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PubMed1999

The use of micro-dose aprotinin with continuous infusion in coronary artery bypass surgery.

BACKGROUND: To evaluate the efficacy of aprotinin at a dose far less than standard. METHODS EXPERIMENTAL DESIGN: Retrospective, case-control study. SETTING: community-based, teaching hospital PATIENTS: one hundred one patients undergoing primary, non-emergent, coronary artery bypass during two, six-month periods were studied. INTERVENTIONS: during the first period aprotinin was not administered, and these patients served as controls (n = 52). During the second period all patients received aprotinin via a micro-dose regimen (n = 49). MEASURES: postoperative bleeding and blood product usage served as determinants of efficacy. RESULTS: A significant difference existed in postoperative bleeding with the mean thoracic drain outputs being reduced in the aprotinin group both at 6 hours (p = 0.0003) and in total (p = 0.0004). This was further supported by significantly higher hematocrits (p = 0.03) on the first postoperative day in patients receiving aprotinin. Likewise, there was a significant reduction in total blood product exposures (p = 0.04) and platelet usage (p = 0.02) in the aprotinin group with a tendency towards decreased red cell usage. Further, when all patients with a hematocrit < or =30% prior to bypass were excluded, the significant reduction in total blood product exposures persisted (p = 0.04), and there was a significant reduction in red cell usage (p = 0.04) with a trend towards decreased platelet usage (p = 0.06) in the aprotinin group. CONCLUSIONS: Micro-dose aprotinin significantly reduces postoperative bleeding and blood product usage in primary, non-emergent, CABG patients.

Aprotinin↗
PubMed2005

Accuracy of frozen section in distinguishing primary ovarian neoplasia from tumors metastatic to the ovary.

Frozen section is widely used in the intra-operative assessment of patients with ovarian tumors. The diagnosis of malignancy is usually straightforward but in some cases it may be difficult to distinguish whether tumors are of ovarian origin or represent matastases from other sites. Recently, Seidman and colleagues presented a simple algorithm based on tumor size and unilateral versus bilateral involvement to aid in intra-operative assessment of ovarian mucinous neoplasms. In this study we have reviewed the accuracy of frozen section in distinguishing primary ovarian malignancies from tumors metastatic to the ovaries encountered in two hospitals over a 5-year period. The algorithm was also applied to our cases retrospectively irrespective of histological type. Nine hundred fourteen ovarian frozen sections were performed in the study period including 266 cases with a final diagnosis of malignancy. Thirty-seven malignancies (13.9%) were of metastatic origin (exclusing one lymphoma), 21 of which (58.8%) were correctly identified on frozen section. In 5 additional cases metastatic origin was included in the differential diagnosis while a primary ovarian tumor was favored un 11 cases (29.7%). Application of the algorithm to the metastatic tumors led to correct classification in 26/33 (78.8%) assessable cases. Conversely, 195/228 primary ovarian malignancies were correctly identified intra-operatively but the possibility of extra-ovarian malignancy was considered or not excluded in 33 cases (14.5%). Application of the algorithm to the latter problematic primary ovarian tumors overall was not helpful in distinguishing primary or metastatic origin. However if only low-grade primary adenocarcinomas were considered then 10/12 assessable cases were correctly assigned. In conclusion frozen section is only moderately successful in distinguishing primary ovarian malignancies fron tumors metastatic to the ovaries. The simple algorithm proposed by Seidman and colleagues for assessment of ovarian mucinous tumors is helpful and can be applied to low-grade adenocarcinomas of other histological types.

Algorithms↗
PubMed1993

Changes in plasma dopamine-beta-hydroxylase activity during the perioperative period of cardiac surgery: an index of sympathetic nerve activity.

To evaluate the usefulness of plasma dopamine-beta-hydroxylase (DBH) activity as an index of sympathetic nerve activity during cardiac operations, we examined the serial changes in plasma DBH activity, in relation to the plasma noradrenaline (NA) level and hemodynamic parameters, in patients who underwent cardiac surgery. The plasma DBH activity decreased significantly after cardiopulmonary bypass, and remained low during dopamine (DA) infusion until 72 h after the operation. However, recovery of the hemodynamic parameters, being the mean arterial pressure, heart rate and cardiac index, was seen as early as 1-3 h postoperatively. It was therefore assumed that the plasma DBH activity takes a long time to recover after an operation. The time-course changes in the plasma NA level were quite different from the changes in DBH activity, with an apparent negative correlation being observed between them. Thus, there is a possibility that exogenously administered DA, as well as increased plasma NA, might inhibit DBH activity during cardiac surgery. Moreover, since catecholamines are often administered upon completion of cardiac surgery, measurement of the plasma catecholamine level would be inappropriate for evaluating real sympathetic nerve activity. From the results of this study, it is surmised that measurement of the plasma DBH activity could be useful for estimating the intrinsic sympathetic nerve activity of patients who have undergone cardiac surgery.

Adult↗
PubMed2004

Conservative treatment of a mesenteric lymphangiomyomatosis in an 11-year-old girl with a long follow-up period.

The authors report the case of a 11-year-old girl admitted for a mesenteric tumor discovered during an appendicectomy. The abdominal Doppler echography and computed tomography (CT) scan showed a 8 x 6 x 7-cm multinodular mass involved in the mesenterium. Biological markers and iodine 131 meta-iodobenzylguanidine (MIBG) scintigraphy results were normal. Percutaneous biopsies were performed. Pathology results showed perilymphatic proliferation of smooth muscle cells leading to cystic lesions. No sign of malignancy was seen. Laparotomy showed a multinodular fixed mass involved from the root of the mesenterium. The superior mesenteric vessels were encircled by the tumor, which could not be resected completely. Partial resection was performed. The pathology and the immunohistochemical tests confirmed the diagnosis of lymphangiomyomatosis. At 21 years of age, she remains asymptomatic. An echography and CT scan showed the mass remaining unchanged in size and echopattern. Lymphangiomyomatosis (LMA) is thought to affect exclusively women in their reproductive life, and the steroid hormones are supposed to play an essential role in the pathology and in the behavior of this condition. Infantile LMA is exceptional. The patient reported is remarkable for her young age, the location of the tumor, her long history, and her benign course. Because the tumor is supposed to be hormone dependent, the surge of oestrogen in this 21-year-old woman may initiate the extensive form of lymphangiomyomatosis with pulmonary involvement, the prognosis of which is extremely poor.

Appendectomy↗
PubMedDate not supplied

Operative ankle arthroscopy. Long-term followup.

Ankle arthroscopy has become an accepted procedure for the treatment of various intraarticular disorders. More than 100 ankle arthroscopies have been performed at our institution since 1983. To better define the role of arthroscopic surgery in the treatment of ankle disorders, we evaluated the preoperative examination and indications, operative data, and radiographs of those patients with a minimum of 1 year of followup. Fifty-eight ankles in 57 patients were identified; their average follow-up period was 25 months (range, 12 to 49 months). Preoperative diagnoses were synovitis (26), transchondral defects of the talus (17), degenerative joint disease (8), and osteophytes or loose bodies (7). Subjective results were good or excellent in 64% of cases. The best overall results were achieved in patients with synovitis (77%) and transchondral defects of the talus (71%). Degenerative joint disease patients did not do well. They had only 12% good or excellent results and a 43% rate of subsequent fusion. Complications included superficial and deep infections, temporary and permanent paresthesias, and hemarthroses; the overall complication rate was 15%. In conclusion, operative ankle arthroscopy can be useful in selected patients. It is an effective surgical procedure in patients with synovitis and transchondral defects of the talus. The benefits and long-term results are less predictable with loose bodies and impinging osteophytes; the results are poor with degenerative joint disease. There appears to be a significant risk of complication with ankle arthroscopy; however, with proper indications, a thorough knowledge of anatomical landmarks, and meticulous technique, good results can be obtained.

Adolescent↗
PubMed2005

Long term complications in single and dual chamber pacing are influenced by surgical experience and patient morbidity.

OBJECTIVE: To determine how short and long term complication rates after pacemaker implantation are influenced by patient morbidity, operator experience, and choice of pacing system. DESIGN: Retrospective analysis of 1884 patients who received VVI (n = 610), VDD (n = 371), or DDD devices (n = 903) between 1990 and 2001. Follow up period was 64 (34) months. The influence of age, sex, coronary artery disease, myocardial infarction, reduced left ventricular (LV) function, right ventricular (RV) dilatation, atrial fibrillation, device type, and operator experience on operation time and complication rate were analysed. RESULTS: Operation time was prolonged in patients with coronary artery disease, inferior myocardial infarction, reduced LV function, and RV dilatation. Implantation of DDD pacemakers prolonged operation time, particularly among operators with a low or medium level of experience. The overall complication rate was 4.5%. Sixty seven per cent of these complications occurred within the first three months. Complication rate was increased by age, reduced LV function, and RV dilatation. Implantation of DDD systems led to a higher complication rate (6.3%) than implantation of VVI (2.6%) or VDD pacemakers (3.2%). These differences were present only among operators with a low or medium level of experience. CONCLUSIONS: Operation time and complication rate increased with age, impaired LV function, and RV dilatation. Complication rates were higher with DDD than with VVI or VDD implantation and were excessive among inexperienced but not experienced operators.

Age Factors↗
PubMed1983

[Results of endoscopic urethrotomy in the treatment of urethral stricture. Apropos of 72 cases].

Seventy-two patients with strictures of the urethra were treated by endoscopic urethrotomy over a period of 2 years, the strictures being of iatrogenic origin in 37.5% and of undetermined etiology in 22% Important features of this series were the advanced age of the patients (57% between 60 and 80 years) and the iatrogenic nature of the lesion in many cases. Strictures were perineobulbar in 36 cases, of the anterior urethra in 13, multiple or extending in 6, and of the membranous urethra in 17 cases. Retromeatal and cervical strictures were not included. Urethrotomy (at 12 o'clock) was followed by insertion of a urethral catheter retained for 5 days. Complications included one case of severe infection and 2 cases of epididymo-orchitis. Follow-up has been for from 6 to 36 months. Good results were obtained in 41 cases (57%), with absence of dysuria and lack of the need for dilatation. Results were moderate in 9 cases (12.5%), with functional improvement but altered flow and the need for less than 2 dilatations per year. Treatment was a failure in 23 cases (32%), the condition remaining unaltered and requiring either multiple dilatations or a repeat urethrotomy. Overall therapeutic efficacy was 70%, the poorest results being observed in extensive or membranous urethra strictures.

Adult↗
PubMed2000

A prospective study of serum pseudocholinesterase levels in patients with chronic spinal pain: a preliminary study.

STUDY DESIGN: One-dimensional polyacrylamide gel electrophoresis was used to study serum esterase enzymatic activity in three groups of patients and one group of normal volunteers. OBJECTIVES: To determine whether there is a statistically significant correlation between variations of serum pseudocholinesterase and the perception of pain in patients with chronic spinal pain. SUMMARY OF BACKGROUND DATA: Changes in levels of cholinesterase in the extracellular space of the brain and in the cerebral spinal fluid have been found to be associated in animal pain experimentation. METHODS: Ninety-three surgical patients with chronic spinal pain, six surgical control subjects operated for conditions not associated with pain, 21 normal control volunteers, and nine disabled patients receiving monetary benefits were studied. The patients were analyzed for a period of time by rating the perception of their pain with a visual assessment score at the time venous blood was drawn. Serum samples were prepared, serum pseudocholinesterase was monitored, separated, and quantified according to Allen et al.5 Paired sample t tests were used to statistically evaluate the data. RESULTS: A trend of correlation was noted between preoperative serum pseudocholinesterase levels and visual assessment score: serum pseudocholinesterase levels increased as visual assessment score increased. The mean preoperative serum pseudocholinesterase level of chronic spinal pain patients (1313; SE = 26), which was significantly higher than the mean levels of the normal control volunteers (941; SE = 24; P<0.001) and that of surgical control subjects (1018; SE = 63; P <0.01), decreased significantly with anesthesia (P<0.005). The mean preoperative serum pseudocholinesterase level of the surgical controls, however, remained unchanged with anesthesia. A correlation demonstrated between visual assessment score and serum pseudocholinesterase in chronic spinal pain patients was not observed in six of nine patients receiving disability payments for more than a year. CONCLUSIONS: Measurements of quantitative alterations of serum pseudocholinesterase levels may be useful in the treatment of patients with chronic spinal pain.

Adult↗
PubMed2005

Frame-based stereotactic biopsy remains an important diagnostic tool with distinct advantages over frameless stereotactic biopsy.

OBJECT: As the availability of image-guided surgical navigation systems has increased, the application of frame-based biopsy has declined at our institution, despite equivalent accuracy and safety. There are several cost issues separating the use of surgical navigation systems and stereotactic frames for simple biopsy which may have implications in this era of health care cost control. We retrospectively reviewed the UCSF experience with stereotactic brain biopsy from a 9 year period. METHODS: Data were collected for 213 consecutive stereotactic brain biopsies performed at UCSF (139 frame-based and 74 frameless). There were no significant differences between the frame-based and frameless biopsy groups with regard to patient demographics, overall histopathology, proportion of nondiagnostic biopsies, or incidence of complications. General anesthesia was used for 9 (6%) and 70 (95%) of the frame-based and frameless biopsy cases, respectively. Frame-based biopsies required a mean of 114+/-3 min of operating room time, while frameless biopsies required 185+/-6 min (P<0.0001). For patients admitted to our neurosurgery service who underwent frame-based (n=110) or frameless (n=52) biopsy within 24 h of admission, the mean lengths of hospital stay were 1.8+/-0.2 and 3.2+/-0.6 days, respectively (P=0.007). CONCLUSION: Frame-based and frameless stereotactic biopsy approaches were equally effective at providing a tissue diagnosis with minimum morbidity and mortality. The frame-based approach, however, required significantly less anesthesia resources, less operating room time and shorter hospital stays, and thus should still be considered a first-line approach for stereotactic brain biopsy.

Adolescent↗
PubMed1999

Video-assisted thoracoscopic surgery for spontaneous pneumothorax--a 7-year learning experience.

OBJECTIVES: To determine the effect of increasing experience of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous pneumothorax (SP) on clinical efficacy and surgical practice. PATIENTS AND METHODS: A prospective study of 180 consecutive operations in 173 patients who underwent VATS for SP by a single surgeon during a 7 year period. RESULTS: 118 patients, mean age 32.1 years (range 13-63 years), were treated for primary spontaneous pneumothorax (PSP) while 55 patients, mean age 65.9 years (range 28-92 years), were treated for secondary spontaneous pneumothorax (SSP). All patients had VAT parietal pleurectomy combined in 162 (90%) patients with stapled bullectomy. At a current median experience of 2.0 years (range 0.4-6.8 years), 12 (6.6%) patients required reoperation for treatment failures within 12 months of surgery--9 patients within 30 days of VATS and 3 for late recurrent pneumothorax. Two patients (both with SSP) died within 30 days of surgery. When compared with PSP, VATS in SSP is characterized by an elderly, male predominance, a longer postoperative stay, a higher mortality rate and a lower rate of late recurrence. With increasing experience of the technique, there has been a significant decrease in treatment failures. In the treatment of PSP, both operating time and postoperative stay have decreased significantly with experience whilst the use of staple cartridges per patient has increased significantly with experience in both PSP and SSP. CONCLUSION: There is a demonstrable 'learning curve' effect on the clinical efficacy and surgical practice of video assisted thoracoscopic surgery for spontaneous pneumothorax.

Adolescent↗
PubMed1995

Transurethral resection versus incision of the prostate: a randomized, prospective study.

OBJECTIVES: To evaluate longer term effects of transurethral resection (TURP) and incision (TUIP) of the prostate in randomized patients. METHODS: In a randomized, prospective study, 120 patients with symptoms of bladder outlet obstruction caused by smaller benign prostates (estimated resectable weight less than 20 g) were assigned to TURP or TUIP. Patients were evaluated preoperatively and at intervals postoperatively as to urinary symptoms (Madsen's questionnaire), sexual function, and uroflowmetry. Overall evaluation of outcome of surgery was also assessed at follow-up visits. RESULTS: Fifty-six patients received a TURP and 61 a TUIP. Three patients refused to participate in the project after randomization, and 5 patients were lost to or excluded from follow-up. A group of 112 patients were obtainable for postoperative evaluation with a mean follow-up time of 34 months (1 to 82 months). Improvements in mean urinary peak flow rates were seen in both groups throughout the study period. The peak flow rates generally were higher (but not statistically so) in the TURP group. Postoperative irritative, obstructive, as well as total symptom scores decreased significantly at all follow-up visits after both TURP and TUIP (P < or = 0.034). Preoperatively and at all postoperative follow-up there was no statistically significant difference in irritative, obstructive, or total symptom scores between TURP and TUIP. The patients indicated an overall subjective improvement at all follow-ups in both groups, with no statistically significant difference between the treatment groups. Fifteen of 22 (68%) patients receiving TURP and 8 of 23 (35%) in the TUIP group who were sexually active before and after surgery developed postoperative retrograde ejaculation (P = 0.020). Postoperatively, 9 (16%) of the patients in the TURP and 14 (23%) in the TUIP group received further treatment for benign prostatic hyperplasia (BPH)-related infravesical obstruction. This difference was not statistically significant (P = 0.908). CONCLUSIONS: In small prostates TURP and TUIP were generally equally effective in relieving bladder outlet obstruction secondary to BPH. Most surgically treated BPH cases can be well managed by the incision technique, which is an underutilized procedure.

Adult↗
PubMed1995

[Loss of brain stem auditory evoked potential waves I and II during controlled hypotension].

For surgical removal of a malignant choroid melanoma, it is necessary to reduce systolic blood pressure to around 50-60 mmHg in order to prevent choroidal haemorrhages. However, blood pressure reduction is associated with the risk of cerebral ischaemia. We report a patient with a malignant choroid melanoma in whom waves I and II of the brainstem auditory evoked potentials (BAEP) disappeared during surgery under controlled arterial hypotension and hypothermia (31.1 degrees C). The waves could be recorded again immediately after the mean arterial pressure was increased from 48 to 77 mmHg. The oesophageal temperature had dropped by 0.3 degrees C at this time. The 2-channel electroencephalogram (EEG) showed no irregularities during this time period. A bilateral, reversible, apparently blood-pressure-dependent loss of waves I and II during arterial hypotension despite a normal EEG has to our knowledge not been previously described in the literature. The isolated loss of waves I and II with maintenance of waves III, IV, and V is unusual. The literature contains reports of acoustic neurinoma patients in whom only wave V could be recorded. This is regarded as an indication of continued impulse conduction despite the loss of waves I to IV. Others have observed a patient with temporary and reversible loss of BAEP wave I due to vasospasm of the internal auditory artery that apparently occurred during or shortly after manipulation of the internal auditory meatus. Assuming anatomic peculiarities in the blood supply to the generators of the BAEP waves, a stenosis of the basilar artery could be considered as the cause of the bilateral reversible loss of waves I and II. Another potential source could be induced hypothermia, but this does not seem very likely because the patient's temperature was 0.3 degrees C lower at the return of the waves than at their loss.

Choroid Neoplasms↗
PubMed1996

Haemostatic changes in the pulmonary blood during cardiopulmonary bypass.

Pulmonary injury may result from the use of cardiopulmonary bypass (CPB). We investigated changes in the haemostatic system in the pulmonary vein during CPB compared with blood that circulated through the bypass circuit. Paired samples were taken from the pulmonary vein and central venous pressure (CVP) line during the peri-operative period from ten patients. Plasma levels of factor VII (P < 0.001), prekallikrein (P < 0.05), antithrombin III (P < 0.001) and heparin cofactor II (P < 0.005) were decreased in the pulmonary vein after 20 min of bypass compared with pre-operative levels. In the pulmonary vein there was a significant increase in neutrophil expressed CD11b (P < 0.001), neutrophil elastase: alpha 1-antitrypsin complexes (P < 0.001), endothelin-1(P < 0.001) and thrombin-antithrombin complexes (P < 0.001) by the end of bypass compared with pre-operative levels. There was no significant change in monocyte expressed CD11b, factor XII or C1-esterase inhibitor in the pulmonary vein for the study period. None of these variables were significantly different in the pulmonary vein compared with CVP line. In the pulmonary vein plasma levels of activated factor VII decreased following heparin administration (P < 0.001) in the majority of patients which was coincidental to an increase (P < 0.001) in tissue factor pathway inhibitor (TFPI). This increase in TFPI was significantly higher in the pulmonary vein compared with CVP line (P < 0.05) There was a decrease in neutrophil count by 20 min on CPB in both the pulmonary vein and CVP line (P < 0.001) and this did not return to pre-operative levels in the pulmonary vein. Soluble thrombomodulin levels decreased by 20 min on CPB in the CVP line (P < 0.05) but tended to increase in the pulmonary vein, although this was not statistically significant. In conclusion we found evidence of thrombin generation and possible endothelial damage together with increased neutrophil activation and adhesion molecule expression in the pulmonary vein during CPB which may play an important role in the development of post-CPB pulmonary injury.

Adult↗
PubMed2006

[Study on TCM syndrome differentiation rules in coronary artery bypass grafting patients during peri-operation period].

OBJECTIVE: To study the TCM syndrome differentiation rules in coronary artery bypass grafting (CABG) patients during peri-operation period. METHODS: According to the Guideline for Clinical Trail of Traditional Chinese New Drugs and experience of Professor DENG Tie-tao, the standard of TCM syndrome differentiation for CABG patients was established, with which 161 CABG patients were classified before and two weeks after CABG operation. RESULTS: Before CABG, the qi stagnation and blood stasis syndrome type was the type most commonly seen (46.0%), the next in turn was the phlegm stagnation type (24.8%), the yang-qi deficiency type (15.5%), and the yin-blood deficiency type (13.7%). While after CABG, the phlegm stagnation syndrome type was the most frequently occurred one (35.9%), then in turn was the yang-qi deficiency type (30.8%), the yin-blood deficiency type (21.2%) and the qi stagnation with blood stasis type (12.2%). CONCLUSION: For patients before CABG, the pathological characteristic is mostly the deficiency in root with excess in superficiality, and the commonest syndrome is the qi stagnation with blood stasis type. For patients after CABG, both deficiency and excess is the pathological characteristic, the Xin-qi and Xin-yang deficiency syndrome the commonest type, and with phlegm as the main pathologic factor.

Adult↗
PubMed2003

The use of acute normovolemic hemodilution in patients undergoing cardiac surgery.

Avoiding allogeneic blood transfusion during cardiac surgery and during the post-operative period is of great importance. Acute normovolemic hemodilution (ANH) is one of the options for blood salvage. We have prospectively analyzed 310 consecutive patients (pts) after different open heart procedures, operated on during April-May, 2000. ANH was possible in 226 pts (73%) with hemoglobin level over 125 g/l and hematocrit over 36%. Of those, one unit of blood was withdrawn in 128 pts (70%), while two to five units of blood were taken in 68 pts (30%). Total number of autologous blood units taken was 296, for the average of 1.31 units/pt. Predictors of increased intra- and post-operative blood loss were hematocrit (Hct) <39% (76% vs. 24%, p<0.001), age over 65 (p=0.028), female sex (p=0.006), CPB duration over 90 min (63% vs. 37%; p<0.001) and preoperative left ventricular ejection fraction (LVEF) <35% (63% vs. 37%; p<0.001). All pts with the above-mentioned characteristics were in need for allogeneic blood transfusion. During their hospital stay, 142 pts did not get allogeneic blood (142/310, 46%), and all were in the ANH group (142/226, 62%).

Blood Transfusion↗
PubMed2001

Effect of diabetes on nitric oxide metabolism during cardiac surgery.

The metabolism of nitric oxide (NO) during cardiac surgery is unclear. We studied the effect of diabetes on NO metabolism during cardiac surgery in 40 subjects (20 with diabetes and 20 without diabetes). The patients were randomized to receive an infusion of physiological saline or nitroglycerin (GTN) at 1 microg. kg(-1). min(-1) starting 10 min before the initiation of cardiopulmonary bypass and then continuing for a period of 4 h. Blood and urine samples were collected at several time points for up to 8 h. NO metabolites were determined by the measurement of nitrate/nitrite (NOx, micromol/mmol creatinine) and cyclic guanosine monophosphate (cGMP, nmol/mmol creatinine) in plasma and urine. Plasma insulin levels were also determined at selected time points. Plasma NOx levels before surgery were significantly elevated in the group with diabetes compared with the group without diabetes (P < 0.001), and values were further increased during surgery in the former (P = 0.005) but not in the latter (P = 0.8). The greater plasma NOx values in patients with diabetes were matched by commensurate elevations in plasma cGMP levels (P = 0.01). Interestingly, infusion of GTN, an NO donor, significantly reduced plasma NOx (P < 0.001) and its urine elimination (P < 0.001) in patients with diabetes without reducing plasma cGMP levels (P = 0.89). Cardiac surgery increased plasma insulin in patients with and without diabetes; this increase was delayed by the infusion of GTN, but it was not related to the changes in NO production. In conclusion, NO production during cardiac surgery is increased in patients with diabetes, and this elevation can be blunted by the infusion of GTN in a rapid and reversible manner.

Aged↗
PubMed1991

The neocortico to mesio-basal limbic propagation of focal epileptic activity during the spike-wave complex.

In order to localize epileptogenic electrophysiological sources, a multichannel MEG system was used in 3 patients with partial epilepsy during presurgical evaluation. MEG and EEG (including scalp, sphenoidal and intracranial foramen ovale electrodes) were recorded simultaneously during a period of intensive video-EEG monitoring in order to observe single spontaneous spikes. In addition to MRI, SPECT and PET investigations were performed. Electrical activity subsequent to the activity of the epileptic focus could be localized by the MEG after noise reduction using a temporal correlation technique. Simultaneous registration of the magnetic field and the electrical field showed that the source of the primary focal epileptic activity (first period during the total spike wave complex where a dipolar magnetic field pattern is found) is localized in neocortical lateral regions, whereas another focal epileptic activity in a later phase of propagation occurs in temporal mesial regions. In 1 patient (case 1) the primary focal epileptic activity was localized in the surrounding neocortical tissue of an angioma and the middle and inferior temporal gyrus. The second phase of propagation is localized in temporo-basal-mesial regions, including para- and hippocampal structures. The latest center of activity occurred in posterior parts of the gyrus cinguli. In 2 other patients, the primary focal epileptogenic activity was localized at the insula and also spread into temporal basal mesial regions. A multi-modal approach to research of focal epilepsy, combining metabolic, electrical potential, magnetoencephalographic and morphological data, recorded by non-invasive techniques, offers new perspectives for the detection of involved brain regions. The 3-D and time-resolved localization of focal epileptic activity, correlated with the individual anatomy of the human brain, may improve the determination of neuronal populations involved in the individual epileptogenic process, especially in the interaction between temporal or extratemporal neocortex and limbic system.

Adult↗
PubMed1990

Quantitative and qualitative ST segment monitoring during and after percutaneous transluminal coronary angioplasty.

Patients who undergo elective percutaneous transluminal coronary angioplasty (PTCA) provide a unique human model, with fully defined coronary anatomy and known sites and periods of coronary occlusion. High-resolution, quantitative ST segment monitoring during PTCA procedures allows characterization of the first moments of coronary occlusion, as well as the effect of interventions intended to reduce ischemia during occlusion. Data from more than 1,000 coronary occlusions are reviewed in this presentation. Intracoronary interventions during acute myocardial infarction (MI) and elective PTCA create a potentially unstable coronary nidus through their therapeutic effect. Angiographic evidence of the anatomic appearance remains the "gold standard" for real-time assessment of success although angiography has limited ability to identify the 2-4% of patients who suffer morbidity or mortality in the coronary care unit (CCU) after an apparently successful intervention. Standard CCU monitoring of patient symptoms and rhythms underestimates transient ischemic activity in 87% of patients who experience ischemia after interventions. The capabilities of real-time multilead ST segment monitoring are reviewed from 8,331 hours of monitoring in 338 patients after intracoronary interventions. The documentation of persistent ischemia after angiographically successful PTCA and the clinical potential of qualitative patient-specific, coronary site-specific, precordial "fingerprinting" for identification of high-risk patients before or in the absence of anginal symptoms are discussed.

Angina Pectoris↗