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PubMedDate not supplied

Psychosocial coping strategies and cardiac capacity before and after coronary artery bypass surgery.

One hundred patients, eighty-nine men and eleven women, with chronic stable angina who were previously selected for aortocoronary bypass grafting gave informed consent for non-invasive and invasive testing of hemodynamic responses to symptom-limited maximal exercise before surgery. Psychosocial coping strategies were evaluated preoperatively by structured interviews and assessment of patients perceptions of symptoms (Cornell Medical Index) and life changes (Holmes and Rahe Schedule of Recent Experiences). Preoperatively forty-one patients were "compartmentalized," forty-two "generalized" and seventeen "vacillated" according to Josten's classification of coping strategies. The Berle Index of social assets was lower and the prevalence of psychiatric symptoms (Cornell categories M to R) was greater in the vacillators preoperatively. Despite less ischemic ST depression in vacillators, no other significant physiological differences were noted between these categories preoperatively. Postoperatively more of the vacillators refused follow-up evaluation, and of vacillators who returned, only one-half were adequately revascularized at operation. Of sixty-five reevaluated after surgery, eight improved, twelve worsened and forty-five did not change classification of coping strategies, yet physiological variables of cardiac function when invasively measured in sixty patients were significantly improved in all three groups. Amounts of improvement, both absolutely and relative to sex- and age-adjusted normal values, were least in vacillators with virtually normal cardiac capacity, and/or inadequate revascularization. Compartmentalized patients were more frequently working, yet only sixty-four in all psychosocial classifications worked before surgery. After this event only forty-five resumed working; none of the non-workers or retired returned to work. Both physiologic improvement and working status were independent of postoperative psychosocial status.

Adaptation, Psychological↗
PubMedDate not supplied

Further study of physical exercise and locomotor balance compensation after unilateral labyrinthectomy in squirrel monkeys.

The effect of physical exercise on compensation for locomotor asymmetry after unilateral labyrinthectomy was studied in squirrel monkeys. Five monkeys were assigned to the motor-driven rotating cage exercise, and another five, non-exercise control. Daily exercise (cumulative time of 2 1/2 hours) was given for three weeks preoperatively and continuously (daily) post-operatively. The average number of calendar days to attain the locomotor balance compensation was 20 days in the exercise group, and 35 days in the non-exercise control group. Statistical analysis showed the former compensated (according to the previously established criterion) significantly faster than the latter ( less than 0.05). Furthermore, faster reduction of gait deviation was found in the exercise group. Therefore, when physical exercise was given extensively and continuously, and locomotor balance function was measured by the squirrel monkey platform runway test (Igarashi, 1974), physical exercise application enhanced the locomotor equilibrium compensation.

Animals↗
PubMed2002

Combined spinal and epidural anesthesia for abdominal aortic aneurysm surgery in patients with severe chronic pulmonary obstructive disease.

BACKGROUND: The presence of chronic obstructive pulmonary disease (COPD) should not be considered a contraindication to operation but should rather identify those patients that require special preoperative and postoperative pulmonary care. The purpose of this paper is to report our experience in the use of combined spinal and epidural anesthesia (CSEA) for open AAA repair in such patients. METHODS: From April 1997 to November 1998, three patients with severe COPD underwent elective open infrarenal AAA repair under CSEA. All the patients satisfied one or more of the following criteria: a room air PaO2 =or<60 mmHg, PaCO2 =or>45 mmHg, FEV1 =or<50% of predicted, and/or FVC =or<75% of predicted, and one of them was on home oxygen preoperatively. Preoperative preparation of the patients consisted of breathing exercises with incentive espirometry, elimination of underlaying pulmonary infections and usage of bronchodilator therapy. RESULTS: All the patients tolerated surgery safely. None of them developed postoperative complications, including pneumonia and other respiratory conditions. No significant changes in room air arterial blood gas or pulmonary function was recognized before and after surgery. CONCLUSIONS: CSE anesthesia is a viable anesthetic option for conventional AAA surgery in patients with severe COPD since it can preserve spontaneous breathing and provide additional respiratory benefits over general anesthesia.

Aged↗
PubMed2005

Hand circulation after radial artery harvest for coronary artery bypass grafting.

Despite wide spread use of the radial artery (RA) graft for coronary artery bypass grafting, the change of hand circulation after RA harvest has not been fully clarified. Severe hand ischemia such as resting pain or gangrene is a rare complication and has been reported in 4 patients. These cases resulted from occlusive artery disease in forearm, which should be carefully explored before RA harvest. Incidence of mild hand ischemia such as hand claudication or fatigue is unknown, but our study suggested that around 10% of the patients developed mild hand ischemia after RA harvest. The blood flow to the forearm territory was decreased by 20% after RA harvest despite the compensatory dilatation of ulnar artery. The presence of low perfusion in the affected hand has been pointed out in some studies. We reported the decreased tissue oxygenation of the affected hand during hand grip exercise. The Allen test is the most popular preoperative screening method, but is associated with considerable numbers of false-positive and false-negative results. Full length scanning of ulnar artery by ultrasonography seems to have a lower false-positive rate. But further clinical experience is necessary to establish a more reliable screening method.

Coronary Artery Bypass↗
PubMed1986

[Cystic meningioma associated with intratumor and subarachnoid hemorrhage during embolization--a case report].

We present a case of a cystic meningioma accompanied with hemorrhage in a cyst and adjacent subarachnoid space that occurred while preoperative embolization in feeders for the tumor was being applied. A 73-year-old male patient was admitted for a complaint of convulsion. Under CT examination, a tumor was observed at the left frontal convexity and found to be fed by the middle cerebral artery shown in the left cerebral angiograms. The tumor was diagnosed meningioma. After removing the tumor, we conducted histological study. Gross findings of its cross section had an atypical bleeding pattern which was resulted from the ruptures of the criss-crossing internal and external carotid arteries in the tumor. The findings indicated that the tumor was an angiomatous meningioma and contained meningotheliomatous components. The hemorrhage was occurred in the portion of the angiomatous meningioma. The possible reason for the hemorrhage was thought that sudden dynamic changes in blood flow which were triggered by the embolization. The sudden changes could have caused multiple ruptures on pathologic small vessels. Therefore, we strongly recommend that preoperative embolization should be proceeded with caution for exercising a cyst meningioma, since it could increase the possibility of bleeding from pathologic weak vessels.

Aged↗
PubMed1980

Total hip replacement: its influence on spontaneous recreation exercise habits.

The effect of total hip replacement (McKee-Farrar or Brunswik prosthesis) on recreational exercise habits was evaluated with a retrospective interview of 539 patients operated on at the orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland. The mean age of the patients was 63.8 years and the mean follow-up time 4.2 years. The proportion of those who engaged in regular walking increased from 2 to 55%, in cycling from 7 to 29%, in swimming from 13 to 30% and in skiing from 0 to 9%. Prolonged use of the prosthesis (up to 9 years) had no significant deteriorating effect on the intensity of the recreation exercises. The number of those who were able to cycle or swim preoperatively was greater than that of those who were able to walk at that time. Cycling and swimming are especially valuable forms of physical exercise after total hip replacement because the load placed by the body weight on the hip joint is reduced.

Adult↗
PubMed1996

Stentless aortic valve replacement with the biocor prosthesis: indications and outcome.

BACKGROUND AND AIMS OF THE STUDY: Due to improved hemodynamic properties stentless bioprostheses represent a new therapeutic option in the surgical treatment of aortic valve disease. MATERIALS AND METHODS: Between February 1993 and June 1995 22 patients with a small aortic root regarded as suboptimal for a stented bioprosthesis (diameter < or = 23 mm, mean 21.6 +/- 1.9 mm) underwent aortic valve replacement with a Biocor stentless prosthesis. Mean age was 63.9 +/- 15.4 years (17-85 years). Valve size ranged from 21 to 27 mm (mean 25 mm) and exceeded the root diameter by 4 mm. As compared to a control group of patients with root enlargement (n = 10) total bypass time and cross-clamp time in the stentless group were significantly shorter (83.3 +/- 12.7 and 60.9 +/- 9.2 min versus 95.8 +/- 27.1 and 69.5 +/- 16.5 min, p = 0.054 and p < 0.05), respectively. RESULTS: Three patients died postoperatively unrelated to the choice of valve. There were no late deaths. No thromboembolic or bleeding events were observed. Follow up data are available over a period of 1-25 months (mean 12.5 months, median 16 months). Echocardiographic evaluation revealed no aortic regurgitation; mean valve gradients were 9.9 +/- 4.1 mmHg (peak 19.2 +/- 6.0 mmHg). For specific root diameters these gradients were compared to established data for Hancock bioprostheses demonstrating significant differences in transvalvular gradients between the two valve designs for given root diameters. Unloading the left ventricle resulted in regression of left ventricular hypertrophy (decrease in wall thickness from 13.6 +/- 1.7 mm to 11.2 +/- 2.0 mm). Exercise capacity improved from NYHA III-IV preoperative to I-II postoperative. CONCLUSIONS: In patients with a small aortic root stentless valves represent a new option. Compared to root enlargement with standard bioprosthesis myocardial ischemia is shorter and implantation of larger valve sizes results in superior hemodynamics.

Adolescent↗
PubMed1995

Preoperative strategies to assess cardiac risk before noncardiac surgery.

The strategies recommended in the preoperative cardiac risk assessment prior to major vascular and nonvascular surgery are reviewed. The role of clinical evaluation, noninvasive stress testing (exercise test, stress myocardial perfusion imaging, stress echocardiography), and Holter monitoring during the preoperative evaluation are outlined and the value of intervention based on the use of each test is discussed. Recommended strategies to evaluate patients based on their clinical risk markers in addition to the results of the noninvasive risk assessment are presented.

Heart Diseases↗
PubMed1981

Assessment of donor limb hemodynamics in femorofemoral bypass for claudication.

During a 5-year period (1975 to 1980), 44 patients underwent femorofemoral bypass for unilateral disabling claudication caused by iliac atheroocclusive disease. All patients had complete Doppler arterial examination performed pre- and postoperatively, including segmental thigh and ankle pressure and calculation of an ankle/brachial (A/B) index for each limb. In 37 patients, standard treadmill exercise testing was performed before and after femorofemoral grafting. Hemodynamic improvement in the symptomatic limb was evidenced by an increase in resting A/B index from a mean of 0.54 +/- 0.14 before to 0.76 +/- 0.22 after operation (P less than 0.001). Exercise tests which were abnormal in all 37 recipient limbs preoperatively were improved. Six of the seven unimproved recipient limbs had associated femoropopliteal occlusion. Donor limb mean resting ankle/brachial index fell from 0.93 +/- 0.22 before to 0.83 +/- 0.22 after surgery (P less than 0.05). However, in 13 of 23 donor limbs, exercise response which had been normal before surgery became abnormal. Additionally, in 14 patients with abnormal donor limb exercise response before grafting, seven limbs had a significantly worsening of the exercise response postoperatively. These findings were not related to the patency of the superficial femoral artery in the donor limb. Deterioration in donor limb hemodynamics noted in 20 (45%) of the 44 patients in this series suggests that strict patient selection criteria should be maintained. Unlike in healthy subjects, an arteriographically patent atherosclerosis iliac artery may not support flow requirements of bilateral lower limb exercise.

Adult↗
PubMed1984

Comparison of supervised and unsupervised exercise training after coronary bypass surgery.

Functional capacity and cardiovascular responses to serial graded treadmill testing ( GXT ) were compared in 180 patients who performed prescribed unsupervised exercise and 24 patients who were referred for supervised exercise after coronary artery bypass surgery (CABS). The groups were men similar in age range, number of bypass grafts, preoperative left ventricular impairment and number of days hospitalized. All patients received similar predischarge exercise monitoring and began a progressive home walking or cycling program. Initial GXT (T1) was performed 44 +/- 9 days postoperatively. Both groups were instructed to continue prescribed exercise at 75 to 85% maximal heart rate (HR) for 30 to 40 minutes 3 days (supervised) or 5 days ( unsupervised ) per week. The second GXT (T2) was performed 115 +/- 27 days after CABS. In each group there were significant (p less than 0.01) increases in exercise capacity and HR from T1 to T2. However, there were no significant differences in maximal exercise capacity and HR between groups at T1 or T2. Improvement in functional capacity was not influenced by therapeutic beta blockade. These findings indicate that prescribed unsupervised exercise can be performed safely and results in similar functional improvements compared with supervised exercise after uncomplicated CABS.

Adrenergic beta-Antagonists↗
PubMed1979

Objective improvement after aortofemoral bypass for exercise ischemia.

The physiologic and functional improvement after aortofemoral bypass was quantitatively assessed by preoperative and postoperative noninvasive vascular testing in two groups of patients operated upon for claudication alone, those with significant occlusive disease of the lower extremity limited to the aortoiliac segments and those with combined disease of both the aortoiliac and superficial femoral arteries. While there is a statistically significant increase in segmental pressures and exercise times after aortofemoral bypass in the group with combined disease, these objective hemodynamic parameters are far from normal and are statistically significantly lower than values obtained in the group of patients with open superficial femoral arteries. Accordingly, we question the advisability of proximal arterial reconstruction in patients with combined hemodynamically significant aortoiliac and occlusive disease of the superficial femoral artery and claudication as the only indication for operation.

Aorta↗
PubMed1978

[Hemodynamic results after tricuspid valvuloplasty (author's transl)].

Postoperative hemodynamic studies were conducted at rest and during exercise in 24 patients who, in addition to mitral and/or aortic valve surgery, had De Vega's tricuspid anuloplasty. To determine the degree of tricuspid insufficiency (TI), right atrial pressure (PRA) tracings, biplane right ventricular cineangiograms, and ultrasonic Doppler flow patterns were obtained. 20 patients had postoperative by a mild to moderate TI, but after operation the TI had improved by one or more degrees in 14 cases. In addition, a mild to moderate tricuspid stenosis with pressure gradients from 2.0 to 7.8 mm Hg were found in 12 patients. There was no significant change in mean right atrial pressure (PRA) with 8.0 +/- 4.5 mm Hg preoperatively and 7.5 +/- 3.5 mmHg postoperatively at rest. During exercise PRA rose to 17.0 +/- 6.5 mmHg. This pressure increase is in part due to the persistent elevation of left atrial and pulmonary artery pressure, in part to the TI and the tricuspid stenosis. De Vega's anuloplasty does not answer the tricuspid challenge, since the results are unpredictable.

Adolescent↗
PubMed1997

Preoperative pulmonary evaluation.

The incidence of peri-operative pulmonary complications varies, depending on surgery and patient related determinants. Risk factors include upper abdominal or thoracic surgery, duration of anaesthesia, age, obesity, smoking history and underlying respiratory diseases such as COPD. The preoperative evaluation of patients undergoing general surgery is predominantly based on medical history and physical examination. A preoperative chest radiograph and pulmonary function tests are indicated in some high risk patient groups, and in all patients about to undergo lung resection surgery. If in this latter group, the preoperative lung function is severely compromised, a quantitative perfusion scan and exercise testing may be useful for the assessment of the operative risk. Prevention of postoperative pulmonary complications should begin with discontinuation of smoking at least 8 weeks prior to surgery. In high risk patients preoperative chest physiotherapy, including incentive spirometry, is clearly beneficial.

Age Factors↗