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Biomedical subjects

T K Larmi

Publications and source records attributed to T K Larmi.

At least 19 recordsLinked to original sources
PubMed1979

Liver drug metabolism in patients undergoing open-heart surgery.

The effect of open-heart surgery on the drug metabolism of the liver was investigated in 17 patients by using the rate of antipyrine elimination as an index. A correlation was found between the pre-operative heart size and the antipyrine elimination rate. In patients with a markedly dilated heart, the plasma antipyrine half-life was prolonged and apparent clearance significantly impaired. Immediately postoperatively, antipyrine elimination was impaired in all patients. Later, the drug metabolism improved in patients with atrial septal defect, changed temporarily in patients with aortic valve replacement, and remained unchanged in patients with mitral valve replacement. The results indicate that adaptive changes in drug metabolizing capacity occur in patients undergoing cardiac surgery. The changes are related to the type of lesion corrected, the pre-operative functional capacity of the liver, and the time lapse after surgery.

Adolescent↗
PubMed1978

Intraoperative changes in coronary resistance during aortic valve replacement.

Coronary vascular resistance was investigated in 10 patients undergoing aortic valve replacement using continuous constant-pressure coronary perfusion at 32 degrees C. After coronary flow was initiated, resistance was low but increased steadily until it reached a certain resting level. The plateau was attained faster after a short period of anoxia than after a longer period. The initial postischemic resistance was dependent on the duration preceding anoxia, being of the same magnitude after short and moderate periods of anoxia but significantly higher after a long period. This resistance difference between the groups lasted for the whole perfusion. The total coronary resistance and flow reached a plateau in 30 minutes, while resistance increased threefold but flow decreased to half of the initial postanoxia flow. Our results indicate the importance of initiating coronary perfusion soon after aortic cross-clamping to avoid increase in the initial vascular resistance and subsequent inadequate myocardial flow.

Adult↗
PubMed1978

Anaesthesia induction and lower oesophageal sphincter pressure.

The effects of some drugs generally used in premedication for and induction of anaesthesia on the lower oesophageal sphincter (LOS) pressure were investigated in 30 dogs, using the modern oesophageal manometric technique. In thiopental-induced anaesthesia, a distinct pressure gradient was noted between the LOS and gastric pressure. Atropine eliminated this pressure gradient almost completely. Metoclopramide increased the LOS pressure significantly, and subsequent atropine administration was unable to bring it down. Metoclopramide administered after atropine was unable to elevate the LOS pressure reduced by atropine. Succinylcholine had no observable lasting effect on the LOS pressure. The present findings seem to indicate that of the drugs generally used in premedication for and induction of anaesthesia, atropine significantly reduces the LOS competence, thereby creating favourable conditions for gastro-oesophageal reflux (GOR) and consequent postoperative pulmonary complications. Use of metoclopramide in premedication for or induction of anaesthesia to eliminate the depressant effect of atropine on the LOS pressure appears to be indicated.

Anesthesia, General↗
PubMed1978

Effect of intragastric bile on canine lower oesophageal sphincter pressure.

The effect of intragastric bile on lower oesophageal sphincter (LES) pressure was studied in 7 dogs. Five ml of fresh canine bile was instilled into the stomach, and its effect on LES pressure and intragastric pH was observed for one hour. In a control study 5 ml of physiological saline was used instead of bile. Bile instillation led to a statistically significant increase in LES pressure, which reached its maximum in 20 min. LES pressure returned to the resting level in 60 min. Saline instillation produced no signficant change in LES pressure. The rise in intragastric pH was slight and equal in both groups. The results suggest that bile contamination of gastric juice, at least one of short duration, does not have any immediate harmful effect on LES competence in the dog.

Animals↗
PubMed1978

Myocardial reactive hyperemia caused by initial myocardial anoxia during aortic valve replacement.

Reactive hyperemic response of individual coronary arteries and of the whole heart to anoxia during coronary cannulation was investigated in 10 patients undergoing aortic valve replacement. Reactive hyperemic response in man is identical to that reported in experimental investigations. The duration of hyperemic response was dependent on the length of the preceding period of anoxia; the longer the period of anoxia, the more prolonged was the hyperemic response. No significant collateral circulation between the coronary arteries could be demonstrated during prolonged anoxia of an individual coronary artery. Blood flow debt was almost always overpaid, but the repayment percentage decreased with the lengthening of the anoxic period, being 460 percent after a short period of anoxia (less than or equal to 2 minutes), 230 percent after an anoxic period of moderate length (3 to 5 minutes), and only 160 percent after a long period of anoxia (greater than or equal to 7 minutes). The total mean repayment of blood flow debt of the whole heart was 195 percent.

Adult↗
PubMed1978

Chronic intragastric bile contamination and lower esophageal sphincter competence. An experimental study in dogs.

The possible association between intragastric bile reflux and lower esophageal sphincter (LES) incompetence was elucidated in an experimental work in dogs. Chronic intragestric bile contamination was produced by cholecystogastrostomy. The effect of this procedure on LES competence was evaluated by manometric, radiologic and endoscopic studies two weeks, one month, and then once a month for 6 months after operation. No significant change occurred in LES pressure, and neither radiological reflux nor endoscopic evidence of esophagitis developed during the follow-up period. According to the present study intragastric bile reflux does not have a significant role in the pathogenesis of LES incompetence in the dog, but esophagitis effected by bile reflux seems to require previously existing LES incompetence.

Animals↗
PubMed1978

Total pancreatectomy for acute hemorrhagic pancreatitis. A case report.

A patient with acute hemorrhagic pancreatitis treated successfully with total pancreatectomy is reported. Total pancreatectomy is rarely indicated in acute hemorrhagic pancreatitis as suggested by only one surviving patient in the literature so far. Though near total pancreatectomy remains the best surgical treatment in patients with acute hemorrhagic pancreatitis dying from the disease because of failure of nonoperative treatment, total pancreatectomy may be considered as an alternative if circumstances so indicate.

Acute Disease↗
PubMed1978

Effect of initial myocardial anoxia on coronary flow during aortic valve replacement.

Flow to the right and left coronary arteries was recorded continuously during aortic valve replacement using continous constant-pressure coronary perfusion at 32 degrees C in 13 patients. The initially high coronary flow decreased gradually until a certain level, the so-called resting flow level, was reached and stabilized there as long as perfusion temperature remained unchanged. At 32 degrees C, resting flow was about 50% of the peak hyperaemic flow. The length of preceding anoxia had a significant effect on the duration of reactive hyperaemic response. After a short anoxic period, resting flow level was reached in about 3 min, after moderate period in 15 min and after long anoxia in 35 min, respectively.

Adolescent↗
PubMed1977

Mesenteric infarction.

The most common etiologies of mesenteric infarction in fifty-one patients were arterial thrombosis (in 42 per cent), bowel infarction without major vessel occlusion (in 28 per cent), and arterial embolus (in 22 per cent), but the etiology also included some very rare vascular diseases--two cases of the malignant atrophic papulosis of Degos. In the group of forty-four operative patients the mortality was 70 per cent. All the patients treated medically died. Mesenteric infarction should be suspected in all elderly cardiac patients with symptoms of acute abdomen. The value of an early diagnosis, fast resuscitation, and aggressive operative treatment cannot be overstated. Bowel resections yielded the best results in this series. However, the operative treatment of the mesenteric infarction should be individual, depending on the etiologic factors and the time which has elapsed from the onset of the symptoms.

Adult↗
PubMed1977

Calcium microemboli and microfilters in valve operations.

Fatal microemboli occurred in 3 of 100 consecutive patients having aortic valve replacement; 2 occurred during perfusion before the microfilter era, and 1 occurred intraoperatively despite the use of in-line filters. In all 3 patients cerebral symptoms were present immediately postoperatively, and each died of severe brain damage. On postmortem examination cerebral calcium microemboli were verified in only 2 patients, although the brain of each patient contained minute infarctions. However, calcium particles were found in the kidneys of all 3 patients. Thus the kidneys proved to be the best place for detection of calcium emboli on postmortem examination. Although the microfilters currently available effectively prevent microemboli during extracorporeal circulation, the surgeon should be aware that embolization can also occur immediately after discontinuation of perfusion. The means of protecting the patient from this are discussed.

Aortic Valve↗
PubMed1977

Intra-operative ascending aortic flowmetry.

Intra-operative flowmetry was carried out before and after cardiopulmonary bypass in 34 patients who underwent aortic root surgery. Most of the patients had either aortic or combined aortic and mitral valve replacement. Flowmetry performed before and after the procedure proved to be a very useful diagnostic tool, particularly in evaluating the immediate postoperative haemodynamic performance of the replaced aortic valve and the completeness of the correction.

Adolescent↗
PubMed1977

Surgical treatment of axial hiatal hernia-reflux complex by Nissen fundoplication. A cineradiologic and manometric study.

This study was undertaken to review our result in the surgical treatment of the axial hiatal hernia-reflux complex with Nissen fundoplication using cineradiologic, manometric, and endoscopic studies and an analysis of objective symptoms of the patients as criteria in evaluation. During the period 1966-1975 86 patients underwent Nissen fundoplication at Oulu University Central Hospital. In 50 of the 86 patients it was possible to carry out thorough pre- and postoperative examinations and a long-term follow-up using the aforementioned methods. There was some discrepancy between objective and subjective postoperative results. During the 10-year follow-up period, mean 5 years, the recurrency frequency was 14% (7/50), but 22% (11/50) of the patients considered the postoperative result subjectively to be poor. On the other hand, 3 patients with a definite recurrence considered the end result subjectively to be good. On the basis of these findings we were able to conclude that the objective postoperative examinations in themselves are not sufficient for thorough, long-term evaluation of postoperative results, but that the patient's subjective postoperative symptoms and his opinion of the success or failure of the operation should also be taken into consideration.

Adult↗
PubMed1977

Myocardial protection by continuous coronary perfusion during aortic valve replacement.

The coronary perfusion system used at Oulu University Central Hospital is described and the importance of physiological coronary perfusion stressed. Our method of protecting the myocardium from ischemic injury during aortic valve replacement included the following: phasic constant-pressure coronary perfusion, maintenance of coronary perfusion pressure larger than or equal to 80 mmHg, maintenance of the heart in a beating, empty, oxygenated state, and the use of the largest possible coronary canula. Under these circumstances, autoregulation of the coronary vascular bed was maintained. When small coronary cannulae were used a significant pressure drop occured across the tubing system, especially at high flow rates. Flow measurements recorded by an on-line electromagnetic flowmeter proved reliable.

Adolescent↗
PubMed1977

Renal blood flow and intrarenal oxygen tension in haemorrhagic hypotension.

The changes occurring in renal cortical and medullary tissue oxygen tensions and in renal total blood flow (RBF) were studied during haemorrhagic hypotension in six dogs. The flow was measured with an electromagnetic flowmeter, and tissue oxygen tension with IBC (Ineternational Biophysics Corporation, USA) oxygen electrodes. Haemorrhagic hypotension led to a considerable decrease in cortical tissue oxygen tension. The decrease in the medullary tissue oxygen tension was smaller, while the renal total flow decreased considerably during haemorrhage. The role of perfusion pressure alone in the redistribution of renal blood flow during haemorrhagic hypotension is discussed.

Animals↗
PubMed1977

Celestin tube palliation of unresectable esophageal carcinoma.

Celestin tube intubation was performed in 108 patients with unresectable carcinoma of the esophagus and cardia, in 83 per cent as the initial operation and in 17 per cent after exploration. The hospital mortality rate was 16 per cent, including a 7.4 per cent mortality rate from technical causes. The most frequent causes of death were perforations of the esophagus and cardia and aspiration pneumonia. Nonfatal complications occurred in 13 per cent of surviving patients, obstruction and dislodgment of the tube being the most common. All patients were able to swallow at discharge, and 91 per cent of them could take food by mouth until the time of death. In 9 per cent, additional palliation, usually esophagoscopy or gastrostomy, was required. Ninety-one patients survived one to 21 months (average 5.8 months). The 6 month survival rate was 44 per cent and the one-year survival 9 per cent.

Aged↗
PubMed1977

Carcinoma of the oesophagus and cardia.

234 patients, 146 with carcinoma of the oesophagus and 88 with carcinoma of the cardia are reported. There were 82 females and 152 males, mean age 62 years. The overall operability and resectability of the whole series was 38% and 23%. In cardiac carcinoma operability was 50% and resectability 32%, while in oesophageal carcinoma it was 31% and 18% respectively. 54 patients underwent resection, 44 received irradiation, and in 136 patients only palliative treatment was possible. The overall hospital mortality after resection was 15%, after oesophageal resection 12%, after cardiac resection 18%, and after palliative procedures 14%. Anastomotic leakage occurred in 9 patients (17%), four of whom died. The overall 5-year survival rate for the whole series was 4%, after resection 11%, and after radiotherapy 4%. No patient in the palliative group survived for 2 years. The mean survival time after irradiation was 11.5 months and after palliative procedures 5.5 months. The 5-year survival rate after oesophageal resection was 13% and after cardiac resection 6%.

Cardia↗
PubMed1977

A simple cannulation technique for perfusion problems in advanced aortic dissection.

A simplified left atrial-distal aorta bypass for operative treatment of extensive dissecting. Type III, aneurysms of the distal thoracic aorta is reported. In this technique the lower part of the body is perfused through a large cannula placed into the true lumen of the several distal aorta. The indications and advantages of the method are discussed.

Aorta, Thoracic↗