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Biomedical subjects

H Dajee

Publications and source records attributed to H Dajee.

9 recordsLinked to original sources

Haemodynamic effects of verapamil administration after large doses of fentanyl in man.

Thirteen patients with good left ventricular function undergoing coronary artery revascularization were studied to determine the cardiovascular effects of verapamil, 75-150 micrograms X kg-1, after a large dose (100 micrograms X kg-1) of fentanyl, with pancuronium for muscle relaxation. The patients were continued on their usual cardiovascular medications until the time of surgery, which included nitrates, beta adrenergic blockers, and nifedipine. Anaesthesia with fentanyl was associated with decreases in mean arterial blood pressure, systemic vascular resistance, left ventricular stroke work index, and circulating catecholamine levels. Mean values were not further changed by verapamil, but individual patients had additional modest decreases in blood pressure and systemic vascular resistance. Cardiac index, however, was well maintained. Plasma catecholamines remained depressed after verapamil under the study condition. Thus, in patients with good left ventricular function, clinically relevant doses of verapamil were well tolerated even in the presence of an anaesthetic that included large doses of fentanyl, with suppression of circulating catecholamine levels.

Adult

Surgical correction of pulmonary atresia and ventricular septal defect with large systemic-pulmonary collaterals.

A two-stage surgical procedure was performed in a young adult with pulmonary atresia and a ventricular septal defect with upper lobe pulmonary artery flow from confluent central pulmonary arteries and lower lobe pulmonary blood flow originating from two large systemic-pulmonary collaterals. Initially a Dacron Y graft was anastomosed between the ascending aorta and the collaterals and a graft to the left pulmonary artery. At the second operation, continuity was established between the right ventricle and the Y graft by using a valved Dacron conduit and the ventricular septal defect was closed.

Adult

Pulmonary chondroma, extra-adrenal paraganglioma, and gastric leiomyosarcoma: Carney's triad.

The triad of pulmonary chondroma, extra-adrenal paraganglioma, and gastric leiomyosarcoma has been reported in five patients, all young women. The association of tumors apparently constitutes a syndrome. This paper describes the sixth affected patient, also a young woman, draws attention to the frequency of thoracic paraganglioma in the syndrome, and notes that the pulmonary cartilaginous lesion has frequently been misinterpreted as pulmonary hamartoma. Early exploration of the chest is indicated not only to rule out the possibility of metastatic gastric tumor but also to search for paragangliomas.

Calcinosis

Analysis of 29 cases of pancreatic pseudocyst treated surgically.

Twenty-nine cases of pancreatic pseudocyst requiring operative management were reviewed to determine the method of diagnosis and to analyse the results of internal and external drainage. Pain and the presence of an intra-abdominal mass were the two most common clinical features in the 29 patients. Serum amylase values were elevated in 50%. Diagnosis was confirmed by barium contrast roentgenography and abdominal ultrasonography in 60% of cases. Endoscopic retrograde cholangiopancreatography was a valuable diagnotic technique in four problem cases. The most common form of surgical treatment was internal drainage of the pseudocyst (18 patients). Th mortality resulting from internal drainage was 6% and there was an overall complication rate of 44%. External drainage was carried out in seven patients (six required emergency operation). The mortality associated with external drainage was 43% and the overall complication rate 86%.

Adult

Traumatic abdominal hernia.

Traumatic abdominal hernias are rare, but are easily missed in patients with multiple injuries in whom life-threatening injuries take precedence. A case is reported in which difficulty was experienced with closure of the abdominal wall; at re-exploration a diagnosis of abdominal hernia was made, and a tear in the retroperitoneum with herniation of 2 feet of small bowel on the right side of the abdomen found. The hernia was reduced and the patient's recovery was uneventful. In all cases of celiotomy for trauma, complete exploration of the abdomen should be performed before closure to assure normal anatomic relationships of all structures.

Abdominal Injuries

Aortocoronary bypass for critical stenosis of the left main coronary artery.

Over a 2-year period 33 patients with symptomatic stenosis (greater than 75%) of the left main coronary artery underwent aortocoronary bypass. Intra-aortic balloon counterpulsation was used preoperatively in only two patients as a therapeutic measure for medically unstable angina. There were no operative deaths. Follow-up study 3 to 27 months (mean 13.3 months) after operation revealed one death. Twenty-two patients were free of pain. The authors conclude that aortocoronary bypass surgery for severe stenosis of the left main coronary artery can be safely accomplished, without prophylactic use of intra-aortic balloon counterpulsation in the majority of cases, with an acceptable operative mortality and morbidity.

Adult

Seat belt aorta: acute dissection and thrombosis of the abdominal aorta.

Aortic trauma mainly involves the thoracic aorta (95%), while the abdominal aorta is infrequently involved (5%). Of growing interest is the role of seat belts in abdominal aortic injuries. Although seat belts are known to cause injuries to the abdominal viscera, they rarely produce aortic trauma. We report here an acute dissection with thrombosis of the abdominal aorta leading to complete peripheral occlusion as a result of lap-type seat belt injury. The two previously reported cases of similar injuries which resulted in incomplete occlusion are reviewed. A hypothesis for the causal mechanism of these injuries is described. The authors also stress careful follow-up of all patients with seat belt injuries since other intra-abdominal vascular injuries may be present.

Accidents, Traffic

Assessment of the isolated right atrium as a pump.

The ability of the hemodynamically isolated dog right atrium to pump against a resistance equivalent to normal pulmonary artery pressure was tested in an in vivo preparation. At a preload of 10 mm. Hg, the right atrium reached a peak systolic pressure of 18.2 mm. Hg (+/- 1.3 S.E.M.) against an afterload of 12 mm. Hg, but it could eject a flow only equivalent to 53 percent (+/-6) of the dog's cardiac output (n = 6). At a preload of 15 mm. Hg, a peak systolic pressure of 21.5 mm. Hg (+/- 0.8) was recorded against an afterload of 17 mm. Hg, but again, only 55 percent +/-5) of the dog's cardiac output was ejected. It appears that the cardiac output from the nonhypertrophied right atrium is limited by the strength of the right atrial contraction and the physiological limits imposed by the venous driving pressure.

Animals

Friedreich's disease--a family study.

Friedreich's disease occurring in 4 male siblings in a sibship of seven caused cardiac and neurological abnormalities and one twin of an affected member died in cardiac failure; at autopsy characteristic pathological features of Friedreich's disease were demonstrated in the nervous system and heart. One female sibling had a patent ductus arteriosus which was treated surgically and a continuous murmur was present in another sister but cardiac catheterization in childhood had been normal.

Adult