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At least 793 records · Page 44Linked to original sources
PubMed1981

Surgical treatment of ventricular tachycardia guided by ventricular mapping in 23 patients without coronary artery disease.

Twenty-three patients with resistant ventricular tachycardia not related to coronary artery disease underwent surgical treatment guided by ventricular mapping. The patients were grouped according to radiological and anatomical findings. Group 1 (13 patients) had arrhythmogenic right ventricular dysplasia. Group 2 (3 patients) had left ventricular aneurysm. Group 3 (2 patients) had nonobstructive myocardiopathy. Group 4 (5 patients) had normal-appearing hearts. At operation all patients underwent ventricular mapping when in sinus rhythm and during ventricular tachycardia. The rationale of operation was ventriculotomy or cryosurgery at the site of origin of ventricular tachycardia or exclusion, resection, or undermining of arrhythmogenic areas where delayed potentials were observed. Four patients died during the perioperative period, 3 of low-output failure and 1 from bleeding. Ventricular tachycardia recurred immediately after operation in 4 patients, 3 of whom died during the perioperative period. Ventricular tachycardia recurred late in 5 patients. Three had only episodic, unsustained runs of tachycardia. Two were well controlled by drugs. All patients with ventricular tachycardia situated over the free wall of the ventricles had inducible ventricular tachycardia and had good surgical results. Three out of 5 patients with ventricular tachycardia situated in the septum had poor surgical results. Septal ventricular tachycardia needs a better surgical approach to the septum and a suitable surgical concept.

Adult↗
PubMed1988

[Continuous EEG monitoring in carotid surgery].

From March 1980 to March 1987, at the Department of Vascular Surgery of the University of Padua, 217 patients underwent 252 carotid revascularizations with routine use of an intraluminal shunt (IS) for symptomatic (70%) or asymptomatic (30%) internal carotid artery (ICA) atherosclerotic stenosis. All carotid endarterectomies (CEs) were routinely performed with patch graft angioplasty to prevent restenosis. In the immediate post-operative period, no patient presented permanent or transient neurological deficits; no patient died. In the early post-operative course there was a 0.9% (2 patients) stroke rate and 0.4% (1 patient) mortality rate. These results suggest that the selective use of the IS on the basis of EEG changes is able to reduce the perioperative morbidity and mortality to nearly zero.

Adult↗
PubMed2006

A prospective trial for avoiding cervical lymph node dissection for thoracic esophageal cancers, based on intra-operative genetic diagnosis of micrometastasis in recurrent laryngeal nerve chain nodes.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the usefulness of intra-operative genetic diagnosis of RN node micrometastasis in the decision-making of 3FL for thoracic esophageal cancers. METHODS: Eighty-nine patients with middle and lower thoracic esophageal cancer were enrolled in a prospective study, in which 3FL was performed when RN node metastasis was revealed by intra-operative histological examination and/or genetic analysis using real-time RT-PCR assay. For other cases, 2FL was performed. RESULTS: Of the 89 patients, 3FL was performed for 33 patients and 2FL for 56 patients. In the 3FL group, RN node metastasis was both histologically and genetically positive in 19 patients, histologically negative and genetically positive in 11, and histologically positive and genetically negative in 3, with cervical node metastasis being detected in 7, 3, and 0 patients, respectively. In the 2FL group, only one patient had cervical node recurrence during the follow-up period. The post-operative survival in this study was equivalent to that of the historical controls (3-year survival rates 63.9% vs. 52.3%, P = 0.1513) of 66 3FL patients when 3FL was the first choice for thoracic esophageal cancers. CONCLUSIONS: Intra-operative histological and genetic diagnosis of RN node metastasis may help avoid unnecessary cervical node resection. A Phase III trial should be done.

Aged↗
PubMed1990

[Obstruction of total anomalous pulmonary venous drainage. Factors influencing improvement in surgical results].

Of 107 patients operated for total anomalous pulmonary venous drainage (TAPVD) at Marie-Lannelongue Hospital between January 1980 and November 1989, 57 had severe pulmonary venous obstruction. The average age of the patients at operation was 13.6 days and their average body weight was 3.2 kg. Twenty eight patients had an infracardiac, 23 patients a supracardiac, 2 patients an intracardiac and 4 patients a mixed type of TAPVD. The diagnosis of pulmonary venous obstruction was made on the findings of low cardiac output and pulmonary hypertension exceeding the systemic blood pressure, and on the results of angiography and Doppler echocardiography. Seventy five per cent of patients were admitted in Class IV of the NYHA Classification. Since 1985, treatment has been directed towards prevention of pulmonary hypertension. Echocardiographic diagnosis is considered sufficient for posing the surgical indication. Surgery should be performed before degradation of the patient's clinical condition or after a short period of stabilisation. The prevention of hypertensive crises in the postoperative period depends on continuous monitoring of pulmonary pressures. This approach has considerably improved our surgical results as the mortality rate has fallen from 59 p. 100 (1980-1984) to 13.3 p. 100 (1985-1989) (p less than 0.005). In conclusion, obstruction of the pulmonary veins in TAPVD is no longer considered to be a poor prognostic factor, providing measures are taken to prevent pulmonary hypertension before, during and after surgery.

Actuarial Analysis↗
PubMedDate not supplied

Histochemical reactions of myocardial proteases during open heart surgery.

Histochemical analysis of some lysosomal and sarcoplasmic proteolytic enzymes was assayed in human myocardial biopsies taken from 26 cardiopathic patients subjected to open heart operations, under extracorporeal circulation and protection with cardioplegic solution and hypothermia. The investigated myocardial proteases were: cathepsin B, cysteine aminopeptidase, acid gelatinases, trypsin-like endopeptidase, chymotrypsin-like endopeptidase and neutral gelatinases. The effects of surgical interventions appreciated by comparing the myocardium fragments harvested before, and at various intervals after aorta clamping (6-90 minutes) revealed disorders in the activity and compartmentalization of all the investigated proteases, whose histochemical reactions increased between 10 and 20 minutes after aorta clamping and manifested a lowering tendency with sarcoplasmic diffusion and extracellular release at longer periods than 20 minutes. The early activation of the neutral proteases and their sarcolemmal expression even before 10 minutes after aorta clamping, suggested the involvement of the nonlysosomal proteases in the first proteolytic events implied in the molecular membrane damage of the myocardial fibre. Sequential proteolytic cascades of abnormal neutral and acid proteases were emphasized as possible mediators and effectors of molecular and subcellular damages suffered by the myocardial fibers during the open heart operations, even under cardioplegic and hypothermic protection.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Patient-controlled analgesic therapy. Part I: Pharmacokinetics of pethidine in the per- and postoperative periods.

The influence of anaesthesia and surgery on the pharmacokinetics of pethidine (meperidine) was studied in 12 patients. Plasma pethidine concentrations in central venous blood collected during anaesthesia and the ensuing postoperative hours were by gas chromatography with electron capture detection. Postoperative analgesia was accomplished by patient-controlled intravenous administration of small doses of pethidine. The NONLIN program was used to calculate pharmacokinetic parameters for each individual. A single dose study of pethidine kinetics was carried out in all patients 3 to 5 days postoperatively. Mean +/- SD for peroperative Vd area was 4.3 +/- 1.7L/kg and for the elimination half-life was 6.1 +/- 3.6h. In the postoperative period Vdarea was 3.2 +/- 0.8L/kg and the elimination half-life was 3.2 +/- 1.4h. Plasma clearance increased from a peroperative value of 8.9 +/- 1.9 ml/min/kg to a postoperative value of 12 +/- 3.0 ml/min/kg. The changes in elimination half-life and plasma clearance are significant. The postoperative pharmacokinetics of pethidine were in accordance with those reported for healthy volunteers. The fraction of unbound pethidine was significantly reduced postoperatively - from 0.26 +/- 0.10 (peroperatively) to 0.18 +/- 0.10 (3 to 5 days later).

Adult↗
PubMed1982

[The artificial pancreas in surgery. An attempt to simplify intra- and post-operative insulin therapy].

The insulin requirements of 10 insulin-dependent diabetic patients were evaluated during and after surgery (including 4 caesarian sections) by connecting the patients with an artificial pancreas. Considerable variations were observed in the intra-operative period. In contrast, the amounts of insulin released during the immediate post-operative period were more regular and reproducible (mean: 2.36 U/h for a glucose intake of 200-250 g/24 h). A satisfactory control of glycaemia was obtained with this dosage in 7 insulin-dependent post-operative patients without using an artificial pancreas. It would therefore seem that in most cases continuous insulin infusion combined with direct measurement of capillary glycaemia could replace an artificial pancreas and make the intra- and post-operative care of diabetic patients simpler and more effective.

Adult↗
PubMed1980

Effect of cardiopulmonary bypass on cefazolin disposition.

Cefazolin kinetics was studied in 8 patients the day before (PREOP), during (SURG), and the day after (POSTOP) cardiopulmonary bypass (CPB) surgery. PREOP (48.6 ml/min) and POSTOP (46.6 ml/min) total body clearances were of the same order and both were greater than the SURG (27.4 ml/min) total body clearance. Since cefazolin is almost entirely eliminated by the kidney, the lower SURG clearance is a result of reduced renal elimination, as confirmed by measuring cefazolin SURG (28.7 ml/min) and POSTOP (52.9 ml/min) renal clearance. The reduction in cefazolin renal elimination was the same throughout the surgical procedure, including the period of extracorporeal circulation. Cefazolin distribution was altered by the operative procedure as evidence by a higher SURG steady-state volume of distribution. This increase in apparent cefazolin distribution volume brought about by surgery was not seen with cephalothin, which was investigated by us in a similar group of patients. The different effect of CPB surgery on cefazolin and cephalothin distribution may be due to differences in plasma protein binding.

Aged↗
PubMed2002

The effects of systolic arterial blood pressure variations on postoperative nausea and vomiting.

UNLABELLED: In this clinical study, we tested the hypothesis that a marked systolic blood pressure decrease >35% (DeltaSBP >35%) from preanesthetic baseline during the induction and maintenance of anesthesia is associated with more postoperative nausea and vomiting (PONV). In 300 ASA physical status I and II women undergoing elective gynecological surgery with general anesthesia, the maximum DeltaSBP during the induction as well as maintenance of general anesthesia were calculated. Observers blinded to hemodynamic variables assessed the incidence of PONV. The overall incidence of nausea (visual analog scale >4) and vomiting within the immediate observation period (0-2 h) was 39% and 25%, respectively. Frequency of nausea and vomiting in the late observation period was 21% and 9%, respectively. Women with a DeltaSBP >35% during the induction of anesthesia suffered from a more frequent incidence of PONV within the immediate (57% versus 35% and 41% versus 22%, respectively; P < 0.01) and within the late observation period (33% versus 18% and 19% versus 7%, respectively; P < or = 0.01). In women with a DeltaSBP >35% during maintenance of anesthesia, a more frequent incidence of nausea within the immediate observation period (53% versus 36%; P < 0.05) was found. We conclude that a maximum DeltaSBP >35% during the anesthetic induction is associated with an increased incidence of PONV after gynecological surgery during general anesthesia. IMPLICATIONS: A prospective clinical investigation revealed that a marked systolic blood pressure decrease >35% (DeltaSBP >35%) during the induction of general anesthesia is associated with an increased incidence of postoperative nausea and vomiting (PONV). The association between a DeltaSBP >35% during maintenance of general anesthesia and PONV is less pronounced.

Adult↗
PubMed1983

Osmolal excretion after open heart surgery.

Water and osmolal balance was investigated during the peri-operative period in twenty unselected adult patients presenting for open heart surgery. On the day before surgery the mean urine output was 1.13 litres/sq m/24 hours and osmolal output 430 mOs/sq m/24 hours. Using a haemodilution cardiopulmonary bypass technique, patients received 2.62 litres/sq m and 792 mOs/sq m in the operating room. The pattern of excretion of this water and solute load was identified. Patients were still in positive balance on the day following surgery despite a considerable diuresis, with solute retention exceeding water retention.

Adult↗
PubMed2001

Gender-related plasma levels of progesterone, interleukin-8 and interleukin-10 during and after cardiopulmonary bypass in infants and children.

BACKGROUND: It is known that proinflammatory and anti-inflammatory cytokines are released during and after cardiopulmonary bypass (CPB) in infants and children. Sex steroids are known to have immunomodulatory functions, and release of the anti-inflammatory cytokine IL-10 is stimulated by progesterone in vitro. The purpose of the present study was to investigate the plasma levels of progesterone, IL-8 (proinflammatory cytokine) and IL-10, and to relate them to sex and postoperative morbidity. METHOD: Eighteen infants and children (eight female) undergoing CPB were prospectively studied. Plasma levels of progesterone, IL-8 and IL-10 were determined before and 10 min after the start of CPB, and immediately after CPB; and 6 h, 24 h, 3 days and 7 days postoperatively. Organ dysfunction was identified on the basis of arbitrarily defined criteria. RESULTS: After CPB, all patients showed significant increases in plasma levels of progesterone, IL-8 and IL-10. Plasma levels of IL-10 were significantly higher in female patients, except for during the immediate postoperative period. According to the criteria used, six out of 10 male patients, but none of the female patients developed multiple organ dysfunction (MOD). CONCLUSION: The present study shows that CPB induces a significant and marked increase in plasma levels of progesterone in infants and children. Studies of administration of progesterone-blocking substances to male and female animals may help to elucidate the roles of sex and progesterone in the setting of CBP.

Adolescent↗
PubMed1993

Prospective survey of the use of the laryngeal mask airway in 2359 patients.

Patients undergoing anaesthesia in which the laryngeal mask airway was used were prospectively audited over a 6-month period. A simple record sheet was completed at the time of anaesthetic administration and 2359 completed forms were analysed to assess problems encountered with its use. It was used successfully in 2350 patients (99.61%); of these, 1399 patients (59%) breathed spontaneously through the airway and 960 patients (41%) underwent intermittent positive pressure ventilation of the lungs. Two patients (0.08%) were reported to have regurgitated during the use of the laryngeal mask airway, but no serious sequelae associated with its use were encountered.

Adolescent↗
PubMed1985

Intraocular pressure in the first days after implantation of the semiflexible McGhan/3 M, style 70, anterior chamber lens.

Intracapsular cataract extraction employing a corneal incision and with implantation of the semiflexible McGhan/3 M, style 70, anterior chamber lens was performed in a group of 25 patients with senile cataract. Intraocular pressure (IOP) was measured prior to and daily in the first 4 days after the operation. IOP was slightly, but significantly (P less than or equal to 0.05) lower in the observed post-operative period as compared to the pre-operative measurement. Similar results have previously been found after cataract extraction with an identical technique, but without lens implantation. This probably means that early post-operative intraocular homeostasis with respect to IOP is unaffected by the implantation of this type of lens. The fine regulation of early post-operative IOP is probably related to the fact that the described surgical technique usually is associated with only minor gonioscopically visible changes of the trabecular meshwork.

Aged↗
PubMed1983

Complement activation during cardiopulmonary bypass: quantitative study of effects of methylprednisolone and pulsatile flow.

Forty four patients undergoing open heart surgery were divided into three groups. Group 1 (17 patients) underwent routine anaesthesia and surgery; group 2 (17 patients) received two doses of methylprednisolone (30 mg/kg), one during induction of anaesthesia and the other immediately before induction of cardiopulmonary bypass; and group 3 (10 patients) received pulsatile flow while undergoing pulsatile perfusion by the heart-lung machine. A modification of the previously described technique was used to detect and measure complement activation in plasma before and during the bypass period using crossed immunoelectrophoresis. About 45% of all patients showed measurable complement activation (greater than 4.5%) during cardiopulmonary bypass and the mean activation in this group was 6.4%. There was no significant difference between the three groups in complement activation. In group 2, however, women showed significantly more complement activation than men (p less than 0.05). It is suggested that neither corticosteroids nor pulsatile flow affect complement activation, but caution should be exercised in women receiving methylprednisolone.

Animals↗
PubMed2005

Dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation in humans.

OBJECTIVE: To compare the dose requirements of continuous infusion of rocuronium and atracurium throughout orthotopic liver transplantation (OLT) in humans. METHODS: Twenty male patients undergoing liver transplantation were randomly assigned to two comparable groups of 10 patients each to receive a continuous infusion of rocuronium or atracurium under intravenous balanced anesthesia. The response of adductor pollicis to train-of-four (TOF) stimulation of unlar nerve was monitored. The infusion rates of rocuronium and atracurium were adjusted to maintain T1/Tc ratio of 2%~10%. The total dose of each drug given during each of the three phases of OLT was recorded. RESULTS: Rocuronium requirement, which were (0.468+/-0.167) mg/(kg.h) during the paleohepatic phase, decreased significantly during the anhepatic phase to (0.303+/-0.134) mg/(kg.h) and returned to the initial values at the neohepatic period ((0.429+/-0.130) mg/(kg.h)); whereas atracuruim requirements remained unchanged during orthotopic liver transplantation. CONCLUSIONS: This study showed that the exclusion of the liver from the circulation results in the significantly reduced requirement of rocuronium while the requirement of atracurium was not changed, which suggests that the liver is of major importance in the clearance of rocuronium. A continuous infusion of atracurium with constant rate can provide stable neuromuscular blockade during the three stages of OLT.

Adult↗
PubMed2004

A pilot study on the acceptability of levonorgestrel-releasing intrauterine device by young, single, nulliparous Chinese females following surgical abortion.

This study investigated the acceptability of the levonorgestrel-releasing intrauterine device (LNG-IUS) as contraception among young, single women after termination of pregnancy. Twenty subjects, with a median age of 21 years, had LNG-IUS inserted immediately after suction termination of first-trimester pregnancy. The subjects were followed-up at 6 weeks, 3 months, 6 months and 12 months. Fifteen subjects (75%) had other pregnancies terminated in the past. There were no serious complications or pregnancies. The acceptability of the LNG-IUS was generally above 86% during each follow-up visit. A total of seven (35%) subjects were lost to follow-up at different periods of the study. Overall, four subjects (22%) had the LNG-IUS removed. Nine subjects were seen at the end of the 1-year study period and all continued with the LNG-IUS for contraception. Side effects were commonly observed and irregular vaginal bleeding was the most common. We conclude that the LNG-IUS may be an acceptable method among selective young, single, nulliparous clients after termination of pregnancy and could be offered as an option of contraception to them. However, the small sample size and the high lost-to-follow-up rate are the major limitations of this study.

Abortion, Induced↗
PubMed1986

[Control of diabetes in the perioperative period].

Surgical procedure and anaesthesia commonly induce severe diabetes maladjustment. In these circumstances, optimal insulin administration is crucial and has been shown to prevent hyperglycaemia which is mostly due to insulin-counteracting hormones. We report the results obtained in 12 diabetic patients treated with a new method during various surgical procedures. The method consists of constant rate intravenous administration of a 5% glucose solution associated with intravenous insulin infusion delivered by an electric syringe at the rate of 1/2 U of insulin per hour for each glycaemic variation of 50 mg/dl. With this simple method, blood glucose concentrations remain close to physiological levels, and no hypoglycaemia occurs.

Adult↗
PubMed1994

[Total hip prosthesis in young patients].

Total hip prostheses are functional for a shorter period of time in young patients than in elderly. This problem is essentially related to the production of wear debris consecutively to metal versus polyethylene friction. New materials, such as alumina, produce less debris and therefore have been used for more than fifteen years with acceptable results at ten years (> 90% of functional hips). Total hip prostheses are sometimes needed in young patients suffering of post traumatic lesions, severe osteonecrosis and early osteoarthritis. In these cases, the indication of the prostheses should be accurately discussed, since it gives very often excellent results in comparison to more conservative treatments.

Adult↗