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PubMed1982

Neurologic, psychiatric, and cardiovascular complications in children struck by lightning.

The neurologic changes following lightning injury include coma with cerebral edema, inappropriate secretion of antidiuretic hormone (ADH), seizures, cerebellar ataxia, and painful sensory disturbances. Deteriorating neurologic status may warrant the use of intracranial pressure monitoring devices. Myocardial injury and transient hypertension are generally evident at the onset. Monitoring of the cardiac rhythm may be needed for as long as a week for late onset arrythmia. Abnormalities of memory, mood, and affect noted on recovery of consciousness may persist for months, necessitating close psychiatric and neurlologic follow-up.

Brain Diseases↗
PubMed1980

Rational treatment of hypotension after carotid endarterectomy by carotid sinus nerve blockade.

Intraarterial blood pressure was monitored continuously for the first 24 postoperative hours in twenty consecutive patients subjected to carotid endarterectomy. Ten patients developed postoperative hypotension not attributable to hypovolaemia, depressant drugs, myocardial impairment or arrythmias. The postoperative hypotension was readily reversed by local blockade of the sinus nerve on the operated side. This blockade was accomplished by the injection of 2 ml of Lignocain (1%) through a catheter placed with its tip in the vicinity of the sinus nerve at the carotid bifurcation. It is concluded that the postoperative hypotension is due to increased activity in the sinus nerve and that this hypotension should rationally be treated by carotid sinus nerve blockade.

Carotid Arteries↗
PubMedDate not supplied

[Late arrhythmias in the operated interatrial communication. Analysis of sinus node function and the conduction pathways by His bundle electrocardiography].

Four hundred patients with atrial septal defect treated surgically were reviewed. Thirty five (8.7%) developed arrhytmias post-surgery which persisted for over a year. Sinus bradycardia was found in 10 patients, nodal rhythm in 21, and atrial fibrilation and flutter in 4 patients. Thirty five per cent of the patients with late arrhythmias developed related symptomatology. In 14 patients the function of the sinus node was studied with electrical stimulation of the atrium and with His registry. The interatrial conduction time, AV node and His Purkinje were analized employing various stimulation frequencies. All the cases studied had normal intra-atrial conduction; the response of the atrio-ventricular node to increasing frequencies was normal, an the intraventricular conduction remained constant. In 8 patients (52%), alterations of the sinus node were found; these consisted of prolonged post-stimulation pauses, Wenckebach's type sinoatrial block and suppression of sinus automatism employing vagal procedures or through electrical stimulation. A patient with severe bradycardia detected by dynamic electrocardiography had to be treated with a permanent pacemaker. We confirm that these arrhytmias are not produced by lesions of the internodal tracts, and that an alteration of the sinus node is frequent without a concomitant lesion of the intraventricular pathway. The lesion to the nutrient artery could be due to trauma and/or surgically induced. The response to anticholinergic drugs was good. Prolonged observation of these patients could increase the morbility of these arrythmias and raise doubts of the surgical indications in cases with moderate hemodynamic repercussion.

Adolescent↗
PubMed1978

Myocardial infarction--the problems and prognosis: Paper 3--A summary.

In the pre-hospital phase of myocardial infarction, the overriding problem is our present inability to alter the fact that approximately 50 per cent of all deaths from infarction occur prior to the patient's arrival in hospital, despite the knowledge that these deaths are due largely to potentially correctible arrythmias.

Arrhythmias, Cardiac↗
PubMed1982

[Prognostic factors in acute digitalis poisoning].

The prognostic significance of various clinical and biochemical factors was investigated in 179 patients who had ingested more than 2 mg digitoxin. The mortality rate in this series was 17%. Supraventricular arrythmias had no influence on prognosis, but the death risk was higher in males and in patients with AV block. It increased with age, with digitoxin and potassium serum levels and even more with persistent hyperkalemia. Two other factors--previous heart disease and vomiting--were also significant in patients without heart block. Calculated on the basis of 4 clinical factors, the mortality rate varied from 2 to 74%. The death risk in acute digitalis poisoning can therefore be easily assessed simply from clinical criteria.

Acute Disease↗
PubMed1982

[Effects of lithium preparations in certain forms of experimental arrhythmias].

In tests on cats with cut vagus and aortal nerves, clipped common carotid arteries caused a sharp increase in sympathic activity (SA) in the cardiac nerves, a rise of arterial pressure (AP) and ventricular arrhythmias. Lithium chloride and hydroxibutirate injected intravenously reduced SA, AP and restored sinus rhythm. While administering arrhythmogenic doses of strophantin R, similar rhythm disturbances were observed in addition to increase in SA in animals with denervated cardio-aortal and sinocarotid areas. In these cases lithium drugs also had an antiarrhythmic action and reduced SA. In cats with the preserved innervation of the above reflexogenic sites, reflexogenic sites, strophantine arrythmias developed against the background of SA reduction and lithium drugs were inefficacious. In experiments on rats, while injecting large doses of intravenous adrenalin secondary ventricular rhythm disturbances have been shown to occur 1-1.5 min after the drug injection and to result in death, Lithium chloride and hydroxibutirate prevent the development of these arrhythmias and the animals' death.

Animals↗
PubMed1978

[Cardiovascular effects produced by prophylactic digitalization during introduction of anaesthesia (author's transl)].

The narrow field of non-controversial indications concerning the application of digitalis glycosides is pointed out. Problems of routine digitalization of older patients not suffering from cardiac insuffiency are discussed with special regard to preparing them for operations. Up to now, from the viewpoint of anaesthesiologists no benefits of prophylactic digitalization have been found. In a retrospective computerized study, clinical hemodynamic parameters during introduction of anaesthesia have been investigated by means of anaesthetic data recorded during three years. Nondigitalized patients older than fifty years showed satisfactory cardiac functions, whereas prophylactically digitalized patients--compared with the control group--have been treated with plasma expanders earlier and at a double rate. Furthermore, higher heart frequencies and greater tendency to arrythmias were observed. Consequently, prophylactic digitalization cannot be recommended in general.

Age Factors↗
PubMed1981

[Prognostic factors in acute digitalis poisoning (author's transl)].

The prognostic significance of various clinical and biochemical factors was investigated in 179 patients who had absorbed more than 2 mg of digitoxin. The mortality rate in this series was 17%. Supraventricular arrythmias had no influence on prognosis, but the death risk was higher in males and in patients with A-V block. It increased with age, with digitoxin and potassium serum levels and even more with persistent hyperkalemia. Two other factors, previous heart disease and vomiting, were also significant in patients without heart block. Calculated on the basis of 4 clinical factors, the mortality rate varied from 2 to 74%. The death risk in acute digitalis poisoning can therefore be easily assessed from simple clinical criteria.

Acute Disease↗
PubMed1980

'Missed beats' in a fetus. A case report.

The unique documentation by ultrasonography of a cardiac conduction abnormality in a fetus resulting in 'missed beats' is presented. Whereas cardiac arrythmias in the neonate are well described, the aetiology in the fetus remains obscure.

Adult↗
PubMed1980

The incidence of vasovagal reflex activity during radical neck dissection.

Pressure receptors exist within the walls of the carotid bulb which are responsible for maintaining the balance between blood volume, vascular tone, and cardiac output. When these receptors are manipulated during neck surgery the result may be bradycardia, hypotension or cardiac arrythmia. Such events occur sporatically during head and neck surgery and occasionally may prove fatal. While many surgeons advocate anesthetizing the carotid bulb prophylactically, this practice is not universally accepted. A retrospective appraisal of 76 radical neck dissections demonstrated an incidence of clear cut vasovagal reflex activity of 10%. Thirty-one radical neck procedures were then randomized into treatment and control groups in a prospective fashion. The treatment group (12 patients) had 5 cc. of 2% lidocaine applied topically to the carotid bifurcation. Nineteen controls had normal saline applied to the same site. The incidence of vasovagal reflexes in the control group was 10% and 16% in the treatment group. The similarity of these treatment groups is highly significant. It is concluded that topical 2% lidocaine is not an adequate prophylaxis for vasovagal reflexes during radical neck dissection.

Anesthesia, Local↗
PubMed1978

Some preliminary observations on the effects of kola nut on the cardiovascular system.

The prevalence of kola nut chewing and the effects attributed to it are briefly reviewed. Except for a generalisation that its effects are probably due to its caffeine content, no attempts have been made to quantify its specific actions. Preliminary observations on the cardiovascular system of the cat show that aqueous extracts of the nut evoke a dose dependent differential response - the 8 - 9% hypertensive effect of 0.01 ug - 1mg/ml doses contrasting with the 18--71% hypotensive response of 10--1000mgs/ml doses. Adrenergic receptor blockade showed no significant alteration of the response. With larger doses a bradycardia developed and cardiac arrythmias were observed as a terminal event. These results are compatible with the action of xanthines on the heart and peripheral vasculature. The possible role of the habitually chewed kola nut in the pathophysiology of cardiovascular disease and its implications have been briefly discussed.

Animals↗
PubMed1994

[Myocardial infarction after 80 years of age. Apropos of 157 cases].

The authors evaluated the features of myocardial infarctions in a population of 157 subjects aged 80 years or more out of a total of 1,610 patients admitted for myocardial infarction. It was a common condition in this age group (9.8% of the population) with a female predominance (61.8%), the main risk factor begin hypertension. A previous history of angina or infarctions, silent ischaemia, atypical electrocardiographic forms and anterior infarction were significantly more common. The outcome was characterised by a higher prevalence of haemodynamic complications with cardiac failure in 60% of cases and cardiogenic shock in 10% of cases. Atrial fibrillation was also more common though severe ventricular arrythmias were more infrequent. From the therapeutic point of view, 95.7% of octogenarians were given intravenous heparin but thrombolysis was undertaken in only one case. Coronary angiography, angioplasty and cardiac surgery were exceptional. Hospital mortality was 26.7%, seven times higher than that observed in patients under 65 years of age and nearly twice that of patients 65 to 79 years of age. After hospital admission, 45% of octogenarians were prescribed a calcium inhibitor, 37.2% a platelet anti-aggregant agent, 17.2% long-term oral anticoagulants and 1.9% a betablocker. These results show that myocardial infarction after 80 years of age is common, serious, but treated conventionally.

Age Factors↗
PubMedDate not supplied

The role of nerves in the production of cardiac arrest during surgical anaesthesia.

The role of cardiac nerves in the production of cardiac arrest during surgical anaesthesia on coronary ligated hypoxic heart has been studied. When atropinished coronary ligated dogs were exposed to hypoxia the terminal event was a cardiac asystole in 88% of the dogs. In propranolol treated dogs, or in dogs where sympathetic ganglia upto T6 were bilaterally removed earlier, coronary ligation and hypoxia produced ventricular extrasystoles, ventricular tachycardia and repeated sinus arrest followed by ventricular fibrillation. The possibility of the origin of arrythmia from the damaged myocardium, and the presence of an intact vagus in the production of ventricular fibrillation has been discussed.

Anesthesia, Intravenous↗
PubMed1994

Cardiac surgery in octogenarians.

Age as an important risk factor in surgery has always been debatable. Between January 1991 and December 1992, 35 consecutive octogenarian patients (23 males and 12 females; average age 82.3 years) were retrospectively evaluated. Twenty-five patients had only coronary artery by-pass graft operations (CABG), five had aortic valve replacements (AVR) and five had combined AVR-CABG operations. Twenty-five of the 30 patients (83%) who underwent CABG alone or a combined procedure had suffered from unstable angina. The mean ejection fraction was 40% in this group. An average of 2.8 grafts per patient was performed. The left internal mammary artery (LIMA) was-used in nine patients (30%). The average hospitalization period was 11.5 days. Operative mortality (within 30 days) was zero. Patients who underwent AVR only were hospitalized for an average of 17.6 days and there were two cases (6%) of mortality in this group. All patients who underwent AVR and CABG were discharged within 14 days. Overall complications occurred in nine patients (25.7%); cardiac arrythmias, (4) neurological deficits (2), severe wound infections (2), and adult respiratory distress syndrome (1). The use of the LIMA was not associated with an increased incidence of bleeding or sternal infection. The low rates of mortality and major complications lead us to conclude that, when indicated, surgical treatment including the use of LIMA in selected cases, should be offered to this group of patients, even in the presence of moderate LV dysfunction.

Age Factors↗
PubMed1976

[Results of the automatic analysis of a group of 2,250 electrocardiograms examined with the HP4 system and supplied by 13 hospitals associated with a single computer center].

The reliability of the HP4 programme for automatic ECG reading has been studied. 13 Lombardy Hospitals together with the Italian Diagnostic Centre took part in the experiments. In each hospital, 170 ECG's were simultaneously recorded on paper and magnetic tape, a total of 2.252 examinations. The tapes were sent to the Italian Diagnostic Centre for processing. The ECG's were also examined by hospital cardiologists using their own criteria and by a cardiologist of the I.D.C. according to the HP4 programme criteria. The evaluation criteria were of two types: 1) according to a final synthetic judgment (normal, atypical, at the limit of the normal, abnormal); 2) according to the type of pathology (arrythmia, left ventricular hypertrophy, infarction, repolarization alterations, intraventricular conduction disturbances). The data obtained in this study showed the reliability of the HP4 programme for screening the population, for use in Cardiology Departments (hospital or out-clinics) and in Social Cardiology centres. Its practical use is excluded (as are most of the programmes on the market) where a specific diagnosis in particular types of pathology is required (e.g. coronary units, cardiology division, etc.) The cardiologist is irreplaceable although this equipment provides him with a considerable aid for the performance of his work.

Diagnosis, Computer-Assisted↗
PubMed1994

An instrument for dissecting the esophagus.

BACKGROUND: We describe an instrument for mobilizing the normal esophagus without thoracotomy. It is essentially a metal ring introduced through the neck that encircles the esophagus, separating it from surrounding tissues. METHODS: Preliminary studies of 12 cadavers were followed by clinical application in 18 patients with esophageal carcinoma and two with benign esophageal lesions. RESULTS: Pneumothorax occurred in 20%, recurrent laryngeal nerve palsy in 25% (4 of 5 were transient), and thoracotomy for postoperative bleeding from the tumor bed in two cases. No anastomotic leakage occurred. Mortality rate at 30 days after operation was 15%, with an in-hospital mortality rate of 20%. Use of the instrument did not cause any of the described complications. In one patient the esophageal carcinoma was adherent to the trachea, which was injured. No incidence of hypotension or arrhythmia was observed during thoracic esophageal dissection. Blood loss from the mediastinum wa unremarkable. The treatment by stripping is a palliative treatment and precludes a radical curative attempt. The use of this instrument is contraindicated in lesions of the upper and middle parts of the esophagus, and it is not intended to strip a bulky esophagus as in achalasia. CONCLUSIONS: The esophageal dissector made mobilization of the normal thoracic esophagus easier and less time consuming, and yielded no episodes of hypotension or arrythmia.

Adult↗
PubMed1994

[A case of hepatoblastoma using intraarterial hepatic chemotherapy with THP-ADR].

The patient was a 2-year-old who was admitted with the diagnosis of liver tumor. The diagnosis at admission was stage III A hepatoblastoma complicated with tumor thrombosis of portal vein. Soon after the admission, the patient's general condition became deteriorated with increased ascites and severer jaundice. As the patient was considered to be in oncogenic emergency, chemotherapy with systemic administration of ADR and CDDP was started. Despite decreases in tumor marker and tumor shrinkage on imaging examinations, tachycardia and arrythmia occurred from the end of the second course of chemotherapy, suggesting ADR-induced cardiomyopathy, when the systemic administration of ADR was switched to less cardiotoxic hepatic arterial infusion of THP-ADR. Following 13 courses of intra-arterial infusion with the total dose of THP-ADR of 200 mg/m2, the tumor was found to have reduced markably in size and thus surgical resection of the tumor was performed. Our experience of this case indicates that, considering the pharmacokinetics and side effects, THP-ADR should be a very effective anti-tumor agent for intra-arterial hepatic infusion. The patient died 10 months after surgery because of multiple metastases into the brain and lungs.

Antibiotics, Antineoplastic↗
PubMed1994

[Analgesic effect and toxicity of 3,15-diacetylbenzoylaconine and comparison with its analogues].

3, 15-Diacetylbenzoylaconine (Dia) is a new aconite alkaloid derivative. The analgesic ED50 (95% confidence limit) of sc Dia measured with the HAc-induced writhing method, hot-plate method and electric stimulation method in mice were 2.76 (2.34-3.26), 3.50 (2.69-4.54), and 4.20 (3.72-4.73) mg.kg-1, respectively. With the hot-plate method and tail flick method in rats, the analgesic ED50 of ip Dia were 2.75 (2.28-3.31) and 5.24 (4.35-6.31) mg.kg-1, respectively. The LD50 of sc Dia in mice and ip Dia in rats were 21.68 (17.25-27.25) and 10.96 (8.24-14.56) mg.kg-1, respectively. The magnitude of the analgesic therapeutic indices of Dia, 3-acetylaconitine (Ace) and aconitine (Aco) in all the above-mentioned algo-model were in the order of Dia > Ace > Aco. When they were injected iv at 0.1 ml.min-1 in rats, the doses of Dia, Ace, and Aco producing arrythmia were 3.3, 0.8, and 0.5 times as large as those producing analgesia while those of Dia, Ace, and Aco inducing respiratory inhibition were 3.9, 0.5 and 0.3 times, respectively. The magnitudes of the oil/water distribution coefficients with two method and the quotient ED50 icv/ED50 sc of Dia and Ace were > Aco.

Aconitine↗