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Biomedical subjects

P Alstrup

Publications and source records attributed to P Alstrup.

At least 19 recordsLinked to original sources
PubMed1992

Long-term survival and complications in patients with mechanical aortic valves without anticoagulation. A follow-up study from 1 to 15 years.

In aortic valve replacement most centres prefer to use a mechanical valve for younger patients without special bleeding risks and treat the patient with lifelong anticoagulation. However, a few patients do not receive anticoagulation at all or have this withdrawn after some time. We examined the prognosis of 43 patients, 37 men and 6 women (mean age 52 years), who were treated with anticoagulation for approximately only 1 year (mean 13 months; range 4-35 months) after isolated aortic valve replacement with a mechanical valve. The mean follow-up period was 7 years and 3 months (1.5 months to 15 years and 10 months). After 5 and 10 years, 70% and 59%, respectively, were free of thromboembolic events, 65% and 55%, respectively, were free of valve-related events, and 87% and 83%, respectively, had survived. These figures correspond to linearized rates of thromboembolic events of 5.2%/pt-yr, valve-related events of 6.2%/pt-yr and death of 2.9%/pt-yr. We conclude that the best postoperative treatment in isolated aortic valve replacement with a mechanical valve is lifelong anticoagulation.

Adolescent↗
PubMed1991

Magnesium content of the human heart.

Although changes in the body's magnesium status have been linked to ischemic heart disease, sudden death and arrhythmia, there is as yet no recommended, established procedure for evaluation of magnesium homeostasis. We therefore explored the relationship between the magnesium content of the heart and that of serum, lymphocytes and skeletal muscle in 50 men undergoing cardiac surgery, using biopsies from the right auricula, right atrium and skeletal muscle and simultaneously drawn venous blood for measurement of lymphocyte and serum electrolyte concentration. Median magnesium values (mumol/g wet weight) were 7.42 (3.98-8.89) in skeletal muscle, 5.49 (3.44-7.66) in right auricula and 5.80 (2.60-7.53) in right atrium. The magnesium concentration in skeletal muscle was found to correlate with that in right auricula (r = 0.46, p less than 0.01) and right atrium (r = 0.43, p less than 0.01), whereas values in serum and lymphocytes showed no correlation with the heart's magnesium content. When myocardial biopsy is not available, skeletal muscle magnesium concentration seems to be the best predictor of the human myocardium's magnesium status.

Chlorides↗
PubMed1990

[Mediastinal infection following open heart surgery].

A retrospective investigation was undertaken of the mediastinal infections in patients submitted to cardiac surgery. A total of 1,763 patients participated in a period of 11 years from 1978 to 1988. All of the case records were reviewed for the occurrence of infections in the mediastinum and 24 patients (1.4%) were found to have had mediastinitis. Predisposing factors to mediastinal infections are reviewed. In all of the cases, treatment consisted re-thoracotomy with removal of all necrotic and infectious material. This was followed by primary closure over a retrosternal irrigation system which supplied an antibiotic solution for six days. In addition, oral antibiotics were administered on the basis of the findings on culture. The incidence of infection was found to be increased when the left internal mammary artery (LIMA) had been employed and in cases of combined cusp and coronary surgery. In 20 patients (83%), relevant culture findings were found from the mediastinal drain on an average of 2.5 days after the primary operation. These were reencountered in the mediastinum at rethoracotomy which was performed on an average of 15 days after the primary operation. This raises the question of the possibility of earlier intervention. The commonest microorganisms were micrococci and Staphylococcus aureus which together comprized approximately 83%. The antibiotic treatment routinely employed was 1 g meticillin four times daily. Five patients died (21%) and 19 patients were discharged. On follow-up examination, the sternum was stable and the scar healed. When infection in the mediastinum is suspected after cardiac surgery, early diagnosis and active surgical treatment are important. The closed method of irrigation drainage is recommended by the authors.

Aged↗
PubMed1990

Open-heart surgery in Jehovah's Witnesses.

During a 7-year period, 11 adult members of the religious sect Jehovah's Witnesses underwent cardiac surgery with extracorporeal circulation. No homologous blood transfusions were given. Blood-conserving procedures were employed, viz. initial collection of autologous blood, haemofiltration or processing (Cell Saver) of blood collected during extracorporeal circulation and reinfusion of shed mediastinal blood. The total perioperative blood loss averaged 1080 ml (15 ml/kg body weight), equalling 19% of total body blood volume. The mean haemoglobin on discharge from hospital was 11.0 g/100 ml. There was no perioperative mortality. Postoperative pulmonary function was good and there was no serious morbidity. Jehovah's witnesses with serious, surgery-necessitating heart disease can be offered operation comprising recognized blood-conserving procedures.

Blood Loss, Surgical↗
PubMed1988

Outbreak of infection with Achromobacter xylosoxidans from contaminated intravascular pressure transducers.

Achromobacter xylosoxidans contaminating transducers caused 15 cases of hospital infection. In the eight patients with bacteraemia the interval from inoculation to fever was an average of 6.6 days. All the infected patients recovered. Computerization of laboratory records allowed retrieval of previous isolates, and review of clinical records focused the problem on patients with cardiac and aortic diseases. The problem arose from the re-use of disposable equipment after disinfection with a benzalcone.

Aged↗
PubMed1988

Supraventricular tachyarrhythmias after coronary bypass surgery--a double blind randomized trial of prophylactic low dose propranolol.

In the present study 75 patients were double blind randomized either to receive 10 mg propranolol orally 4 times a day (35 patients) or a placebo (40 patients). Episodes of clinically important supraventricular tachyarrhythmias were recorded in the first 4 postoperative days. They appeared in 5 of 35 patients receiving propranolol and in 5 of 40 patients receiving placebo (no statistically significant difference). In conclusion this study indicates the need for further evaluation to clarify if low-dose propranolol or any other drug is effective in reducing the frequency of SVT in the early postoperative period after coronary artery bypass surgery.

Adrenergic beta-Antagonists↗
PubMed1987

Neutrophil lysosomal enzyme release and complement activation during cardiopulmonary bypass.

Complement activation and neutrophil degranulation were concomitantly studied during uncomplicated cardiopulmonary bypass (CPB). Plasma concentrations of complement factor C4, complement split product C3d, the neutrophil lysosomal enzyme elastase complexed with alpha 1-proteinase inhibitor (PI) and fibronectin were measured in 12 patients, C3d and elastase/PI increased significantly during CPB (volume-corrected results). The C3d rise was almost linear, whereas elastase/PI showed exponential increase. Mean elastase/PI and mean C3d concentrations at different times during CPB covaried closely. The study showed that during CPB neutrophil lysosomal enzyme release is intimately related to complement activation, although activation of the two systems may be caused by a common third activator within the extracorporeal circuit.

Adult↗
PubMed1986

[Vascular ring].

Explore the source record for details and available documents.

Aorta, Thoracic↗
PubMed1986

Survival in small cell lung carcinoma after surgery.

In a retrospective study of long term survival in patients with small cell carcinoma of the lung who had been treated purely by surgery, 1820 patients with lung cancer seen during the 15 years 1962-77 were reviewed and reclassified histologically and according to the TNM system. Of these patients, 924 had had resections and 284 exploratory thoracotomies. Cancer chemotherapy was not used in this period and radiotherapy was given only occasionally as palliative treatment. Seventy seven of the patients having pulmonary resections had small cell carcinoma (8.4%), and there were six survivors among the 71 with T1-2, N0-1, M0 tumours. The five and 10 year survival rates were both 12%. The histological specimens from these six patients with a small cell carcinoma who survived more than 10 years were re-evaluated and confirmed as small cell by an independent group of pathologists. It seems justified to conclude that a selected group of patients with small cell carcinoma should be treated by surgery alone without adjuvant chemotherapy, which might reduce the long term survival.

Carcinoma, Small Cell↗
PubMed1979

Two cases of anomalies of the bronchi combined with cancer in the lung.

Two cases of right-sided bronchus anomalies are described. These represent two groups, stated in the literature to be the commonest anomalies, viz. displaced apical bronchus and bronchus cardiacus superior. The first case was combined with an epidermoid carcinoma localized to the displaced apical bronchus and was found during surgery. In the second case, the anomaly was diagnosed by bronchoscopy and verified by thoracotomy with bilobectomy for adenocarcinoma. Anomalies of these types should be borne in mind in the bronchoscopic assessment of the operability and treatment of benign and malignant pulmonary disease.

Bronchi↗
PubMed1978

Bronchoscopy with normoventilation. Automatic ventilation with Sanders technique. A clinical investigation.

Forty six patients, who had to be subjected to diagnostic bronchoscopy under general anaesthesia (thiopental, pethidine, O2-N2O, suxamethonium) were ventilated using Wolf's injectomat (automated Sanders principle) in an attempt to find a setting for the apparatus that would provide normoventilation of the patient, independently of the diagnostic procedure. The first 24 patients were ventilated with the apparatus having a fixed setting: the latter being presumed to provide normo- or hyperventilation. This was confirmed and a steady state of PaCO2 was reached after ventilation for 10 min. This PaCO2 was well correlated with the vital capacity of the patients expressed factorially, in relation to the expected normal value. The investigation renders probable the observation that patients with a greatly reduced vital capacity (less than 50% of the normal value) can rarely be ventilated with the apparatus. On the other hand, a reduced FEV1 has little influence on the efficiency of the apparatus. The apparatus was adjusted in agreement with the above mentioned relation to vital capacity for the following 21 patients, in as much as the change in ventilation was carried out by a change in frequency, while the driving pressure of the apparatus and the inspiration time were maintained unchanged. Normoventilation was obtained in these patients independently of the fact that the bronchoscope was constantly open for the insertion of instruments.

Bronchoscopy↗