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Biomedical subjects

M V Inberg

Publications and source records attributed to M V Inberg.

At least 37 records · Page 2Linked to original sources
PubMed1981

Oxygen transport to tissue under normovolemic moderate and extreme hemodilution during coronary bypass operation.

Oxygen transport to tissue was studied in 12 patients undergoing coronary bypass operation under normovolemic moderate and extreme hemodilution. Normovolemic moderate hemodilution (15 ml per kilogram of body weight), carried out immediately after induction of anesthesia, decreased the mean hematocrit from 0.43 to 0.33. Simultaneously, the cardiac index and the left ventricular filling pressure increased slightly but the systemic oxygen transport was reduced by 20%. The subcutaneous tissue oxygen tension (PO2) was approximately 40 mm Hg after induction of anesthesia and underwent a transient increase during moderate hemodilution. During cardiopulmonary bypass and extreme hemodilution, the mean hematocrit declined to 0.16. Concurrently, the mean tissue PO2 fell sharply and reached a minimum of 14 mm Hg at deepest hypothermia. After decannulation and reinfusion of autologous blood, the PO2 rose to 30 mm Hg. In general, total-body oxygen consumption changed along with tissue PO2. Blood lactate concentration underwent a clear increase in the early phase of extracorporeal circulation and remained rather stationary thereafter. No perioperative myocardial infarctions were encountered, and each patient made an uneventful recovery.

2,3-Diphosphoglycerate↗
PubMed1981

Reduced lactate washout from the myocardium after combining St. Thomas I type cardioplegia with topical cooling of the heart. Myocardial oxygenation and performance after cardioplegia in coronary artery bypass grafting patients.

The myocardial oxygen extraction was diminished with a resulting coronary sinus blood oxygen saturation of 48 +/- 5 (SEM) %, as compared to the pre-bypass control level of 30 +/- 1%, two minutes after the ischaemic period in St. Thomas I type cardioplegia (CPL) with topical cooling of the heart during a coronary bypass operation. The myocardial oxygen extraction returned to prebypass levels after ten minutes of reperfusion following ischaemia and remained so after the bypass. The postischaemic myocardial lactate washout of the CPL-patients was compared to that of another group of coronary surgical patients, in whom intermittent ischaemia and topical cooling (IITC) were used for myocardial protection. It was found that the lactate washout two minutes after the single ischaemic period in the CPL-patients was far less than the lactate washout two minutes after each ischaemic period in the IITC-group. The greatest arterial-coronary sinus lactate difference in the IITC-group was -1.7 +/- 0.2 mmol/l and in the CPL-group -0.7 +/- 0.2 mmol/l. Cardiac performance (assessed by the CI-PCWP relationship) which was moderately depressed by the anaesthesia and surgery before bypass, returned gradually to the control level within 20 hours after operation. The present study shows that no apparent postischaemic abnormality in myocardial oxygen utilization develops when single dose cardioplegia, together with topical cooling of the heart, is used for myocardial protection, and that the accumulation of myocardial lactate during ischaemia is less during cardioplegia with topical cooling of the heart than during intermittent ischaemic with topical cooling for coronary artery bypass grafting operations.

Adult↗
PubMed1981

Haemodynamic effects of nitroglycerin in comparison with preload and sodium nitroprusside on patients after coronary bypass surgery.

To differentiate between the haemodynamic effects of intravenous nitroglycerin (NTG) and preload, left ventricular function curves were constructed for 10 patients with and without a steady NTG-infusion at left ventricular filling pressure (LVFP) levels of between 9 and 17 mmHg eight hours after coronary bypass grafting. The haemodynamic effects of NTG were compared with those caused by sodium nitroprusside (NP) at identical filling pressures. Although NTG as such decreased cardiac index (CI) (p less than 0.05), when systemic vasodilation was induced, CI was 18% greater with than without NTG at constant filling pressures (p less than 0.02). At identical LVFP, mean arterial pressure remained unchanged by NTG, whereas systemic vascular resistance was reduced by 16%. NTG augmented the left ventricular stroke work index (LVSWI) only in patients whose initial LVSWI was below 30 gm-m/m2 (a 20% increase, p less than 0.05). Although NTG relaxes the capacitance vessels more than the resistance vessels, its haemodynamic effects are far superior to the changes that can be induced by preload alteration alone. NTG enhances myocardial performance, especially if LVFP is kept balanced with the reduction of afterload. The increase in left ventricular pumping performance produced by NTG was 45% of the increase produced by NP at identical filling pressures. The results, however, indicate that NTG may affect the myocardial oxygen supply/demand ratio more favourably than NP.

Adult↗
PubMed1981

Oxygen transport and tissue oxygenation under moderate and extreme hemodilution during coronary bypass surgery.

Oxygen transport and tissue oxygenation were investigated in twelve patients undergoing coronary bypass surgery under normovolemic moderate and extreme hemodilution. Moderate hemodilution, that was carried out after induction of anesthesia, decreased the mean hematocrit from 0.43 to 0.33. Concurrently, the cardiac index and the left ventricular filling pressure increased slightly whereas the systemic oxygen transport declined by 20%. This was associated with elevated oxygen extraction. The subcutaneous tissue oxygen tension underwent a transient increase during moderate hemodilution. During cardiopulmonary bypass and extreme hemodilution the mean hematocrit declined to 0.16. Simultaneously, the tissue PO2 decreased clearly reaching its minimum at the deepest hypothermia. After coming off bypass and reinfusion of the autologous blood the tissue PO2 approached the preoperative levels. In general, total body oxygen consumption changed parallelly with the tissue oxygen tension. Lactate concentration in the mixed venous blood increased in the beginning of the extracorporeal circulation and remained rather stationary thereafter. All patients recovered normally without any perioperative myocardial infarctions.

Adult↗
PubMed1981

Complications of aortofemoral graft reconstructions.

A retrospective study of 162 patients with synthetic aortofemoral grafts was made. The total number of distal femoral anastomoses was 309. The indication for reconstruction was chronic occlusive arterial disease. Early mortality rate was 3.1%. There were only three primary thromboses. The incidence of deep infection was 1.2%. False aneurysms occurred in 12 distal anastomoses, a frequency of 3.9%. The mean time of occurrence of pseudoaneurysms was 4.6 years after surgery. No single etiologic factor responsible for false aneurysm formation was found. Considering the low complication rate, aortofemoral grafting can be regarded as suitable for extended reconstruction.

Aneurysm↗
PubMed1981

Tracheal stenosis after tracheostomy and after orotracheal cuffed intubation.

Tracheal stenosis occurred in 9 cases in a series of 812 tracheostomized patients, an incidence of 1.1%. Two additional stenoses had developed after orotracheal cuffed intubation. Two suprastomal, two stomal and seven infrastomal stenoses were confirmed. The stenosis was diagnosed within 10 weeks of extubation in 10 patients and 5 months after extubation in 1 case. The airway results were good after segmental resection and end to end anastomosis in 5 patients; satisfactory in 4 patients after various dilatation procedures and poor in 1 case after removal of granulation tissue. The mortality rate was 18%. One patient died on account of missed diagnosis and another of tracheo-innominate artery erosion with massive bleeding after tracheal resection. The present report indicates that the best airway results are achieved by segmental resection. Various dilatation procedures, however, produced satisfactory airway results and should be used as primary treatment when the stage of the stenosis makes resection inappropriate. When planning surgical treatment, X-ray examinations, tomography or tracheo-graphy are necessary for evaluation of the site and length of the stenosis. The stage of the stenosis can best be evaluated by tracheoscopy. The use of large, low-pressure thin-walled cuffs and avoidance of overinflation of the cuff are the most important measures for preventing the cuff-induced tracheal injury which may lead to tracheal stenosis.

Adolescent↗
PubMed1980

The use of oncofetal antigen FSA in discrimination between benign and malignant gastric ulceration.

Discrimination between histologically confirmed benign and malignant gastric ulcerations was studied, using an oncofetal antigen (FSA) as the parameter of malignant transformation. In chronic gastric ulcer FSA could be found in 54.2% as compared with 20.0% in duodenal ulcer patients. 91.1% of gastric cancers were FSA positive. A current epidemiological study on a non-selected population gives 8.8% FSA secretors. The study supports the earlier conception that chronic gastric ulcer must be considered a precursor of cancer, and indicates the need, especially in cases showing FSA secretion, for active surgical therapy or a long-term follow-up with endoscopic biopsies.

Adult↗
PubMed1980

Clinicopathological study of gastric cancers and precancerous states detected by fetal sulfoglycoprotein antigen screening.

A clinicopathological analysis is presented of gastric cancer cases detected in a mass screening trial in Finland, using the oncofetal antigen, fetal sulfoglycoprotein antigen, as a marker. The survey covered a population of 53,020 between the ages of 40 and 70, the percentage of participation being 74.8%. Of these participants, 3,508 subjects (8.8%) were found to be fetal sulfoglycoprotein antigen secretors, and among them 36 gastric cancers, one gastric carcinoid, and 10 tubular adenomas were detected. Both main histological types of gastric cancer, intestinal and diffuse, were represented. There were 15 early cancers. In addition, there were three widely spread superficial cancers. Because of early diagnosis, the prognostic view for these cases is clearly better than that found in the clinic by conventional means, curative resection being carried out in 28 cases (78%).

Adult↗
PubMed1979

Tissue gas tensions in the calf muscles of patients with lower limb arterial ischaemia.

O2 and CO2 tensions were measured in the gastrocnemius muscles of patients submitted for reconstructive arterial surgery due to obstructive arteriosclerosis (37) or abdominal aortic aneurysm (5). Four patients without signs of arterial ischaemia served as controls. Measurements were carried out by means of implanted silastic tonometers during breathing of air and 100% O2 and immediately after walking on a treadmill. Peripheral blood pressures in the ankles were recorded with a Doppler apparatus. Baseline tissue gas tensions showed no essential differences between the various groups of patients: intermittent claudication, pain at rest, praegangrene, abdominal aortic aneurysm and controls. In contrast, baseline ankle pressures correlated well with the severity of the disease. During breathing of oxygen, the smallest increases of muscle PO2 were observed in extremities with pain at rest or praegangrene and the highest responses were recorded in controls and aneurysm patients. Muscle PCO2 values showed no alterations during oxygen breathing. In physical exercise, muscle PO2 and PCO2 levels as well as ankle blood pressures remained unchanged in controls and patients with aneurysm but no claudication. However, in all groups with arterial ischaemia, the exercise test resulted in a profound fall of muscle PO2 and ankle blood pressure and an increase of muscle PCO2.

Aged↗
PubMed1979

Tracheo-arterial erosion complicating tracheostomy.

Tracheo-arterial erosion occurred in 5 cases out of 816 tracheostomized patients, i.e. an incidence of 0.6%. The complication is serious and is nearly always fatal. In one case, treatment was successful, but the other four patients died as a result of massive haemorrhage. On the basis of these cases the factors leading to this complication and the possibilities of treatment are discussed. In one case the main cause of innominate artery erosion was the low lying tracheostomy. This patient was rapidly resuscitated, the blood volume was restored, bleeding controlled by direct finger pressure on the innominate artery and an emergency operation was performed immediately. The innominate artery was excluded from circulation and bypassed with an autogenous venous graft. The patient recovered and is doing well after a follow-up of two and half years.

Adult↗
PubMed1979

The insulin test after vagotomy and antral resection or drainage. Stability and reversal of test response in repeated tests.

Repeated insulin tests were carried out on 118 patients after vagotomy and antral resection or vagotomy and drainage. The main indication for operation was gastro-duodenal ulcer. The test was performed in both the early (average 13.7 days after the operation) and late (average 3.3 years) postoperative phase. After vagotomy and antral resection, the proportion of Hollander-positive responses decreased from 21.1% in the early phase to 11.1% in the late phase, but after vagotomy and drainage, it increased from 32.1% to 57.1% (p greater than 0.05 in both). Changes of the test response from negative to positive and vice versa were seen after both types of operations. After vagotomy and antral resection, in tests with a change of the response from positive to negative (14.4%) there was a significant decrease in insulin-stimulated acid secretion. After vagotomy and drainage, there were more changes from negative to positive (28.6%), but no significant differences were seen in acid secretion values. Some tests showed a change from early positive to late positive (Ross & Kay). The significance and possible explanations for the changes are discussed in the light of acid secretion values.

Blood Glucose↗