Biomedical subjects
Publications and source records attributed to G M Lemole.
A patient is described who developed hypoglycemia and generalized neurologic depression after cardiac surgery, while receiving an infusion of glucose, insulin, and potassium (GIK). Hypoglycemia as a complication of the use of GIK solution in patients with hepatic dysfunction, malnutrition and low cardiac output is discussed.
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The mechanism of protamine-induced hypotension and bradycardia was investigated in anesthetized, heparinized dogs. Several groups of animals with intact circulation were studied for their responses to protamine under control conditions and following the administration of various pharmacological agents. The parameters observed include femoral arterial pressure (FAP), central venous pressure (CVP), left ventricular pressure (LVP) and its rate of rise (dp/dt), left ventricular contractile element velocity of shortening (Vce), maximal Vce (V max) and cardiac output (CO). Various groups were studied under the following pharmacological conditions: autonomic cholinergic blockade by atropine; alpha and beta adrenergic receptor blockade using phenoxybenzamine and propranolol respectively; ganglionic and adrenal medullary block using hexamethonium, and depletion of endogenous histamine by means of compound 48/80. Another group was placed on total cardiopulmonary bypass thus isolating the heart from the peripheral circulation. The effect of protamine on the vascular tree alone was then observed by monitoring FAP before and after protamine administration. The findings indicate that the cardiovascular effects of protamine are produced by a direct effect on the myocardium and vascular tree.
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Transient bacteremia leading to hematogenous infection of atherosclerotic vessels is the most common cause of mycotic aneurysms. Salmonella species, which are especially potent pathogens, often are the infecting organisms. A high index of suspicion is the cornerstone of diagnosis. Patients with salmonella cultured from the sputum, blood, or urine without adequate explanation must be suspected of intravascular infection. Surgical intervention with adjuvant ampicillin therapy should be expediently initiated after diagnosis. Provided no gross infection exists and prompt debridement and drainage are obtained, an "in situ" interposition graft is adequate. A ring graft has the advantage of allowing a shorter cross clamp time and eliminates the risks inherent in contaminated anastomotic suture lines. Prolonged, possibly life-long, antibiotic therapy offers the best prognosis for this disease after surgical repair.
Although aortic root cardioplegia infusion has been generally satisfactory, adequate myocardial protection in patients with critical coronary artery disease (CAD) cannot always be achieved by this route. We report our experience with our first 19 consecutive patients, all with exceptionally severe disease in whom the coronary sinus route was utilized for cardioplegia infusion. Eleven had unstable angina, and three had persistent chest pain requiring intensive antianginal therapy right up to time of surgery. Blood cardioplegia was infused via the coronary sinus using a Foley Catheter under a monitored pressure of 30 mmHg. Ischemic time was 83 +/- 27 minutes. Number of vessels bypassed was 4.9 +/- 0.9. Prebypass hemodynamic profile was compared to the profile at 15 and 75 minutes, and at 6, 12 and 24 hours after cessation of bypass, and revealed good preservation of myocardial function: Cardiac index, stroke volume index and pulmonary capillary wedge pressure remained unchanged, systemic vascular resistance decreased by 30%, while changes of lesser magnitude were observed in systemic and pulmonary blood pressure. There was no death and one perioperative myocardial infarction. Myocardial temperature was monitored by needle thermisters and demonstrated homogeneous myocardial cooling in spite of the severity of CAD. Thus, preservation of cardiac function even in patients with critical and extensive CAD can be achieved by coronary sinus infusion of cardioplegia.