Intramyocardial pH during Elective Arrest of the Heart: Relative Effects of Hypothermia versus Potassium Cardioplegia on Anaerobic Metabolism

Using an intramyocardial pH needle probe (21 gauge) to monitor myocardial metabolism during ischemia, we determined the effect of potassium cardioplegia at both moderate and deep hypothermia. Five groups of 5 dogs each were placed on cardiopulmonary bypass and the pH probe was inserted approximately 10 mm into the left ventricular free wall. Cardiac ischemia was achieved by cross-clamping the ascending aorta at 37°C (Group 1), 27°C (Group 2), or 17°C (Group 3). In the remaining two groups, aortic cross-clamping was followed by the infusion of 600 to 800 ml of potassium cardioplegic solution adjusted to cardiac temperatures of 27°C (Group 4) or 17°C (Group 5). In each group, myocardial temperature was maintained constant, electrical and mechanical activity observed, and pH recorded until a plateau was reached or for 3 hours.Our results show a progressive and significant decrease in the metabolic rate with reduction in temperature over the 37° to 17°C range. By abolishing contractile activity, potassium cardioplegia markedly reduces the rate of hydrogen ion accumulation at 27 °C, but at 17 °C the additive effect of cardioplegia is much less pronounced. These observations support the principle of reducing contractile activity to a minimum during elective arrest of the heart but indicate that potassium cardioplegia does little to further reduce the rate of anaerobic metabolism, as shown by the measurement of intramyocardial pH, under conditions of deep hypothermia.     

Elective resection for diverticular disease and carcinoma

A retrospective comparison was made of 47 patients who underwent elective surgical resection for diverticular disease and 106 patients who had sigmoid colectomy or left hemicolectomy for carcinoma over an eight and one-half-year period. There was higher morbidity and mortality in those patients with diverticular disease.     

Male transsexualism: Two cases in a single family

Two Chinese brothers who underwent sex-change surgery to female status are described. Early life experiences of the two siblings differed from those of their non-transsexual brothers and sisters. The pre-transsexual males were raised primarily by the maternal grandmother, whereas the others were reared by their parents. Feminine role orientation began during childhood and continued through adolescence. Sex-change surgery was performed during adulthood in two stages, and both patients are currently living as women. With the exception of another article in this journal issue, there are no other reports of transsexualism in male siblings.     

Positive emotions: exploring the other hemisphere in behavioral medicine

The search for the psychological antecedents of medical disorders has focused on the role of stress and negative emotional states. Previous research in this area has investigated relations between negative emotions and physiological adaptations (e.g., blood pressure elevations), adverse health behaviors (e.g., smoking), and social conditions (e.g., social isolation). In this discussion, we argue that more attention is needed to understand the effects of positive emotional states on health enhancement and disease prevention. In each of the areas cited previously, evidence is beginning to emerge that indicates that positive emotions can be associated with health promoting conditions. Interventions using cognitive behavioral strategies or meditation can increase positive emotional states that are maintained over time and that may benefit health and well-being. Implications for behavioral medicine are discussed. This article is based on a presentation given by the first author at the International Congress of Behavioral Medicine, Helsinki, Finland, August 2002. This work was supported by grants R01 MH57233 (Margaret A. Chesney, principal investigator) and P30-MH62246 (Thomas J. Coates, principal investigator) from the National Institute of Mental Health. The authors thank Susan Folkman and Judith Moskowitz at the Osher Center for Integrative Medicine at the University of California, San Francisco, for their collaboration and guidance in the theoretical aspects of enhancing positive affect and meaning through coping effectiveness training (CET). We also thank the dedicated staff members and participants of the CET research trials.     

Laparostomy for severe intra-abdominal infection complicating colorectal disease

PURPOSE: The aim of this study was to evaluate the use of laparostomy in the management of patients with severe intra-abdominal infection resulting from colorectal disease. METHODS: Seven patients, four with inflammatory bowel disease, two with colorectal carcinoma, and one with diverticular perforation, underwent laparostomy during a six-year period for postoperative, severe, intra-abdominal infection. RESULTS: The median age was 42 years, the mean Acute Physiology and Chronic Health Evaluation II score was 22.7, and the observed mortality was 28.6 percent (2/7 patients). In one patient the laparostomy was closed at 11 days; in all the others the wound was left to heal by granulation and contraction, and two of these later required reconstructive surgery. The median follow-up was three years and seven months. CONCLUSION: Laparostomy is an effective and practical method of managing patients with severe intra-abdominal infection as a result of colorectal disease.Presented at the European Council of Coloproctology Biennial Meeting, Edinburgh, United Kingdom, June 17 to 19, 1997.     

Cardiac disease and the skin

Many cutaneous abnormalities are associated with cardiac disease. General signs found in cardiac patients include cyanosis, flushing, erythema and digital clubbing. Multisystem disorders and inherited diseases are also associated with cutaneous and cardiac abnormalities.