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Biomedical subjects

T Treasure

Publications and source records attributed to T Treasure.

At least 109 records · Page 6Linked to original sources
PubMed1994

The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning.

BACKGROUND AND PURPOSE: Microemboli have been implicated in the etiology of neuropsychological deficits after cardiopulmonary bypass. This study examined the incidence of high-intensity transcranial signals (microemboli) and their relation to changes in neuropsychological performance after surgery. METHODS: Transcranial Doppler ultrasonography was used to measure middle cerebral artery blood flow velocity and detect microemboli. The number of high-intensity transcranial signals was determined and related to a neurological examination and absolute changes in neuropsychological performance as well as the number of patients considered to exhibit a neuropsychological deficit. Data were available on 100 consenting patients undergoing routine cardiopulmonary bypass. Fifty of the patients were randomly assigned to a procedure that included a 40-microns arterial line filter, and 50 had the procedure without any arterial line filter. RESULTS: Significantly more patients were found to have neuropsychological deficits in the group without the arterial line filter at both 8 days (P < .05) and 8 weeks (P < .03) after surgery. In addition, more "soft" neurological signs were found in the nonfiltered group 24 hours after surgery (P < .05). More high-intensity transcranial signals were found in the nonfiltered group, and the number of high-intensity transcranial signals was found to be related to the likelihood of a patient having a neuropsychological deficit at 8 weeks. CONCLUSIONS: These data suggest that neuropsychological deficits after routine cardiopulmonary bypass are related to the number of microemboli delivered during surgery. Furthermore, the numbers of microemboli may be reduced by including a 40-microns filter on the arterial line.

Cardiopulmonary Bypass↗
PubMed1994

Traumatic rupture of the thoracic aorta: computed tomography may be a dangerous waste of time.

Traumatic rupture of the thoracic aorta is a justifiably feared condition. Some authors have proposed the use of computed tomography as a non-invasive means of diagnosis. We report two cases where computed tomographic scans were misinterpreted, leading to erroneous diagnoses and inappropriate referrals. The pitfalls of using a cross-sectional imaging technique to diagnose a transverse lesion and the relative ease and accuracy of aortography are discussed.

Aorta, Thoracic↗
PubMed1994

Creatine kinase MB isoforms: sensitive markers of ischemic myocardial damage.

We investigated the use of creatine kinase (CK) MB isoforms as a marker of myocardial cell injury in a preliminary study of 16 patients with chronic stable angina after successful percutaneous transluminal coronary angioplasty (PTCA) and 25 patients after coronary artery bypass grafting (CABG). Three control groups were studied: apparently healthy volunteers (n = 31), patients undergoing thoracotomy (n = 10), and patients undergoing routine coronary angiography (n = 9). Patients in the PTCA group showed an association between ischemic ST segment changes lasting > 3 min and a transient increase in the MB2/MB1 ratio; however, all had total CK-MB activity within normal limits. Routine coronary angiography subjects had no significant change in MB2/MB1. In the CABG patients, MB2/MB1 peaked within 1 h after the cross-clamp release and returned to baseline by 24 h postoperatively. The median time to peak MM3/MM1 and total CK-MB activity was 2 and 8 h after reperfusion, respectively, returning to baseline values by 2 and 5 days, respectively. After thoracotomy, MB2/MB1 was increased only in elderly patients (n = 5) with risk factors for ischemic heart disease; total CK-MB activity was increased in only three of these. Apparently, CK-MB isoforms can detect myocardial damage in clinical settings with less overt damage than myocardial infarction.

Adolescent↗
PubMed1993

Aprotinin therapy in cardiac operations: a report on use in 41 cardiac centers in the United Kingdom.

Aprotinin, a serine protease inhibitor, has recently been shown to reduce blood loss in cardiac surgical patients. Data on the safety and efficacy of aprotinin therapy administered to 671 cardiac surgical patients in 41 United Kingdom cardiac surgical units have been submitted to interim analysis. The patients studied were in high-risk categories for excessive bleeding, including 457 redo operations and 79 patients with active infective endocarditis. Overall mortality was 12% in redo cases and 5.1% in first-time operations. Adverse events were reported in only 20 patients (3%). Median blood loss at 24 hours after operation was 400 mL, and median transfusion volume throughout the operative and postoperative period was 2 units. These data confirm that the use of aprotinin therapy in high-risk cardiac surgical patients is associated with a low incidence of adverse events.

Adolescent↗
PubMed1993

Early results of intravascular oxygenation.

We have used the intravascular oxygenator (IVOX) in eight patients (14-76 years) with acute respiratory failure. At the time of referral for IVOX all patients were on inotropic support, five had pneumothoraces and two were on haemofiltration. Ventilatory data before IVOX were: ventilated for 2-14 days (median 6), PEEP 5-12 cm H2O (12), PIP 34-95 cm H2O (49), FiO2 0.7-1 (1), PaO2 5.4-26 KPa (8.5) and PaCO2 3.7-23 KPa (8). The intravascular oxygenator was used for 6 h-12 days (median 4), the oxygen transfer achieved was 68-140 ml/min (85) and the carbon dioxide removed was 40-106 ml/min (59). It was possible to decrease the ventilator settings with a significant increase in the PaO2 by 48 h (P < 0.05) but the fall in PaCO2 did not reach significance. As the IVOX was turned from "off" to "on" the mean PaO2 increase was 0.35 KPa +/- 0.14 SEM (P = 0.04) and the mean PaCO2 decrease 0.7 KPa +/- 0.2 SEM (P = 0.02) without any significant change in cardiac output. Two patients survived and six died from multisystem failure with three patients being hypoxic at the time of death. Postmortem examinations on five patients did not reveal any IVOX-related complications. We conclude that IVOX is safe but it is not as efficient in gas exchange as extracorporeal membrane oxygenation at present. Further improvement in the gas exchange efficiency of this prototype could render IVOX a very useful device.

Acute Disease↗
PubMed1993

Disability and distress following cardiac surgery in patients over 70 years of age.

We have reviewed the outcome in a consecutive series of 254 patients over the age of 70 undergoing cardiac surgery between 1987-89. Of the patients, 62% were male and the median age was 73 years. Operations included: coronary bypass 57%, valve replacement 26%, combinations 14% and other procedures 3%. The hospital mortality was 7.5% and late mortality was 13.8%. Complications included: intraaortic balloon 6%, resternotomy for bleeding 4%, permanent pacing 3%, chest infection 14%, tracheostomy 5%, major cerebrovascular events 3% and minor 4%. Eighty-two percent left the intensive care unit within 24 h and 89% left hospital within 8 days. Two questionnaires (York University) were sent to 207 patients believed to be alive in order to evaluate the change in their quality of life following surgery. Of the 207 questionnaires 197 (95%) were returned, 7 of which were from relatives of patients who had died and 7 were incomplete. The responses of 183 assessable patients (at a mean follow-up of 36 months) were converted into Rosser disability (I-VIII) and distress (A-D) groups. There was a decrease in disability and distress in 60% and 67%, respectively, no change in 34% and 30% and deterioration in 6% and 3%. Cardiac surgery can be carried out in elderly patients with an acceptable early morbidity and mortality, and although many patients show sustained improvement in their quality of life, this was not demonstrated in about a third of patients. As the emphasis in the elderly should be on quality of life we ought to continue to concentrate on careful selection in this age group.

Aged↗
PubMed1993

Pulmonary embolus and patent foramen ovale: a rare cause of refractory hypoxaemia.

A patient with a large pulmonary embolus is described. The striking features were those of cardiovascular stability with hypoxaemia and hypercapnia. Cardiac catheterization confirmed the pulmonary embolus; in addition there was found to be a patent foramen ovale (PFO), causing a large right-to-left shunt. Removal of the pulmonary embolus and closure of the PFO dramatically improved alveolar-arterial oxygen gradient and ventilatory requirements.

Heart Septal Defects, Atrial↗
PubMed1993

Elective replacement of the aortic root in Marfan's syndrome.

We offer elective aortic replacement ot those we regard as being at high risk. The aortic root dimension and its rate of increase are the best predictors we have. We regard 5.5 cm as the probable upper limit and we are inclined to advocate surgery at an earlier stage in high risk families and in women planning pregnancy. These operations are planned for a calculated gain in life expectancy and it would be reasonable for there to be a degree of centralisation of referral and development of surgical expertise. We use beta-blockade for life, both before and after surgery, in all patients with Marfan's syndrome with aortic root enlargement. The data on which these recommendations are based are incomplete and we can only hope that with an increasing number of carefully documented cases we will refine them and improve upon them in the future. The concept of a "forme fruste" or a "Marfanoid aorta" in the absence of the syndrome is highly questionable so the comments made apply only to patients with Marfan's syndrome--not to other forms of annuloaortic ectasia or other less well characterised forms of aortic root disease.

Aortic Dissection↗
PubMed1993

Cardiovascular manifestations of Marfan's syndrome: improved evaluation by transoesophageal echocardiography.

OBJECTIVES: To assess the value of transoesophageal echocardiography in patients with Marfan syndrome particularly those with suspected aortic pathology or where conventional transthoracic imaging was suboptimal. DESIGN AND PATIENTS: Eleven patients with Marfan syndrome. Seven patients were studied because of suspected aortic dissection and four because of inadequate transthoracic imaging. INTERVENTION: Transoesophageal echocardiography and colour Doppler flow mapping by a 5 MHz single plane transoesophageal probe. RESULTS: Aortic dissection was identified in six patients with subsequent diagnostic confirmation in all six. No dissection was found in one patient in whom the diagnosis had been suspected clinically. Estimates of aortic root dimensions and assessment of aortic and mitral valve pathology were made in four other patients with inadequate transthoracic imaging. CONCLUSIONS: Transoesophageal echocardiography provides rapid diagnostic information in patients with Marfan syndrome with suspected aortic dissection and enhances the assessment of cardiovascular manifestations of this condition.

Adult↗
PubMed1992

Exocrine pancreatic function in mediastinal teratomata: an aid to preoperative diagnosis?

The diagnosis of teratoma may be made by demonstration of high amylase content in fluid aspirated from anterior mediastinal lesions. In 2 cases of mediastinal teratoma proteolytic enzyme activity was evident at the time of operation. A diagnosis of mediastinal teratoma was aided in 2 subsequent cases by demonstration of elevated amylase activity in the aspirated fluid before definitive operation.

Adolescent↗
PubMed1992

Absence of the right superior caval vein associated with disease of the sinus node.

Absence of the right superior caval vein has been shown by postmortem studies of infants and children to be associated with histological abnormalities of the sinus node. We report the case of a 32-yr-old man who presented with syncope due to disease of the sinus node and was found to have absence of the right superior caval vein. He was successfully managed with implantation of an epicardial atrioventricular sequential pacemaker.

Adult↗