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Biomedical subjects

C Beghi

Publications and source records attributed to C Beghi.

At least 19 recordsLinked to original sources
PubMed1995

[Unilateral pulmonary embolectomy without extracorporeal circulation. A report of a clinical case].

The surgical treatment of pulmonary embolectomy is currently indicated for acute massive obstruction of the pulmonary artery with severe haemodynamic failure and, as in this case, when medical treatment with anticoagulants or thrombolytic drugs is contraindicated. In this work, the Authors focus on the technique of unilateral pulmonary embolectomy through a median sternotomy; this approach allowed an easier and safer embolectomy without extracorporeal circulation.

Embolectomy↗
PubMed1995

[Surgical treatment of saccular aneurysm of the left anterior descending coronary artery].

We report a case of a 74 old man presenting unstable angina and history of previous myocardial infarction. Coronary angiography showed significant stenoses of the left main and right coronary arteries and saccular aneurysm of the left anterior descending coronary artery. The patient underwent surgical treatment consisting in coronary artery bypass grafts and aneurysm resection. This procedure appears indicated, in author's opinion, when coronary aneurysm is saccular as in the described case.

Aged↗
PubMed1995

[Autotransfusion of the blood drained from mediastinum in the course of myocardial revascularization].

To determine if autotransfusion of unwashed shed mediastinal blood led to a reduction in the postoperative banked blood requirements were analyzed in a prospective study 82 patients undergoing myocardial revascularization during 1994 at Cardiovascular Surgery Center of Parma, randomized to receive (ATS) or not (noATS) the system. No differences were noted between two groups in terms of clinical parameters; likewise the operative characteristics were similar for the two groups. The mean 24-hours postoperative blood loss was 719.5 +/- 196 ml in the ATS group and 843 +/- 292 ml in the nonATS group (p = 0.027); the mean volume autotransfused in the ATS group was 416 +/- 167 ml. There were no reoperations for bleeding. In the nonATS group 65.8% of patients required postoperative homologous transfusions compared with 41.5% in the ATS group (p = 0.05). The mean immediate and 24-hour postoperative hemoglobin values were similar in the two groups, but at hospital discharge were 21.1 +/- 1.4 g/dL in the nonATS group and 11.3 +/- 1.4 g/dL in the ATS (p = 0.015). By logistic stepwise multiple analysis were identified as risk factors for banked blood requirement the variables: age, preoperative blood drawing patient, blood drawing before institution of cardiopulmonary bypass and postoperative blood loss. Non use of ATS was not a significant incremental risk factor for banked blood requirement, furthermore we think that use of ATS system is a primary blood volume support and confers to reduce homologous transfusions and their related complications after cardiac operations.

Aged↗
PubMed1995

[Combined cardiac surgery and aneurysm of subrenal abdominal aorta].

The authors explain their experience about the combined correction of cardiac pathology and infrarental aortic aneurysm repair. Seven patients of mean age of 63 years underwent simultaneous myocardial revascularization (5 cases) or aortic valve replacement (2 cases) and abdominal aortic aneurysm repair with bifurcated vascular prosthesis (6 cases) and tubular prosthesis (1 case) between 1987 and 1995. Cardiac operation was performed first with a mean number of 2.4 coronary artery by-pass grafts, with a mean by-pass time of 51 min, and a mean abdominal aortic cross-clamp time of 46 min. The mean total operating time was 231 min. All patients were managed postoperatively in the cardiac intensive care unit with a mean duration of 2.5 days and were transfused with a mean of 5 units of donor blood. The mean postoperative hospitalization was 9 days. One patient died for complication of postoperative myocardial infarction. The authors conclude that combined cardiac operation and abdominal aortic aneurysm repair is feasible in carefully selected patients.

Aged↗
PubMed1994

Hemodynamic, respiratory, and metabolic effects of medium-chain triglyceride-enriched lipid emulsions following valvular heart surgery.

STUDY: A lipid emulsion containing 10 percent medium-chain triglycerides (MCT) and 10 percent long-chain triglycerides (LCT) was infused at a rate of 1 ml/kg/h (3.3 mg/kg/min) for 2 h, in 12 patients (2 males, 10 females; mean age, 54 +/- 3 (SEM) years; range, 34 to 67 years) 24 h after open-heart surgery (mitral valve replacement). METHODS: Hemodynamic factors (pulmonary and radial artery indwelling catheters), oxygen and carbon dioxide partial pressures, oxygen saturation, oxygen delivery and consumption, and intrapulmonary shunt fraction were obtained before, during, and after lipid infusion (for 2 h), at 30-s intervals, along with some metabolic indexes (triglycerides, free fatty acids, glucose, insulin, lactate, acetoacetate). RESULTS: No statistically significant changes in heart rate, cardiac index, systemic and pulmonary pressures and resistances, central venous and pulmonary capillary pressures, or arterial oxygen partial pressure were observed during infusion. Arterial carbon dioxide partial pressure values were constantly reduced throughout and after the end of lipid infusion, as compared with baseline values, while oxygen consumption was increased significantly without any change in oxygen delivery. No adverse effects on intrapulmonary shunt fraction were observed. Statistically significant increases of triglycerides, free fatty acids, acetoacetate and insulin (peak values at end of the lipid infusion) were found in comparison with baseline values. Plasma glucose increased significantly during lipid infusion and remained higher than baseline values until the end of the study. Lactate levels were unchanged except for a slight decrease at the end of the study, without any derangement of acid-base equilibrium. Neither arrhythmias nor adverse clinical reactions were observed as a consequence of lipid infusion. CONCLUSIONS: Fat emulsions containing both MCT and LCT, when given at 3.3 mg/kg/min for 120 min following valvular heart surgery, do not exert negative cardiopulmonary effects, and could represent a source of rapidly metabolized substrates.

Acetoacetates↗
PubMed1993

Prevention of deep venous thrombosis by a new low molecular weight heparin (Fluxum) in cardiac surgery.

The prophylactic deep venous antithrombotic efficacy of a low molecular weight heparin (LMWH) was compared with traditional unfractionated calcium heparin in 39 patients submitted to cardiac surgery. The patients were allocated at random to receive either LMWH-Fluxum 3200 IUaXa daily (Group A: 20 patients) or calcium heparin 5000 IU three times daily (Group B: 19 patients). Both treatments were started on the first day after surgery and continued over the fourth postoperative days. One or more risk factors for deep venous thrombosis in addition to the cardiac pathology were present in all the patients of group A and in 13 (72.2%) of group B. Mean times of surgery, blood loss during the perioperative period and number of blood units transfused in both groups were not statistically significant. The deep venous system was investigated by continuous wave Doppler and real time colour Echotomography. No evidence of thrombosis was detected in the two groups. Side effects and subcutaneous hematomas were present in only four patients of group B. Both drugs showed good tolerance, provoking no variations of the main laboratory parameters. We conclude that Fluxum (LMWH) for the efficacy and convenience given by a single daily dose, could represent an alternative choice in the prevention of deep venous thrombosis in cardiac surgery.

Female↗
PubMed1993

[Thallium-201 myocardial perfusion imaging after aortocoronary bypass in patients treated with sulodexide or ASA-dipyridamole].

The aim of this investigation was to compare the preventive effect of sulodexide, a glycosaminoglycan drug, tested versus ASA-dipyridamole association, on the occlusion of venous aortocoronary bypass. A group A of 23 patients, for a total of 22 anastomosis with internal mammary artery and 46 venous bypass, was treated with sulodexide 500 USL/day. A group B of 18 patients for a total of 19 anastomosis with internal mammary artery and 33 venous bypass, was treated with ASA-dipyridamole 300 mg + 400 mg/day. Three and 9 months after surgery, all patients underwent thallium-201 myocardial perfusion imaging, associated with ergometric test. At the first control after 3 months, reversible perfusion defect in one or more myocardial segments was observed in 8 patients of group A and 3 patients of group B (2 A patients and 1 B patient in non revascularized myocardial segments); after 9 months, reversible perfusion defects were observed in 4 A patients and in 4 B patients. After 3 months, non reversible perfusion defect imaging in non infarcted myocardial segments was observed in 2 A patients and in 1 B patient; after 9 months, in 1 patient of both groups. This research shows higher incidence, at first control after 3 months, of ischemic reversible perfusion defects in patients treated with sulodexide, with an evident improvement in some patients recontrolled after 9 months. At the last control after 9 months, the scintigraphic findings showed similar evidence of perfusion defects in both groups treated with sulodexide or ASA-dipyridamole, with concordant angiographic findings (78.6%). Our preliminary results are encouraging and suggest further widespread studies on sulodexide therapy.

Arterial Occlusive Diseases↗
PubMed1990

[Is a simultaneous correction of coronary, carotid and major peripheral arterial lesions indicated?].

The contemporaneous surgical treatment of coronary and vascular disease is still controversial. In the attempt to bring our contribution at this chapter, we present a case series of 69 patients, among 2149 operated on myocardial revascularization between January 1982 and December 1990, submitted simultaneously to aortocoronary bypass and vascular procedures, i.e. carotid endarterectomy or limbs' revascularization. The immediate and late results achieved through the combined surgical approach have shown a mortality slightly greater than the staged procedure. However, the absence of neurological or abdominal complication and the improvement in term of survival and life's quality encourage us to continue with this surgical strategy, whenever the clinical status of the patients and the pathological aspect of the lesions permit it.

Aged↗
PubMed1990

A comparative clinical study on the effects of cardiopulmonary bypass with different flows and pressures on skeletal muscle cell metabolism in patients undergoing coronary bypass grafting.

This study compares the effects of cardiopulmonary bypass with different flows and pressures on intracellular energy metabolism, acid-base equilibrium, and muscle water compartments in two groups of patients undergoing coronary artery bypass grafting. Eighteen patients (16 men and two women aged 54 +/- 7 years, New York Heart Association class I-II) undergoing low flow (flow rate 1.5 L/min/m2 at 26 degrees C), low pressure (mean arterial pressure 40 to 60 mm Hg) cardiopulmonary bypass, as well as 10 age-matched and sex-matched patients undergoing normal flow (flow rate 2.2 L/min/m2 at 26 degrees C), normal pressure (mean arterial pressure 60 to 80 mm Hg) bypass were studied. Intracellular acid-base equilibrium (intracellular pH and intracellular bicarbonate), cell energetics (adenosine triphosphate, diphosphate, and monophosphate, phosphocreatine, and lactate), and muscle water compartments were evaluated in specimens of the quadriceps femoris muscle obtained by needle biopsy before and at the end of cardiopulmonary bypass. In both the low flow-low pressure and normal flow-normal pressure groups, adenosine triphosphate levels were unchanged at the end of bypass, whereas phosphocreatine concentration was decreased; muscle total water and extracellular water increased without variations of intracellular water; muscle and plasma lactate increased as intracellular bicarbonate decreased; intracellular pH values remained unchanged. The present study suggests the following: (1) Cardiopulmonary bypass is associated with the overall preservation of intracellular compartment metabolism in skeletal muscle (about 40% of body cell mass) of patients undergoing coronary bypass grafting, even though low phosphocreatine values and increased plasma and muscle lactate values found at the end of bypass could be an expression of cell functional reserve exhaustion; (2) the effects of cardiopulmonary bypass on cell metabolism are comparable, regardless of the flows and pressures used.

Blood Pressure↗
PubMed1989

Cell metabolism in patients undergoing major valvular heart surgery: relationship with intra and postoperative hemodynamics, oxygen transport, and oxygen utilization patterns.

The relationships between cell metabolism and both hemodynamics and oxygen transport/utilization (VO2/DO2) pattern were evaluated intra and postoperatively in eight patients undergoing major valvular heart surgery with the aid of moderately hypothermic cardiopulmonary bypass (CPB). Quadriceps femoris specimens were obtained by the needle biopsy technique for muscle ATP, ADP, AMP, phosphocreatine (PCr), creatine and lactate determination at anesthesia induction, after CPB, as well as in the ICU 18 h after surgery. Moreover, hemodynamic variables, oxygen transport and utilization indices, and plasma lactate were measured at the same intervals and throughout the CPB period. After CPB, muscle ATP and PCr contents were reduced (p less than .05) as compared to those of both pre-CPB patients and healthy control subjects; muscle and plasma lactate levels were increased (p less than .05). Mean VO2 and DO2 values measured during CPB significantly decreased (p less than .05), but VO2 reduction was proportionally greater than that of DO2 (-62% vs. -41%). No correlation was found between VO2 and DO2 at that time, but a significant relationship (p less than .05) was found at the end of CPB. A further decrease in muscle ATP and PCr levels was measured in the ICU, as muscle and plasma lactate levels were still elevated. At that time, VO2 and DO2 were not significantly different from pre-CPB values, but were significantly (p less than .05) correlated with each other.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenine Nucleotides↗
PubMed1989

[Surgical therapy of post-infarct aneurysm of the left ventricle. Immediate and long-term results].

Between January 1982 and December 1986, 62 patients (59 male and 3 female) ranging in age from 37 to 69 years (mean 53) underwent resection of postinfarction left ventricular aneurysm. The indication for operation was angina in 23 cases (37%), congestive heart failure (CHF) in 7 (11.2%), angina and CHF in 29 (46.8%), rupture in 1; 2 patients were low symptomatic. Ventricular arrhythmias were present in 6 (9.7%) cases and previous systemic embolism in 4 (6.4%). Forty-seven (75.8%) patients had lesions of three coronary arteries with involvement of left main coronary artery in 4 cases; 10 (16.1%) had lesions of two vessels [left anterior descending (LAD) and/or right coronary artery]; 4 (6.4%) had only LAD artery involvement, and 1 had no significant coronary artery stenoses. Left ventricular ejection fraction (EF) was less than 0.30 in 22% of cases, between 0.30 and 0.40 in 25.4% and greater than 0.40 in 50%. The location of the aneurysm was anterolateral or apical (83.8%), posterior (14.5%) and lateral (1.6%). Left ventricular aneurysmectomy with myocardial revascularization was performed in 61 patients (bypass/patient = 2.7), with ventricular septoplasty in 20 and concomitant mitral valve replacement in 3 patients. LAD was grafted in 59.6% of anterior aneurysm. Operative mortality (30 days) was 4.8%, the late mortality, with a follow-up between 12 and 72 months (mean 38), was 6.7% and the actuarial 5 year survival rate was 85% (91% without operative mortality). In our experience, despite no evidence of any operative risk factors, no improvement was noted in radionuclide left ventricular ejection fraction in patients undergoing aneurysmectomy with ventricular septoplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Immediate and distant results of aorto-coronary bypass performed in patients with compromised cardiac contraction].

From March 1979 to December 1985 at Cardiac Surgery Department of Parma 1064 patients underwent myocardial revascularization. Of them, 82 (7.7%) with poor left ventricular function (ejection fraction less than 40%) were studied to evaluate the effects of coronary artery bypass grafting on surgical risk, survival, ventricular performance and late clinical status. Three vessels disease was present in 65.9% and severe stenosis of left main coronary artery in 21.9% of patients. There were 74 (90.2%) patients with a history of previous myocardial infarction and 8 (9.75%) with congestive heart failure. Mean ejection fraction was 32.21 +/- 3.6%. On biplane left ventricular angiography 60 (73.2%) cases had two or more akinetic segments and 22 (21.9%) only hypokinesia. Operative mortality rate was 4.9%; perioperative myocardial infarction occurred in 5 patients (6.2%). Mean follow-up was 37.64 +/- 9.23 months and survival rate, including operative mortality, was 91.3%. Among the long-term survivors 89.04% are asymptomatic and in 49% there was a significantly improvement of preoperative left ventricular ejection fraction. We conclude that myocardial revascularization should be performed also in patients with left ventricular dysfunction, because of improvement of quality of life.

Coronary Artery Bypass↗
PubMed1987

[Digital angiography and surgery of the carotid: our experience].

Digital subtraction angiography (DSA) has became a common diagnostic procedure in the investigation of patients with cerebrovascular disorders. In these report is described a series of 80 cases previously examined in 8 different department of radiology, 59 with IV.DSA and 21 with IA.DSA. Thirty per cent of IV.DSA images were judged to be technically inadequate, so that further evaluations with conventional angiography have been needed, and in 3 patients (5.0%) the IV.DSA diagnosis was overturned. The authors recommend intraarterial digital subtraction angiography for evaluation of extracranial carotid occlusive disease always resulted the definitive diagnostic procedure in their experience.

Carotid Artery Diseases↗
PubMed1986

Myocardial infarction in rats. Infarct size, myocyte hypertrophy, and capillary growth.

To determine the compensatory reserve capacity of the ventricular myocardium following infarction, the left coronary artery in rats was ligated, and the animals were killed 40 days later. Infarcts affecting an average 23% of the left ventricle were characterized by a 27% hypertrophic growth of the remaining myocardium that produced a complete replacement of the necrotic tissue. In contrast, infarcts with an average 50% loss of mass resulted in 83% expansion of the spared myocardium that was inadequate for a complete restoration of ventricular tissue. Myocyte hypertrophy was 26% and 78% in small and large infarcts, respectively. Cellular hypertrophy in both cases involved significant increases in myocyte transverse area and myocyte length. After large infarcts, there was an 18% reduction in capillary surface and a 16% increase in the diffusion distance. Corresponding values for small infarcts were -10% and 9%. These alterations combined with the deficient reconstitution of myocardial mass following large infarcts resulted in 25%, 29%, and 30% deficits in the absolute amounts of capillary lumen, surface, and length per ventricle respectively. Even with small infarcts, a deficit was seen in capillary luminal surface (-16%), and length (-19%). In conclusion, we have demonstrated that cardiac hypertrophy following myocardial infarction is consistent with cellular shape changes characteristic of a combination of concentric and eccentric hypertrophic growth. However, cardiac muscle cells appear to be unable to compensate for the loss of mass induced by a 50% infarct. The inadequate adaptation of the capillary vasculature in the infarcted hearts suggests that the injured ventricle is more vulnerable to additional ischemic episodes.

Animals↗
PubMed1986

Effects of low flux-low pressure cardiopulmonary bypass on intracellular acid-base and water metabolism.

In eight patients undergoing open heart surgery for elective myocardial revascularization, extra-intracellular acid-base and water metabolism parameters were studied before and after cardiopulmonary bypass procedures. All patients presented a different degree of metabolic acidosis related to plasma lactate increase. Intracellular acid-base indexes did not change significantly, though all but one patient showed an intracellular buffers consumption. Both total muscle and extracellular water increased, while intracellular water did not change. It was concluded that low flux-low pressure perfusion CPB was related to a substantial preservation of cell integrity.

Acidosis↗
PubMed1986

Response of the border zone to myocardial infarction in rats.

The response of the surviving myocardium 30 days after coronary artery occlusion was measured morphometrically in the regions bordering and remote from infarcts of different sizes. Mean cell volume per nucleus increased with infarct size in both zones, but the rate of change was greater in the border than in the remote portion of the unaffected myocardium. Capillary numerical density within the uninjured tissue progressively decreased with infarct size leading to an increased diffusion distance for oxygen. Although the magnitude of changes in capillary density was similar in the two regions of the ventricle, the analysis of the individual values in each heart showed that in infarcts comprising more than 11% of the ventricular wall capillary concentration and the path length for oxygen supply to the myocytes were affected more in the border zone than in the myocardium remote from the scar. In conclusion, the border zone participates in the hypertrophic recovery process after infarction, but the inadequate growth of the capillary microvasculature suggests that this region is more susceptible to additional ischemic episodes.

Animals↗
PubMed1985

Effects of strenuous exercise on the quantitative morphology of left ventricular myocardium in the rat.

The adaptation of the structural components in the myocardium of the left ventricle to strenuous exercise was studied morphometrically in rats following a treadmill running program. The response of the left ventricle was evaluated separately in the interventricular septum and in the left ventricular free wall. Exercise produced a 24% growth of the septum without altering free wall volume. The hypertrophic expansion of the septum was characterized by a decrease in the volume fraction of capillary lumen in the myocardium (-20%), a reduction in the capillary luminal surface per unit volume of myocytes (-17%) and by an increase in the maximum distance from the capillary wall to the mitochondria of myocytes (9%). Although none of these changes were demonstrable on a statistical basis in the left ventricular free wall, similar results were obtained in the whole left ventricle by combining the data from the septum and free wall. Since the septum constitutes a functional unit with the free wall, it was concluded that the effect of excessive physical activity on the capillary parameters responsible for oxygen availability and diffusion could lead to a local reduction in the oxygenation potential of ventricular myocardium.

Animals↗