摘要:

At the Texas Heart Institute, from October 1969 through December 1974 a consecutive series of 4,522 patients who underwent aortocoronary bypass procedures was analyzed. Our experience with this procedure over a 5-year period demonstrated a decreasing operative and long-term mortality. This included patients who had aortocoronary bypass alone or in combination with other procedures such as resection of a left ventricular aneurysm or aortic and mitral valve procedures. Actuarial follow-up during the 5 years revealed mortality to be approximately 2.5% per year. Current operative mortality is less than 3.5% regardless of the number of grafts implanted. The rate of late myocardial infarction was only 4% for the entire series. Coronary artery bypass can be safely performed with minimal mortality and increased long-term survival.

ISSN:0014-312X    

DOI:10.1159/000127880

出版商:S. Karger AG    

年代:1976

数据来源: Karger

摘要:

Retroperfusion of the superficial coronary venous system was studied in 44 canine fibrillating in vivo, normothermic preparations, with exclusion of the systemic circulation using cardiopulmonary bypass techniques in order to assess its value as a method of myocardial revascularization. Perfusion of either the isolated aortic arch via a brachiocephalic cannula or of the coronary sinus through the free end of a vein anastomosed to the atrial rim of the sinus was performed for 1 h at 100 cm3/min in groups II–IV following 30 min of anoxia. Oxygen uptake, vascular resistance, venous outflow and venous enzyme levels (CPK, GDH) were studied. Group I controls (antegrade perfusion, no anoxia) showed continued aerobic metabolism in contrast to group II (antegrade perfusion) and III (retrograde perfusion) which displayed negative lactate balance. Oxygen consumption was greater in group III than II (p < 0.01) with a higher oxygen extraction in III (p < 0.005). Group IV, which was given intravenously 30 mg/kg methylprednisolone prior to anoxia and then retroperfused, showed continued aerobic metabolism with low GDH venous levels and adequate oxygen consumption. Three dogs were then subjected to aortoatrial rim coronary sinus vein grafts with ligation of the left common coronary artery at its bifurcation with distal left circumflex and anterior descending artery-internal mammary vein anastomoses for venous drainage. The right coronary artery was left intact. Arterial inflow into the coronary sinus was associated with a left ventricular pressure of 70–80 mm Hg for up to 1.5 h while regular sinus rhythm was maintained. We conclude that retroperfusion of the coronary sinus represents a surgically feasible technique for providing oxygen delivery to the ischemic myocard

ISSN:0014-312X    

DOI:10.1159/000127881

出版商:S. Karger AG    

年代:1976

数据来源: Karger

摘要:

Acute changes of lung function and morphology were studied in 3 groups of dogs: after bilateral hilar stripping by ipsilateral approach (group 1), after right-side hilar stripping and left pneumonectomy by left-sided approach only (group 2) and in a control group. All dogs of group 1 showed a syndrome corresponding to functional hilar stripping with absent Hering-Breuer and cough reflex, slow respiration with increased tidal volume and discharge of fluid from the airways. Alveolar ventilation and oxygen tension, dead space/tidal volume ratio and pulmonary shunting did not change. Cardiac output and arterial oxygen tension were decreased. The lungs were heavy and histological examination showed lymphostasis and interstitial edema. The dogs of group 2 did not show significant changes in comparison to the control group.

ISSN:0014-312X    

DOI:10.1159/000127882

出版商:S. Karger AG    

年代:1976

数据来源: Karger

摘要:

Incompatibility reactions due to hydroxyethyl starch (HES) were observed during 8 out of 10,273 infusions of 500 ml 6% HES (Plasmasteril®). The clinical symptoms ranged from skin reactions to tachycardia, hypotension and shock. In 3 of the 8 patients with incompatibility serum immunoglobulin concentrations were reduced after the anaphylactoid reaction. Specific antibodies against HES were, however, not detected. Serum IgE levels stayed within their normal limits. Positive reactions of the immediate type to intradermal skin tests with different dilutions of Plasmasteril were obtained in five patients

ISSN:0014-312X    

DOI:10.1159/000127883

出版商:S. Karger AG    

年代:1976

数据来源: Karger

摘要:

A procedure is described which allows to objectify the indication for primary operations on the papilla of Vater. During operations on the gallbladder or biliary tract, a radiomanometric examination of the common bile duct is carried out. The study comprises 255 patients. Based upon the results of radiomanometry in 77 patients, a transduodenal revision (papilloplasty) of the papilla was performed. Biopsies from the papilla revealed a high incidence of histological changes. There was a significant correlation between pathological findings on the papilla and abnormal bile pressures. Biochemical signs of cholestasis also correlated significantly with bile pressures. The results of intraoperative manometry allowed therefore conclusions on the functional and morphological state of the papilla. By this method, the indication for operations on the papilla can be objectified and unnecessary papillotomies avoided.

ISSN:0014-312X    

DOI:10.1159/000127884

出版商:S. Karger AG    

年代:1976

数据来源: Karger

摘要:

This experimental study describes the pressure changes of the descending colon before and after total and selective vagotomy combined with Finney’s pyloroplasty as estimated by telemetry. The results obtained from the study of 20 dogs show that the motility of the descending colon is extremely reduced after total vagotomy with no change after selective vagotom

ISSN:0014-312X    

DOI:10.1159/000127885

出版商:S. Karger AG    

年代:1976

数据来源: Karger

摘要:

Two 10-cm long Thiry-Vella (TV) loops were constructed in each of 20 rats. An elastic-plastic device, which served as a source of continuous intraluminal mechanical stimulation, was fixed in one of the loops. Two weeks later the jejunum, ileum and both TV-loops were biopsied. Wet and dry weight per 3 cm intestine, villus height and muscular thickness, were determined. Both TV loops were atrophic, but the wet and dry weight and muscular thickness were significantly greater in the mechanically stimulated ones. The villus height was not significantly effected by the mechanical stimulation. The experiments demonstrate that the effect of mechanical stimulation on the food-deprived small intestine is limited to a certain extent of muscular hypertrophy resulting in a lesser degree of atrophy expressed in terms of wet and dry weight of the intestine.

ISSN:0014-312X    

DOI:10.1159/000127886

出版商:S. Karger AG    

年代:1976

数据来源: Karger

摘要:

Fat embolism was induced in rabbits by giving an intravenous injection of radioactively labelled homologous retroperitoneal fat. One group was defibrino-genated by Arvin®. A second group was made thrombocytopenic by treatment with Busulphan®. After the animals had been made thrombocytopenic and had been defibrinogenated, respectively, fat embolism was induced. Macroscopic and histologic examinations were carried out, as well as recordings of wet weight and radioactivity content of the lung. There was a highly significant increase in the pulmonary wet weight of thrombocytopenic animals compared with controls. Macroscopic as well as histologic examination revealed a massive interstitial and alveolar oedema. Half of the specimens showed moderate to massive bleedings. Defibrinogenated animals did not differ from controls. Under the given circumstances, the results suggest that platelets are protective to the endothelial lining of the pulmonary capillaries during embolism. The presence or absence of fibrinogen initially does not seem to be of major importance for the pulmonary damage induced by fat injectio

ISSN:0014-312X    

DOI:10.1159/000127887

出版商:S. Karger AG    

年代:1976

数据来源: Karger

摘要:

Mucosal lesions were produced in feline small intestine by evoking a simulated intestinal shock (local hypotension at 30 mm Hg and stimulation of regional sympathetic vasoconstrictor nerves at 6 Hz for 2 h). The degree of mucosal damage was correlated to the level of intestinal blood flow. Microscopically characteristic lesions developed regularly in the small intestinal mucosa when intestinal blood flow was reduced below 12 ml/min × 100 g during the regional shock. The mucosal damage was graded histologically. No difference was found between untreated controls and cats in which the intestinal lumen was perfused with nitrogenated saline. Perfusion with oxygenated saline and i.v. injections of methylprednisolone on the other hand, prevented almost completely the development of the lesions. Albumin, activated charcoal and aprotinin instilled into the intestinal lumen reduced to some extent the mucosal damage. The obtained data support the view that hypoxia is the key factor in the pathogenesis of the mucosal lesions. However, epithelial and intraluminal enzymes are probably important contributing factors

ISSN:0014-312X    

DOI:10.1159/000127888

出版商:S. Karger AG    

年代:1976

数据来源: Karger

摘要:

The relationship between the mucosal lesions in the gut, observed after a 2-hour period of regional hypotension, and the blood pressure fall seen after the hypotensive period was investigated in cats. Untreated controls were compared to animals treated with intraluminal perfusion with nitrogenated or oxygenated saline or treated with intraluminal instillation of albumin, activated charcoal or aprotinin or i.v. injections of methylprednisolone. Untreated controls and cats perfused with nitrogenated saline exhibited a pronounced reduction in arterial blood pressure during the first posthypotensive hour. In the animals treated with methylprednisolone or perfused intraluminally with oxygenated saline only a small fall of blood pressure was observed. In the remaining groups of animals a moderate blood pressure reduction was noted. These results suggest a causal relationship between the intestinal mucosal damage and the posthypotensive cardiovascular derangement possibly via the release of cardiotoxic material from the hypoxic intestinal villi.

ISSN:0014-312X    

DOI:10.1159/000127889

出版商:S. Karger AG    

年代:1976

数据来源: Karger