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At least 649 records · Page 36Linked to original sources
PubMed2000

Coping strategies, life style changes, and pessimism after open-heart surgery.

A mail questionnaire was completed by 171 patients two to 20 months after undergoing coronary artery bypass graft surgery (CABG). The post-CABG period was characterized by fewer working hours, a higher level of physical exercise, a reduction in smoking, and more appropriate nutritional habits, compared with the preoperation period. At the same time, the anxiety level of post-CABG patients was higher than that measured in a community sample. Post-CABG high psychological distress (anxiety and mood states) and low functional capacity were associated with high levels of pessimism and ineffective emotion-focused coping strategies. These results may be used by social workers in devising psychological interventions aimed at improving post-CABG patients' quality of life and bolstering their coping strategies.

Adaptation, Psychological↗
PubMed1980

Management of brachial artery occlusion after cardiac catheterization.

Our management of patients with suspected brachial artery injury following cardiac catheterization and the results of operative management in 42 patients are reported. From this review the following suggestions or conclusions are made: 1) The absence of a distal radial pulse or a 30-mm Hg difference in forearm pressures four hours after brachial artery catheterization is indicative of a pathologic occlusion at the site of catheterization. 2) Adequate anticoagulation with heparin should be used during the observation period. 3) When indicated, reexploration of the brachial artery should be performed in the operating room using local anesthesia. 4) Resection of a segment of injured brachial artery with an end-to-end anastomosis using interrupted sutures gives good results. Attempts at "plastic" repair without resection were ususlly accompanied by reobstruction. 5) Arterial pressures in both arms, as monitored with a Doppler instrument before and after exercise, were of value in evaluating these patients pre- and postoperatively. 6) No preoperative arteriograms were required. 7) Restoration of adequate circulation was achieved in 97 per cent of patients operated on for brachial artery injury within 24 hours of cardiac catheterization and using the techniques described. 8) The good operative results and low morbidity suggest early repair for all confirmed brachial artery injuries.

Arterial Occlusive Diseases↗
PubMed1994

[Coronary disease and noncardiac surgery. An evaluation of the surgical risk].

Coronary artery disease is one of the leading causes of death in developed countries and one of the factors contributing to high mortality associated with noncardiac surgical procedures. This is the reason why is so important to correctly assess surgical risk in patients with ischemic heart disease. These patients can be evaluated by a simple clinic examination, electrocardiogram and chest X-ray. In asymptomatic patients or in patients with angina (Class I-II), normal electrocardiogram and chest X-ray, the operative risk is low. On the other hand, patients with severe heart failure (Class IV NYHA), unstable angina or acute myocardial infarction have a high surgical risk. The exercise stress testing must be performed in some cases in order to identify preoperative factors (electrocardiographic ischemic changes, low functional capacity) that might affect the development of cardiac events after noncardiac surgery. When not possible a thallium-dipyridamole scintigraphy should be considered. We discuss preoperative indications for coronary angiography and coronary revascularization. Coronary artery bypass surgery must be thought based on clinic severity, therapeutic results, left ventricular function and patient age, among other factors.

Coronary Disease↗
PubMed1996

Iatrogenic facial palsy: the cost.

The cost of iatrogenic facial paralysis can be high. Ways to avoid facial nerve injury during surgery and, should it occur, ways to minimize the disability and cost are discussed. These include adequate preparation and training by the surgeon, the exercise of sound judgment, the presence of high morals by the surgeon, adequate preoperative diagnosis and surgical instrumentation and thorough preoperative oral and written informed consent. Should facial nerve injury occur, immediate consultation and reparative decompression, anastomosis or grafting should be performed to obtain the best ultimate result. The value of prompt, competent, sympathetic and continuing concern offered by the surgeon to the patient cannot be over emphasized.

Adult↗
PubMed1987

Dipyridamole thallium 201 scintigraphy to detect coronary artery disease before abdominal aortic surgery.

Dipyridamole thallium 201 scintigraphy (DTS) was used to screen 116 consecutive patients referred for aortic reconstructive surgery for coronary artery disease (CAD). Thallium redistribution was found to have the best statistical correlation with postoperative myocardial infarction (MI). No MIs occurred after aortic operations among 60 patients with normal scans compared with 8 of 31 patients with abnormal ones. The odds of a patient with abnormalities found by DTS having a postoperative MI were 12 times greater than for those with a normal scan. No symptom or combination of symptoms of CAD was as good as an abnormal DTS in identifying patients at risk. The incidence of MI was 7.0% for patients with symptomatic CAD and 8.5% for those who were asymptomatic. Cardiac complications gradually declined as surgeons gained confidence in the use of DTS, to the point where no postoperative MIs occurred during the final year of the study. DTS approaches the ideal preoperative test for CAD in patients with peripheral vascular disease. The test does not require exercise, is minimally invasive, safe, and of sufficient sensitivity to detect myocardial ischemia in the absence of symptoms. Furthermore, it is cost-effective; only those patients with an abnormal scan and an imperative need for aortic surgical treatment need further cardiac evaluation.

Aged↗
PubMed1979

The effect of physical training on exercise ability in adolescent idiopathic scoliosis.

Twenty subjects with adolescent idiopathic scoliosis, aged 11--17 years, were studied before spinal fusion. Half the patients underwent a programme of daily physical exercises for 6--10 weeks. Before and after this period all the patients carried out a range of lung function tests and a progressive exercise test. There were no significant differences in any of the results between the control group and the training group. The cardiac and respiratory complications of spinal fusion are therefore unlikely to be lessened by preoperative physical training, except in selected subjects.

Adolescent↗
PubMed1995

Stress echocardiography. Part II. Dobutamine stress echocardiography: techniques, implementation, clinical applications, and correlations.

OBJECTIVE: To describe the rationale, methods, and clinical applications for dobutamine stress echocardiography. DESIGN: We review our experience with the first 1,000 Mayo Clinic patients who underwent this procedure and discuss studies from the literature that have assessed the accuracy of dobutamine stress echocardiography in determining the presence and extent of coronary artery disease. MATERIAL AND METHODS: The Mayo protocol for dobutamine stress echocardiography is presented, and the indications for use of this test and comparisons of sensitivity and specificity with other tests are summarized. RESULTS: Although exercise stress testing is the usual noninvasive method for the detection and assessment of coronary artery disease, a substantial number of patients are unable to perform adequate exercise because of physical limitations. In these patients, dobutamine stress echocardiography has emerged as a feasible, safe, and accurate method for the evaluation of coronary artery disease. The test has been proved to be valuable in the noninvasive diagnosis of coronary artery disease and to have an accuracy comparable to that of tomographic perfusion imaging. Other indications for dobutamine stress echocardiography include risk stratification before noncardiac surgical procedures, risk stratification after myocardial infarction, and identification of viable myocardium in patients with left ventricular dysfunction. CONCLUSION: Dobutamine stress echocardiography is an accurate, safe, cost-effective, and portable procedure for the noninvasive diagnosis of coronary artery disease and for the preoperative assessment of patients with such disease, especially those who are unable to perform adequate exercise tests.

Adult↗
PubMed1993

Cardiopulmonary function after pulmonary lobectomy in patients with lung cancer.

The effects of pulmonary lobectomy on cardiopulmonary function were investigated in 9 patients with lung cancer. Hemodynamic studies at rest and during exercise were performed before and 4 to 6 months after the operation. Differences in hemodynamics between before and after operation were observed with respect to heart rate, pulmonary arterial pressure, pulmonary vascular resistance index, and stroke volume index. Heart rate, pulmonary arterial pressure, and pulmonary vascular resistance index were significantly increased after operation, whereas stroke volume index was significantly decreased. It is thought that cardiac index was preserved by the increase in heart rate despite a decrease in stroke volume index associated with the decreased pulmonary vascular bed after the operation. When driving pressure and cardiac index were studied after operation, the pressure at rest and during exercise was higher, and the pressure-flow curve increased more steeply, as compared with the preoperative values. These results suggest a significant deterioration in cardiopulmonary function after lobectomy. As the patient characteristics were heterogeneous (five lobectomies and four bilobectomies), and their findings are limited, additional studies may be necessary in the future.

Aged↗
PubMed2001

Surgical and physical stress increases circulating blood dendritic cell counts independently of monocyte counts.

Dendritic cells (DCs) are specialized antigen-presenting cells that have the unique ability to initiate a primary immune response. The effect of physiologic stress on circulating blood DCs has thus far not been studied. In this study, we applied a recently developed method of counting blood DCs to test the hypothesis that significant stress to the body such as surgery and exercise might induce measurable changes in the DC numbers, subsets, phenotype, and function. Twenty-six patients scheduled for elective laparoscopic cholecystectomy, 4 for elective hysterectomy, 56 controls, and 5 volunteers who underwent a stress exercise test were enrolled in the study. Absolute DC counts increased acutely (71.7% +/- 11% [SEM], P =.0001) in response to the stress of surgery and dropped below preoperative levels (-25% +/- 14% [SEM], P =.05) on days 2-3. The perioperative DC subset balance remained constant. Interestingly, DC counts changed independently of monocyte counts. Exercise also induced a rise in DC counts but coincidentally with monocyte counts. Surprisingly, no phenotypic or functional activation of DCs was seen in either stress situations in vivo. DCs are rapidly mobilized into the circulation in response to surgical and exercise stress, which may serve to prepare the host's immune defenses against trauma. The independent regulation of the DC and monocyte counts reinforces the distinction between these 2 cell populations.

Adult↗
PubMed2004

[Application of separating brachial plexus block combined with preoperative analgesia by patient controlled intravenous analgesia in tendon repair].

OBJECTIVE: To investigate whether the separating brachial plexus block combined with preoperative analgesia by patient controlled analgesia (PCA) can be applied in tendon repair and postoperative active or passive functional exercise. METHODS: Two hundred and ten cases with tendon injury were randomly divided into 3 groups and all of the patients were administered Bupivacaine (0.25%), Papaverine (0.0625 mg/ml), and Dexamethasone (0.25 mg/ml) in separating brachial plexus block through axillary approach. Group A was control group, and preoperative analgesia was not applied. Preoperative analgesia was applied in group B and C. Tramadol and Ondansetron were administered in group B, Midazolam was administered besides Tramadol and Ondansetron in group C. The injection volume in the PCIA pump was increased to 100 ml by mixing physiologic saline. The pump was started after separating brachial plexus block in velocity of 2 ml/h, and its maintenance time was 48 h. The effect of separating brachial plexus block at 1, 2, 3, 6 and 12 h after finishing brachial plexus block was compared. The VAS, Ramesay assessment scoring were recorded at 0, 12, 24 and 48 h after starting pump. RESULTS: In each group, the effect of motor block became greater in the ascending order from 1, 2 to 3 h after finishing brachial plexus block, and less in the descending order from 3, 6 to 12 h after finishing brachial plexus block. Only at 6 and 12 h after finishing brachial plexus block, the effect of motor block of group B and group C was significantly less than that of group A (P < 0.05, < 0.01), the effect of motor block of group C was less than that of group B (P > 0.05). The effect of sensory block in the patients of all 3 groups was satisfactory. The VAS, Ramesay assessment scoring, effect of analgesia and sedation at 24 and 48 h after starting pump became greater in the ascending order from group A to group C, in which group B and group C were significantly greater than group A (P < 0.01). CONCLUSIONS: The separating brachial plexus block combined with preoperative analgesia by 2 kinds of PCIA dispensation can be both applied in tendon repair, but the separating effect of brachial plexus block of group B was superior to the group C.

Adolescent↗
PubMed1994

[Stress echocardiography--an evaluation of current status].

Exercise echocardiography, a versatile, noninvasive diagnostic test of left ventricular wall motion performed at rest and under induced stress, enables the cardiologist to detect and assess coronary artery disease. Stress-induced ischemia is thereby expressed as left ventricular regional wall motion abnormality. By using various physical (bicycle or treadmill exercise) and pharmacological (dipyridamole, dobutamine, adenosine) stress inducers, the test provides information about the localization and extent of coronary artery disease in addition to detecting stress-induced coronary insufficiency. As regards diagnostic accuracy in detecting coronary artery disease, stress echocardiography is superior to exercise electrocardiography and, according to the available data, it is comparable to perfusion scintigraphic testing. Studies have demonstrated the clinical value of stress echocardiography in detecting residual stenosis after angioplasty, for diagnosing bypass dysfunction after heart surgery, for preoperative risk assessment in noncardiac surgeries, and for obtaining prognostic information, e.g., after myocardial infarction. Preliminary studies have shown that pharmacological exercise echocardiography is able to identify viable myocardium in the early phases after acute myocardial infarction. Furthermore, it is able to predict the functional success of revascularization in chronic regional left ventricular dysfunction. In addition to the wide range of diagnostic possibilities in coronary artery disease, other notable applications include stress testing for assessment of global left ventricular pump function in patients with aortic regurgitation or cardiomyopathy.

Adenosine↗
PubMed1977

[Value of the exercise test after aortocoronary bypass].

The 100 patients who underwent an exercise test and a follow-up coronary arteriogram at a mean interval of 10.1 months after an aorto-coronary bypass had suffered preoperatively from incapacitating angina 50%), a threatened infarction syndrome (35%), or Prinzmetal's angina (15%). The majority had a single bypass graft (72%), but 28% had two or three grafts. The exercise test was positive 39 times, negative 51 times, and indeterminate in 10. Correlation with the clinical picture shows that 27% of the patients in functional category I had a positive exercise test. Correlation with coronary arteriography shows that a positive test is reliable evidence for a defect or occlusion of the graft. On the other hand, a negative exercise test is a less reliable indicator of a good result. No instances of positive exercise tests were found when there was complete alleviation of the coronary condition.

Adult↗
PubMedDate not supplied

Preoperative cardiac risk assessment for noncardiac surgery.

Patients presenting for noncardiac surgery should receive careful preoperative cardiac risk stratification. This has implications not only for the perioperative period, but also for long-term survival. After an initial clinical evaluation, certain patients will be referred for noninvasive testing. Those without significant inducible ischemia at a high workload have a low risk for perioperative cardiac complications. Patients who are unable to exercise adequately may require alternative forms of testing, of which dipyridamole thallium scintigraphy is the most thoroughly studied and validated option. Patients with either high-risk clinical profiles or significant thallium redistribution merit consideration for preoperative coronary angiography. Treatment options for high-risk patients include: (1) Proceeding with surgery as planned along with aggressive perioperative monitoring and anti-ischemic therapy, (2) coronary angiography with subsequent myocardial revascularization as appropriate before elective surgery, (3) selecting an alternative, lower risk surgical approach, and (4) cancellation of surgery in lieu of a trial of conservative therapy.

Coronary Circulation↗
PubMed2004

Decreased right ventricular function after coronary artery bypass grafting and its relation to exercise capacity: a tricuspid annular motion-based study.

BACKGROUND: Decreased right ventricular (RV) function is a known echocardiographic finding after coronary artery bypass grafting (CABG). For patients with heart failure, RV dysfunction is a predictor of poor exercise capacity. The significance and time course of RV dysfunction and its relation to exercise capacity after CABG have not been elucidated, however. OBJECTIVES: In this prospective study, we assessed RV function measured from echocardiographic tricuspid annular motion (TAM) before and after CABG and its relation to exercise capacity. METHODS: In 99 patients accepted for CABG, we did a baseline echocardiographic investigation before operation, followed by repeated echocardiograms 3 months and 1 year after CABG. RV function was assessed using the magnitude of TAM measured at the RV free wall. An exercise stress test and coronary angiography were performed before and 3 months after CABG. RESULTS: RV function assessed by TAM was significantly reduced 3 months after CABG (22.4 vs 14.5 mm, P <.001) compared with preoperative measurements and remained so after 1 year (14.7 mm, P <.001). Left ventricular systolic function was unchanged 3 months after CABG. The 1-year echocardiographic follow-up showed paradoxical septal movement in 96% of the patients. Exercise capacity improved significantly 3 months after CABG compared with before (1.6 vs 1.83 W/kg, P <.001). These finding are independent of the state of the right coronary artery. CONCLUSIONS: One year after CABG, RV function remained depressed and septal motion remained paradoxical compared with the preoperative investigation, suggesting that these postoperative findings might be permanent in the majority of patients. Despite the reduced RV function, exercise performance 3 months after CABG was improved. The depressed RV function, measured from TAM after CABG, probably lacks clinical significance.

Aged↗
PubMed1994

High thoracic epidural sufentanil with bupivacaine: continuous infusion of high volume versus low volume.

The purpose of the study was to investigate whether continuous infusion of a high volume of a sufentanil/bupivacaine mixture at a high thoracic level improves the analgesic effect of the mixture, compared with a dose-equivalent continuous low-volume infusion. In a prospective, observer-blind study, 60 patients scheduled for thoracic surgery received a thoracic epidural catheter for 3 days. The patients were randomly assigned by lot to one of two groups: a low-volume (LV) group (bupivacaine 0.75% with sufentanil 4 micrograms/mL, 1.0-1.3 mL/h), or a high-volume (HV) group (bupivacaine 0.125% with sufentanil 0.7 microgram/mL, 6-8 mL/h). On the first postoperative day significantly more patients in the LV group needed one or more epidural bolus injections because they experienced pain at rest (P < 0.05). On the second and third postoperative days there were no differences in bolus injections. Significantly more patients in the HV group did not require an extra epidural bolus injection (P < 0.05). There were no differences in the number of patients experiencing pain at exercise or in the incidence of side effects. A difference was found between both groups in the mean preoperative PaCO2 value (P < 0.05) and also for the PaCO2 values on Day 1 versus the preoperative values within the group (P < 0.05). On the first postoperative day the analgesic effects of a sufentanil/bupivacaine mixture at a high thoracic epidural level can be improved when injected at a continuous high-volume rate compared with a dose-equivalent continuous low-volume rate. This is true for pain at rest; for pain at exercise, there were no differences.

Analgesia, Epidural↗
PubMed2001

Partial left ventriculectomy for dilated cardiomyopathy: is this an alternative to transplantation?

OBJECTIVE: To determine the late effectiveness of partial left ventriculectomy and risk factors for failure. METHODS: Between May 1996 and December 1998, partial left ventriculectomy and concomitant mitral valve surgery were performed in 62 patients (95% transplant candidates) with a mean age of 54 years (range 17-72 years). All patients were in New York Heart Association functional class III (38%) or IV (62%) because of idiopathic dilated cardiomyopathy (59 patients) or ischemic, valvular, or familial cardiomyopathy (1 patient each). Outcomes considered for multivariable analysis included implantation of left ventricular assist device, return to class IV heart failure, relisting for transplantation, and death. RESULTS: Partial left ventriculectomy reduced the left ventricular end-diastolic diameter immediately preoperatively to immediately postoperatively (from 8.4 +/- 1.1 cm to 5.92 +/- 0.8 cm; P =.01), reduced the left ventricular end-diastolic volume index (from 133 +/- 48.6 mL to 64.1 +/- 26 mL; P <.0001), and increased the left ventricular ejection fraction (from 16 +/- 7.6 to 31.5 +/- 10.9; P <.0001). Survival was 80% and 60% at 1 and 3 years after surgery and freedom from failure was 49% and 26%, respectively. Increased systolic pulmonary artery pressure, decreased maximum exercise oxygen consumption, and increased left atrial pressure were associated with failure and/or death. The degree of preoperative mitral regurgitation did not correlate with clinical outcome. CONCLUSIONS: Early and late failures preclude the widespread use of partial left ventriculectomy. However, in view of its sometimes beneficial effect, use in situations that do not allow for transplantation or as a biologic bridge to transplantation may be appropriate.

Adolescent↗