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Biomedical subjects

R Lorusso

Publications and source records attributed to R Lorusso.

At least 55 records · Page 3Linked to original sources
PubMed1995

Beat-to-beat analysis of left ventricular pressure-volume relation and stroke volume by conductance catheter and aortic Modelflow in cardiomyoplasty patients.

BACKGROUND: Since the clinical introduction of dynamic cardiomyoplasty, a discrepancy has been observed between unchanged measurements of cardiac function and improved clinical outcome. METHODS AND RESULTS: We performed a beat-to-beat analysis of cardiac performance at rest in nine cardiomyoplasty patients 6 to 24 months after operation. Conductance and micromanometer catheters were placed in left ventricle and aorta and used for measurements over a 15-second period, during which the wrapped latissimus dorsi (LD) muscle was stimulated for 10 seconds in a 1:2 synchronization mode followed by a 5-second period without LD stimulation. The synchronization delay between start of the QRS complex and the LD contraction was changed from 4 up to 125 ms at the patient's clinical stimulation strength and at an increased supramaximal amplitude. Comparing the LD assisted period to the unassisted period, at the clinical settings no significant changes in stroke volume (SV) as measured by the conductance technique and the aortic Modelflow technique were observed. A significant (P < .05) rise in left ventricular end-diastolic pressure (LVEDP) was observed directly after the assisted 10-second period. The peak ejection rate (PER) of left ventricular volume increased (P < .05), with a mean of 28 +/- 23% during the LD stimulated beats. At the patient's individual best setting, SV of the stimulated beats increased (P < .01) by a mean of 20 +/- 15%. Systolic aortic pressure increased (P < .01) by a mean of 7 mm Hg, peak negative dP/dt increased (P < .01), and PER increased, with a mean of 68 +/- 24% (P < .01). LVEDP was similar in stimulated and unstimulated beats and increased (P < .05) in the nonpaced 5-second period. The delay for the best setting ranged from 25 to 125 ms; the stimulus strength was 1.5 to 3 V higher than the clinical setting. At the patient's individual worst setting, SV remained unchanged and PER was higher, with a mean of 30 +/- 25% (P < .05). The worst setting was observed at the 1.5- to 3-V-higher stimulus strength; in six patients, it was at a short delay (4 to 25 ms) and in three patients, at the longest delay (100 to 125 ms). CONCLUSIONS: By the left ventricular conductance catheter and aortic Modelflow methods, improvement in cardiac function by dynamic cardiomyoplasty was demonstrated in this patient group. The synchronization interval, stimulus strength, and stimulus duration appeared to be critical for obtaining optimal improvement.

Aged↗
PubMed1995

Impact of autologous blood predonation on a comprehensive blood conservation program.

Preoperative autologous donation has been shown to be a highly effective measure in reducing homologous blood use in cardiac operations. The aim of our study was to verify the effectiveness of this procedure and to see whether it is compatible with a comprehensive blood conservation program. Three hundred forty-eight patients (group 1) donated an average of 657 +/- 199 mL of blood before open heart operation, whereas 344 patients (group 2) without autologous predonation were used as a control. The two groups were compared with regard to homologous blood use and the possibility of applying other blood conservation measures. Homologous transfusion rate in group 1 was 12.6%, whereas in group 2 it was 46% (p < 0.001). Patients with three units of predonated autologous blood had a transfusion rate of 0.8% (p < 0.001 compared with group 2). In group 1, acute normovolemic hemodilution was accomplished in a lower number of patients and with a lower average withdrawal (338 +/- 102 versus 403 +/- 145 mL; p < 0.001). Other blood conservation measures such as the return of mediastinal drainage and use of residual blood of extracorporeal circulation were applied with similar results in both groups. In our experience, preoperative autologous donation was compatible with the application of other blood conservation measures, but acute normovolemic hemodilution was achieved in a lower number of patients. Preoperative autologous donation proved to be a highly effective method for reducing banked blood use and therefore homologous blood exposure during and after cardiac operations.

Adult↗
PubMed1995

Right latissimus dorsi cardiomyoplasty in diaphragm eventration and cardiac malposition.

Cardiomyoplasty recently has been introduced as a surgical therapy for long-lasting cardiac dysfunction in selected patients. We report the case of a patient affected by chronic heart failure, unresponsive to maximal medical therapy, with concomitant posttraumatic injury of the left phrenic nerve, left diaphragm eventration, and cardiac malposition (right displacement). In view of the progressive deterioration of the cardiac function, cardiomyoplasty was recommended, and the right latissimus dorsi muscle was used to perform the wrapping procedure. A 6-month follow-up showed significant functional, as well as hemodynamic, improvements in addition to a reduction in medical therapy.

Cardiomyopathy, Dilated↗
PubMed1995

Surgical management of left ventricular free wall rupture after acute myocardial infarction.

Left ventricular rupture after acute myocardial infarction occurs more often than suspected and diagnosis is rarely made before death. Left ventricular rupture has been reported to contribute to the overall in-hospital mortality after acute myocardial infarction in up to 24% of cases and to be present in 40% of patients dying within the first week after infarction. Only prompt diagnosis and aggressive surgical treatment can be lifesaving under these circumstances. Between February 1991 and August 1993 five patients underwent emergency operation for left ventricular rupture after acute myocardial infarction using exclusively transoesophageal echocardiography as a diagnostic tool. All patients had evidence of cardiac tamponade and electrocardiography showed signs of anterolateral acute myocardial infarction in one, inferolateral acute myocardial infarction in three and lateral acute myocardial infarction in one. In two cases the infarcted area was debrided and an interrupted pledgetted 2/0 polypropylene suture was placed from inside of the ventricle outward to the epicardial surface and then through the pericardial patch. In the other three cases an original technique was used: an autologous glutaraldehyde-stiffened pericardial patch was sealed over the infarcted area using fibrin glue and fixed with running suture on the surrounding healthy myocardium. One patient died in the operating room because of low cardiac output syndrome which was possibly the result of an excessively extended area of infarction. Left ventricular rupture is a catastrophic complication of acute myocardial infarction and prompt diagnosis with transoesophageal echocardiography followed by emergency operation can be lifesaving.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Developments in surgical techniques for coronary revascularization.

The wider application of arterial conduits represents a current trend in myocardial revascularization. More complex and demanding surgical techniques are being developed as alternatives to traditional grafting procedures, in order to permit total arterial revascularization in patients with diffuse coronary artery disease. The rationale behind this strategy is the expected higher long-term patency rate of arterial conduits as compared with vein grafts. Avoidance of proximal anastomoses is another argument in favor of coronary revascularization with arterial grafts, particularly in patients with atherosclerotic changes in the ascending aorta. Although the reported operative results are good, total arterial revascularization in multivessel disease is a complex procedure, and serious perioperative complications are possible. In planning the revascularization strategy, therefore, the surgeon should take into account age, clinical condition, coexisting medical problems, coronary anatomy, and left ventricular function. The method of myocardial revascularization is an important aspect of the surgical procedure and plays a major role in the outcome of the operation in the presence of severe left ventricular dysfunction or when the operation requires prolonged ischemic times. To avoid the inevitable damaging effects of cardiopulmonary bypass and aortic cross-clamping, myocardial revascularization is carried out without extracorporeal circulation. This technique should be part of the armamentarium of the cardiac surgeon and should occasionally be considered in patients who have serious coexisting medical problems or severe left ventricular dysfunction.

Age Factors↗
PubMed1995

Bacterial infection of cardiomyostimulator abdominal pocket following cardiomyoplasty procedure: an original approach to preserve synchronous muscle stimulation.

Dynamic cardiomyoplasty (DC) represents a new technique in therapy for refractory heart failure. So far, DC has been applied to more than 500 cases worldwide but reports on postoperative complications and related management are still lacking. We present the case of a patient suffering from refractory chronic heart failure for which the DC procedure was applied also accompanied by the complication of an infection process at the cardiomyostimulator pocket that began 2 weeks postoperatively. Following trials with several unsuccessful conservative approaches, an original procedure was developed to temporarily retain the implanted stimulation system, while at the same time maintain the synchronous contractions of the wrapped muscle. Finally, reimplantation of the pacing system was achieved with a low-risk procedure, effective cardiac assistance was preserved, and the infection process was arrested 3 years following DC.

Cardiac Output, Low↗
PubMed1993

Long-term follow-up (12 to 35 weeks) after dynamic cardiomyoplasty.

OBJECTIVES: To obtain information on the long-term effects of dynamic cardiomyoplasty on hemodynamics and muscle histology, this surgical method was evaluated in goats. BACKGROUND: Dynamic cardiomyoplasty has been introduced as a new method to treat patients with severe cardiac failure. METHODS: In 24 goats, the left latissimus dorsi muscle was wrapped around the heart. The muscle was then subjected to progressive electrical stimulation. In 16 goats, invasive transesophageal Doppler echocardiographic measurements and histologic evaluation of the latissimus dorsi muscle were performed at > or = 12 weeks after the wrapping. RESULTS: Only two goats showed an increase in aortic and left and right ventricular pressures concomitant with increased aortic flow during latissimus dorsi muscle stimulation both before and after induction of cardiac failure using imipramine. This was accompanied by a preserved latissimus dorsi muscle structure and nearly complete transformation to type I muscle fibers. The remaining 14 goats showed extensive lipomatosis in the latissimus dorsi muscle, with severe intimal hyperplasia and proliferation of smooth muscle cells in the walls of the thoracodorsal artery and its branches. An increase in endoneural and endomysial connective tissue was observed, with some goats showing destroyed nerve branches near the electrodes. These findings differed from those observed after long-term electrical stimulation of goat latissimus dorsi muscle in situ. CONCLUSIONS: Dynamic cardiomyoplasty is of use in the treatment of severe heart failure if the histologic structure of the wrapped latissimus dorsi muscle remains intact. Long-term results in goats suggest that the current approach used in dynamic cardiomyoplasty may lead to deterioration of the wrapped muscle.

Animals↗
PubMed1993

Dynamic cardiomyoplasty as an effective therapy for dilated cardiomyopathy.

Nine male patients with dilated cardiomyopathy unresponsive to maximal medical therapy were submitted to dynamic cardiomyoplasty according to the technique described by Carpentier and Chachques, and preliminary postoperative results are reported. Seven patients were in New York Heart Association (NYHA) Class III and two were in intermittent Class IV. The mean age was 56 years (range 51 to 61 years). Preoperative ejection fraction (EF) by multiple gated acquisition ranged from 14% to 28% (mean 20.7%). No additional surgery was performed. Transesophageal echocardiographic monitoring was used during surgery to guide the wrapping procedure. There was no operative mortality. There was one early death (1 month). One late death (sudden death) occurred 7 months after surgery despite significant clinical improvement. Follow-up ranges from 2 to 16 months. Six patients were submitted to hemodynamic evaluation from 4 to 6 months after surgery by transthoracic and transesophageal echo-Doppler assessment. Effective latissimus dorsi support was clearly documented in all patients by comparing postoperative basal hemodynamic values (Cardiomyostimulator [Medtronic, Inc.] switched off) and data obtained during assisted beats (EF increased from 19.4% +/- 8.6% to 32.6% +/- 13.8%, p = 0.043; and stroke volume increased from 51.6 +/- 20.6 mL to 63.0 +/- 22.0 mL, p = 0.014). All patients who completed the latissimus dorsi training protocol were in NYHA Class I or II. A significant reduction in postoperative medical therapy was achieved in all patients. Our preliminary results confirm that the cardiomyoplasty procedure is to be considered a safe and valuable mean for treating selected patients with dilated cardiomyopathy refractory to maximal pharmacological treatment.

Assisted Circulation↗
PubMed1991

Postinfarction left ventricular free wall rupture: original management and surgical technique.

A case of postinfarction left ventricular free wall rupture is successfully treated. Prompt diagnosis was provided by echocardiography and an emergency operation was carried out. Following sternotomy, hemodynamic stabilization was obtained by gradually evacuating blood from the pericardium, while the femoral vessels were cannulated and the extracorporeal circulation was established. An autologous glutaraldehyde stiffened pericardial patch was sealed over the infarcted area using fibrin glue and fixed with a running suture on the surrounding healthy myocardium.

Echocardiography↗
PubMed1991

A new method to select stimulus strength after cardiomyoplasty.

At present, there is no technique available for the determination of optimal stimulus strength in patients after cardiomyoplasty. To stimulate the latissimus dorsi (LD) muscle, we implanted Itrel stimulators in two goats and cardiomyostimulators in three goats following the routine cardiomyoplasty procedure. During the following 3 months, these LD muscles were conditioned at 2.5-4.0 volts (V). After conditioning, LD muscle shortening was measured on x-ray films using the distance between two stimulation electrodes as references. LD muscle shortening increased rapidly at higher stimulus strength and reached 13% +/- 2% at 2.0 V. Shortening was calculated in one patient at 4, 6, and 9 weeks following surgery. The increase in the number of pulses per burst (2, 3, and 6, respectively) had a positive effect on muscle shortening between the two stimulation electrodes (10%, 14%, and 20%, respectively). Also, muscle shortening was measured between two clips attached to the distal part of the LD muscle. Muscle shortening in the area wrapped around the left ventricle was 15% after 9 weeks. In a second patient, shortening between the electrodes was 16% at 14 months after surgery, and distal muscle shortening was 11%. We concluded that optimal stimulation after cardiomyoplasty could be detected more accurately by measurement of LD muscle shortening using the stimulation electrodes or surgical clips as markers.

Animals↗
PubMed1985

Ultrasonic findings in polycystic ovarian disease.

The uterus and ovaries of 50 patients with polycystic ovarian disease (PCOD) and 30 eumenorrheic women were studied with a real-time ultrasound mechanical sector scanner. Uterine and ovarian volumes (UV and OV) and the OV/UV ratio were calculated, and ovarian morphology was classified as prevalently solid and cystic. Both ovaries were displayed in 44 of the PCOD and in 25 of the normal patients and appeared bilaterally solid, cystic, or with different morphology, respectively, in 43.2%, 47.7%, and 9.1% of cases in the former group and in 76%, 20%, and 4% in the latter group. Statistically significant differences between normal and PCOD patients were found in OV, UV, and OV/UV ratio. Bilaterally enlarged ovaries with multiple tiny cysts, the classic ultrasonographic picture of the polycystic ovary, were found in only 16 (36.3%) of the PCOD cases, while 34 (77.3%) had an OV/UV ratio greater than 1 standard deviation above the mean. Four ultrasonographic ovarian patterns were observed in the PCOD patients: enlarged cystic; enlarged solid; normal-sized cystic; and normal-sized solid. These findings emphasize the need for a reconsideration of the ultrasonographic criteria of PCOD.

Adolescent↗
PubMedDate not supplied

Pericardial "suspenders" to enhance right latissimus dorsi cardiomyoplasty.

Right latissimus dorsi cardiomyoplasty has recently been shown to provide effective support for the chronic failing heart. A simplified technique to perform this procedure is described here. The use of the pericardial "suspenders" may avoid dangerous lifting of the heart out of its sac position, and allow a more appropriate adjustment of the wrapping tension with enhanced surgical management and potential benefits for postoperative outcome.

Aged↗
PubMedDate not supplied

Hemodynamic effects in acute cardiomyoplasty of different wrapped muscle activation times as measured by pressure-volume relations.

BACKGROUND: Correct timing of mechanical interaction between wrapped latissimus dorsi muscle (LDM) and the heart during cardiac systole has been poorly understood and remains a controversial issue. Therefore, left ventricular pressure-volume relations were analyzed in acute cardiomyoplasty while changing the synchronization delays. METHODS: Effects of different delays between the sensed cardiac R wave and wrapped muscle contraction were studied in goats submitted to acute left cardiomyoplasty. Conductance and micromanometer catheters were used to evaluate hemodynamics. Systolic contribution of the wrapped muscle was studied in preassisted and assisted beats, whereas diastolic effects were studied in assisted and postassisted beats. RESULTS: At best settings, cardiomyoplasty resulted in a significant (p < 0.05) increase in left ventricular ejection fraction (from 42.2 +/- 9.2 to 56.7% +/- 13%), in stroke work (from 2769 +/- 1140 to 4271 +/- 1717 gm/m2), in dP/dt (from 1185 +/- 342 to 1510 +/- 285 mmHg/sec), in end-systolic pressure (from 93.5 +/- 22.5 mmHg to 97.3 +/- 22.3 mmHg), and in peak ejection rate (from 282 +/- 64 to 533 +/- 241 mL/sec). Stroke volume showed a mean increase of 35% (from 42.2 +/- 9.9 mL to 56.9 +/- 20.1 mL) during assisted beats. Diastolic function was not substantially impaired at optimal stimulation delay. Incorrect timing of LD contraction resulted in suboptimal improvement or no change in comparison with unassisted hemodynamics. CONCLUSIONS: Our study documents support of cardiac performance by LDM. Incorrect timing of heart/wrapped muscle interaction led to suboptimal hemodynamic results. Muscle contraction timing is an important factor in cardiomyoplasty outcome.

Animals↗
PubMedDate not supplied

Papillomatosis and breast cancer: a case report and a review of the literature.

Papillomatosis is a relatively common (22%) benign microscopic lesion in the breast and rarely seen in women less than 30 years old. It is a papillary proliferation of the ductal epithelium which partly fills up smaller ducts and to degree distends them. The histological classification of this entity is controversial because similar or identical lesions have been classified using different terms such as epitheliosis and epithelial hyperplasia, and interpretation of published series has been difficult due to imprecise definition of this term. Clinical, radiological and histological patterns of this entity are often sufficient to raise concern as to possible malignancy. Moderate or florid hyperplasia without atypia is considered to carry slight (1,5-2 times) increase in risk of later developing cancer, while in the atypical hyperplasia the risk is four to five times that of the general population. The authors describe a case of papillonlatosis recentely observed in a 67 years old female patient and, confirmed the importance to establish an accurate preoperative diagnosis. It is important that the surgeon works with the pathologist to produce clear descriptive report of epithelial changes from normal through hyperplasia to atypias in order to establish a precise surgical indication.

Aged↗
PubMedDate not supplied

[Use of abdominal wall retractor Laparo Tenser in gasless laparoscopic cholecystectomy].

High pressure CO2-peritoneum for laparoscopic surgery is not indicated in patients with impairment of cardiorespiratory and renal function and in high risk patients and in obesity. On the other site the uncontrolled abdominal insufflation and the blind insertion of the first trocar in patients with extended intraperitoneal adhesions, often cause bleeding and the intestinal loops dislocation, and can determine visceral lesions. In these patients gasless technique with an abdominal laparolifter can be employed. We report an experience of 36 patients undergoing laparoscopic cholecystectomy by a subcutaneous planar retractor. It was observed a good operative exposure in 83.3%; the surgery was safely performed in 88.8%. Two suprafascial hematoma related to the insertion of the needles of the Laparo Tenser occurred. A regular post-operative discharge was observed in 84.4%. These good results supports the extension of the laparoscopic approach for the cholecystectomy to complicated or to high risk patients.

Abdominal Wall↗
PubMedDate not supplied

[Small bowel stromal tumors in a "meckelian" location. About a clinical observation].

The Meckels divetriculum has a prevalence of the 0.3-3%. It is surgically removed only when arise a complication or a neoplasia. The Meckels diverticulum tumors are unfrequent and observed in only the 0.5-3.2% of the Meckels diverticula. The 12% of these tumors are a GIST. We report a case of a gastrointestinal stromal tumor with neural immunophenotype, observed in a patient presenting a deep venous thrombosis perhaps with a paraneoplastic origin. We also report some observations about the state of the art about the GIST management and particularly of all of them arising in a Meckels diverticulum.

Humans↗