[Antibiotic prevention of endocarditis. A reference program for physicians and dentists].
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Anti-Bacterial Agents↗
Biomedical subjects
E Hjelms
Publications and source records attributed to E Hjelms.
Accelerated cholesterol accumulation in homologous arterial transplants in cholesterol-fed rabbits. A surgical model to study transplantation atherosclerosis.
Accelerated coronary artery disease has become a major complication to heart transplantation in humans. Therefore, we have developed a surgical model in the rabbit, with transplantation of the thoracic aorta as a bypass graft onto the abdominal aorta of another rabbit. The model permits the study of cholesterol metabolism in transplanted arteries. The graft did not accumulate cholesterol for as long as 298 days, provided that the rabbits were normocholesterolemic, i.e., with plasma cholesterol levels of 0.3-0.7 mmol/l. However, after a few weeks of cholesterol feeding resulting in plasma cholesterol levels of 2-5 mmol/l, the homologous graft accumulated cholesterol compared with intact aortic tissue in the rabbits and also compared with autologous aortic grafts. The intimal clearance of plasma cholesteryl ester, mainly high density lipoprotein cholesteryl ester, in the luminal layer of the aortic graft was 60-150 nl x cm-2 x hr-1 1-2 hours after transplantation. The intimal clearance in the corresponding intact thoracic aorta of the recipient animal was 5-20 nl x cm-2 x hr-1. The values were 1,500-3,000 nl x cm-2 x hr-1 51-298 days after transplantation, while the intimal clearance of the rabbit's own aorta remained unchanged. A pronounced increase in plasma lipoprotein permeability is thus an early event in transplanted arteries. It results in a higher cholesteryl ester influx that leads to cholesterol accumulation in the artery, but only if the rabbits are fed a cholesterol-enriched diet. This rabbit model may be useful in the search for interventional measures to prevent or diminish the accelerated coronary artery disease in transplanted hearts in humans.
Animals↗
Procainamide conversion of acute atrial fibrillation after open-heart surgery compared with digoxin treatment.
In 30 patients who developed atrial fibrillation after open-heart surgery the efficacy of intravenous procainamide was evaluated and compared with standard acute digoxin digitalisation. The patients were randomized to two groups of 15. One group received procainamide intravenously at a rate of 25 mg/min and with maximum dose 15 mg/kg. In the other group digoxin 0.75-1.0 mg was given intravenously according to renal function and body weight. Conversion to sinus rhythm occurred during or immediately after the infusion in 87% of the procainamide group, but only in 60% of the digoxin group (p < 0.05). The mean time from start of treatment to conversion was 40 min in the procainamide vs. 540 min in the digoxin group (p < 0.002). There were no serious complications of the procainamide treatment. Intravenous procainamide conversion of postoperative atrial fibrillation is concluded to be effective and safe and can be recommended as the treatment of first choice in awake and nonintubated postoperative cardiac patients.
Adolescent↗
An experimental study of hot air thermocoagulation in cardiac surgery.
Recently a thermocoagulator using hot air has been developed. It has been used for haemostatic purposes in a number of cases of liver, pulmonary and retroperitoneal cancer surgery. An experimental animal study was undertaken to evaluate the use of the thermocoagulator during cardiac surgery. Since the thermocoagulator produces coagulation necrosis, the epi-/myocardium including the epicardial coronary arteries was investigated microscopically for acute and chronic histopathological changes. The investigation demonstrated that the thermocoagulator is an effective hemostatic tool during cardiac surgery. The histological examination of the hearts has shown that the technique does not damage the myocardium or the coronary arteries neither at the time of application nor in the long term.
Animals↗
Aneurysm of the ductus arteriosus. A review of the literature and the surgical implications.
One hundred and forty-four cases of aneurysms of the ductus arteriosus (DAA) have been reported in the literature of which 106 appeared spontaneously and 38 followed surgical treatment of a patent ductus arteriosus (PDA). Within the last few years there has been an increasing number of reported spontaneous DAA. However, the real incidence is presumably still underestimated. Aortography is a well established diagnostic method. In neonates, transthoracic echocardiography has shown convincing potential, whereas in older children and adults, transoesophageal echocardiography has yielded very promising results. Serious complications following spontaneous DAA are rupture, erosion, infection and thromboembolism. In infants younger than 2 months of age, the complication rate is 31%, in children between 2 months and 15 years, 66%, in adults, 47%. The rate of complications following postoperative DAA is even higher: 91% of the unoperated cases died due to rupture or infection. The operative mortality in children older than 2 months and adults is low. In the neonate group, 2 of 8 died during operation. The operative mortality in patients with postoperative DAA was 26%. Based on information from the literature, we suggest prompt surgical treatment of all spontaneous DAA in patients older than 2 months of age, and in all patients with postoperative DAA. In infants, a DAA should be closely followed with echocardiography, as spontaneous regression has been reported in this age group. If no regression is seen within a few days, it should be surgically corrected.
Adult↗
Repeat coronary artery bypass grafting.
In 1981-1989 we performed repeat coronary artery bypass grafting on 42 men and 10 women (mean age 55 years) with angina pectoris recurring on average 27 months after the primary operation. The cause was occlusion or stenosis of vein grafts alone (59%) or in combination with progression of native coronary atherosclerosis (31%) or progression in the native circulation without graft failure (10%). Complications at the repeat operation included five lesions of the right ventricle and five lesions of patient grafts. The 30-day mortality was 3.8% (95% confidence limits 0.5-13.2%). Survival after observation averaging 2 1/2 years was 92.3% (95% confidence limits 81.5-97.9%). Angina pectoris was completely relieved after the operation in 48% of the patients, lessened in 35% and unchanged in 17%. Although repeat coronary artery bypass grafting carries heightened mortality and morbidity, and the results are less satisfactory than after first-time bypass, the operation can be worthwhile.
Angina Pectoris↗
[Surgical treatment of cancer of the cardia and the esophagus].
During the period 1977 to 1989, 379 patients with cancer cardiac and cancer esophagi were admitted. The ages ranged from 18-88 years with an average of 65 years. The treatment concept was basically unchanged during the study period. Resection as described by Ivor Lewis was employed as palliative or curative treatment when resection was considered possible. Intubation of the esophagus was employed when no other treatment was considered possible. Resection was employed in 251 patients, eight of these emergencies on account of perforation or haemorrhage. Bypass operations were employed in five patients, intubations in 63 and no surgical treatment was undertaken in 60 patients. The all over operative mortality for resections was 11.2% and for elective operations 9.9%. The operative mortality increased with the TNM stage of the tumour and was 3.2% for stages I + II, 8.2% for stage III and 24.4% for stage IV. The complication ration was 42%. 15% of the patients submitted to resection required reoperation. Anastomotic leaks were encountered in 18 patients and nine of these died. Pulmonary complications were the most frequent and resulted in ten early postoperative deaths. The mortality connected with intubations was 15%. The over all five-year survival rate after resections was 10.4%. In stages I + II this was 42% and 8% in stage III. None of the patients in stage IV survived for two years. The longest survival after intubation was less than one year.
Adolescent↗
[Reoperation because of mechanical heart valve prosthesis dysfunction].
Thromboembolism, haemolysis, prosthetic endocarditis and paravalvular leakage are the commonest complications of introduction of mechanical heart valve prosthesis. Malfunction of the cusps inside the sewing ring is a rare but serious condition, which is due to partial or total prevention of the free movements of the cusps or valves resulting in symptoms of valvular stenosis or incompetence. Twenty-six valvular prosthesis (2.3%) were replaced on account of malfunction. Fifteen out of the 26 patients were submitted to emergency operation and 11 to elective intervention. Four out of the 26 patients died preoperatively or during the postoperative course, corresponding to a lethality of 15%. The operative lethality was associated with emergency operations exclusively. The authors conclude that patients with previously well functioning valvular prosthesis who develop symptoms of cardiac failure should be referred to the cardiological centre where the operation was carried out as rapidly as possible instead of institution of traditional medical treatment.
Adult↗
[Acute aortic dissection].
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Acute Disease↗
[Diaphragm pacing by electric stimulation of the phrenic nerves].
Artificial ventilation by electric stimulation of the phrenic nerves has become clinically significant within the past 20 years and, in the world as a whole, approximately 700 patients have been treated with implanted diaphragmatic pacemakers. The two first patients in whom diaphragmatic pacemakers were implanted in Denmark, had sustained accidental fractures of the second cervical vertebra with subsequent high cervical spinal cord lesions with not only tetraplegia but also respiratory arrest. In both patients, diaphragmatic pacemakers were implanted bilaterally and these were employed for 12-14 hours daily while ventilation with a respirator was employed at night. The main indications for diaphragmatic pacing are paralysis of respiration following high cervical spinal traumata and the chronic central hypoventilation syndrome (sleep apnoea of Undine's curse). Diaphragmatic pacing may improve the mode of ventilation and the quality of life for patients with tetraplegia and respiratory insufficiency. On account of the potential technical problems, the risk of complications and the limited number of patients in whom this operation is suitable, implantation of diaphragmatic pacemakers should be concentrated in a few centres and probably only one in Denmark.
Adolescent↗
Inferior infarction with large nonapical mobile thrombus mimicking myxoma.
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Adult↗
[Results with the Ionescu-Shiley bioprosthesis].
During the period 1.1.1982-31.12.1987, 61 patients were submitted to operative introduction of the Ionescu-Shiley pericardial xenograft. The indications were anticipated brief survival or conditions which rendered anticoagulation therapy undesirable. Because of this, the operative lethality was high (12/61). No thromboembolic complications were observed during a period of observation of up to five years and no cases of primary destruction of valvular tissue.
Adult↗
A surgical model to study in vivo efflux of cholesterol from porcine aorta. Evidence for cholesteryl ester transfer through the aortic wall.
We describe a surgical procedure in pigs which makes it possible to follow the influx into, the penetration through and the efflux from the arterial wall of labeled lipoproteins. After 4 h exposure of the luminal side of the arterial wall to labeled lipoproteins, labeled esterified cholesterol was found in all layers of the aortic wall, whereas labeled free cholesterol gained access only to the most luminal layer. The data suggest that at least 40%, if not 80-90%, of the cholesteryl ester that enters the aortic wall from the luminal side, passes through the entire wall and leaves the aortic wall through vasa vasorum and lymphatics. They also suggest that free cholesterol in the lipoproteins exchanges extensively with cellular free cholesterol while the lipoproteins penetrate through the most luminal layer. More than 90% of the labeled cholesteryl ester disappeared from the arterial wall during a cold chase period of 4 days. By the simultaneous use of [3H]cholesterol and [14C]cholesterol it was shown that only 10-20% of this disappearance can be explained by cholesteryl ester hydrolysis in the arterial wall.
Animals↗
Intravascular air after fibrin sealing by spray gun in cardiovascular surgery.
During an operation for an ascending aortic aneurysm with implantation of a saphenous vein graft to the left coronary artery into a prosthesis, we occasionally observed air bubbles in the graft after application of fibrin glue to the anastomosis to control bleeding. In an experimental study in a pig, a vascular prosthesis was anastomosed to the descending aorta. The aorta and the prosthesis were transected and reanastomosed. Air bubbles were collected in a glass flask placed at the end of the prosthesis. Fibrin glue was applied with a spray catheter on all anastomoses at varying distances and with different air pressures. Small amounts of air were collected in the glass flask when an air pressure of 3 or 4 bar was used. This study demonstrates that the use of fibrin glue in cardiovascular surgery can introduce air into the vascular system with subsequent air emboli as a possible side-effect.
Aged↗
Beta 2-mediated changes in central haemodynamics, coronary circulation and myocardial metabolism in canine.
The combined effect of terbutaline on systemic and coronary circulation was investigated in dogs to clarify its influence on myocardial oxygen supply and lactate balance. The dogs were anaesthetized and the chest opened. Coronary sinus blood flow and cardiac output were monitored by thermodilution, aortic pressure was measured by tip-transducer and heart rate by RR-interval on ECG, coronary sinus blood were analyzed for lactate, oxygen and carbon dioxide. Terbutaline caused a substantial systemic vasodilation and an increased heart rate, the total external cardiac work increased to a minor degree. Terbutaline increased arterial lactate concentration. Coronary vascular resistance was reduced after terbutaline. Even if myocardial perfusion pressure was reduced and an increased external cardiac work was present, no signs of myocardial distress was observed in lactate metabolism or coronary sinus oxygen content. In fact a tendency to increased myocardial aerobic metabolism was observed, as myocardial lactate consumption increased after terbutaline. Terbutaline seems to be a coronary vasodilator in dogs. However, the demand for oxygen secondary to both an increase in cardiac work and aerobic metabolism can be hazardous to the potentially ischaemic myocardium.
Animals↗
[Bronchoplasty--an important alternative for lung resection].
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Adolescent↗
Evaluation of increased serum creatine kinase as an indicator of irreversible myocardial damage in dogs.
To evaluate the relationship between creatine kinase (CK) elevation and irreversible myocardial damage, a coronary artery branch was occluded for periods of 5 to 40 min in ten dogs. In five other dogs the coronary vessel was occluded for 480 min, and five dogs underwent the same operative procedure but without occlusion of the artery. The serum CK was monitored for 8 hours postoperatively in all dogs. Elevation of the CK levels occurred in all groups, but the area under the time-enzyme activity curve showed no statistically significant difference between the group with 480-min occlusion, in which transmural myocardial infarction occurred in all dogs, and the group with temporary occlusion, in which no infarction could be histologically or histochemically demonstrated. Contrastingly, a statistically significant difference was found between the group with temporary occlusion and the control group with no occlusion. The results suggest that CK elevation is of no value as an indicator of irreversible myocardial damage during heart surgery that involves temporary myocardial ischaemia.
Animals↗