PubMed · 2078699
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M Schaldach, A Bolz, J Jirmann, H Hutten. 1990. [Recent developments in position sensors].. https://pubmed.ncbi.nlm.nih.gov/2078699/
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BACKGROUND AND OBJECTIVE: The efficacy of the Trendelenburg position, a common first step to treat suspected hypovolaemia, remains controversial. We evaluated its haemodynamic effects on cardiac preload and performance in patients after cardiac surgery. METHODS: Twelve patients undergoing mechanical ventilation of the lungs who demonstrated left ventricular 'kissing papillary muscles' by transoesophageal echocardiography, thus suggesting hypovolaemia, were positioned 30 degrees head down for 15 min immediately after cardiac surgery. Cardiac output by thermodilution, central venous pressure, pulmonary artery occlusion pressure, left ventricular end-diastolic area by transoesophageal echocardiography and intrathoracic blood volume by thermo- and dye dilution were determined before, during and after this Trendelenburg manoeuvre. RESULTS: Trendelenburg's manoeuvre was associated with increases in central venous pressure (9 +/- 2 to 12 +/- 3 mmHg) and pulmonary artery occlusion pressure (8 +/- 2 to 11 +/- 3 mmHg). The intrathoracic blood volume index increased slightly (dye dilution from 836 +/- 129 to 872 +/- 112 mL m(-2); thermodilution from 823 +/- 129 to 850 +/- 131 mL m(-2)) as did the left ventricular end-diastolic area index (7.5 +/- 2.1 to 8.1 +/- 1.7 cm2 m(-2)), whereas mean arterial pressure and the cardiac index did not change significantly. After supine repositioning, the cardiac index decreased significantly below baseline (3.0 +/- 0.6 versus 3.5 +/- 0.8 L min(-1) m(-2)) as did mean arterial pressure (76 +/- 12 versus 85 +/- 11 mmHg), central venous pressure (8 +/- 2 mmHg) and pulmonary artery occlusion pressure (6 +/- 4 mmHg). The intrathoracic blood volume index and left ventricular end-diastolic area index did not differ significantly from baseline. CONCLUSIONS: Trendelenburg's manoeuvre caused only a slight increase of preload volume, despite marked increases in cardiac-filling pressures, without significantly improving cardiac performance.
New commercial liquid light guides have an advantage over fiberoptic bundles regarding breakage during clinical handling. We investigate the quality of clinical data collection using liquid versus fiber bundles as receivers. A four-wavelength NIRO-500 near-IR spectrophotometer is used with single-terminal fiber bundles, multiterminal fiber bundles, or a single-terminal liquid light guide as receivers. Repeated 3-min trials are done using a stable phantom, an unstable phantom, and the human forearm. A least-squares linear best-fit line and its root mean square error (RMSE), a measure of signal noise, are derived for each wavelength of each trial. The mean and standard deviations for the RMSEs of the single-terminal fiber optic receiving cable are derived for comparison standards. The liquid light guides have 51 to 174% greater signal noise with RMSEs 2 to 12 standard deviations above the mean of the single-terminal fiber bundle. The multiterminal fiber bundles have 49% less to 32% greater signal noise and had RMSEs within 1 to 4 standard deviations above the mean of the single-terminal fiber bundle. These comparisons suggest fiber optic bundles are preferable for clinical near-IR spectroscopy (NIRS) applications requiring low signal noise.
Multidetector row CT is a feasible diagnostic tool in pre- and postoperative liver partial transplantation. We can assess vascular anatomy and liver parenchyma as well as volumetry, which provide useful information for both donor selection and surgical planning. Disorders of the vascular and biliary systems are carefully observed in recipients. In addition, we evaluate liver regeneration of both the donor and the recipient by serial volumetry. We present how multidetector row CT with state-of-the-art three-dimensional volume renderings may be used in right lobe liver transplantation.