Clinical significance of 201Tl reverse redistribution in patients with aorto-coronary bypass surgery

Detection of myocardial ischemia by the stress thallium scan has traditionally been performed using transient defect analysis on exercise, followed by redistribution studies. Worsening of the ²⁰¹Tl myocardial image from exercise to redistribution is referred to as reverse redistribution. In this study, we found reverse redistribution in 10 (21%) of 48 angina pectoris patients who had undergone aortocoronary bypass surgery. The clinical significance of this phenomenon in these patients was investigated in relation to angiographic and surgical findings. Reverse redistribution was found to occur in regions which were supplied by bypass grafts. These areas showed increased coronary blood flow and rapid thallium washout. Our results indicate that a perfusion defect in the bypass region of the redistribution image might be caused by relatively rapid washout in the bypass graft region compared to the adjacent normal myocardium. These results should be considered in the clinical interpretation of stress thallium scans.     

Urgent coronary artery bypass surgery in the presence of Dressler's syndrome

The clinical features of Dressler's syndrome which developed in a patient following a third myocardial infarction responded to a short course of prednisolone. However, angina at rest precipitated urgent coronary artery bypass surgery and pericardectomy.     

Splanchnic ischaemia and its role in multiple organ failure

Multiple organ failure remains the leading cause of death in the intensive care unit. Increasing numbers of investigators have focused their attention on the role of gastrointestinal tract in the pathogenesis of this syndrome. Their data indicate that inadequate gut perfusion leads to a measurable imbalance between oxygen delivery and the needs of the tissues, i.e., ischaemia. Gut ischaemia of sufficient duration impairs gastrointestinal tract barrier function, facilitating the passage of enteric bacterial endotoxin into the circulation. It has been hypothesized that production of tumor necrosis factor α, and other biologic mediators by endotoxin–stimulated macrophages, triggers a generalized and uncontrolled inflammatory response that ultimately leads to multiple organ failure.
Preliminary evidence suggests that survival can be improved significantly if gut ischaemia is promptly identifed and aggressively treated by administration of fluids and inotropic drugs, using gastric intramucosal pH as the therapeutic endpoint. Future studies are needed to determine whether additional treatment modalities can improve outcome once the inflammatory response has fully developed.     

Our Distal Aortic Perfusion System in Descending Thoracic and Thoracoabdominal Aortic Aneurysm Repairs

Abstract: We have used heparin-bonded partial cardio-pulmonary bypass to support distal aortic circulation during aortic cross-clamping. However, there were no cardiotomy reservoirs with fully reliable thromboresistance. To resolve this problem, a short-acting anticoagulant (nafamostat mesilate) was added into a cardiotomy reservoir. The present study was designed to evaluate the efficacy of our distal perfusion system. From May 1995 through the end of May 1996, 27 patients underwent descending thoracic and thoracoabdominal aortic aneurysm repairs with this adjunct, 4 being excluded from the experiment. Twenty patients who had undergone conventional partial cardiopulmonary bypass were defined as the control group. There were no significant differences between the 2 groups in the morbidity, mortality, gas transfer, or transfusion requirements despite the fact that more complicated surgical procedures (shown by a two-fold increase in the prevalence of reoperation) were required in the group that had received the current distal perfusion adjunct. the heparin-bonded group. In conclusion, our perfusion system is very effective for descending thoracic and thoracoabdominal aortic aneurysm repairs.     

Extracorporeal membrane oxygenation (ECMO) as lung or heart assist

Extracorporeal membrane oxygenation (ECMO) may serve as extracorporeal lung assist (ECLA) in patients with acute respiratory failure (ARF) or as extracorporeal heart assist (ECHA) in patients with low output syndrome (LOS) after open heart surgery. From 1988 to 1992 seven patients underwent ECMO in our hospital; four suffered from ARF and three from LOS. Various bypass techniques were employed. Two ARF patients, aged 58 and 18 years, had veno-venous bypass; in the latter, ECMO was reinstituted as a veno-arterial bypass one week after weaning. In a three-year-old boy, the ECMO outflow tubing was primarily connected to the pulmonary artery, and shortly afterwards relocated to the common carotid artery. In a 31-year-old man with ARF, and three LOS patients, a 56-year-old woman, and two men aged 68 and 70 years, ECMO was veno-arterial with direct access to the ascending aorta. A heparin-coated system was used, and all but one patient, who was treated with warfarin, received a daily low dose of heparin, which was withdrawn after from one to nine days.
Six patients were weaned off ECMO after 4.5 to 21 days. Three ARF patients recovered completely; the child died. In one LOS patient, ECMO was withdrawn due to a poor general condition. Two others were weaned off ECMO and the intra-aortic balloon pump, and the inotropic support was significantly reduced, but both died of multiple system organ failure. Although no firm conclusions can be drawn from these few case reports, the heparin-coated system used as ECLA appears promising, whereas ECHA seems to imply a poor prognosis in patients who are not candidates for cardiac transplantation.     

停跳或不停跳心脏手术对血清 S-100B蛋白表达的影响

【目的】研究心脏手术围术期血清S-100B蛋白表达及其与停跳或不停跳心肺转流方式和时间的关系。【方法】体外循环心脏手术患者23例,测转流前、转流10min、转流末、转流后24h的血清S-100B蛋白表达水平。【结果】①血清S-100B蛋白质量浓度在体外循环前后动态变化:转流前(M)为0.27μg/L,转流10min后升至0.57μg/L(P<0.01),转流末达峰值1.80μg/L(P<0.01),转流后24h降为0.22μg/L(P>0.05)。转流末的血清S-100B蛋白质量浓度与转流时间呈正相关(r=0.488,P<0.05)。②停跳组(n=6)转流前、转流10min、转流末、转流后24h平均血清S-100B蛋白质量浓度分别为(0.17±0.09)μg/L、(0.48±0.13)μg/L、(1.65±0.52)μg/L和(0.19±0.04)μg/L,不停跳组(n=6)分别为(0.26±0.14)μg/L、(0.71±0.41)μg/L、(1.59±0.84)μg/L和(0.23±0.11)μg/L,两组差别无统计学意义(P>0.05)。【结论】体外循环可导致血清S-100B蛋白表达增高,其表达水平与心肺转流时间呈正相关,但与停跳或不停跳转流方式无关。     

冠状动脉粥样硬化性心脏病病人冠状动脉旁路移置术的治疗效果

①目的 探讨冠状动脉粥样硬化性心脏病(CAD)病人行冠状动脉旁路移置术的治疗效果。②方法 148例CAD病人，体外循环下行旁路移置术(CABG)62例，非体外循环下行旁路移置术(OPCAB)86例。③结果 围手术期死亡3例，8例病人使用主动脉内球囊反搏(IABP)，145例病人术后康复出院。④结论 冠状动脉旁路移置术是治疗CAD的一种安全有效的方法，在掌握手术适应证及技术条件允许情况下应尽量行非体外循环旁路移置术和全动脉化旁路移置术。     

脑立体定向术临床应用

目的：探讨以脑立体定向术治疗震颤麻痹、癫痫、癌性疼痛、慢性精神病及颅内金属异物的方法和疗效。方法：用多功能脑立体定向仪对不同疾病毁损其不同的核团。结果：震颤麻痹１６６例共１８２次手术中治愈１３例次，显效１４５例次，有效１１例次，无效１２例次，死亡１例，有效率达９２９％；癫痫１８例，显效１１例，有效４例，无效３例，有效率达８３３％；癌性痛疼５例均显效；精神病３例，显效２例，有效１例；颅内异物２例均治愈。结论：脑立体定向术对以上疾病均取得了较为满意及良好的疗效，总有效率达９２４％，并且比传统开颅术简便安全     

体外循环对紫绀型先天性心脏病病人血小板的影响

检测１８例体外循环紫绀型先天性心脏病手术病人术前，术中及术后３，８天外周血血小数量和 附，聚集功能，探讨体外循环对血小板质和量的影响。结果显示，血小板数量和聚集功能在术后显著下降并持续至术后８天，血小板粘附功能显著下降，术后３天恢复。提示体外循环气血界面，人工材料非内皮表面可导致血小板激活，粘附，聚集面在量消耗，数量和功能显著下降。