Hypoperfusion as a possible factor in the development of gastrointestinal complications after cardiac surgery

This study has presented the spectrum of postoperative gastrointestinal system complications after open heart surgery at the University of Washington from 1980 through 1983. The frequent necessity for operative intervention and a mortality rate of 17 percent in our study of gastrointestinal complications in patients who have undergone open heart surgery indicates the need for early diagnosis and treatment. The data suggest that bypass times approaching 100 minutes and the presence of postoperative cardiogenic shock are important risk factors in the development of such complications in elective cardiac surgery patients. An incidence of gastrointestinal complications of 8.6 percent in those undergoing repair of acute aortic dissections makes gastrointestinal complaints particularly suspicious in this subgroup.     

The use of Forane anesthesia for surface-induced deep hypothermia.

The effects of Forane anesthesia for deep surface hypothermia with 30 minutes of total circulatory occlusion were evaluated. With 100% O2 6 of 7 dogs developed motor disorders postoperatively, while 3 of 5 with 98% O2/2% CO2 and none with 95% O2/5% CO2 developed motor disorders. Cooling was uneventful except for 1 episode of ventricular fibrillation in the 5% CO2 group at 23 degrees C. Resuscitation was easy, but the early rewarming period was characterized by repeated episodes of ventricular fibrillation and delayed recovery of cardiac function, especially in the 100% O2 group. Blood lactate levels remained low during cooling and gradually increased during rewarming in all groups, with the highest levels in the 100% O2 group and the lowest in the 5% CO2 group. It is concluded that Forane can be used for surface hypothermia with 30 minutes' circulatory occlusion when administered in 95% O2/5% CO2. A Comparison of these results with previously reported series indicates that Forane is inferior to ether but may be superior to halothane for surface hypothermia.     

U wave alternans: an electrocardiographic sign of left ventricular failure

All postextrasystolic complexes seen over a twelve year period were carefully analyzed. Normally only the first complex is different, showing a slightly altered T and a larger U wave. Ten patients with left ventricular failure and postextrasystolic pulsus alternans consistently showed postextrasystolic U wave alternans. Besides introducing an electrocardiographic sign of heart failure, this provides some insight into the underlying etiology of the U wave.     

Monozygotic twinning and structural defects.

An excess of structural defects occurs in monozygotic twins compared in dizygotic twins or singletons. The excess is composed of three categories of defects. The first includes defects which are part of the MZ twinning, such as conjoined twins and some amorphous twins. In addition, all early embryonic malformations and malformation complexes such as sirenomelia mc. holoprosencephaly mc. and anencephaly mc are increased in MZ twins. The reason for this association is considered to be the common etiology for both the MZ twinning and the early malformation problem. MZ twins provide an excellent model for appreciating the spectra of particular malformation complexes, since the twins often have different gradations in severity of the same type of structural defect. The finding of both discordant and concordant MZ twins with Goldenhar, de Lange, and Rubinstein-Taybi syndromes suggests that these "syndromes" might be early malformation complexes. The other two categories are considered secondary to the MZ twinning process. The most unique category results from any vascular interchange between the MZ twins. Depending on their nature, vascular connections may give rise to reverse flow with acardiac status in one twin during early development, or to vascular disruptions from a deceased co-twin with intravascular coagulation causing embolization in the surviving co-twin. The latter defects may include microcephaly, porencephalic cysts, hydranencephaly, intestinal atresia, aplasia cutis, and limb amputation. Unequal growth may occur as a result of artery to vein placental anastomoses. The final category is deformations due to crowding in utero during late gestation. These do not differ from those in DZ twins.     

Oxygen Consumption during Surface-Induced Deep Hypothermia under Halothane Anesthesia

The effect of halothane-100% oxygen anesthesia on oxygen consumption was studied in 10 dogs subjected to surface-induced deep hypothermia with 30 minutes of circulatory arrest. The results were compared with previous oxygen consumption data under ether-100% oxygen anesthesia.Low cardiac output, especially during the rewarming period, low Pa02, and a large arteriovenous oxygen difference during rewarming were significantly different in the halothane group, despite identical oxygen consumption in both groups. These differences could not elucidate the exact cause of postoperative motor disturbances associated with 30 minutes of circulatory arrest in the halothane group. The possibility that there was higher oxygen consumption under halothane anesthesia is discussed.     

Synapse development within the spinal trigeminal nucleus

Pars interpolaris of the spinal trigeminal nucleus of kittens has been studied with the electron microscope at birth and at several subsequent ages during the first month of life. Attention has been given to ultrastructural maturational changes that occur in this neuropil, especially events in synaptogenesis. The results of this investigation include the following observations: (1) the neuropil, even at the earliest ages studied (three-hour-old kittens), is strikingly mature, necessitating a quantitative assessment in order to determine subtle developmental changes in synaptic patterns; (2) the number of axoaxonic contacts at birth are few, and their emergence is essentially a postnatal phenomenon; (3) it appears that the immature Gray type II or symmetrical synapse possesses distinct cleft material and dense, parallel membrane specializations. Synaptic vesicle accumulation at this contact appears to occur after the membrane specializations have formed. A previous study by Kerr26 has shown a reduced potential for primary afferent reorganization with the spinal trigeminal nucleus when kittens are subjected to trigeminal rhizotomy after three days of age. Our observations on the development of axoaxonic synaptic arrangements in the neonatal period may provide an explanation for these earlier results.     

New tube for the diagnosis and treatment of upper gastrointestinal hemorrhage

The design, use, and applications of a new tube for the treatment and diagnosis of upper gastrointestinal hemorrhage are presented. The tube incorporates suction, air sump, and irrigating components in a triple-lumen construction. The tube allows constant irrigation of the bleeding stomach with large quantities of irrigant that may contain antacids, vasoconstrictors, or both. The efficient evacuation of the stomach may result in more productive gastroscopy and upper gastrointestinal roentgenographic examinations. The tube can provide early warning of rebleeding as well as perhaps providing definitive or temporizing therapy in some cases of bleeding.