Retrograde perfusion through the superior vena cava was used in 2 patients who were injured by massive air embolism occurring during open-heart surgery. They underwent hyperbaric treatment immediately following completion of the intracardiac repair. Both patients made complete recovery and were discharged, with no defects attributable to the incident.

Adult↗

PubMed1983

[Effects of cardioplegic solutions on coronary and myocardial ultrastructure. Preliminary note].

Ultrastructural changes of the myocardium and the coronary arterial endothelium were studied following cold perfusion with two different cardioplegic solutions (CPS) (the University of Alabama and the St. Thomas Hospital solutions), and with Krebs' solution as a control (CS). Guinea pig heart-lung preparations (HLP) were subjected to cardiac arrest by perfusion under CPS or CS (4 ml/Kg/min. X 4 min.). The duration of the cardiac arrest was 60 minutes, and additional amounts of cold solution were perfused after the first 30 minutes. In a second experimental group, HLP were reperfused with blood following 60 minutes of cardioplegic arrest, and maintained under full activity for the next 30 minutes. At the end of the study, specimens of coronary artery and myocardium were obtained and observed by Scanning (SEM) and Trasmission (TEM) electron microscopy. All the specimens were compared with additional specimens obtained from control hearts not subjected to cardiac arrest. The myocardial ultrastructure of hearts arrested with CPS was well preserved, whereas severe myocardial damage, consisting in the absence of glycogen granules, intracellular edema and myofibrillar contraction, was following CS-induced cardiac arrest. In contrast, perfusion with the St. Thomas CPS produced severe vascular damage, characterized by interruption of the endothelial layer, and bulging of endothelial cells into the lumen; no vascular changes were observed following cardiac arrest with CS or Alabama CPS. We conclude that the damage to the coronary arterial endothelium is not related to cardiac arrest, or to perfusion with cristalloid solution, or to myocardial damage, but appears to depend on the composition of the CPS.

Animals↗

PubMed1983

[Chronic brucellosis: diagnostic problems and case presentations].

Chronic Brucellosis is an infection disease, which is still of great clinical interest whether due to the difficulties of diagnosis involved or to the peculiar course of the illness. For this reasons, we have considered several cases of Chronic Brucellosis observed over a period of 10 years, which have presented particular problems of diagnosis. Furthermore, we have underlined the importance in the diagnosis, of intradermal reaction and the hemoreaction to the anamelitina injection. We propose therefore, to consider their diagnostic specificity by analyzing the results obtained.

Adolescent↗

PubMed1982

Pharmacokinetic and pharmacodynamic studies of oral clonidine in normotensive subjects.

The pharmacokinetics of clonidine and its relation to blood pressure response and side effects were studied after single oral doses of 75 micrograms, 150 micrograms and 250 micrograms in normotensive subjects. Following oral administration, the drug was absorbed rapidly after an initial lag time of 19-22 min and peak levels were reached between 2.4 and 2.9 h. Sampling over 48 h was necessary for accurate estimation of pharmacokinetic parameters. Post-peak plasma concentration declined in a monoexponential manner and the half-life of the elimination phase ranged from 9.0 to 15.1 h. Maximum plasma concentration (Cmax) and area under curve (AUC) increased proportionally with increasing doses. Clonidine produced significant reductions in the pulse rate and a dose dependent decrease in blood pressure. Clonidine (150 micrograms) also produced significant reductions in plasma catecholamine levels.

Adult↗

PubMed1982

Effects of cardioplegic solutions on conductive coronary arteries.

The effects of two cardioplegic solutions (CPSs) on isolated, superfused, bovine coronary arteries were compared with those produced by changes in composition of standard Krebs medium. High potassium, low sodium content or the addition of albumin produced vasoconstriction; high magnesium, high glucose content or the addition of mannitol led to vasodilatation. In most cases hypothermia slightly reduced vasoconstriction and enhanced vasodilatation. The action of the two CPSs is the result of the interaction of these basic effects. The results suggest that the vasomotor reactions of coronary arteries to CPS may affect the delivery of the CPS to the myocardium and exert a critical influence on successful cardioplegia.

Animals↗

PubMed1982

[Rhabdomyoma of the left atrium. A rare case of mitral valve congenital obstruction simulating hypoplastic left heart syndrome. Echocardiographic diagnosis].

The AA. describe the clinical, surgical and pathological features of a 13-days old infant with multiple cardiac rhabdomyomas diagnosed by two-dimensional echocardiography (2DE). The clinical picture simulated hypoplastic left heart syndrome (HLHS). 2DE showed a well developed left heart. The apical four chamber view disclosed a mass of echoes between the left atrium and ventricle, across the mitral valve. Another little mass of echoes was attached to the left surface of the ventricular septum. The other cardiac chambers and the great arteries were normal. These multiple intracardiac masses were interpreted as rhabdomyomas. The infant underwent an operation at the age of 21 days because of mitral valve obstruction and CHF. At surgery, a left atrial rhabdomyoma was found, that severely obstructed the mitral valve orifice. Although after resecting the tumour we felt that the obstruction was adequately relieved, the little patient died of pulmonary oedema one hour after surgery. At autopsy all the previously detected myomas were confirmed and a small additional one was discovered within the crista supraventricularis. Unexpectedly, the chordae tendineae of the mitral valve were extremely short. This anomaly, masked preoperatively by the rhabdomyoma, was probably the cause of the fatal postoperative mitral regurgitation.

Diagnosis, Differential↗

PubMed1982

[Value of a rational postoperative treatment protocol in cardiac surgery].

The postoperative course of 76 patients, who underwent valve and/or coronary surgery during a period of 18 months, was analyzed to determine the influence of the overall non-surgical management on the results of the operations. We used an approach (System analysis) based upon analysis of the cardiac, pulmonary, renal, general metabolic, neurologic, and gastrointestinal subsystems. The use of inotropic support and the incidence of postoperative arrhythmias were lower. The permanence in intensive care unit and the hospital postoperative course were shorter in comparison with all series of patients who had the same type of surgery over the same period in our unit. These results indicate that the postoperative care after cardiac surgery needs accurate analysis, precise deductions and effective treatment.

Cardiac Surgical Procedures↗

PubMed1981

[Hyperbaric oxygenation in cerebral air embolism occurring during open-heart surgery (author's transl)].

Hyperbaric oxygenation was used in two patients with extensive neurologic damage from cerebral air embolism occurring during open-heart surgery. One patient made a full recovery. The use of hyperbaric oxygenation produces the most direct relief of the mechanical obstruction and provides the definitive treatment for cerebral air embolism. First consideration must be given to the prevention of this complication, but once an embolus has occurred, hyperbaric treatment should be instituted promptly and early. Therefore every team engaged in open-heart operations should be familiar with the diagnosis and the therapy of air embolism.

Cardiac Surgical Procedures↗

PubMed1981

[Intensive care chart for postoperative treatment based on systems analysis].

Explore the source record for details and available documents.

Cardiac Surgical Procedures↗