Biomedical subjects
J Mulet
Publications and source records attributed to J Mulet.
Simultaneous revascularization of coronary and vertebral arteries.
Simultaneous vertebral artery and coronary artery bypass are reported in a patient with unstable angina who exhibited signs and symptoms of vertebrobasilar insufficiency while awaiting myocardial revascularization. The indications and various technical options for vertebral artery bypass are reviewed, and the techniques applied in this case are described. Observations on coronary and vertebral vein graft flow, with and without intra-aortic balloon counterpulsation, are presented. Late patency of the aortovertebral vein graft has been documented, and the patient has been free from symptoms of vertebrobasilar and coronary insufficiency for 5 years.
The advantages of open mitral commissurotomy for mitral stenosis.
Mitral commissurotomy is the treatment of choice for mitral stenosis. If this is not feasible, replacement of the valve becomes necessary. Open commissurotomy has been performed at Loyola University Medical Center, Maywood, Ill, in 105 patients since 1970. The mean age was 45 years. The indication for surgery was heart failure in 92 of the cases. Sixty of the patients were in class 3 of the New York Heart Association (NYHA) classification. Eighty-five underwent open mitral commissurotomy alone. This was not feasible in 42 patients scheduled for it who required valvular replacement. Twenty-five patients had a left atrial thrombus. Two patients died, one from aortic dissection and the other from acute infarction in the perioperative period. Ninety-eight patients are NYHA class 1 or 2 at present. Two patients required valvular replacement following the commissurotomy. The low mobidity and mortality with excellent long-term results support our contention that open mitral commissurotomy is the treatment of choice for mitral stenosis.
Hemorrhagic infarct following myocardial revascularization.
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Results of coronary artery surgery in patients receiving propranolol.
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Coronary revascularization in patients receiving propranolol.
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Letter: Propranolol and cardiac surgery.
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Surgical treatment of post infarction ventricular aneurysms.
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Correlation of histological changes produced in the gland during pancreatic stimulation with blood enzyme levels.
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Pseudoaneurysm following axillo-femoral by-pass: unusual presentation.
An unusual presentation of a false aneurysm following axillo-femoral by-pass is reported. The leak at the femoral anastomosis dissected the fibrous tissue along the Dacron tube, causing the peculiar appearance of this case. A brief review of recent literature regarding the etiology of this complication is included.
[Intrathecal synthesis of IgG evaluated using different formulas: importance of multivariate analysis in the diagnosis of multiple sclerosis].
INTRODUCTION: Synthesis of IgG is useful data for the diagnosis of multiple sclerosis, and different formulas, both direct and indirect, are used to quantify this. We analyze these formulas with the objective of finding whether certain combinations of them would give better results than the individual formulas on their own. PATIENTS AND METHODS: We studied the cerebrospinal fluid of 45 patients with neurological disorders and determined the results of the two formulas which are most effective, according to some studies (Reiber's formula and IgG index) together with a direct formula (IgG ratio) and another indirect formula (the 'classical' formula of Tourtellotte). RESULTS: The IgG index was, in general, the formula which best differentiated between patients with multiple sclerosis and persons with other neurological disorders. CONCLUSIONS: We found a tendency which supported the original hypothesis that it is possible to use combinations of formulas to obtain better results than individual formulas. This fact may serve as a basis for further studies in which different combinations are tested, including analytical and clinical data, and this may be of use in the diagnosis of multiple sclerosis.
[The arterial complications of closed injuries to the shoulder girdle].
After a period of time of 5 years, we made a review of all the patients registered at our Center. Eight cases of closed traumatism at the scapulohumeral belt, with vascular injury associated (0.2% of all closed traumatisms at this level registered in our center during this time) were reported. Six patients presented also an osteoarticular injury associated. Three different vascular injuries were showed: three cases of complete arterial section, two arterial contusions and a partial arterial section. From the two cases without osteoarticular injuries, one of them showed a complete section and the other presented an arterial contusion. Polytraumatic patients showed multiple osteoarticular injuries. We registered one fracture-luxation at the shoulder, 3 diafisaric humeral fractures, one humeral neck fracture, one clavicle fracture, one fracture-luxation at the cervical column and one simple luxation of the shoulder.
[Aneurysms of the abdominal aorta in patients on a permanent hemodialysis program].
Surgical approach of an aneurysm at the infrarenal aorta abdominal, in six patients with terminal renal failure and chronic hemodialysis, is presented. They were all men, and the middle age was 62 years. There were two hospital deaths and a latter death. At the moment of this report, the three survival patients are well, after a follow-time of 34.6 months. Treatment of this group of patients, as well as the literature concerning to this subject are reviewed.
Traumatic tricuspid regurgitation.
Tricuspid valvular insufficiency caused by blunt thoracic trauma may be clinically silent and imprecise. Diagnosis is often done by cardiac catheterization and two-dimensional echocardiography (2-DE); the latter may show abnormalities of the tricuspid leaflet motion. The surgical technique for its correction is still controversial. We report here the case of an eighteen year old man who was involved in a high-speed motorcycle accident. Seven months later, due to dyspnoea and fatigue, 2D-E examination revealed cardiac enlargement and severe tricuspid regurgitation. Surgery was indicated in order to repair valve incompetence. Reinsertion of the chordae tendineae at the anterolateral papillary muscle and annuloplasty was performed and ten months postoperatively, he is in good clinical condition and 2D-E control shows a trivial residual tricuspid insufficiency.
[Use of a new inotropic agent, enoximone, in heart surgery].
We report our experience with the use of enoximone in 5 patients with severely depressed preoperative myocardial function who underwent cardiac surgery. In patients 1 and 2, enoximone was administered as the inotropic of choice before cardiopulmonary bypass (CPB) and a substantial improvement of cardiac index was achieved; in these patients, enoximone administration after CPB permitted to overcome low cardiac output which persisted after high dose dobutamine in patient 1, and in patient 2 right ventricular contractility improved. In patient 3 the use of enoximone permitted the discontinuation of CPB, which had not been previously possible with the association of dopamine and dobutamine. In this patient, adrenaline perfusion improved the low cardiac output syndrome but resulted in poorly tolerated side effects. However, in patient 4 the administration of enoximone during pre-CPB did not improve in a reduction in filling pressures without an increase in the cardiac index because the patient was hypovolemic. In patient 5, the administration of enoximone permitted to interrupt the infusion of dobutamine and to reduce the dose of sodium nitroprusside, which had resulted in significant tachycardia, with increased myocardial contractility and a reduction of vascular peripheral and pulmonary resistances. We conclude that enoximone, single or in association with other inotropics, should be considered a drug of choice in patients undergoing cardiac surgery who develop a low cardiac output syndrome.
[Vascular injuries of the lower extremity].
Authors present their experience (32 patients affected by a traumatic femoropopliteal injury) with vascular traumatisms at the lower limb. Causes, treatment and successful results with the new technics and the early clinical management to the patients are commented.
[Splenorenal arterial shunt in the surgical treatment of renovascular hypertension. Lumbo-retroperitoneal approach].
Experience with the arterial shunt spleno-renal technics, made by lumbotomy and retroperitoneal approach into a group of 31 patients is reported. The medium age of patients was 44 years. Twenty patients were men and 11 women. All of them presented severe vasculo-renal hypertension and 13 had signs of renal failure. All patients underwent an arterial shunt spleno-renal, recording a case of postoperative death (rate of hospitalary mortality 3.2%). The 30 survivor patients underwent a follow-up as external patients during a medium period of 57.3 months. Renal failure improved after surgical procedure in 12 cases between the 13 patients with such disorder. Arterial pressure returned to normal levels in 24 cases, improved in 5 cases and failed in 1 case. This latter patient was re-operated, underwent a renal autograft with successful results. Historical evolution of such surgical procedure, as well as its indications and advantages, are commented. A bibliographic review about the subject is made.
Splenorenal arterial shunt in the treatment of renovascular hypertension. Approach by a lumbar-retroperitoneal incision.
In a period of 16 years, 29 consecutive patients were operated on for a splenorenal arterial shunt through a lumbotomy incision and a retroperitoneal approach. There were 18 males and 11 females with a medium age of 42 years. All cases had uncontrollable and severe hypertension for an average medium time of 48 months, 11 patients had variable degrees of renal insufficiency. The diagnosis was made utilizing standard methods including in all cases angiography of the abdominal aorta, celiac axis and renal arteries. One patient died after the operation due to intestinal infarction, the remaining have been followed for a medium time of 50 months. All patients improved or cured their renal insufficiency. The hypertension was cured in 23, improved in 4 and failed in 1, this latter patient was successfully autotransplanted. A precise exposition of the surgical technique is presented with comments about their advantages and indications. A review of the literature in surgical experience with the technique of splenorenal arterial anastomosis has been done.