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Biomedical subjects

V A Ferraris

Publications and source records attributed to V A Ferraris.

43 records · Page 3Linked to original sources

Aspirin usage and perioperative blood loss in patients undergoing unexpected operations.

The effect of aspirin on perioperative blood loss was studied in 52 patients undergoing unplanned operation. Twenty-two of 52 patients were found to have taken aspirin prior to operation. Five others were suspected of having taken aspirin or some aspirin-like drug prior to operation. All patients who remembered taking aspirin preoperatively had significantly decreased platelet thromboxane B2 levels caused by aspirin inhibition of platelet arachidonic acid metabolism. Eight of 22 patients who took aspirin had abnormal template bleeding times. No significant increase occurred in the perioperative blood loss of patients who had taken aspirin. Neither the aspirin induced decrease in thromboxane B2 levels nor the increase in template bleeding times was associated with an increased perioperative blood loss. We concluded that aspirin is commonly used prior to unplanned operations but that preoperative aspirin usage does not result in increased perioperative blood loss in patients with normal platelet counts and with normal coagulation factors. These results suggest that there is no need to delay operation in this group of patients because of recent aspirin ingestion.

Arachidonic Acids↗

Retrospective study of the surgical management of reflux esophagitis.

Surgical management of reflux esophagitis in 101 patients was reviewed. All antireflux operations at this medical center between January 1970 and September 1978 were included. The most successful and least morbid procedure was found to the the Hill-Nissen posterior gastropexy with fundoplication. Twenty-two patients in the study group underwent second and third operations for recurrent reflux esophagitis. Patients undergoing operation for a recurrence were found to have increased operative morbidity and an increased chance of further recurrence. There were ten instances of incidental splenectomy, and this factor was found to be associated with increased postoperative morbidity. Postoperatively, the most common complication was related to pulmonary atelectasis.

Adolescent↗

Release of prostaglandin by mitogen- and antigen-stimulated leukocytes in culture.

The prostaglandin (PG) content of mitogen- and antigen-stimulated leukocyte cultures was examined by a radioimmunoassay procedure empolying an antiserum reactive with PGB(1) and PGB(2), the alkaline dehydration products of PGE and PGA. At 48 h, mitogen-activated mouse spleen cell cultures showed 2-10-fold increases in the PGE, but not in the PGA, component of immunoreactive PG (iPG) fractionated by silicic acid column chromatography. Increases in iPG were detectable by h 16 in spleen cell cultures incubated with staphylococcal enterotoxin B. Since iPG levels rose only in the culture supernates and not in cells exposed to mitogens for 48 h, increases reflected extracellular release of PG. The validity of the radioimmunoassay determinations of PGE in spleen cell cultures was supported by the results of concomitant assessment of the PGE(2) content of basal and enterotoxin-stimulated cultures by gas chromatography/mass spectrometry. By the latter method, the PGE(2) content was three-fold higher in enterotoxin-activated, compared to basal, cultures at 48 h. Aspirin effectively suppressed increases in both iPG and PGE(2). In spleen cell cultures prepared from mice previously inoculated with an attenuated strain of yellow fever virus in vivo and then incubated with this virus in vitro, iPG levels increased twofold over basal at 48 h. By contrast, iPG content of spleen cell cultures prepared from saline-inoculated mice was not appreciably altered by exposure to the virus in vitro. The enhancement of iPG release from cultured spleen cells by mitogens did not correlate with an ability of these agents to increase cellular cyclic AMP (cAMP) levels. Moreover, epinephrine and cholera toxin markedly increased spleen cell cAMP content but had no demonstrable effect on basal iPG levels, suggesting iPG release from these cells was not mediated by cAMP. Incubation with mitogens also enhanced the iPG content of 72-cultures of human peripheral leukocytes and of human lymphocytes isolated by nylon chromatography. However, the iPG of cultures of human lymphocytes purified by glass bead chromatography and of mouse thymocytes was not appreciably altered when these cells were cultured with mitogens, even though DNA synthesis in both instances was markedly increased. Accordingly, iPG release was not an invariable concomitant of increased DNA synthesis in lymphoid cell cultures. In summary, the results demonstrate that mitogen and antigen stimulation of leukocytes in culture may be accompanied by enhanced release of PGE. The mechanisms mediating this phenomenon and its biologic significance remain to be delineated, but participation of PGE in immunologically induced inflammatory responses seems possible.

Animals↗

Transesophageal echocardiography in the surgical management of renal cell carcinoma with intracardiac extension.

Renal cell carcinomas may extend into the vena cava and the tumor thrombus occasionally involves the right atrium. The operative approach depends upon precise preoperative and intraoperative staging and thrombus localization. We report a case of renal cell carcinoma with complete inferior vena caval and hepatic vein occlusion with tumor extension into the right atrium. Preoperatively, transesophageal echocardiography provided superior images of the tumor and its extension, and intraoperatively allowed continuous monitoring of cardiac function and the removal of tumor from the atrium and inferior vena cava. Its use obviated the need for more costly and invasive preoperative and intraoperative procedures.

Carcinoma, Renal Cell↗

Mitral valve replacement in a patient with idiopathic thrombocytopenic purpura: preoperative treatment with danazol.

A 64-year-old woman with refractory idiopathic (autoimmune) thrombocytopenic purpura required urgent mitral valve replacement. Preoperative therapeutic interventions to raise dangerously low platelet counts were unsuccessful until danazol therapy was institued. Danazol therapy was associated with elevation of the platelet count to greater than 125 x 10(9)/L and allowed successful mitral valve replacement and left atrial thrombectomy to be performed. Postoperative bleeding was average and blood product replacement was not excessive. This case of mitral valve disease in a patient with idiopathic (autoimmune) thrombocytopenic purpura is unique, because perioperative hemostasis was accomplished using danazol and splenectomy was not required.

Danazol↗

Predictors of postoperative ventricular dysrhythmias: a multivariate study.

Postoperative ventricular dysrhythmias were studied to document their incidence after coronary bypass grafting and to identify risk factors for their development with the hope of finding a subgroup of patients who might benefit from postoperative, prophylactic drug therapy. One-hundred-nine patients who were undergoing urgent or elective coronary bypass grafting were studied, prospectively. Twenty-five of 109 patients (23%) developed significant postoperative ventricular dysrhythmias that required counter-shock or drug intervention. Seven of eight instances of sustained ventricular tachycardia, the most serious dysrhythmia, occurred within 36 hours of operation. There was no postoperative mortality related to these dysrhythmias. Serious postoperative complications, such as stroke, hemorrhage, or myocardial infarction, were decreased in patients with ventricular dysrhythmias versus those without (8% versus 16%, p = 0.053 for the Fisher's exact test statistic). Univariate statistical analysis was performed using 15 patient variables and revealed that advanced age (p = 0.008 for the unpaired t test), failure to use an internal mammary artery conduit (p = 0.03 for the two-tailed Fisher's exact test), and development of postoperative atrial dysrhythmias (p = 0.02 for the two-tailed Fisher's exact test) were significantly more common in patients with postoperative ventricular dysrhythmias. Variables such as previous myocardial infarction, ejection fraction less than 50%, prolonged operative time, perioperative myocardial infarction, or fewer number of vessels bypassed were not significantly increased in patients with dysrhythmias (the statistical power for these "negative" results was greater than 0.8).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗