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排序方式: 共有661条查询结果,搜索用时 15 毫秒
1.
Dr. Arni Raghavendrarao Raghuram M.Ch. Subbiah Kumar MD Kathamuthu Balamurugan DA Arulmurugan DA Ramiah Krishnan M.Ch. Perichiappan Sivakami BS Eluvathingal Varghese John M.Ch. 《Indian Journal of Thoracic and Cardiovascular Surgery》2006,22(3):178-181
Background Beating heart surgery has now become the commonest technique of doing Coronary Artery Bypass Graft Surgery (CABG) in our country.
It is being used even in such high risk situations like diffuse coronary disease and Critical Left Main stem Stenosis (LMCS)
with good results. The aim of this study is to retrospectively review our results in Off-Pump Coronary Artery Bypass Surgery
(OPCAB) in patients with critical left main stem stenosis.
Methods This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery. During
the period from April 2003 to September 2005 a total of 64 patients underwent OPCAB procedure for critical LMCS. During the
same period 10 patients underwent CABG on Cardio Pulmonary Bypass (CPB). The age range was 36–77yrs. The sex distribution
was M: F 53∶10. Ten patients were done as emergency. 2 of them were on Intra Aortic Balloon Pump (IABP) support preoperatively.
10 patients were high risk with a Euro score of ≥5.
Results Left Internal Mammary Artery (LIMA) was used in 78% of cases. Average grafts per patient was 2.96. The median ventilation
time was 5.91 hrs. New IABP insertion in postoperative period was required in 1 patient. One patient was reexplored for bleeding.
There was one perioperative myocardial infarction. 57% of patients did not need any blood transfusion. There was no conversion
to CPB. There was no operative mortality. Inotropes were used in ten cases.
Conclusions OPCAB is a safe method of revascularization in patients with critical LMCS. Preoperative IABP is useful in patients with cardiogenic
shock. However, there is a place for CPB in patients needing additional procedures like Mitral Valve repair (MV repair) or
Dor's procedure or when the vessels are very diffusely diseased. Those patients who are unstable despite IABP support may
be managed by Beating heart On Pump (BHOP) technique. 相似文献
2.
Rakesh Lodha Subbiah Vivekanandhan Manjunatha Sarthi Sushil K Kabra 《Pediatric critical care medicine》2006,7(3):220-224
BACKGROUND: Septic shock is an important cause of death in pediatric intensive care units. Initial evaluations have shown that vasopressin may have a role in catecholamine refractory shock in adults. It is important to determine whether children with septic shock have deficiency of vasopressin. This will help in defining the role of vasopressin in septic shock. DESIGN: Prospective cohort study. SETTING: Pediatric intensive care unit of a tertiary care hospital in north India. PATIENTS: Patients were children with septic shock, and controls were children with sepsis but no shock. STUDY DESIGN: Vasopressin levels in plasma were determined by enzyme-linked immunosorbent assay for children with septic shock at diagnosis (baseline) and thereafter at 24, 48, and 96 hrs to determine the time trends. The baseline vasopressin values for children with septic shock were compared with those for children without shock. RESULTS: The median (95% confidence interval) vasopressin level at baseline in children with septic shock was 116 (63.3-130.7) pg/mL, and in children with sepsis but no shock it was 106 (61.7-131.77) pg/mL. The median value for survivors was 76 (44.6-130.9) pg/mL, and for nonsurvivors, 118 (81.7-259) pg/mL (p = .16). The serial values also did not show any significant changes; the values at 24 hrs (n = 17), 48 hrs (n = 16), and 96 hrs (n = 15) were 105 (76.1-125.9), 105 (41.4-155.5), and 109.5 (54.9-154.8) pg/mL, respectively. CONCLUSIONS: The results of our study suggest that vasopressin levels are elevated in children with septic shock and that serial values up to 96 hrs do not show any decline. 相似文献
3.
D I Ben-Tovim N Subbiah B Scheutz J Morton 《The Australian and New Zealand journal of psychiatry》1989,23(1):73-80
The widely used DSM-III criteria for the diagnosis of bulimia essentially define bulimia as a syndrome of guilty, secretive and subjectively hard to control binge over-eating. A self-report questionnaire for bulimic behavior was administered to three community and two hospital populations in South Australia. 13% of females in the community samples could be categorized as bulimic according to the DSM-III criteria. Those criteria did not adequately define the behaviour of patients in treatment for bulimia in a Weight Disorders Unit, 85% of whom not only binged, but induced vomiting afterwards. When diagnostic criteria were more closely aligned to clinical experience, the prevalence of bulimia in the community appeared closer to 1-2%. New DSM criteria (DSM-III-R) have been proposed and prevalence rates using them fell within the 1-2% range. 相似文献
4.
Pressure recovery distal to a stenosis: potential cause of gradient "overestimation" by Doppler echocardiography 总被引:1,自引:0,他引:1
R A Levine A Jimoh E G Cape S McMillan A P Yoganathan A E Weyman 《Journal of the American College of Cardiology》1989,13(3):706-715
Doppler ultrasound is currently being widely applied to measure intracardiac pressure gradients noninvasively. In comparative invasive studies, it is generally assumed that pressure is effectively uniform distal to the stenosis. As the poststenotic jet expands, however, its velocity decreases, and pressure is recovered to the extent permitted by turbulence, so that the measured gradient will be lower if the distal catheter is positioned downstream from the vena contracta. This can lead to apparent Doppler "overestimation" of the pressure gradient because of this phenomenon of pressure recovery. This study demonstrates that pressure recovery can be important in a variety of clinical settings studied by in vitro models. Although most prominent in streamlined tunnels modeled after the obstruction in patients with hypertrophic cardiomyopathy, these effects are important even for central stenoses at physiologic flow rates. Because precise catheter position is not always known or controlled, these findings suggest an important advantage for Doppler gradient estimation, because it provides the maximal gradient at the vena contracta, which determines the load on the proximal chamber. 相似文献
5.
Joanne Hopmeyer Erika Whitney Dana A. Papp Manisha S. Navathe Robert A. Levine Young H. Kim Ajit P. Yoganathan 《Annals of biomedical engineering》1996,24(5):561-572
Mitral regurgitation results from the incomplete closure of the mitral valve, and the noninvasive diagnosis of this disease
remains an important clinical goal. In this study, steady flow computer simulations were used to evaluate flow convergence
method for flow rate estimation. The hemispheric and hemielliptic formulae were compared for accuracy in the presence of complicating
factors such, as ventricular confinement, orifice shape, and aortic outflow. Results showed that in the absence of aortic
outflow and ventricular confinement, there was a plateau zone where the hemispheric formula approximated the true flow rate,
independent of orifice shape. However, in the presence of complicating factors such as aortic outflow and ventricular confinement,
there was no clear zone where the hemispheric formula could be applied. The hemielliptic formula, however, worked in, all
cases, regardless of chamber size or magnitude of aortic outflow. Therefore, application of the hemielliptic formula shold
be considered in future clinical studies. 相似文献
6.
Hanle D. D. Harrison E. C. Yoganathan A. P. Corcoran W. H. 《Medical & biological engineering & computing》1986,24(5):449-459
Velocity measurements were made in vitro using laser Doppler anemometry (LDA) downstream from an lonescu-Shiley (IS) bioprosthetic
aortic heart valve. Velocity measurements were made in both steady and pulsatile flow. A systematic, flow mapping approach
to the measurement methodology showed that the IS valve generated a large jetlike flow constriction. The acceleration ratio,
defined as the maximum mean velocity for the IS valve divided by that for no valve obstructing the flow, was as high as 2·4
for steady flow and 2·6 for pulsatile flow. It was concluded that the IS valve generated a flow quite unlike that observed
by other in vestigators for the natural human aortic valve, after which the leaflet design of the IS valve was modelled. In
addition, a comparative analysis of steady and pulsatile results was undertaken. It was found that the pulsatile flow results
for the systolic ejection interval could be divided into three phases, denoted early, mid, and late systole, as defined by
the flow structure at the data plane location. Only during midsystole were the pulsatile flow results approximated by the
steady flow results. Also, it was found that the magnitude of the flow disturbance measured in steady flow tended to be an
upper bound on that measured for pulsatile flow. 相似文献
7.
Travis BR Marzec UM Leo HL Momin T Sanders C Hanson SR Yoganathan AP 《Annals of biomedical engineering》2001,29(8):657-664
The clinical histories of the Medtronic Parallel (MP) and St. Jude Medical (SJM) Standard valves suggest pivot geometry influences the thrombogenic characteristics of bileaflet prostheses. This work studied the effects of various pivot geometries on markers of platelet damage in a controlled, in vitro apparatus. The Medtronic Parallel valve, two St. Jude Medical valves, and two demonstration prostheses were used to study the effects of bileaflet pivot design, gap width, and size on platelet secretion and anionic phospholipid expression during leakage flow. A centrifugal pump was used to drive blood through a circuit containing a bileaflet prosthesis. Samples were taken at set time intervals after the start of the pump. These samples were analyzed by cell counting, flow cytometry, and enzyme-linked immunosorbant assay. No significant differences were observed in platelet secretion or anionic phospholipid expression between experiments with the SJM 27 Standard regular leaker, the SJM 20 regular leaker, and the MP 27 valves. Significant differences in platelet secretion and anionic phospholipid expression were observed between a SJM 27 Standard regular leaker and a SJM 27 high leaker valve. These studies suggest that leakage gap width within bileaflet valve pivots has a significant effect on platelet damage initiated by leakage flow. © 2001 Biomedical Engineering Society.
PAC01: 8719Uv, 8719Tt, 8380Lz, 8768+z 相似文献
8.
D. W. Suobank A. P. Yoganathan E. C. Harrison W. H. Corcoran 《Medical & biological engineering & computing》1984,22(1):40-47
A comparative study was made of the sounds produced by a normal Starr-Edwards 2400 aortic valve prosthesis with those produced
by the same valve but having a simulated overgrowth at the apex of the struts. Comparisons were made over the entire cardiac
cycle for time and amplitude, power-density spectra, power-distribution spectra, power-distribution surfaces associated with
individual valves, and three-dimensional power-distribution-difference surface. Power-density spectra were compared for portions
of the cycle corresponding to the opening, systolic, and closing sounds of the valve. Physical parameters of an acoustical
model were estimated from the power-density spectra. The results showed that each comparison gave information pertinent to
the simulated malfunction. Opening. systolic and closing sounds, respectively, were different for each valve. The opening
sound of the abnormal valve displayed a much lower frequency. Systolic sounds for the two valves were similar in frequency,
but the normal valve produced more total power for this sound. The closing sound of the abnormal valve occurred later than
that of the normal valve. These differences were more clearly seen when viewed in the frequency domain. 相似文献
9.
The analgesic effect, of intracerebroventricular administration of morphine, ketocyclazocine, [D-ala2]-methionine enkephalinamide (DAM), [D-ala2-D-leu5]-enkephalin. (DADLE), leuenkephalin, metenkephalin, and -endorphin on acetic acid-induced abdominal writhing (AAW) was investigated in naive and morphine-tolerant mice. It was found that the relative potencies of a series of opioids are different in naive and morphine-tolerant groups. In naive animals, the order of potency (ED50, nmol) was -endorphin > morphine=DAM > DADLE > ketocyclazocine=leuenkephalin=metenkephalin. The morphine-tolerant animals were cross-tolerant to ketocyclazocine and to all the peptides studied; DAM and -endorphin exhibited the highest degree of tolerance. In morphine-tolerant animals, the order of potency was morphine=DADLE=-endorphin > DAM=ketocyclazocine =metenkephalin > leuenkephalin. The results indicate that endogenous opioid systems may be affected by tolerance development to morphine. 相似文献
10.
Walker PG Kim Y Muralidharan E Miyajima Y Delatore J Yoganathan AP 《Echocardiography (Mount Kisco, N.Y.)》1994,11(1):11-28
An in vitro steady flow experiment was performed in order to test the accuracy of velocity measurements obtained through color Doppler flow mapping (CDFM). Using the American Society of Echocardiography (ASE) flow phantom, low (maximum velocity = 60 cm/sec), medium (maximum velocity = 300 cm/sec) and high (maximum velocity = 600 cm/sec) speed accelerating flow fields, in which multiple aliases were visible, were imaged. A fully automatic computer algorithm was used to unwrap the aliases and to convert the CDFM to digital velocity. Packet size and wall filter frequency on the ultrasound machine were varied and the measured velocity compared to the true velocity. The results show that the velocity obtained in this way from the CDFM is very accurate at the low and medium velocities, but for the high velocity the turbulence is too intense to obtain an accurate result. There was no marked difference between the data for different packet sizes or wall filter settings. 相似文献