Biomedical subjects
Publications and source records attributed to K Hiotakis.
Two patients with myasthenia gravis were ventilated postoperatively using propofol and piritramide for analgosedation. Under this treatment the patients' ability to cooperate and communicate was maintained and allowed a patient-controlled readjustment of pyridostigmine dosage and weaning from the respirator.
Antithrombin III activity was evaluated preoperatively, intraoperatively and postoperatively in the plasma of 54 children with congenital heart disease undergoing open heart surgery. The patients were divided into an acyanotic and a cyanotic group. A comparison of these two groups indicated a significantly decreased AT III activity in cyanotic children as compared to acyanotic children throughout the perioperative phase. AT III levels decreased in the cyanotic group from 71.9 +/- 3.77% preoperatively to 61.5 +/- 2.15% (p less than 0.01) postoperatively and rose to 69.6 +/- 2.36% (p less than 0.01) on the first and to 78.9 +/- 2.24% (p less than 0.01) on the second postoperative day. In the acyanotic group AT III levels decreased from 84.3 +/- 1.98% to 73 +/- 2.97% (p less than 0.01) postoperatively and increased to 78.5 +/- 2.96% (p less than 0.01) on the first and to 90.2 +/- 3.06% on the second postoperative day. A few acyanotic patients, too, showed decreased values of AT III. However, they were never found to be as low as in the cyanotic group. Preoperative AT III values as well as the severity of underlying disease, the success of corrective surgical treatment and postoperative complications proved to be the predominant influencing factors of AT III activity.
From April 1980 to June 1985 7.3% (15) of 205 PTCA-treated patients required emergency operations. The spectrum of PTCA-induced ischemia included anginal pain alone (2/1, 13%) or transmural infarction (13/15, 87%) with hypotension (8/15), cardiac arrest (4/15), and severe cardiogenic shock (3/15, 20%). 14 patients underwent saphenous-vein-bypass-graft operation (ACBG) with a mean of 1.7 grafts performed per patient. The average time from onset of symptoms to completed revascularisation was 166.5 (110 to 290) minutes. Inspite of the use of IABP one hospital death (6.6%) occurred prior to the institution of ECC in a patient with previous ACBG surgery. No late death was observed during a mean follow up of 11.1 (1 to 33) months with 13/14 patients free of anginal symptoms. Retrospective assessment of postoperative serum enzyme levels of CPK and CK-MB showed evidence of myocardial infarctions in 7/14 (50%) patient. The incidence on ECG of Q-wave infarctions was 35,7% (5/14). With the exception of one patient, IABP was not used pre- or postoperatively. In patients with acute myocardial ischemia following PTCA-attempts immediate restoration of myocardial blood flow can stabilize left ventricular function and reduce the incidence and size of myocardial infarctions. The availability of emergency ACBG-surgery and facilities remain an important prerequisite of PTCA-programs due to the unpredictable natural course of PTCA-induced myocardial ischemia.
Patients who are Jehovah's Witnesses present a special problem when undergoing open heart surgery since they refuse blood transfusion. We performed 15 open heart operations for both acquired and congenital heart disease using a modified version of isovolaemic haemodilution and bloodless prime technique of extracorporeal circulation. Two patients died. One death might have been at least indirectly related to the regimen which excludes blood substitution. We believe that our experience demonstrates the feasibility of open heart procedures in Jehovah's Witnesses, although the mortality risk is increased in these patients.
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Between 1970 and 1978 135 infants with congenital malformations underwent operations due to congestive heart failure, progressive pulmonary hypertension, and severe cyanosis. Of them, 63% were acyanotic; 68% of all operations became necessary during the first 6 months of life. The late mortality rate was 5% and the hospital mortality rate 17%. A remarkably higher operative risk was found during the first 6 months of life. Ligation of patent ductus arteriosus as the most common lesion was done with a mortality rate of 2.5% which is comparable to the risk of late repair in childhood. Pulmonary artery banding could be performed in all acyanotic malformations with a mortality rate of 17% and of 12.5% in isolated VSD (including debanding and VSD closure in several cases). Coarctation of the aorta was corrected with a overall mortality rate of 26%. Because of a recurrence rate of 20%, the authors think that operations are only indicated in symptomatic cases of coarctation. In complex cyanotic malformations, a higher operative risk was observed in both pulmonary artery banding (38%) and shunt operations (44%). If surgical treatment is necessary, the earlier, the better.
In 26 adult patients arterial pO2 was measured continuously with intra-arterial pO2 electrodes over 24 hr after cardiac surgery. The effects of nitroglycerin, Thalamonal and change of body position were investigated. Hyperoxygenation with 100% O2 was tested. The following results were obtained: 1. pO2 and drugs: i.v. nitroglycerin and Thalamonal lead to a decrease in pO2, which occurred with a delay after the blood pressure fall. - 2 pO2 and body position: In the majority of patients with mitral stenosis and in one patient with acute myocardial infarction we found increased pO2 values with 40 degrees head up tilt as compared to supine position. - 3. Hyperoxygenation: The peak values of pO2 after a F1O2 of 1.0 were reached between 6-18 min, with a gradual fall afterwards. The relationship of measured pO2 values, cardiac disease and surgical procedures is discussed.
Two cases of severe pancreatitis and deep shock are reviewed. In the first case measures to relieve the shock state were unsuccessful. Laparatomy was, therefore, performed and revealed acute haemorrhagic pancreatitis with diffuse purulent peritonitis. After insertion of a drain and irrigation of the abdominal cavity the incision was closed. Twice-daily lavage of the pancreatic fistula via a drain was continued until, after 5 months, the fistula healed spontaneously. In the second case intensive therapy succeeded after 9 days in controlling the acute stage of the disease. Conservative treatment was continued for 6 weeks and the patient was then discharged from hospital. He was re-admitted 3 weeks later because of suspicious clinical and biochemical signs of obstructive jaundice. Laparatomy disclosed inflammatory stenosis of the distal portion of the common bile duct and Vater's papilla and also a pancreatic pseudocyst the size of a child's head. The latter was removed and a drain was inserted. There were no postoperative complications.
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