual multicystic cardiac mass that echocardiographically mimicked an echinococcal cyst. The management of this patient is highlighted, including the clinical diagnosis, investigation, surgical management, pathological studies and review of the relevant literature.

Adult↗
PubMed1991

Not all neonatal hearts are equally protected from ischemic damage during hypothermia.

Despite hypothermia, pediatric cardiac surgeons continue to experience difficulties in providing adequate myocardial protection in newborns. This study examines the effects of deep hypothermia on neonatal heart tolerance to ischemia by measuring metabolic responses and the time to onset of ischemic contracture, or "stone heart." After control right ventricular biopsy specimens were obtained, hearts of newborn pigs (n = 36) were excised and placed in temperature-regulated baths: 37.5 degrees +/- 0.5 degrees C (n = 9), 19.0 degrees +/- 0.5 degrees C (n = 14), and 12.0 degrees +/- 0.5 degrees C (n = 13). With a compliant balloon in the left ventricle to measure pressure, time to onset of ischemic contracture (greater than 2-mm Hg rise) was recorded, and sequential biopsies were done. Data indicated hypothermia significantly (p less than 0.001) prolonged time to onset of ischemic contracture from 29.5 +/- 1.7 minutes (mean +/- standard error of the mean) at normothermia to 150.0 +/- 6.4 minutes at 19 degrees C and to 283.8 +/- 46.4 minutes at 12 degrees C. Lactate buildup at 30 minutes of ischemia was significantly reduced by 70% with hypothermia. Decline in adenosine triphosphate level was significantly reduced by 50% (19 degrees C) and 75% (12 degrees C) with hypothermia. More importantly, a subgroup of hearts in each hypothermia group (n = 5 per group) was identified by 38% to 48% lower adenosine triphosphate stores before ischemia compared with the group means.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenosine Triphosphate↗
PubMed1991

Myocardial biochemical and hemodynamic adaptations to chronic tachycardia.

The purpose was to determine the biochemical and hemodynamic adaptations of the myocardium to chronic tachycardia. Cardiac pacemakers were implanted in Yorkshire pigs and set at a rate of 180 beats/min for a period of 35-42 days. Animals were then anesthetized with pentobarbital sodium. Myocardial blood flow and hemodynamics were determined at three different heart rates (i.e., 120, 180, and 220 beats/min). Tissue samples were then taken for microsphere and biochemical analyses. Chronically paced hearts maintained better cardiac function and had consistently higher left ventricular blood flow with a higher endocardial-to-epicardial ratio. The activities of citrate synthase and 3-hydroxyacyl-CoA dehydrogenase were 23 and 45% greater in the paced hearts, respectively. The sarcoplasmic reticulum adenosinetriphosphatase activity was 55% greater in the paced hearts, whereas the myosin adenosinetriphosphatase was the same as in the control hearts. Polyacrylamide gels of the ventricular myosin isoforms showed only the V3 type to be present in both the control and paced hearts. These findings show that the heart of a large mammal adapts to chronic tachycardia (i.e., 180 beats/min) by elevating the aerobic and calcium-sequestering capacities without altering its myosin type.

3-Hydroxyacyl CoA Dehydrogenases↗
PubMed1989

Valvular surgery in the elderly.

In previous studies from this university, advanced age was identified as an independent predictor of operative mortality for valvular surgery. Therefore, between January 1982 and December 1986, early results were compared in 469 patients greater than 70 years old (Old; 74.0 +/- 3.4 years, mean +/- SD) and in 2,040 patients less than 70 years old (Young; 53.7 +/- 12.1 years). Patients underwent single- or multiple-valve repair or replacement with or without concomitant coronary artery bypass surgery. Data consisting of 31 clinical and angiographic variables were collected prospectively and were analyzed by univariate and multivariate statistics. Old patients were characterized by having more frequent left ventricular dysfunction (left ventricular ejection fraction less than 40%: Old, 33.5%; Young, 22.4%; p less than 0.001), coronary artery disease (Old, 54.5%; Young, 24.2%; p less than 0.001), and urgent surgery (Old, 15.6%; Young, 11.8%; p = 0.02). Aortic valve procedures (Old, 59.7%; Young, 40.1%; p less than 0.001) and concomitant coronary artery bypass surgery (Old, 46.4%; Young, 20.3%; p less than 0.001) were performed more commonly in the Old patient. Operative mortality occurred in 10.0% of Old patients compared with 5.6% of Young patients (p less than 0.001), and major morbidity (low-output syndrome, perioperative myocardial infarction, intra-aortic balloon pump counterpulsation, and stroke) occurred significantly more frequently (p less than 0.001) in the Old. Stepwise logistic regression identified that urgent operation (p = 0.002), mitral or double-valve surgery (p = 0.004), coronary artery disease especially when not treated by bypass surgery (p = 0.02), female gender (p = 0.02), and left ventricular dysfunction (p = 0.05) independently predicted operative death in the Old population. The significant predictors of mortality in the Young patient were urgent operation (p less than 0.001), New York Heart Association class IV (p less than 0.001), associated tricuspid valve disease (p = 0.002), decreased left ventricular function (p = 0.01), valvular re-replacement (p = 0.02), and increasing age (p = 0.03). The predicted probability of operative mortality in Old patients ranged between 0.9 +/- 0.5% and 76 +/- 16%. Elderly patients in good risk categories should be offered surgical intervention for correction of valvular lesions. Alternative therapy may be indicated in patients with multiple risk factors.

Age Factors↗
PubMed1988

Effects of different thyroid treatments on the biochemical characteristics of rabbit myocardium.

It is well established that extreme dysthyroidism drastically alters the biochemical character of cardiac muscle. The purpose of this study was to determine if minor thyroid treatments would result in significant changes in the character of three major biochemical systems of muscle: metabolic; calcium regulating; and contractile systems. Different groups of New Zealand white rabbits had continuous time release propylthiouracil (PTU) pellets (500, 300, 200 and 100 mg) or triiodothyronine (T3) pellets (15 and 25 mg) subcutaneously implanted for 21 days. The ventricular myosin phenotypes shifted from 92% V3 myosin in the control rabbit hearts to 55% V3 and 10% V3 in the 15 mg and 25 mg T3 groups, respectively. PTU treatment resulted in a complete shift to the V3 myosin isoform. The sarcoplasmic reticulum Ca2+-ATPase activity increased with T3 and decreased with PTU treatments, except in the 500 mg PTU group. Ca2+-ATPase activity in the groups either side of the euthyroid group (100 mg PTU and 15 mg T3) did not change significantly. The glycolytic or aerobic potentials of the myocardium did not change with any of these minor thyroid treatments. It was concluded that the metabolic, enzymes, sarcoplasmic reticulum Ca2+-ATPase and myosin isozymes have different sensitivities to thyroid treatment and that minor thyroid treatments do result in significant changes in the biochemical character of the myocardium. These findings indicate that subclinical deviations in euthyroid status may affect myocardial biochemical character.

Animals↗
PubMed1983

The haemodynamic effects of intraaortic versus intravenous administration of protamine for reversal of heparin in man.

A recent report suggests that there may be advantages of intraaortic (IA) versus intravenous (IV) administration of protamine for reversal of heparin at the end of cardiopulmonary bypass. Because complete haemodynamic measurements were not performed in that study, we prospectively and randomly assessed the effects of protamine sulphate administered via either route. Patients were studied in the period immediately following cardiopulmonary bypass. Heparin, 300 units . Kg-1, plus 150 units . Kg-1 when required, was administered to keep the activated clotting time greater than 400 sec. Protamine 3 mg . Kg-1 was injected over 30 sec. intravenously in the IV group (n = 5) and into the ascending aorta in the IA group (n = 5). There was a significant decrease in arterial blood pressure (28.6 per cent) from 109.2 +/- 5.6 mmHg (S.E.) systolic to 78.0 +/- 9.0 mmHg observed in the IA group one minute post protamine, which returned to baseline by 2.5 min (analysis of variance p less than 0.05). No significant hypotension was observed in the IV group. There was no significant change in heart rate, left atrial pressure, central venous pressure, systemic vascular resistance or cardiac index with either IA or IV protamine. In contrast to our recent study in pigs there was no significant change in pulmonary artery pressure, pulmonary vascular resistance or cardiac output with protamine. Results indicate that there are no haemodynamic benefits of IA vs IV injection of protamine.

Blood Pressure↗
PubMed1983

Femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia in the management of upper airway obstruction.

A case is presented of a female with respiratory distress who was initially treated as having asthma. Her chest x-ray was normal but tracheal tomograms revealed a tracheal tumour almost completely occluding the tracheal lumen. The impending tracheal occlusion was managed with femoral-femoral cardiopulmonary bypass instituted under local anaesthesia prior to induction of anaesthesia and diagnostic bronchoscopy and airway establishment with tracheal intubation. Other indications for the use of cardiopulmonary bypass prior to the induction of anaesthesia are reviewed.

Aged↗
PubMed1978

Management of extremity with combined neurovascular and musculoskeletal trauma.

Twenty-five civilians with combined neurovascular and musculo-skeletal trauma to 27 extremities were studied retrospectively. The mechanism of injury was crushing in 16, avulstion in six, and penetrating in three. Autogenous saphenous vein was used to restore arterial circulation in the majority. Nine patients had concurrent repair of venous injuries. Fractures were immobilized by a variety of techniques, the Hoffman external skeletal fixation being preferred. Immediate fasciotomy was performed in five patients and delayed fasciotomy in four. All patients had soft-tissue debridement and initial wound closure with split-skin grafts as biologic dressings. Three immediate amputations were the result of irreversible neurovascular and soft-tissue trauma. Sepsis played a role in three late amputations; delayed primary treatment,, irreversible neurologic injuries and extensive soft-tissue damage contributed. A carefully individualized multidisciplinary approach resulted in salvage of 20 of 27 severely injured extremities.

Adolescent↗
PubMed1978

In vitro translation of the Two RNAs of Nodamura virus, a novel mammalian virus with a divided genome.

Nodamura virus is a small ribovirus containing two RNA molecules. Both RNAs were found to be active messengers for protein synthesis in cell-free extracts prepared from wheat embryo or HeLa cells. RNA 2 directed synthesis of a 43,000-dalton product, p43, whose tryptic fingerprint was similar to that of the major viral coat protein, vp40 (molecular weight, 40,000). Though p43 appears to be a precursor of vp40, processing did not occur in the cell-free extracts. RNA 1 directed synthesis of a 105,000-dalton protein, p105. Its tryptic fingerprint revealed no evidence of coat protein sequences. Hence, the two RNAs represent genes with few, if any, redundant coding sequences.

Amino Acids↗
PubMed1971

An infected toe.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMedDate not supplied

Pancreatic cystosis in cystic fibrosis: case report.

We describe a 19-year-old cystic fibrosis patient, with pancreatic insufficiency since the age of 4 who presented at the age of 13 with postprandial abdominal pain. Ultrasonography and computed tomography showed several pancreatic cysts that progressively increased in diameter over 6 years. The lack of association with clinical and biochemical signs of acute pancreatitis is highlighted.

Adult↗
PubMedDate not supplied

The effect of moderate exercise training on oxygen uptake post-aortic/mitral valve surgery.

BACKGROUND: This study determined the response of aortic and/or mitral valve replacement/reconstruction (AVR/MVR) surgery patients to a 3-month exercise rehabilitation program (ERP) of moderate intensity, frequency, and duration that commenced approximately 9 weeks post-operatively. METHODS: Based on geographic proximity and availability of transportation to attend ERP classes, 29 experimental subjects were enrolled in the ERP and 20 control subjects received standard care that did not include the ERP, but did not prohibit activity/exercise. Exercise tolerance was determined from estimated oxygen uptake (VO2) during exercise tolerance testing (GXT) before and after standard care or the ERP. RESULTS: VO2 at the maximum stage of the GXT increased significantly (P < or = 05) for the experimental (4.89 +/- 5.07 mL/kg/min) and control (5.11 +/- 4.48 mL/kg/min) groups. No significant between-group differences were noted in VO2 at the maximum stage of the exercise testing or at the target heart rate (HR). Furthermore, reported exercise levels of subjects in both groups were comparable and sufficient for training effects to occur. CONCLUSION: Alternate strategies to improve exercise tolerance such as home-based rehabilitation programs should be investigated for relatively healthy aortic and/or mitral valve surgical patients.

Aortic Valve Insufficiency↗