Most patients with traumatic or spontaneous venous fistula can be managed safely and effectively by conventional operative techniques. Infrequently total circulatory arrests with hypothermia may be used to correct this defect. The ideal treatment is transection of the fistula with preservation of the kidney function. A traumatic aorto-left renal vein fistula was successfully treated with preservation of renal function. Diagnosis was made early by the presence of a bruit and a wide pulse pressure. The diagnosis was confirmed on aortography and oxygen saturation in the left renal vein. The fistula was closed by the conventional operative technique without hypothermia or circulatory arrest.

Abdominal Injuries↗

PubMedDate not supplied

"Left ventricular function in mitral stenosis by systolic time intervals".

Explore the source record for details and available documents.

Adult↗

PubMedDate not supplied

Beneficial effects of long-term metoprolol therapy on cardiac haemodynamics in patients with mitral stenosis in sinus rhythm--a randomised clinical trial.

We conducted a placebo controlled randomised clinical trial to evaluate the effects of 6 months therapy with metoprolol on resting and exercise haemodynamics in 31 patients with isolated mitral stenosis in sinus rhythm. Twenty six of them (placebo n = 13, metoprolol n = 13) completed the study protocol. Their mean age was 23.1 +/- 7.9 years and the mean mitral valve area was 0.93 +/- 0.25 cm2. The dose of metoprolol ranged between 50-100 mg per day. The primary outcome variables for the study were the resting and exercise mean pulmonary capillary wedge pressure (PCWP) and cardiac index (CI) and the secondary outcome variables consisted of resting and exercise heart rate, mean pulmonary artery pressure (PAP), mean pulmonary vascular resistance (PVR) and clinical improvement on visual analog scale. These outcome variables were assessed blindly. The resting and exercise mean PCWP (mmHg) increased by 9.1 +/- 3.1 and 16.4 +/- 6.4 on placebo and 2.5 +/- 2.1 and -4.6 +/- 2.3 on metoprolol after 6 months therapy. These differences were statistically significant (p < 0.01). The resting and exercise CI (liters/min/m2) decreased by 0.2 +/- 0.1 and 0.1 +/- 0.1 on placebo and 0.3 +/- 0.5 and 0.3 +/- 1.0 on metoprolol. These haemodynamic effects were accompanied with much better symptomatic improvement in patients treated with metoprolol. The differences in change in mean PAP and PVR in two groups were statistically not significant. Our results suggest that the symptomatic patients with MS, waiting for definitive intervention for 6 months or less, would benefit if given beta blockers during this period.

Adult↗

PubMedDate not supplied

Study of platelet ultrastructure in ischemic heart disease.

The present work was undertaken to study the ultrastructural morphology of blood platelets in angiographically proven patients of ischemic heart disease by scanning and transmission electron microscopy. Various morphological forms of platelets viz. discoid, pseudotubular, membranous, saccular, pseudopodical and hyaline were observed. They showed varying degrees of alterations in organelles and membrane systems. These morphological changes prove that platelets are in an activated state in ischemic heart disease, explaining the functional alterations that have been extensively studied in previous reports.

Blood Platelets↗

PubMedDate not supplied

A study of platelet aggregation, thromboxane A2 and prostacyclin in central aortic and coronary sinus blood in ischemic heart disease.

Aortic and coronary sinus platelet aggregation, thromboxane A2 (TXA2) and prostacyclin (PG12) levels were studied in fourteen patients of stable angina (SA), six of vasopastic angina (VA) and six control subjects (C). Patients of SA were studied at rest and during incremental atrial pacing and patients with VA were studied at rest and during various stages of vasospasm. Platelet aggregation was studied with different working concentrations of ADP, epinephrine and collagen. TX A2 and PGI2 concentrations were estimated by measuring levels of their stable metabolites viz. thromboxane B2 (TXB2) and 6-keto prostaglandin F1 alpha (PGF1 alpha) respectively. Platelet aggregation was increased in SA and VA patients (p < 0.01) and further increase was seen during vasospasm (p < 0.001). However, it failed to increase on incremental atrial pacing. Similarly, TXB2 and PGF1 alpha levels were raised in SA and VA patients. While TXB2 further increased during vasospasm but not during atrial pacing. PGF1 infinity failed to rise with either. Thus platelets are in an activated state in SA and VA. This activated state is a cause and not an effect in SA and VA. An imbalance in the levels of TXA2 and PG12 could account for the vasospasm.

Age Factors↗

PubMedDate not supplied

Predischarge dobutamine induced distant wall motion abnormalities after acute myocardial infarction predict multivessel disease.

Presence of multivessel coronary artery disease (MVD) identifies a high risk subgroup after acute myocardial infarction (AMI). Dobutamine stress echocardiography (DSE) has recently emerged as a promising non invasive test to detect the presence and extent of coronary artery disease. Forty six consecutive patients (38 males, 8 females; mean age 48.6 +/- 10.4 years) of Q-wave acute myocardial infarction were subjected to submaximal treadmill test (TMT) and dobutamine stress echocardiography to see their ability to predict multivessel coronary artery disease as detected by coronary angiography before hospital discharge. Dobutamine infusion was started at 5 micrograms/kg/min to a maximum of 40 micrograms/kg/min, to achieve 70 percent of the age predicted heart rate. Appearance of new regional wall motion abnormality was interpreted as positive DSE for MVD. Mean peak infusion dose of dobutamine used in the study was 28.56 +/- 5.67 micrograms/kg/min. In none of the patients, the test had to be terminated due to side effects. The sensitivity and specificity of DSE to predict MVD was 80 percent and 93.7 percent, respectively as compared to 45 percent and 86 percent for submaximal TMT. Thus, DSE in patients of AMI before hospital discharge is a safe procedure with fairly accurate prediction of multivessel coronary artery disease.

Adult↗