[Renal idiopathic acidosis (type Albright) in 2 sisters with familial nephro-malformations. Studies on administration of hydrochlorothiazide].
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Acidosis, Renal Tubular↗
Biomedical subjects
G Teodori
Publications and source records attributed to G Teodori.
Intermittent antegrade warm blood cardioplegia in aortic valve replacement.
BACKGROUND: Intermittent antegrade warm blood cardioplegia (IAWBC) is a well established technique of myocardial protection for coronary artery surgery, with metabolic and experimental basis. METHODS: To evaluate its effectiveness in aortic valve replacement (AVR), we compared 171 consecutive patients who underwent first AVR using IAWBC (group A) with the last 100 consecutive patients who underwent first AVR using intermittent antegrade cold blood cardioplegia (IACBC) (group B). The endpoints considered were myocardial protection related (recovery of spontaneous rhythm, need for mechanical support, incidence of low-output syndrome, perioperative Q wave myocardial infarct, CK-MB levels, ventricular arryhthmias and lidocaine infusion requirement, cardiac-related deaths, and deaths any cause) and temperature perfusion related (bleeding, awaking time, time to extubation, and cerebrovascular accidents). RESULTS: Mortality was similar in both groups, but no patient in group A died for cardiac-related cause (0 vs 4, p < 0.01). More patients in group A recovered a spontaneous rhythm (144 vs 47, p < 0.0001). Incidence of low-output syndrome was higher in group B (16 vs 3, p < 0.0005), as well as ventricular arryhthmias incidence and need for lidocaine infusion (respectively 15 vs 2, p < 0.0001, and 10 vs 1, p < 0.0005). Awaking time was shorter in warm patients (2.5 +/- 2.5 hours vs 4.4 +/- 3.7 hours, p < 0.0005), as the extubation time (9.4 +/- 7.7 hours vs 13.5 +/- 11.7 hours, p < 0.0005) and bleeding (803 +/- 714 mL/24 hours vs 1051 +/- 1375 mL/24 hours, p < 0.05). As a consequence, the intensive care unit and the postoperative hospital stays were shorter in group A (32 +/- 27 hours vs 48 +/- 20 hours, p < 0.0005, and 7.2 +/- 3.1 days vs 11.3 +/- 5.4 days, p < 0.0001, respectively). CONCLUSIONS: IAWBC provides lower cardiac-related mortality and morbidity in patients who undergo AVR in comparison with IACBC.
Aged↗
Reoperative coronary surgery with and without cardiopulmonary bypass.
BACKGROUND: Reoperative coronary surgery without cardiopulmonary bypass (CPB) was analyzed to evaluate the technical profile of the patients studied and the benefit from this technique. MATERIAL AND METHODS: From November 21, 1994 to May 20, 1999, 166 patients had reoperative coronary surgery, 112 patients (Group A) with and 54 patients (Group B) without CPB. Median sternotomy was used in all the patients in Group A and in 13 patients in Group B. The remaining had a LAST (37 patients) or a posterolateral thoracotomy (4 patients). RESULTS: Anastomoses per patient were 2.4 +/- 0.8 in Group A and 1.1 +/- 0.4 in Group B (p < 0.001). When a single graft was needed, CPB was not used in 82.8% of the cases. However, when more than one graft was required, CPB was not used in only 5.6% of the cases. When a single territory had to be grafted, CPB was not used in 76.6% of the patients. If two territories were grafted, only 6.8% of the patients were in Group B, whereas no patient who needed a graft in all the three territories was in Group B. Overall mortality was 3.6% cerebrovascular accident (CVA) and acute myocardial infarction (AMI) incidence were 0.6% and 1.8%, respectively, and were similar in both groups. Incidence of early major events (overall 8.4%) was not different between groups. CONCLUSIONS: The primary endpoints (mortality, CVA rate, and AMI) were similar in both groups, but patients in Group B were less complicated. However, patients in the two groups were not the same, as the technical profile was quite different. As our results were similar to those obtained in the first operation, we think that consideration of different surgical possibilities, depending on territory to be grafted, will improve the results of redo coronary surgery, making them similar to those obtained in the first operation.
Cardiopulmonary Bypass↗
Surgery of type A acute aortic dissection with Gelatine-Resorcine-Formol biological glue: a twelve-year experience.
Gelatine-Resorcine-Formol Glue has been proposed to reinforce the tissues during surgery of type A acute aortic dissection. From January 1977 to December 1988, 105 patients were operated on in emergency. The ascending aorta was replaced in all patients and the aortic stumps were reinforced with the GRF glue before suturing a Dacron prosthesis. In 29 patients the repair extended to the aortic arch. In these cases, the distal repair was carried out under circulatory arrest and profound hypothermia (21 patients) or carotid perfusion (8 patients). The aortic valve was replaced in 20 patients (20%). Four patients died during surgery and 20 patients died during the postoperative course for an overall hospital mortality rate of 23%. Average follow-up is 51 months (range: 3 to 130 m). Three patients were lost to follow-up. Seven patients died 3 months to 10 years postoperatively. Eleven patients had to be reoperated upon for AVR (3 patients), CABG (1 patient) and recurring or evolving dissecting aneurysm (8 patients). The reoperations resulted in 2 deaths. The remaining 69 patients are in good or fair clinical condition. Postoperative angiograms, CT scans or NMR, have shown a satisfactory repair in all documented patients but a persisting dissection beyond the prosthesis in 75% of them. The GRF glue allows easier and safer repair of type A acute dissection. It has permitted the extension of the repair to the aortic arch whenever necessary.
Acute Disease↗