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Obesity influences propranolol pharmacokinetics in patients undergoing coronary artery bypass grafting employing cardiopulmonary bypass/ Influência da obesidade na farmacocinética do propranolol em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese As concentrações plasmáticas e a disposição cinética do propranolol podem ser alteradas pela circulação extracorpórea (CEC). Investigou-se a influência da obesidade na farmacocinética do propranolol em pacientes submetidos à revascularização do miocárdio empregando a CEC. Investigaram-se quinze pacientes, recebendo cronicamente propranolol no pré- (10-40 mg, 2 a 3 vezes ao dia PO) e no pós-operatório (10 mg, 1 vez ao dia) sendo os mesmos distribuídos em (more) dois grupos: obesos (n = 9, média 29,4) kg/m²; e não-obesos (n = 6, média 24,8 kg/m²). Colheram-se amostras seriadas de sangue nos períodos pré- e pós-operatório (Ä); determinaram-se as concentrações plasmáticas do propranolol através da cromatografia líquida de alta eficiência. Aplicou-se o software PK Solutions 2.0 para estimativa dos parâmetros cinéticos. Não se registrou alteração na farmacocinética do propranolol avaliada através dos parâmetros meia-vida biológica (t1/2), volume de distribuição aparente (Vd/F) e depuração plasmática (CL T/F) no grupo de pacientes não-obesos, enquanto prolongamento relevante da t1/2 (3,2 para 11,2 h, p Abstract in english Propranolol plasma levels and kinetic disposition may be altered by hypothermic cardiopulmonary bypass (CPB-H). We investigated the potential influence of obesity on propranolol pharmacokinetics in patients undergoing coronary artery bypass grafting employing CPB-H. Fifteen patients, receiving propranolol perorally pre- (10-40 mg, 2-3 times a day) and post-operatively (10 mg, once a day) were distributed in two groups, based on body mass index (BMI), in obese (n = 9, BMI: (more) mean 29.4 kg/m²) and non-obese (n=6, BMI: mean 24.8 kg/m²). A serial of blood samples was collected at the pre- and post-operative periods at time dosing interval (Ä); propranolol plasma levels were measured one day before and after surgery using a high performance liquid chromatographic procedure described previously. PK Solutions software 2.0 was applied to obtain pharmacokinetic parameters. No changes on kinetic parameters as biological half-life (t1/2, p = 0.0625, NS), volume of distribution (Vd/F, p=0.8438, NS) and plasma clearance (CL T/F, p = 0.1563, NS) were obtained for the non-obese patients, while a prolongation of t1/2 (3.2 to 11.2 h, p

Pereira, Valéria Adriana; Carmona, Maria José Carvalho; Omosako, Célia Etsuco Kobayashi; Auler Júnior, José Otávio Costa; Santos, Silvia Regina Cavani Jorge

2003-12-01

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Obesity influences propranolol pharmacokinetics in patients undergoing coronary artery bypass grafting employing cardiopulmonary bypass Influência da obesidade na farmacocinética do propranolol em pacientes submetidos à revascularização do miocárdio com circulação extracorpórea  

Directory of Open Access Journals (Sweden)

Full Text Available Propranolol plasma levels and kinetic disposition may be altered by hypothermic cardiopulmonary bypass (CPB-H). We investigated the potential influence of obesity on propranolol pharmacokinetics in patients undergoing coronary artery bypass grafting employing CPB-H. Fifteen patients, receiving propranolol perorally pre- (10-40 mg, 2-3 times a day) and post-operatively (10 mg, once a day) were distributed in two groups, based on body mass index (BMI), in obese (n = 9, BMI: mean 29.4 kg/m²) and non-obese (n=6, BMI: mean 24.8 kg/m²). A serial of blood samples was collected at the pre- and post-operative periods at time dosing interval (Ä); propranolol plasma levels were measured one day before and after surgery using a high performance liquid chromatographic procedure described previously. PK Solutions software 2.0 was applied to obtain pharmacokinetic parameters. No changes on kinetic parameters as biological half-life (t1/2, p = 0.0625, NS), volume of distribution (Vd/F, p=0.8438, NS) and plasma clearance (CL T/F, p = 0.1563, NS) were obtained for the non-obese patients, while a prolongation of t1/2 (3.2 to 11.2 h, pAs concentrações plasmáticas e a disposição cinética do propranolol podem ser alteradas pela circulação extracorpórea (CEC). Investigou-se a influência da obesidade na farmacocinética do propranolol em pacientes submetidos à revascularização do miocárdio empregando a CEC. Investigaram-se quinze pacientes, recebendo cronicamente propranolol no pré- (10-40 mg, 2 a 3 vezes ao dia PO) e no pós-operatório (10 mg, 1 vez ao dia) sendo os mesmos distribuídos em dois grupos: obesos (n = 9, média 29,4) kg/m²; e não-obesos (n = 6, média 24,8 kg/m²). Colheram-se amostras seriadas de sangue nos períodos pré- e pós-operatório (Ä); determinaram-se as concentrações plasmáticas do propranolol através da cromatografia líquida de alta eficiência. Aplicou-se o software PK Solutions 2.0 para estimativa dos parâmetros cinéticos. Não se registrou alteração na farmacocinética do propranolol avaliada através dos parâmetros meia-vida biológica (t1/2), volume de distribuição aparente (Vd/F) e depuração plasmática (CL T/F) no grupo de pacientes não-obesos, enquanto prolongamento relevante da t1/2 (3,2 para 11,2 h, p<0,0039), aumento no Vd/F (3,0 para 7,7 L/kg, p < 0,0039) e redução no CL T/F (11,3 para 9,2 mL/min.kg, p<0,0391) foram observados no grupo de pacientes obesos, no pós-operatório de revascularização do miocárdio empregando circulação extracorpórea e hipotermia. Os parâmetros farmacocinéticos obtidos poderiam justificar as concentrações plasmáticas do propranolol nos pacientes obesos superiores àquelas obtidas para não obesos após a cirurgia cardíaca.

Valéria Adriana Pereira; Maria José Carvalho Carmona; Célia Etsuco Kobayashi Omosako; José Otávio Costa Auler Júnior; Silvia Regina Cavani Jorge Santos

2003-01-01

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Coronary bypass grafting without use of cardiopulmonary bypass for dextrocardia.  

UK PubMed Central (United Kingdom)

Dextrocardia is a condition in which the heart is pointed toward the right side of the chest instead of normally pointing to the left. The rate of atherosclerotic heart disease in subjects with this condition is similar to that of the general population. We present a patient with situs inversus totalis with dextrocardia who underwent coronary artery bypass grafting without use of cardiopulmonary bypass (OPCAB). A 74-year-old man who was known to have dextrocardia with situs inversus was admitted to the hospital because of angina. Coronary angiography was performed and showed ostial occlusion of the left anterior descendng artery (LAD) unsuitable for percutaneous coronary interventions but collatereralised from the right coronary artery. Patient underwent OPCAB under general anestesia. Right internal mammary artery was anastomosed to LAD on the beating heart with the surgeon standing on the right side of the patient. The patient's post-operative course was uneventful, and he was discharged on the 6th postoperative day in good condition. Performing OPCAB surgery is not technically more demanding, and present no unusual challenge on patients with dextrocardia.

Mujanovic E; Bergsland J; Tursic A; Stanimirovic-Mujanovic S; Kabil E

2011-01-01

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Ketamine has no effect on oxygenation indices following elective coronary artery bypass grafting under cardiopulmonary bypass  

Directory of Open Access Journals (Sweden)

Full Text Available Cardiopulmonary bypass is known to elicit systemic inflammatory response syndrome and organ dysfunction. This can result in pulmonary dysfunction and deterioration of oxygenation after cardiac surgery and cardiopulmonary bypass. Previous studies have reported varying results on anti-inflammatory strategies and oxygenation after cardiopulmonary bypass. Ketamine administered as a single dose at induction has been shown to reduce the pro-inflammatory serum markers in patients undergoing cardiopulmonary bypass. Therefore we investigated if ketamine can result in better oxygenation in these patients. This was a prospective randomized blinded study. Eighty consecutive adult patients undergoing elective coronary artery bypass grafting under cardiopulmonary bypass were included in the study. Patients were divided into two groups. Patients in ketamine group received 1mg/kg of ketamine intravenously at induction of anesthesia. Control group patients received an equal volume of saline. All patients received standard anesthesia, operative and postoperative care.Paired t test and independent sample t test were used to compare the inter-group and between group oxygenation indices respectively. Oxygenation index and duration of ventilation were analyzed. Deterioration of oxygenation index was noted in both the groups after cardiopulmonary bypass. However, there was no significant difference in the oxygenation index at various time points after cardiopulmonary bypass or the duration of ventilation between the two groups. This study shows that the administered as a single dose at induction does not result in better oxygenation after cardiopulmonary bypass.

Parthasarathi Gayatri; Raman Suneel; Sinha Prabhat; Singha Subrata; Karunakaran Jayakumar

2011-01-01

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Intraoperative assessment and quantification of coronary artery graft patency performed on or off cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Within the last 10 years, the incorporation of off-pump coronary artery bypass grafting (OPCAB) into many surgical practices has grown. OPCAB requires the surgeon to operate on a beating heart, and it is generally accepted that OPCAB procedures are more technically demanding. Concerns of possible incomplete revascularizations and decreased graft patency have been noted in the literature. The objective of this study was to evaluate and compare on-pump and off-pump intraoperative coronary artery bypass graft (CABG) flow parameters. Intraoperative flow studies conducted with the Butterfly (Medi-Stim Norge AS, Oslo, Norway) flow meter were analyzed retrospectively on 74 patients. Comparisons were completed between patient groups having had their revascularizations performed on or off cardiopulmonary bypass. Our study revealed significant differences in the mean flow rate through saphenous vein grafts (SVG) to the obtuse marginal artery (OM; p = .014), to the diagonal artery (Diag; p = .003), to the right coronary artery (RCA; p = .001), and to the posterior descending artery (PDA; p = .001). Total blood product use showed significantly increased use of both platelets (PLTs) and cryoprecipitate (Cryo) in the on-pump group (p = .027 and .012, respectively). No differences were found for transfusions of red blood cells (RBCs) or fresh frozen plasma (FFP). Additional findings showed a significantly decreased median length of stay (LOS) for the off-pump group. The on-pump patients had a median hospital stay of 7 days (range, 4-24 days), whereas the off-pump patients had a median stay of 6 days (range, 3-22 days; p = .049). Although we were able to show some significance in the mean flow data supporting increased graft flow with the on-pump technique, we were not able to show an overall increase in all recorded flow characteristics to support one method over another.

Rauch ED; Leach C; Barnes T; Driscoll K; Strutz K; Holt DW

2007-06-01

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Neurologic outcomes after coronary artery bypass grafting with and without cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Neurologic injury, in the form of either stroke or more subtle neurocognitive impairment, is a frequent and potentially devastating complication of coronary artery bypass grafting (CABG). The etiology of CABG-associated neurologic injury is likely multifactorial, with the phenomena of cerebral hypoperfusion and embolism being the major contributors. Several perioperative strategies have been developed in an effort to reduce the incidence of CABG-associated neurologic complications. Hypothermic cerebral perfusion, alpha stat acid-base management, and slow patient rewarming have been shown by several investigators to minimize adverse neurologic sequelae associated with the use of cardiopulmonary bypass. Performing CABG without cardiopulmonary bypass (off-pump CABG), meanwhile, has been shown to reduce the risk of perioperative stroke, especially in high-risk patients such as the elderly. Whether off-pump CABG reduces the incidence of less severe neurocognitive impairment has not yet been clearly established and merits further investigation in the form of large, multicenter, randomized trials. Other technical innovations, such as the use of sutureless and clampless aortic anastomotic devices, also may be able to further minimize the neurologic complications associated with CABG.

Scarborough JE; White W; Derilus FE; Mathew JP; Newman MF; Landolfo KP

2003-01-01

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Cytokines and troponin-I in cardiac dysfunction after coronary artery grafting with cardiopulmonary bypass  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVE: The association between cytokines and troponin-I with cardiac function after cardiac surgery with cardiopulmonary bypass remains a topic of continued investigation. METHODS: Serial measurements, within 24h following surgery, of tumor necrosis factor-alpha, its soluble receptors, and troponin-I were performed in patients with normal ejection fraction undergoing coronary artery bypass grafting. Ejection fraction was measured by radioisotopic ventriculography preoperatively, at 24h and at day 7 postoperatively. RESULTS: Of 19 patients studied (59±8.5 years), 10 (group 1) showed no changes in ejection fraction, 53±8% to 55±7%, and 9 (group 2) had a decrease in ejection fraction, 60±11% to 47±11% (p=0.015) before and 24h after coronary artery bypass grafting, respectively. All immunological variables, except tumor necrosis factor-alpha soluble receptor I at 3h postoperation (5.5± 0.5 in group 1 versus 5.9±0.2 pg/ml in group 2; p=0.048), were similar between groups. Postoperative troponin-I had an inverse correlation with ejection fraction at 24h (r= -0.44). CONCLUSIONS: Inflammatory activity, assessed based on tumor necrosis factor-alpha and its receptors, appears to play a minor role in cardiac dysfunction after cardiac surgery. Troponin I levels are inversely associated with early postoperative ejection fraction.

Savaris Neverton; Polanczyk Carisi; Clausell Nadine

2001-01-01

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Emergency Conversion from Off Pump to Cardiopulmonary Bypass in Patients with Coronary Artery Bypass Graft Surgery  

Directory of Open Access Journals (Sweden)

Full Text Available Introduction: As off pump Coronary artery bypass grafting surgery (CABG) is a developing method in coronary cardiac surgery, most surgeons are anxious about the danger of emergency crash conversion. In this observational study we tried to show the rate and outcome of conversion . Material and methods: In this descriptive study about 477 coronary off-pump CABG patients were operated in Ghaem hospital in Mashhad, Iran, from Jan 2012 to Jan 2013.In this group 20 patients needed to convert to Cardiopulmonary Bypass (CPB) immediately .We analyzed these 20 patients and produced the results. Results: There was no cerebrovascular accident (CVA) and no neurologic problems.There was one death among these 20 patients.  There was one case of renal failure who was the same patient that expired. 75% of these 20 patients had hypertension and 45%  had  diabetes .  Conclusion: 20 patients (4.19%) had an emergency switch to On-pump CABG and only one death  occurred among 20 patients.

2013-01-01

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Necrotizing enterocolitis after open heart surgery employing hypothermia and cardiopulmonary bypass.  

Science.gov (United States)

Three patients, 1-11 months of age, who underwent open heart surgery with cardiopulmonary bypass and profound hypothermia, developed necrotizing enterocolitis postoperatively leading to death. Pneumatosis intestinalis and portal vein gas were demonstrated radiographically. Necrotizing enterocolitis has not been previously reported as a complication of cardiopulmonary bypass and profound hypothermia. PMID:973661

Kleinman, P K; Winchester, P; Brill, P W

1976-11-01

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Necrotizing enterocolitis after open heart surgery employing hypothermia and cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Three patients, 1-11 months of age, who underwent open heart surgery with cardiopulmonary bypass and profound hypothermia, developed necrotizing enterocolitis postoperatively leading to death. Pneumatosis intestinalis and portal vein gas were demonstrated radiographically. Necrotizing enterocolitis has not been previously reported as a complication of cardiopulmonary bypass and profound hypothermia.

Kleinman PK; Winchester P; Brill PW

1976-11-01

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Clinical and economic outcomes associated with blood transfusions among elderly Americans following coronary artery bypass graft surgery requiring cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

BACKGROUND: Blood transfusion occurring during hospitalisation for heart surgery has been shown to be associated with increased morbidity and mortality and with increased time spent in hospital, use of healthcare services, and costs. The objective of this study was to assess how perioperative blood transfusion among adults 65 years and older who underwent coronary artery bypass graft surgery requiring cardiopulmonary bypass in the United States is associated with immediate and longer term clinical and economic outcomes. MATERIALS AND METHODS: Using data from a 5% random sample of Medicare patients who underwent their first (within 2 years) coronary artery bypass graft requiring cardiopulmonary bypass procedure in 2005 or 2006, this study estimated associations (hazard ratios and regression coefficients) between transfusion status (received or not) and complications after surgery, serious adverse events, death, and costs using Cox proportional hazard and generalised linear models adjusting for patients' demographic and clinical characteristics. RESULTS: Adjusted hazard ratios were statistically significant (P <0.05) for risks of complications (1.20), serious adverse events (1.58), and death (1.49). There was also a statistically significantly (P ? 0.01) and strong relationship between receiving transfused blood and Medicare payments over the subsequent 45 months following discharge ($ 5,778 per calendar quarter for those receiving transfusion vs $ 5,197; all costs are measured in 2011 USD). CONCLUSION: Blood transfusion during hospitalisation for coronary artery bypass graft requiring cardiopulmonary bypass was significantly associated with increased long-term post-operative morbidity, mortality, and overall healthcare costs. This study contributes to the evidence demonstrating an association between transfusion and adverse clinical and economic outcomes by using a nationally representative longitudinal cost and utilisation database.

Ganz ML; Wu N; Rawn J; Pashos CL; Strandberg-Larsen M

2013-02-01

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Mini-cardiopulmonary bypass impact on blood conservation strategy in coronary artery bypass grafting.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Cardiopulmonary bypass (CPB) using a closed circuit system with minimal priming volume can be a solution to ameliorate adverse effects of CPB. We hypothesize that the use of mini-bypass in routine coronary artery bypass grafting (CABG) reduces homologous blood product use and postoperative bleeding. The study is designed to determine the differences in blood loss and transfusion requirements associated with a minimized CPB circuit vs. a standard bypass circuit. METHODS: From February 2009 to August 2009, 80 patients were prospectively randomized to undergo elective CABG. Group A included 40 patients who had the minimized bypass circuit (Medtronic Resting Heart Circuit). Group B had an equal number of patients who had the standard CPB circuit (Stockert III, SEC.BM). Laboratory parameters for hemoglobin, hematocrit and platelet count were measured at baseline after initiation of CPB and after bypass. Blood usage was controlled by study-specific protocol (transfusion for hemoglobin <8 g/dl). Records were kept for blood products. The chest and mediastinal drainage was monitored for the first 24 postoperative hours. Ventilation time, inotropic use and intensive care unit (ICU) stay was compared in both groups. RESULTS: There were no statistical differences in terms of patients' demographics. Statistically significant differences were seen in transfused red blood cells volume (1.47±1.13 units in group A vs. 2.05±1.19 in group B, P<0.05), fresh frozen plasma (2.5±1.62 unit vs. 3.55±2.58 units, P<0.001), platelets (1.95±2.95 units vs. 3.23±2.85), and postoperative drainage in 24 hours (531.62±220.12 ml vs. 729±294.9 ml, P<0.05). The hematocrit was 33±5% in group A, and 27±1% in group B. There was statistical differences seen in the mean hemoglobin level which was 10.19±0.65 g/dl in group A, and 9.4±0.68 g/dl in group B. There was statistical difference in the duration of ventilation, length of ICU stay. The requirement of inotropic support was lower in group A. CONCLUSIONS: The adoption of mini-bypass significantly reduces morbidity including donor blood usage and postoperative bleeding in routine CABG patients.

Abdel Aal M; ElNahal N; Bakir BM; Fouda M

2011-04-01

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The effect of conventional and mini-invasive cardiopulmonary bypass on neutrophil activation in patients undergoing coronary artery bypass grafting.  

UK PubMed Central (United Kingdom)

Interleukin-10 (IL-10) is considered to be a cytokine with potent anti-inflammatory properties, which have been previously linked to increased incidence of sepsis. The level of IL-10 is elevated by cardiac surgery when cardiopulmonary bypass (CPB) and methylprednisolone are used. In our study, we compare the level of IL-10, IL-10 Receptor (IL-10R), and percentage of neutrophils between two groups of cardiac surgical patients undergoing Coronary Artery Bypass Grafting, both of which were not given methylprednisolone. The first group was operated with conventional CPB, while the second group was operated with minimally invasive CPB (mini-CPB). We detected enhanced level of IL-10 during surgery and at the end of surgery in both groups of patients. While no correlation between IL-10 and IL10R was found, IL-10 was positively correlated with increased percentage of neutrophils at the time points when the level of IL-10 peaked.

Kolackova M; Krejsek J; Svitek V; Kunes P; Mandak J; Holubcova Z; Lonsky V

2012-01-01

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The effect of conventional and mini-invasive cardiopulmonary bypass on neutrophil activation in patients undergoing coronary artery bypass grafting.  

Science.gov (United States)

Interleukin-10 (IL-10) is considered to be a cytokine with potent anti-inflammatory properties, which have been previously linked to increased incidence of sepsis. The level of IL-10 is elevated by cardiac surgery when cardiopulmonary bypass (CPB) and methylprednisolone are used. In our study, we compare the level of IL-10, IL-10 Receptor (IL-10R), and percentage of neutrophils between two groups of cardiac surgical patients undergoing Coronary Artery Bypass Grafting, both of which were not given methylprednisolone. The first group was operated with conventional CPB, while the second group was operated with minimally invasive CPB (mini-CPB). We detected enhanced level of IL-10 during surgery and at the end of surgery in both groups of patients. While no correlation between IL-10 and IL10R was found, IL-10 was positively correlated with increased percentage of neutrophils at the time points when the level of IL-10 peaked. PMID:22529517

Kolackova, Martina; Krejsek, Jan; Svitek, Vladimir; Kunes, Pavel; Mandak, Jiri; Holubcova, Zdenka; Lonsky, Vladimir

2012-02-19

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17?-estradiol effects on human coronaries and grafts employed in myocardial revascularization: a preliminary study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Background This study was undertaken to compare the in vitro effects of 17?-estradiol on human epicardial coronary arteries, resistance coronary arteries and on arterial vessels usually employed as grafts in surgical myocardial revascularization. Methods...

Polvani Gianluca; Barili Fabio; Rossoni Giuseppe; Dainese Luca; Ossola Manuela; Topkara Veli K; Grillo Francesco

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Assessing the effectiveness of retrograde autologous priming of the cardiopulmonary bypass machine in isolated coronary artery bypass grafts.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Currently, around 35-80% of patients undergoing cardiac surgery in the UK receive a blood transfusion. Retrograde autologous priming (RAP) of the cardiopulmonary bypass circuit has been suggested as a possible strategy to reduce blood transfusion during cardiac surgery. METHODS: Data from 101 consecutive patients undergoing isolated coronary artery bypass grafts (where RAP was used) were collected prospectively and compared with 92 historic patients prior to RAP use in our centre. RESULTS: Baseline characteristics (ie age, preoperative haemoglobin [Hb] etc) were not significantly different between the RAP and non-RAP groups. The mean pump priming volume of 1,013ml in the RAP group was significantly lower (p<0.001) than that of 2,450ml in the non-RAP group. The mean Hb level at initiation of bypass of 9.1g/dl in patients having RAP was significantly higher (p<0.001) than that of 7.7g/dl in those who did not have RAP. There was no significant difference between the RAP and non-RAP groups in transfusion of red cells, platelets and fresh frozen plasma, 30-day mortality, re-exploration rate and predischarge Hb level. The median durations of cardiac intensive care unit stay and in-hospital stay of 1 day (inter-quartile range [IQR]: 1-2 days) and 5 days (IQR: 4-6 days) in the RAP group were significantly shorter than those of the non-RAP group (2 days [IQR: 1-3 days] and 6 days [IQR: 5-9 days]). CONCLUSIONS: In the population group studied, RAP did not influence blood transfusion rates but was associated with a reduction in duration of hospital stay.

Kearsey C; Thekkudan J; Robbins S; Ng A; Lakshmanan S; Luckraz H

2013-04-01

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Serum concentrations and pharmacokinetics of moxifloxacin in patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Although cephalosporins are recommended as primary agents, moxifloxacin may be a suitable second-line antibiotic in cardiac surgery, especially if additional Gram-negative coverage is warranted. Cardiopulmonary bypass (CPB) may alter the pharmacokinetics of drugs in numerous ways. Since no such data exist, the aim of this study was to assess the serum concentrations and pharmacokinetics of moxifloxacin in patients undergoing cardiac surgery with CPB. Fourteen coronary artery bypass graft surgery patients received an intravenous infusion of 400 mg moxifloxacin as peri-operative antibiotic prophylaxis. At 15 time points throughout a 24-h period, serum samples were obtained to measure moxifloxacin concentrations using high-performance liquid chromatography. In addition, a non-compartmental pharmacokinetic analysis, i.e. area under the concentration-time curve (AUC), volume of distribution at steady state (V(SS)), drug clearance (CL), elimination half-life (t(1/2)) and mean residence time (MRT), was performed in five patients. Apart from a slight transient decrease in moxifloxacin concentration at the onset, CPB did not affect the concentration-time curve. Mean ± standard deviation maximum drug concentration (C(max)) (5.12 ± 1.58 ?g/mL), AUC (36.5 ± 5.40 ?gh/mL), VSS (2.03 ± 0.30 L/kg), CL (11.2 ± 1.91 L/h), t(1/2) (9.47 ± 0.92 h) and MRT (12.9 ± 1.52 h) were comparable with historical data for healthy volunteers. We conclude that CPB does not alter the pharmacokinetics of moxifloxacin. No dose adjustments, especially with regard to the CPB circuit and its priming volume, are necessary in cardiac surgical patients.

Wiesner G; Martin K; Gertler R; Braun SL; Tassani P; Lange R; Gruber M

2013-05-01

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Cardiopulmonary bypass for a coronary artery bypass graft patient with heterozygous protein C deficiency and protein S deficiency.  

UK PubMed Central (United Kingdom)

Cardiopulmonary bypass (CPB) poses great risks for hypercoagulable patients and requires management techniques to ensure an optimal outcome free from thrombotic events. This case report reviews perfusion management techniques that may contribute to a safer CPB experience for a patient deficient in both protein C and protein S. A patient with heterozygous protein C deficiency is at increased risk of thrombosis, especially in the venous circulation. Since it is an essential cofactor for activated protein C, deficiency of free protein S is also linked to a hypercoagulable condition. A 52-year-old male presented to our institution with a past medical history of hypercoagulable state, multiple deep vein thromboses, pulmonary embolisms, and stroke. He was scheduled for two-vessel coronary artery bypass graft surgery to be followed by right carotid endarterectomy (RCEA) before discharge. The anesthesia and perfusion teams worked closely together to ensure that fresh frozen plasma (FFP) was given intraoperatively at appropriate times. Heparin dose response and protamine dosage was determined with hemostasis management system (HMS) analysis. The closed CPB circuit and cannulae were Carmeda bonded. Rapid autologous priming, along with the use of a hemoconcentrator, kept the hematocrit above 21 during CPB. Zero-balance ultrafiltration and leukocyte depletion were initiated during rewarming to aid in attenuation of the inflammatory response. To conserve coagulation factors, all pump blood was ultrafiltrated post-CPB and returned to the patient. Laboratory samples drawn on postoperative day (POD) one measured normal protein C activity with subnormal protein S activity. On POD six, the patient underwent RCEA and he was discharged on POD eight without complications.

Schneider S; Sakert T; Lucke J; McKeown P; Sharma A

2006-03-01

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Cardiopulmonary bypass for a coronary artery bypass graft patient with heterozygous protein C deficiency and protein S deficiency.  

Science.gov (United States)

Cardiopulmonary bypass (CPB) poses great risks for hypercoagulable patients and requires management techniques to ensure an optimal outcome free from thrombotic events. This case report reviews perfusion management techniques that may contribute to a safer CPB experience for a patient deficient in both protein C and protein S. A patient with heterozygous protein C deficiency is at increased risk of thrombosis, especially in the venous circulation. Since it is an essential cofactor for activated protein C, deficiency of free protein S is also linked to a hypercoagulable condition. A 52-year-old male presented to our institution with a past medical history of hypercoagulable state, multiple deep vein thromboses, pulmonary embolisms, and stroke. He was scheduled for two-vessel coronary artery bypass graft surgery to be followed by right carotid endarterectomy (RCEA) before discharge. The anesthesia and perfusion teams worked closely together to ensure that fresh frozen plasma (FFP) was given intraoperatively at appropriate times. Heparin dose response and protamine dosage was determined with hemostasis management system (HMS) analysis. The closed CPB circuit and cannulae were Carmeda bonded. Rapid autologous priming, along with the use of a hemoconcentrator, kept the hematocrit above 21 during CPB. Zero-balance ultrafiltration and leukocyte depletion were initiated during rewarming to aid in attenuation of the inflammatory response. To conserve coagulation factors, all pump blood was ultrafiltrated post-CPB and returned to the patient. Laboratory samples drawn on postoperative day (POD) one measured normal protein C activity with subnormal protein S activity. On POD six, the patient underwent RCEA and he was discharged on POD eight without complications. PMID:16615690

Schneider, Susan; Sakert, Tamara; Lucke, John; McKeown, Peter; Sharma, Ajeet

2006-03-01

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Effect of cardiopulmonary bypass on tissue injury markers and endothelial activation during coronary artery bypass graft surgery.  

UK PubMed Central (United Kingdom)

BACKGROUND: Coronary artery bypass grafting (CABG) is done either using cardiopulmonary bypass (CPB) or without using CPB (OPCAB). But, recently, reports have shown that CPB is associated with increased postoperative morbidity because of the involvement of many systems. AIMS: The aim of this prospective study was to evaluate the influence of the technique of surgery on various tissue injury markers and the extent of endothelial activation in patients undergoing CABG and OPCAB coronary revascularization. SETTINGS AND DESIGN: This study was conducted at a tertiary healthcare center during the period May 2008 to December 2009. MATERIALS AND METHODS: This was a prospective nonrandomized blinded study. The activities of Creatine Phosphokinase (CK) and its isoenzyme CK-MB, Lactate dehydrogenase (LDH), levels of cardiac Troponin I, soluble vascular cell adhesion molecule-1 (sVCAM-I) and systemic nitric oxide production were assessed. Statistical analysis: All the results were expressed as Mean ± SD. P value ? 0.05 was considered significant. The statistical analysis was carried out using SPSS Version 11.5-computer software (SPSS Inc., Chicago, IL, USA). RESULTS: The surgical trauma had elevated CK, CK-MB and Troponin I in both the groups and further elevation was seen in the CABG group in comparison to OPCAB (P<0.001). The Troponin I concentrations showed an increase from 0.11 ± 0.02 preoperatively to 6.59 ± 0.59 (ng/ml) at 24 h (P<0.001) compared to the OPCAB group. Mean serum levels of sVCAM-1 increased significantly after surgery in both the groups (P<0.02). To determine serum nitric oxide (NO) production, NO2- and NO3- (stable end products of NO oxidation) were analyzed which also increased significantly at 24 h in both the groups. But the increase was not significant at 48 h in both the groups compared to the preoperative value in our study. CONCLUSION: The present study indicates that, despite comparable surgical trauma, the OPCAB significantly reduces tissue injury. The overall pattern of endothelial activation after OPCAB is significantly lower than that after CABG. This may contribute to improved organ function, and improved postoperative recovery.

Nair S; Iqbal K; Phadke M; Jadhav UE; Khandekar J; Khandeparkar JM

2012-01-01

 
 
 
 
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The Effect of Conventional and Mini-Invasive Cardiopulmonary Bypass on Neutrophil Activation in Patients Undergoing Coronary Artery Bypass Grafting  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Interleukin-10 (IL-10) is considered to be a cytokine with potent anti-inflammatory properties, which have been previously linked to increased incidence of sepsis. The level of IL-10 is elevated by cardiac surgery when cardiopulmonary bypass (CPB) and methylprednisolone are used. In our study, we co...

Kolackova, Martina; Krejsek, Jan; Svitek, Vladimir; Kunes, Pavel; Mandak, Jiri; Holubcova, Zdenka; Lonsky, Vladimir

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17?-estradiol effects on human coronaries and grafts employed in myocardial revascularization: a preliminary study  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background This study was undertaken to compare the in vitro effects of 17?-estradiol on human epicardial coronary arteries, resistance coronary arteries and on arterial vessels usually employed as grafts in surgical myocardial revascularization. Methods Coronary artery rings (descending coronary artery, right coronary artery, circumflex coronary artery, first septal branch) and arterial graft rings (internal thoracic artery, gastro-epiploic artery) obtained from human heart donors with heart not suitable to cardiac transplantation were connected to force transducer for isometric force recording. Precontracted specimens with and without endothelium were exposed to increasing concentration of 17?-estradiol (3–30–300–3000 nmol/l) and to vehicle (0.1% v/v ethanol). We also evaluated the effects of 17?-estradiol on vessels before and 20 minutes after exposure to L-monomethyl-arginine and indomethacin. Results 17?-estradiol induced a significant relaxation in all precontracted vessels (mean maximum effect: 78,6% ± 8,5). This effect was not different among the different rings and was not related to the presence of endothelium. N-monomethyl-L-arginine and indomethacin did not modify 17?-estradiol relaxant effect. Conclusion The vasodilator action of the 17?-estradiol is similar on coronary arteries, resistance coronary arteries and arterial vessels usually employed as grafts in myocardial revascularization.

Polvani Gianluca; Barili Fabio; Rossoni Giuseppe; Dainese Luca; Ossola Manuela; Topkara Veli K; Grillo Francesco; Penza Eleonora; Tremoli Elena; Biglioli Paolo

2006-01-01

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17?-estradiol effects on human coronaries and grafts employed in myocardial revascularization: a preliminary study  

Science.gov (United States)

Background This study was undertaken to compare the in vitro effects of 17?-estradiol on human epicardial coronary arteries, resistance coronary arteries and on arterial vessels usually employed as grafts in surgical myocardial revascularization. Methods Coronary artery rings (descending coronary artery, right coronary artery, circumflex coronary artery, first septal branch) and arterial graft rings (internal thoracic artery, gastro-epiploic artery) obtained from human heart donors with heart not suitable to cardiac transplantation were connected to force transducer for isometric force recording. Precontracted specimens with and without endothelium were exposed to increasing concentration of 17?-estradiol (3–30–300–3000 nmol/l) and to vehicle (0.1% v/v ethanol). We also evaluated the effects of 17?-estradiol on vessels before and 20 minutes after exposure to L-monomethyl-arginine and indomethacin. Results 17?-estradiol induced a significant relaxation in all precontracted vessels (mean maximum effect: 78,6% ± 8,5). This effect was not different among the different rings and was not related to the presence of endothelium. N-monomethyl-L-arginine and indomethacin did not modify 17?-estradiol relaxant effect. Conclusion The vasodilator action of the 17?-estradiol is similar on coronary arteries, resistance coronary arteries and arterial vessels usually employed as grafts in myocardial revascularization.

Polvani, Gianluca; Barili, Fabio; Rossoni, Giuseppe; Dainese, Luca; Ossola, Manuela Wally; Topkara, Veli K; Grillo, Francesco; Penza, Eleonora; Tremoli, Elena; Biglioli, Paolo

2006-01-01

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Comparison of Bleeding and Transfusion in Patients who Undergo Coronary Artery Bypass Grafting with and without Cardiopulmonary Bypass  

Directory of Open Access Journals (Sweden)

Full Text Available Background and Aim: Excessive Bleeding continues to play a key role and an important cause of morbidity and mortality after cardiopulmonary bypass (CPB). The goal of this study was to determine the differences in bleeding and transfusion between OPCAB and on -pump CABG patients.Materials and Methods: In a randomized, double blinded prospective study 300 patient's undergoing coronary revascularization surgery were enrolled, 150 CABG patients were compared with 150 OPCAB patients. The patients were assessed during the first 72 hours to determine the postoperative side effects. The 2 groups were compared using the chi-square test or fisher's exact test and the rank sum test.Results: CABG patients received more intraoperative red blood cells (P<0.0001), more albumin and more fresh- frozen plasma (P<0.0001). Postoperatively, CABG patients were more likely to receive more platelets (29.3% ? 70.7 %, P<0.007). During the operative and the initial 4-hour postoperative period OPCAB patients exhibited greater blood loss (P<0.0001); however, at 12,24and 72 hours postoperatively, CABG patients exhibited greater blood loss. There were4 death in CABG patients (P<0.05)Conclusion: Despite not reversing the heparin at the end of the OPCAB surgery, OPCAB surgery was associated with an overall reduction in platelets, fresh- frozen plasma, Albumin and transfusion requirements.

M Abbaszadeh; F Mehrani; A Boloorian; E Jazayeri Gharehbagh

2011-01-01

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The effects of conventional extracorporeal circulation versus miniaturized extracorporeal circulation on microcirculation during cardiopulmonary bypass-assisted coronary artery bypass graft surgery.  

UK PubMed Central (United Kingdom)

OBJECTIVES To reduce the complications associated with cardiopulmonary bypass (CPB) during cardiac surgery, many modifications have been made to conventional extracorporeal circulation systems. This trend has led to the development of miniaturized extracorporeal circulation systems. Cardiac surgery using conventional extracorporeal circulation systems has been associated with significantly reduced microcirculatory perfusion, but it remains unknown whether this could be prevented by an mECC system. Here, we aimed to test the hypothesis that microcirculatory perfusion decreases with the use of a conventional extracorporeal circulation system and would be preserved with the use of an miniaturized extracorporeal circulation system. METHODS Microcirculatory density and perfusion were assessed using sublingual side stream dark-field imaging in patients undergoing on-pump coronary artery bypass graft (CABG) surgery before, during and after the use of either a conventional extracorporeal circulation system (n = 10) or a miniaturized extracorporeal circulation system (n = 10). In addition, plasma neutrophil gelatinase-associated lipocalin and creatinine levels and creatinine clearance were assessed up to 5 days post-surgery to monitor renal function. RESULTS At the end of the CPB, one patient in the miniaturized extracorporeal circulation-treated group and five patients in the conventional extracorporeal circulation-treated group received one bag of packed red blood cells (300 ml). During the CPB, the haematocrit and haemoglobin levels were slightly higher in the miniaturized extracorporeal circulation-treated patients compared with the conventional extracorporeal circulation-treated patients (27.7 ± 3.3 vs 24.7 ± 2.0%; P = 0.03; and 6.42 ± 0.75 vs 5.41 ± 0.64 mmol/l; P < 0.01). The density of perfused vessels with a diameter <25 µm (i.e. perfused vessel density) decreased slightly in the conventional extracorporeal circulation-treated group from 16.4 ± 3.8 to 12.8 ± 3.3 mm/mm(2) (P < 0.01) and remained stable in the miniaturized extracorporeal circulation-treated group (16.3 ± 2.7 and 15.2 ± 2.9 mm/mm(2) before and during the pump, respectively). Plasma neutrophil gelatinase-associated lipocalin levels were increased following the use of extracorporeal circulation in both groups, and no differences were observed between the groups. Plasma creatinine levels and creatinine clearance were not affected by CABG surgery or CPB. CONCLUSIONS The results from this relatively small study suggest that the use of the miniaturized extracorporeal circulation system is associated with a statistically significant (but clinically insignificant) reduction in haemodilution and microcirculatory hypoperfusion compared with the use of the conventional extracorporeal circulation system.

Yuruk K; Bezemer R; Euser M; Milstein DM; de Geus HH; Scholten EW; de Mol BA; Ince C

2012-09-01

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A case report and brief review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION), posterior ischaemic optic neuropathy (PION), and central retinal artery occlusion (CRAO). These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass); general surgery; urology; gynaecology; liposuction; liver transplantation and duration of surgery. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone), alteration of venous drainage of the retina, hypertension, smoking, atherosclerosis, hyperlipidaemia, diabetes, hypercoagulability, hypotension, blood loss and large volume resuscitation. Other important cardiac causes are septic emboli from bacterial endocarditis and emboli caused by atrial myxomata. The majority of AION cases occur during CPB followed by head/neck surgery and prone spine surgery. CPB is used to allow coronary artery bypass grafting on a motionless heart. It has many side-effects and complications associated with its use and we report here a case of bilateral retinal infarction during routine coronary artery bypass grafting in a young male patient with multiple risk factors for developing this complication despite steps to minimise its occurrence.

Trethowan Brian A; Gilliland Helen; Popov Aron F; Varadarajan Barathi; Phillips Sally-Anne; McWhirter Louise; Ghent Robert

2011-01-01

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Comparing microvascular alterations during minimal extracorporeal circulation and conventional cardiopulmonary bypass in coronary artery bypass graft surgery: a prospective, randomized study.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Minimal extracorporeal circulation (MECC) has been introduced in coronary artery bypass graft (CABG) surgery, offering clinical benefits owing to reduced hemodilution and no blood-air interface. Yet, the effects of MECC on the intraoperative microvascular perfusion in comparison with conventional extracorporeal circulation (CECC) have not been studied so far. METHODS: The current study aimed to analyze alterations in microvascular perfusion at 4 predefined time points (T1-T4) during on-pump CABG using orthogonal polarization spectral imaging. Forty patients were randomized for being operated on with either MECC or CECC. Changes in functional capillary density (FCD), blood flow velocity, and vessel diameter were analyzed by a blinded investigator. RESULTS: After start of extracorporeal circulation (ECC) and aortic crossclamping (T2), both groups showed a significant drop of FCD, with a significantly higher FCD in the MECC group (206.8 ± 33.6 cm/cm² in CECC group versus 217.8 ± 35.3 cm/cm² in MECC group; P = .034). In the late phase of the ECC (T3), FCD in the MECC group was already recovered, whereas FCD in the CECC group was still significantly depressed (223.1 ± 35.6 cm/cm² in MECC group; P = .100 vs T1; 211.1 ± 36.9 cm/cm² in CECC group; P = .017 vs T1). After termination of ECC (T4), FCD recovered in both groups to baseline. Blood flow velocity tended to be higher in the MECC group, with a significant intergroup difference after aortic crossclamping (T2). CONCLUSIONS: Orthogonal polarization spectral imaging data reveal an impairment of microvascular perfusion during on-pump CABG. Changes in FCD indicate a faster recovery of the microvascular perfusion in MECC during the reperfusion period. Beneficial recovery of microvascular organ perfusion could partly explain the perioperative advantages reported for MECC.

Donndorf P; Kühn F; Vollmar B; Rösner J; Liebold A; Gierer P; Steinhoff G; Kaminski A

2012-09-01

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PRODUCTION OF INDIAN CITRUS RINGSPOT VIRUS FREE PLANTS OF KINNOW EMPLOYING CHEMOTHERAPY COUPLED WITH SHOOT TIP GRAFTING  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Indian citrus ringspot virus (ICRSV) is known to cause serious problem in Kinnow (Citrus nobilis Lour × C. deliciosa Tenora). This paper reports the elimination of ICRSV from Kinnow by chemotherapy coupled with shoot tip grafting under in vitro conditions. Nodal segments from infected mother plant (...

Sharma SANJEEV; Singh BALWINDER; Rani GITA; Zaidi AIJAZ ASGHAR; Hallan VIPIN; Nagpal AVINASH; Virk GURDEEP SINGH

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PRODUCTION OF INDIAN CITRUS RINGSPOT VIRUS FREE PLANTS OF KINNOW EMPLOYING CHEMOTHERAPY COUPLED WITH SHOOT TIP GRAFTING  

Directory of Open Access Journals (Sweden)

Full Text Available Indian citrus ringspot virus (ICRSV) is known to cause serious problem in Kinnow (Citrus nobilis Lour × C. deliciosa Tenora). This paper reports the elimination of ICRSV from Kinnow by chemotherapy coupled with shoot tip grafting under in vitro conditions. Nodal segments from infected mother plant (indexed by indirect ELISA and RT-PCR) were cultured on MS medium containing 2-iP (1mg/l) and malt extract (800 mg/l) along with different concentrations of five antiviral chemicals acycloguanosine, azidothymidine, 2,4-dioxohexahydro-1, 2,5-triazine (DHT), ribavirin and 2- thiouracil. Shoot tips of size 0.7 mm were excised from the sprouts of these nodal segments and grafted on to rough lemon (Citrus jambhiri) under aseptic conditions. The plantlets obtained from chemotherapy coupled with in vitro micrografting were indexed by indirect ELISA and RT-PCR after acclimatization. Maximum effect (37% virus elimination) was seen for ribavirin at 25 mg/l followed by 2-thiouracil at 25 mg/l (21.4%) and acyclguanosine at 25 mg/l (20.8%). Azidothymidine and DHT at the tested doses could not eliminate ICRSV. In the present study only those plants/plantlets were considered virus free, which showed negative reaction both with indirect ELISA and RT-PCR.

Sharma SANJEEV; Singh BALWINDER; Rani GITA; Zaidi AIJAZ ASGHAR; Hallan VIPIN; Nagpal AVINASH; Virk GURDEEP SINGH

2007-01-01

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Cancer and the cardiopulmonary system  

Energy Technology Data Exchange (ETDEWEB)

This volume addresses the problems induced in the cardiopulmonary function by certain advanced diagnostic techniques and treatment modalities for cancer, reviews the cardiopulmonary changes resulting from cancer itself, and assesses the limitations to surgical and nonsurgical management of diverse neoplastic conditions. Information on the effects of various tumors on cardiopulmonary function and on the spectrum of adverse cardiopulmonary reactions caused by chemotherapy and radiation theorapy is provided, with specific practical guidance on diagnosis and treatment.

Khalil, A.M.; Ewer, M.S.

1984-01-01

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Bone grafting: An overview  

Directory of Open Access Journals (Sweden)

Full Text Available Bone grafting is the process by which bone is transferred from a source (donor) to site (recipient). Due to trauma from accidents by speedy vehicles, falling down from height or gunshot injury particularly in human being, acquired or developmental diseases like rickets, congenital defects like abnormal bone development, wearing out because of age and overuse; lead to bone loss and to replace the loss we need the bone grafting. Osteogenesis, osteoinduction, osteoconduction, mechanical supports are the four basic mechanisms of bone graft. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. An ideal bone graft material is biologically inert, source of osteogenic, act as a mechanical support, readily available, easily adaptable in terms of size, shape, length and replaced by the host bone. Except blood, bone is grafted with greater frequency. Bone graft indicated for variety of orthopedic abnormalities, comminuted fractures, delayed unions, non-unions, arthrodesis and osteomyelitis. Bone graft can be harvested from the iliac crest, proximal tibia, proximal humerus, proximal femur, ribs and sternum. By adopting different procedure of graft preservation its antigenicity can be minimized. The concept of bone banking for obtaining bone grafts and implants is very useful for clinical application. Absolute stability require for successful incorporation. Ideal bone graft must possess osteogenic, osteoinductive and osteocon-ductive properties. Cancellous bone graft is superior to cortical bone graft. Usually autologous cancellous bone graft are used as fresh grafts where as allografts are employed as an alloimplant. None of the available type of bone grafts possesses all these properties therefore, a single type of graft cannot be recomm-ended for all types of orthopedic abnormalities. Bone grafts and implants can be selected as per clinical problems, the equipments available and preference of the surgeon. A search for ideal bone graft is on and may continue till time to time. [Vet World 2010; 3(4.000): 198-200

D. O. Joshi; P. H. Tank; H. K. Mahida; M. A. Dhami; H. S. Vedpathak; A. S. Karle

2010-01-01

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Grafting onto polyformaldehyde fibers  

International Nuclear Information System (INIS)

[en] Acrylic acid (AA), acrylonitrile (AN), and acrylamide (AM) were grafted onto polyformaldehyde (PF) fibers employing ?-ray irradiation as well as benzoyl peroxide initiation. The nature of the graft copolymer obtained from a given monomer was dependent on the type of method used for the grafting reactions. This was reflected in the various characteristics of the grafted PF fibers such as moisture regain and dyeability to disperse, direct, basic, and acid dyes. The extent of grafting was dependent on time, concentration of the initiator, concentration of monomer, and irradiation dose. The grafting reaction with all the three monomers and both methods of grafting studied followed first-order kinetics. The rate constant values for grafting with AA, AN, and AM were 0.493, 0.576, and 0.420 hr-1, respectively for the irradiation method and 0.385, 0.385, and 0.346 hr-1, respectively, for the benzoyl peroxide initiation technique. The increase in the moisture regain was directly proportional to the amount of graft in the fiber. Acrylic acid grafted PF fibers were rendered hydrophilic to the highest extent (7.9 percent M.R. for 42 percent graft), while AM-grafted fibers were rendered so to the lowest extent (7.23 percent M.R. for 76.5 percent graft). The AA-grafted PF fibers gave a six- to sevenfold increase in disperse dye content when the irradiation method was followed and a four- to fivefold improvement when the chemical method was used during the grafting reaction. The AA- and AN-grafted PF fibers could be dyed in intense deep shades with cationic dyes. Similarly, AM-grafted substrates gave bright deep shades with acid dyes. Infrared studies, used to analyze the grafted PF fibers, indicated the presence of --COOH, --CN, and --NH2 groups introduced in the fiber structure as a result of grafting with AA, AN, and AM. 2 tables, 14 figures

1978-01-01

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Cardiopulmonary involvement in Fabry's disease.  

UK PubMed Central (United Kingdom)

BACKGROUND: Fabry's disease is an X-linked lysosomal storage disease caused by deficiency of alpha-galactosidase A enzyme activity. Decreased enzyme activity leads to accumulation of glycosphingolipid in different tissues, including endothelial and smooth-muscle cells and cardiomyocytes. OBJECTIVES: There is controversial data on cardiopulmonary involvement in Fabry's disease, because many reports are based on small and selected populations with Fabry's disease. Furthermore, the aetiology of cardiopulmonary symptoms in Fabry's disease is poorly understood. METHODS: We studied cardiopulmonary involvement in seventeen patients with Fabry's disease (20-65 years, 6 men) using ECG, bicycle stress, cardiac magnetic resonance imaging, spirometry, diffusing capacity and pulmonary high-resolution computed tomography (HRCT) tests. Cardiopulmonary symptoms were compared to observed parameters in cardiopulmonary tests. RESULTS: Left ventricular hypertrophy (LVH) and reduced exercise capacity are the most apparent cardiac changes in both genders with Fabry's disease. ECG parameters were normal when excluding changes related to LVH. Spirometry showed mild reduction in vital capacity and forced expiratory volume in one second (FEV I), and mean values in diffusing capacity tests were within normal limits. Generally, only slight morphological pulmonary changes were detected using pulmonary HRCT, and they were not associated with changes in pulmonary function. The self-reported amount of pulmonary symptoms associated only with lower ejection fraction (P < 0.001) and longer QRS-duration (P = 0.04) of all measured cardiopulmonary parameters, whereas cardiac symptoms have no statistically significant association with any of these parameters. CONCLUSION: LVH and reduced exercise capacity are the most apparent cardiopulmonary changes in Fabry's disease but they have only a minor association to cardiopulmonary symptoms.Therefore, routine cardiopulmonary evaluation in Fabry's disease using echocardiography is maybe enough when integrated to counselling for aerobic exercise training.

Koskenvuo JW; Kantola IM; Nuutila P; Knuuti J; Parkkola R; Mononen I; Hurme S; Kalliokoski R; Viikari JS; Wendelin-Saarenhovi M; Kiviniemi TO; Hartiala JJ

2010-04-01

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Perioperative cardiopulmonary arrest competencies.  

UK PubMed Central (United Kingdom)

Although basic life support skills are not often needed in the surgical setting, it is crucial that surgical team members understand their roles and are ready to intervene swiftly and effectively if necessary. Ongoing education and training are key elements to equip surgical team members with the skills and knowledge they need to handle untimely and unexpected life-threatening scenarios in the perioperative setting. Regular emergency cardiopulmonary arrest skills education, including the use of checklists, and mock codes are ways to validate that team members understand their responsibilities and are competent to help if an arrest occurs in the OR. After a mock drill, a debriefing session can help team members discuss and critique their performances and improve their knowledge and mastery of skills.

Murdock DB

2013-08-01

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[Compartment syndrome after cardiopulmonary bypass].  

Science.gov (United States)

Compartment syndrome of the lower leg is an occasional complication of prolonged ischemia and reperfusion. We present a patient with compartment syndrome of the ipsilateral thigh after femoral arterial and venous cannulation for cardiopulmonary bypass. PMID:20685185

Guillen, G; Llorente, A M; Maseda, R; Belda, S; Olmedilla, M

2010-08-03

36

Skin graft  

Science.gov (United States)

Skin transplant; Skin autografting; FTSG; STSG; Split thickness skin graft; Full thickness skin graft ... donor site. Most people who are having a skin graft have a split-thickness skin graft. This takes ...

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Surgical results of coronary artery bypass grafting without cardiopulmonary bypass: analysis of 3,410 patients/ Resultados cirúrgicos na revascularização do miocárdio sem circulação extracorpórea: análise de 3.410 pacientes  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: Nos últimos anos, tem-se observado um grande avanço na cirurgia de revascularização miocárdica sem circulação extracorpórea (RMSCEC). Esse desenvolvimento deveu-se à combinação dos avanços da técnica cirúrgica e ao desenvolvimento de instrumentos que possibilitam a realização deste procedimento nas mais variadas situações. Este é um estudo retrospectivo, que visa avaliar nossa experiência com este procedimento nos últimos 11,5 anos. Os autor (more) es enfatizam o rápido progresso do método nos últimos anos, suas indicações, contra-indicações e resultados. MÉTODO: No período de agosto de 1991 e dezembro de 2002, 3.410 pacientes consecutivos, portadores de angina do peito, foram submetidos a cirurgia de revascularização miocárdica sem circulação extracorpórea. A idade variou de 13 a 93 anos (63 12,0 anos), sendo 58% dos pacientes do sexo masculino. A angina foi classificada segundo a Canadian Cardiovascular Society, sendo 6,1% na classe I, 6,8% na classe II, 46,3% na classe III e 40,8% na classe IV. RESULTADOS: A mortalidade intra-operatória foi baixa (0,4%). A mortalidade hospitalar (trinta dias de pós-operatório) foi de 2,58%. A mortalidade e morbidade, no grupo dos pacientes octogenários, foram extremamente baixas em relação aos pacientes operados com circulação extracorpórea (2,2% x 12,6%) (p Abstract in english OBJECTIVES: Over the past few years, great strides have been made in off-pump coronary surgery. This progress is due to a combination of the advances in surgical techniques and the development of instruments that make it possible to perform this procedure in the most varied situations. This is a retrospective study, the purpose of which is to assess our experience with this procedure over the last eleven and a half years. The authors underscore the rapid progress of the m (more) ethod in recent years and report on its indications, contraindications and results. METHODS: In the period from August 1991 to December 2003, 3,410 consecutively patients suffering from angina pectoris were submitted to off-pump coronary surgery. Ages ranged from 13 to 93 years, with a mean of 63 ± 12.0 years. Males accounted for 58% of the cases. The angina was rated according to the criteria of the Canadian Cardiovascular Society, 6.1% of the patients being in Class I, 6.8% in Class II, 46.3% in Class III and 40.8% in Class IV. RESULTS: Intraoperative mortality was low (0.4%). Hospital mortality (30 postoperative days) was 2.5%. Mortality and morbidity among the octogenarian patients were extremely low compared with patients operated on with cardiopulmonary bypass (CPB) (2.2% versus 12.6%) (p

Lima, Ricardo de Carvalho; Escobar, Mozart Augusto Soares; Lobo Filho, José Glauco; Diniz, Roberto; Saraiva, Antonio; Césio, Antonio; Gesteira, Mário; Vasconcelos, Frederico

2003-09-01

38

Free graft foreskin anoplasty.  

UK PubMed Central (United Kingdom)

AIM: Reconstruction of a stenotic anal canal and repair of a stenotic perineal colostomy using a free graft foreskin. METHOD: The use of free graft foreskin anoplasty was described by Freeman for the treatment of mucosal prolapse in pediatric patients. The original surgical technique was modified and employed in two adult patients for the reconstruction of the anal region. RESULTS: The graft, in both cases, took well with a satisfactory functional and morphological recovery of the anal canal. CONCLUSION: Free graft foreskin anoplasty, has proved to be an effective solution to stenosis in the anal canal following major local surgery.

Fucini C; Caminati F; Basiricò F; Bartolini N; Mirasolo VM

2012-08-01

39

Effects of cardiopulmonary bypass on propofol pharmacokinetics and bispectral index during coronary surgery  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english PURPOSE: Cardiopulmonary bypass is known to alter propofol pharmacokinetics in patients undergoing cardiac surgery. However, few studies have evaluated the impact of these alterations on postoperative pharmacodynamics. This study was designed to test the hypothesis that changes in propofol pharmacokinetics increase hypnotic effects after cardiopulmonary bypass. METHODS: Twenty patients scheduled for on-pump coronary artery bypass graft (group, n=10) or off-pump coronary a (more) rtery bypass graft (group, n=10) coronary artery bypass grafts were anesthetized with sufentanil and a propofol target controlled infusion (2.0 µg/mL). Depth of hypnosis was monitored using the bispectral index. Blood samples were collected from the induction of anesthesia up to 12 hours after the end of propofol infusion, at predetermined intervals. Plasma propofol concentrations were measured using high-performance liquid chromatography, followed by a non-compartmental propofol pharmacokinetic analysis. Data were analyzed using ANOVA, considering p

Barbosa, Ricardo Antonio G.; Santos, Silvia Regina C. Jorge; White, Paul F.; Pereira, Valéria A.; Silva Filho, Carlos R.; Malbouisson, Luiz M. S.; Carmona, Maria José C.

2009-03-01

40

Improving bystander cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: Summary estimates indicate that bystander cardiopulmonary resuscitation (CPR) can improve the chances of out-of-hospital cardiac arrest survival two-fold to three-fold. And yet, only a minority of arrest victims receive bystander CPR. This summary will review the challenges and approaches to achieve early and effective bystander CPR. RECENT FINDINGS: Given the host of barriers, a successful strategy to improve bystander CPR must enable more timely and comprehensive arrest identification, encourage and empower bystanders to act, and help assure effective CPR. Arrest identification can be simplified so that bystanders should start CPR when a person is unconscious and not breathing normally. Evidence from observational studies and interventional trials supports the effectiveness of chest compression-only CPR for bystanders. As a consequence, the emphasis of bystander CPR training has been modified to feature and assure chest compressions. Bystanders should initiate CPR with compressions and consider the addition of rescue breathing based on their CPR training and skills as well as special circumstances of the victim. Bystander CPR training has evolved to incorporate this emphasis. Although general community-level CPR training remains a cornerstone strategy, training directed to those most likely to witness an arrest also has a useful role. In particular, 'just-in-time' dispatcher-assisted CPR instruction can increase bystander CPR and improve the likelihood of survival. SUMMARY: Recent developments in bystander CPR have simplified arrest recognition and improved CPR training, while retaining CPR effectiveness. The goal of these developments is to increase and improve bystander CPR and in turn improve resuscitation.

Bradley SM; Rea TD

2011-06-01

 
 
 
 
41

Cardiopulmonary coupling during exercise.  

UK PubMed Central (United Kingdom)

Muscular exercise imposes the most potent sustained stress to cellular energetics. At work rates below the anaerobic threshold (i.e. no sustained lactic acidosis), the ventilatory and cardiovascular responses regulate arterial PCO2, [H+] and PO2 at or close to their resting levels in the steady state. However, dynamic forcing and systems-analytic techniques reveal two phases of the non-steady-state response dynamics. In the first phase, increased gas flow to the lungs results solely from increased pulmonary blood flow, with alveolar gas tensions being maintained at their resting levels by a coupled increase in ventilation (VE): evidence for cardiopulmonary coupling being provided by experimentally-altered in man and dog. Arterial chemoreception does not impose humoral feedback control in this phase. Rather, rapid feedforward mechanisms operate, with both intrathoracic (largely cardiac) and exercising-limb mechanoreception proposed as afferent sources. In the second phase, cardiogenic gas flow to the lungs is augmented by altered mixed venous blood gas contents; ventilation responding exponentially with a time constant (tau) which is an inverse function of carotid body gain. The close dynamic coupling of VE with CO2 output (tau VE tau TVCO2) in this phase results in arterial PCO2 and [H+] being maintained close to their resting levels. However, the kinetic dissociation between VE and O2 uptake, with tau VE much greater than tau VO2, leads to an appreciable transient fall of arterial PO2. The respiratory compensation for the sustained lactic acidosis at higher work rates is predominantly mediated by the carotid bodies in man: the aortic bodies subserving no discernible role. Control of the respiratory and circulatory responses to exercise is therefore mediated by both neural and humoral mechanisms: and an important control link appears to couple the responses, via feedforward ventilatory control of cardiac origin.

Whipp BJ; Ward SA

1982-10-01

42

Results of a survey of the professional activities of 811 cardiopulmonary perfusionists.  

UK PubMed Central (United Kingdom)

We queried 811 cardiopulmonary perfusionists in North America on the equipment and techniques they currently use for cardiopulmonary bypass, their professional training, and their income structure. Most cardiac surgical teams use one of four types of bubble oxygenators; only 5% use a membrane oxygenator exclusively. More than 80% monitor the activated clotting time during cardiopulmonary bypass, and 61% confirm the adequacy of heparinization with this test before initiating bypass. Most perfusionists surveyed, 507, are hospital salaried; 117 are employed by cardiac surgeons; and 72 have established a fee for service arrangement. In 1980, reported incomes for cardiopulmonary perfusionists ranged between $12,000 and $110,000, with a mean of $25,000. Only 196 respondents (24%) were graduates of accredited training programs in perfusion technology, but 618 (76%) were board certified in cardiovascular perfusion. This study presents an in-depth survey of the present status of perfusion technology, a discipline which has grown up around the practice of cardiac surgery.

Miller DW Jr; Binford JM; Hessel EA 2nd

1982-03-01

43

Cardiopulmonary changes during endotoxic shock  

International Nuclear Information System (INIS)

[en] Right and left ventricular ejection fraction and cardiopulmonary transit time (LV-RA) were measured prior to and during endotoxic shock in 7 sheeps. RVEF was 49 +- 6%, LVEF 51 +- 6% and CPTT 13 +- 2 beat prior to the septic shock. RVEF dropped rapidly after the injection of 3 mg/kg E.Coli endotoxin to 26 +- 3%, LVEF to 42 +- 6% whereas CPTT prolonged to 26 +- 10 beat. Three minutes later RVEF recovered to 34 +- 10%, LVEF 49 +- 8% and CPTT to 21 +- 12 beat. Thirty to sixty minutes after the induction of shock RVEF was 42 +- 8%, LVEF 61 +- 6% and CPTT 10 +- 2 beat. Poor right ventricular function along with increased cardiopulmonary transit time appears to be the most important determinant of central circulation during the state of septic shock. (Author)

1986-01-01

44

Impact of methylprednisolone in priming solution of cardiopulmonary bypass on anti-inflammatory CD163 receptor during cardiac surgery.  

UK PubMed Central (United Kingdom)

We evaluated the influence of methylprednisolone in cardiopulmonary bypass fluid on scavenger receptor for hemoglobin CD163 molecule expression on monocytes of patients who underwent elective coronary artery bypass grafting with cardiopulmonary bypass with either exposure to methylprednisolone present in the cardiopulmonary bypass fluid (20 patients), or without methylprednisolone in the cardiopulmonary bypass fluid (22 patients) and operated on without cardiopulmonary bypass (42 patients). The dynamics of CD163 expression was also followed in patients operated on without cardiopulmonary bypass. This study was a retrospective analysis of a comparison of two studies. The expression of CD163 was determined quantitatively by standardized flow cytometry technique. The similarities in the dynamics of CD163 monocyte expression, comparing the patients operated on with or without cardiopulmonary bypass, were found. Compared to the preoperative level, CD163 monocyte expression was significantly elevated on the 1(st) postoperative day. Monocyte CD163 expression on the 1(st) postoperative day was evidently similar in both groups of patients operated without cardiopulmonary bypass (median value of mean fluorescence intensity (MFI) 18,896; interquartile range from 27,538 to 57,711; median value of MFI 18,863; interquartile range from 16,514 to 26,559; n.s.), suggesting high reproducibility of our flow cytometric method; the monocyte CD163 expression was significantly higher (median value of MFI 37,902; interquartile range from 27,538 to 57,711) on the 1(st) postoperative day in patients exposed to methylprednisolone compared to patients without this exposure (median value of MFI 20,995; interquartile range from 16,321 to 29,623) (p<0.001). We concluded that the expression of hemoglobin scavenger receptor CD163 on monocytes of cardiac surgical patients is induced by methylprednisolone present in cardiopulmonary bypass fluid.

Krejsek J; Mandak J; Kunes P; Lonsky V; Kolackova M; Jankovicova K; Andrys C

2012-07-01

45

Impact of methylprednisolone in priming solution of cardiopulmonary bypass on anti-inflammatory CD163 receptor during cardiac surgery.  

Science.gov (United States)

We evaluated the influence of methylprednisolone in cardiopulmonary bypass fluid on scavenger receptor for hemoglobin CD163 molecule expression on monocytes of patients who underwent elective coronary artery bypass grafting with cardiopulmonary bypass with either exposure to methylprednisolone present in the cardiopulmonary bypass fluid (20 patients), or without methylprednisolone in the cardiopulmonary bypass fluid (22 patients) and operated on without cardiopulmonary bypass (42 patients). The dynamics of CD163 expression was also followed in patients operated on without cardiopulmonary bypass. This study was a retrospective analysis of a comparison of two studies. The expression of CD163 was determined quantitatively by standardized flow cytometry technique. The similarities in the dynamics of CD163 monocyte expression, comparing the patients operated on with or without cardiopulmonary bypass, were found. Compared to the preoperative level, CD163 monocyte expression was significantly elevated on the 1(st) postoperative day. Monocyte CD163 expression on the 1(st) postoperative day was evidently similar in both groups of patients operated without cardiopulmonary bypass (median value of mean fluorescence intensity (MFI) 18,896; interquartile range from 27,538 to 57,711; median value of MFI 18,863; interquartile range from 16,514 to 26,559; n.s.), suggesting high reproducibility of our flow cytometric method; the monocyte CD163 expression was significantly higher (median value of MFI 37,902; interquartile range from 27,538 to 57,711) on the 1(st) postoperative day in patients exposed to methylprednisolone compared to patients without this exposure (median value of MFI 20,995; interquartile range from 16,321 to 29,623) (p<0.001). We concluded that the expression of hemoglobin scavenger receptor CD163 on monocytes of cardiac surgical patients is induced by methylprednisolone present in cardiopulmonary bypass fluid. PMID:22354894

Krejsek, J; Mandak, J; Kunes, P; Lonsky, V; Kolackova, M; Jankovicova, K; Andrys, C

2012-02-21

46

Effects of cardiopulmonary bypass on propofol pharmacokinetics and bispectral index during coronary surgery  

Directory of Open Access Journals (Sweden)

Full Text Available PURPOSE: Cardiopulmonary bypass is known to alter propofol pharmacokinetics in patients undergoing cardiac surgery. However, few studies have evaluated the impact of these alterations on postoperative pharmacodynamics. This study was designed to test the hypothesis that changes in propofol pharmacokinetics increase hypnotic effects after cardiopulmonary bypass. METHODS: Twenty patients scheduled for on-pump coronary artery bypass graft (group, n=10) or off-pump coronary artery bypass graft (group, n=10) coronary artery bypass grafts were anesthetized with sufentanil and a propofol target controlled infusion (2.0 µg/mL). Depth of hypnosis was monitored using the bispectral index. Blood samples were collected from the induction of anesthesia up to 12 hours after the end of propofol infusion, at predetermined intervals. Plasma propofol concentrations were measured using high-performance liquid chromatography, followed by a non-compartmental propofol pharmacokinetic analysis. Data were analyzed using ANOVA, considering p<0.05 as significant. RESULTS: After cardiopulmonary bypass, despite similar plasma propofol concentrations in both groups, bispectral index values were lower in the on-pump coronary artery bypass graft group. Time to extubation after the end of propofol infusion was greater in the on-pump coronary artery bypass graft group (334 ± 117 vs. 216 ± 85 min, p = 0.04). Patients undergoing cardiopulmonary bypass had shorter biological (1.82 ± 0.5 vs. 3.67 ± 1.15h, p < 0.01) and terminal elimination (6.27 ± 1.29 vs. 10.5h ± 2.18, p < 0.01) half-life values, as well as higher total plasma clearance (28.36 ± 11.40 vs.18.29 ± 7.67 mL/kg/min, p = 0.03), compared to patients in the off-pump coronary artery bypass graft group. CONCLUSION: Aside from the increased sensitivity of the brain to anesthetics after cardiopulmonary bypass, changes in propofol pharmacokinetics may contribute to its central nervous system effects.

Ricardo Antonio G. Barbosa; Silvia Regina C. Jorge Santos; Paul F. White; Valéria A. Pereira; Carlos R. Silva Filho; Luiz M. S. Malbouisson; Maria José C. Carmona

2009-01-01

47

Midterm results of axilloaxillary cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

BACKGROUND: Total axilloaxillary cardiopulmonary bypass (CPB) is an alternative peripheral cannulation technique that has the advantages of antegrade flow during CPB, monohemispherical brain perfusion in case of circulatory arrest, and achieving excellent decompression of the heart during sternotomy. The results of this strategy, particularly beyond the immediately postoperative period, are not well known. METHODS: Eleven patients with huge aortic aneurysms (>80 mm) and/or acute-subacute ascending aorta dissections underwent surgery with totally axilloaxillary CPB. Short- and midterm outcomes, including survival and complications relating to axilloaxillary cannulation, were reported. RESULTS: All attempts at axillary artery cannulation were successful. Ten of the 11 axillary vein cannulation attempts were successful, and the target pump flow was achieved via the axillary vein alone. Postoperatively, clinical examinations revealed no cases of arm ischemia or compartment syndrome. Three patients (27.3%) experienced ipsilateral brachial plexus neuropathy that produced right hand weakness. The neuropathy was transient in 2 patients, and the symptoms resolved completely. Hospital death occurred in 1 (9.1%) of the 11 patients. The mean (±SD) follow-up time was 956 ± 292 days. One of the survivors died on postoperative day 105 from subacute graft infection and sepsis. The right arms of all 9 of the living patients were examined physically and by Doppler ultrasonography. We found a chronic recanalized thrombotic change in the subclavian vein in 1 patient (11.1%), who had no complaints. CONCLUSIONS: Axilloaxillary CPB is an alternative technique that can be used under certain conditions. Adding axillary venous cannulation to axillary artery cannulation at least does not increase the risk of a procedure that uses the axillary artery alone, either in the early or mid term.

Tuncer A; Adademir T; Tuncer E; Tas SG; Donmez AA; Sunar H; Balkanay M

2012-02-01

48

A prospective, randomized comparison of cerebral venous oxygen saturation during normothermic and hypothermic cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Recent reports have described cerebral venous oxygen desaturation during and after rewarming from hypothermic cardiopulmonary bypass. Additionally, patients undergoing normothermic cardiopulmonary bypass may be at higher risk for neurologic injury. This study was designed to determine whether patients undergoing normothermic cardiopulmonary bypass are at increased risk for sustained cerebral desaturation. Fifty-two patients undergoing first-time coronary artery bypass grafting were randomized to receive normothermic (37 degrees C, n = 26) or hypothermic (27 degrees C, n = 26) cardiopulmonary bypass. The anesthetic was standardized and alpha-stat pH management was used. A 4F oximetric catheter was placed in the jugular bulb and cerebral venous and radial arterial blood were sampled. Oxygen partial pressure and saturation were measured at six intervals from cerebral venous blood and from radial arterial blood. Patients receiving normothermic cardiopulmonary bypass had lesser values of oxygen partial pressure and saturation in cerebral venous blood than patients subjected to hypothermia during the first 40 minutes of bypass. Cerebral venous desaturation (oxygen saturation in cerebral venous blood of 50% or less) was observed in 54% of patients in the normothermic group and 12% of patients in the hypothermic group during cardiopulmonary bypass. In the normothermic group, cerebral desaturation occurred primarily in early bypass (14 of 26). The three episodes of desaturation in the hypothermic group occurred during rewarming. During cardiopulmonary bypass, the arteriovenous oxygen content difference was greater in the normothermic group than in that in the hypothermic group, suggesting higher oxygen consumption. Differences in glucose utilization during early cardiopulmonary bypass between the groups was also detected. One patient in the hypothermic group had an embolic stroke and subsequently died. There were no other perioperative strokes or deaths in the study population. The present study demonstrates that patients undergoing normothermic cardiopulmonary bypass are at greater risk for cerebral desaturation. Because it is a global assessment, cerebral venous oxygen saturation may be insensitive to focal ischemic events. It remains to be seen whether these differences in cerebral physiologic states translate into differences in clinical outcome.

Cook DJ; Oliver WC Jr; Orszulak TA; Daly RC

1994-04-01

49

[Plaque surgery for Peyronie's disease: heterologous grafts].  

Science.gov (United States)

Surgical treatment of Induratio Penis Plastica includes conservative procedures (phalloplasty), substitutive procedures (prosthesis) and combined procedures (phalloplasty plus prosthesis). Our policy for conservative treatment is based on radical removal of the plaque and replacement with biological patches. During a 15 year experience we employed lyophilized dura mater, autologous dermal graft, preputial skin, cadaveric dermal graft (AlloDerm), venous graft and porcine SIS (Small Intestine Submucosa) graft. Our experience confirms the superiority of venous grafts, but preliminary results with SIS grafts are encouraging. PMID:12868152

Paradiso, Matteo; Sedigh, Omid; Milan, Gian Luca

2003-06-01

50

Clinical comparison between membrane and bubble oxygenators in cardiopulmonary bypass.  

Science.gov (United States)

The clinical course of two similar patient groups was compared in whom, during cardiopulmonary bypass, a membrane or bubble oxygenator was employed. According to our results there is no significant functional difference between the two types of oxygenators as long as the perfusion time does not exceed 90 minutes. Beyond this time limit, the membrane oxygenator has distinct advantages, particularly with regard to hemolysis. We presently prefer the bubble oxygenator. The use of a membrane oxygenator is restricted to complex open heart procedures with suspected technical problems. PMID:479280

Fenchel, G; Seybold-Epting, W; Schmidt, K; Stunkat, R; Hoffmeister, H E

51

Clinical comparison between membrane and bubble oxygenators in cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

The clinical course of two similar patient groups was compared in whom, during cardiopulmonary bypass, a membrane or bubble oxygenator was employed. According to our results there is no significant functional difference between the two types of oxygenators as long as the perfusion time does not exceed 90 minutes. Beyond this time limit, the membrane oxygenator has distinct advantages, particularly with regard to hemolysis. We presently prefer the bubble oxygenator. The use of a membrane oxygenator is restricted to complex open heart procedures with suspected technical problems.

Fenchel G; Seybold-Epting W; Schmidt K; Stunkat R; Hoffmeister HE

1979-07-01

52

Updates in small animal cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

For dogs and cats that experience cardiopulmonary arrest, rates of survival to discharge are 6% to 7%, as compared with survival rates of 20% for people. The introduction of standardized cardiopulmonary resuscitation guidelines and training in human medicine has led to substantial improvements in outcome. The Reassessment Campaign on Veterinary Resuscitation initiative recently completed an exhaustive literature review and generated a set of evidence-based, consensus cardiopulmonary resuscitation guidelines in 5 domains: preparedness and prevention, basic life support, advanced life support, monitoring, and postcardiac arrest care. This article reviews some of the most important of these new guidelines.

Fletcher DJ; Boller M

2013-07-01

53

Acute pulmonary embolectomy three days following a coronary artery bypass graft procedure.  

Science.gov (United States)

Pulmonary embolism is very rarely reported early after cardiac surgery, most probably due to full heparinisation during cardiopulmonary bypass. We report a 66-year-old man without thromboembolic history who presented three days after a coronary artery bypass grafting procedure with acute dyspnoea and haemodynamic instability. A CT scan confirmed paracentral bilateral pulmonary embolism requiring an urgent and successful embolectomy. Review of the literature confirms that pulmonary embolism may occur in up to 3% of post-cardiopulmonary bypass patients. The possibility of pulmonary embolism must be taken into consideration in post-cardiopulmonary bypass patients with acute onset of chest pain and respiratory insufficiency. PMID:17444325

Kuklinski, D; Tevaearai, H T; Eckstein, F S; Carrel, T P

2007-04-01

54

Acute pulmonary embolectomy three days following a coronary artery bypass graft procedure.  

UK PubMed Central (United Kingdom)

Pulmonary embolism is very rarely reported early after cardiac surgery, most probably due to full heparinisation during cardiopulmonary bypass. We report a 66-year-old man without thromboembolic history who presented three days after a coronary artery bypass grafting procedure with acute dyspnoea and haemodynamic instability. A CT scan confirmed paracentral bilateral pulmonary embolism requiring an urgent and successful embolectomy. Review of the literature confirms that pulmonary embolism may occur in up to 3% of post-cardiopulmonary bypass patients. The possibility of pulmonary embolism must be taken into consideration in post-cardiopulmonary bypass patients with acute onset of chest pain and respiratory insufficiency.

Kuklinski D; Tevaearai HT; Eckstein FS; Carrel TP

2007-04-01

55

Doxycycline Reduces Cardiac Matrix Metalloproteinase-2 Activity but Does not Ameliorate Myocardial Dysfunction During Reperfusion in Coronary Artery Bypass Patients Undergoing Cardiopulmonary Bypass.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Matrix metalloproteinase-2 proteolyzes intracellular proteins in the heart and induces acute myocardial contractile dysfunction in ischemia-reperfusion injury. Doxycycline, a matrix metalloproteinase inhibitor, prevented matrix metalloproteinase-2-induced troponin I cleavage in rat hearts and improved contractile function following ischemia-reperfusion. In patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass, increased atrial matrix metalloproteinase-2 activity was inversely correlated with cardiac mechanical function at 3 hours reperfusion. We performed a study in patients with coronary artery disease undergoing primary elective coronary artery bypass graft surgery with cardiopulmonary bypass to determine whether doxycycline reduces cardiac mechanical dysfunction, matrix metalloproteinase activity, and troponin I degradation after reperfusion. DESIGN: Randomized, double-blinded, placebo-controlled study. SETTING: University of Alberta Hospital. PATIENTS: Forty-two patients with coronary artery disease undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. INTERVENTIONS: Patients were randomized to receive either oral administration of 20 mg of doxycycline or matching placebo pill twice a day at least 2 days prior to surgery, on the day of surgery, and for the first 3 postoperative days. MEASUREMENTS AND MAIN RESULTS: Left ventricular stroke work index was examined prior to cardiopulmonary bypass and at 24 hours reperfusion. Right atrial biopsies were collected before cardiopulmonary bypass and 10 minutes after aortic cross-clamp release to determine matrix metalloproteinase-2 activity and troponin I level. Blood was collected to determine matrix metalloproteinase activity and interleukin-6, C-reactive protein, and troponin I levels. Cardiac 72-kDa matrix metalloproteinase-2 activity was lower upon reperfusion in biopsies from the doxycycline group (p = 0.01), and the increase of matrix metalloproteinase-2 activity in the placebo group due to reperfusion did not appear in the doxycycline group (p = 0.05). Doxycycline, however, did not ameliorate cardiac mechanical dysfunction following reperfusion or the cardiopulmonary bypass-coronary artery bypass graft-induced increased plasma matrix metalloproteinase-9, interleukin-6, and C-reactive protein levels. Cardiopulmonary bypass-coronary artery bypass graft or doxycycline did not change tissue or plasma troponin I levels at 10 minutes reperfusion. CONCLUSIONS: Although doxycycline did not improve myocardial stunning following coronary artery bypass graft surgery with cardiopulmonary bypass, it reduced cardiac matrix metalloproteinase-2 activity in these patients. A larger trial and/or higher dose of doxycycline may yet be warranted.

Schulze CJ; Castro MM; Kandasamy AD; Cena J; Bryden C; Wang SH; Koshal A; Tsuyuki RT; Finegan BA; Schulz R

2013-11-01

56

Doxycycline Reduces Cardiac Matrix Metalloproteinase-2 Activity but Does not Ameliorate Myocardial Dysfunction During Reperfusion in Coronary Artery Bypass Patients Undergoing Cardiopulmonary Bypass.  

UK PubMed Central (United Kingdom)

OBJECTIVES:: Matrix metalloproteinase-2 proteolyzes intracellular proteins in the heart and induces acute myocardial contractile dysfunction in ischemia-reperfusion injury. Doxycycline, a matrix metalloproteinase inhibitor, prevented matrix metalloproteinase-2-induced troponin I cleavage in rat hearts and improved contractile function following ischemia-reperfusion. In patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass, increased atrial matrix metalloproteinase-2 activity was inversely correlated with cardiac mechanical function at 3 hours reperfusion. We performed a study in patients with coronary artery disease undergoing primary elective coronary artery bypass graft surgery with cardiopulmonary bypass to determine whether doxycycline reduces cardiac mechanical dysfunction, matrix metalloproteinase activity, and troponin I degradation after reperfusion. DESIGN:: Randomized, double-blinded, placebo-controlled study. SETTING:: University of Alberta Hospital. PATIENTS:: Forty-two patients with coronary artery disease undergoing coronary artery bypass graft surgery with cardiopulmonary bypass. INTERVENTIONS:: Patients were randomized to receive either oral administration of 20 mg of doxycycline or matching placebo pill twice a day at least 2 days prior to surgery, on the day of surgery, and for the first 3 postoperative days. MEASUREMENTS AND MAIN RESULTS:: Left ventricular stroke work index was examined prior to cardiopulmonary bypass and at 24 hours reperfusion. Right atrial biopsies were collected before cardiopulmonary bypass and 10 minutes after aortic cross-clamp release to determine matrix metalloproteinase-2 activity and troponin I level. Blood was collected to determine matrix metalloproteinase activity and interleukin-6, C-reactive protein, and troponin I levels. Cardiac 72-kDa matrix metalloproteinase-2 activity was lower upon reperfusion in biopsies from the doxycycline group (p = 0.01), and the increase of matrix metalloproteinase-2 activity in the placebo group due to reperfusion did not appear in the doxycycline group (p = 0.05). Doxycycline, however, did not ameliorate cardiac mechanical dysfunction following reperfusion or the cardiopulmonary bypass-coronary artery bypass graft-induced increased plasma matrix metalloproteinase-9, interleukin-6, and C-reactive protein levels. Cardiopulmonary bypass-coronary artery bypass graft or doxycycline did not change tissue or plasma troponin I levels at 10 minutes reperfusion. CONCLUSIONS:: Although doxycycline did not improve myocardial stunning following coronary artery bypass graft surgery with cardiopulmonary bypass, it reduced cardiac matrix metalloproteinase-2 activity in these patients. A larger trial and/or higher dose of doxycycline may yet be warranted.

Schulze CJ; Castro MM; Kandasamy AD; Cena J; Bryden C; Wang SH; Koshal A; Tsuyuki RT; Finegan BA; Schulz R

2013-08-01

57

A large saphenous vein graft aneurysm one year after coronary artery bypass graft surgery presenting as a left lung mass.  

Science.gov (United States)

Aneurysm of a saphenous vein graft (SVG) is a rare but fatal complication of coronary artery bypass graft (CABG) surgery. The development of SVG aneurysms appears usually about 10-20 years after the operation at an estimated rate of tube graft. The patient was transferred to ICU with stable hemodynamic status. SVG aneurysm should be considered while encountering mediastinal mass or undiagnosed cardiopulmonary symptoms in patients with a previous history of CABG because of its rarity and overlap of symptoms with other thoracic, pulmonary, and cardiac diseases. Surgery seems to be the treatment of choice to reduce the risk of rupture and embolism. PMID:19329505

Abbasi, Mohammad; Soltani, Ghasem; Shomali, Ali; Javan, Hadi

2009-03-27

58

Blood transfusion after on-pump coronary artery bypass grafting: focus on modifiable risk factors.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Perioperative transfusions are known to increase morbidity and mortality after coronary artery bypass grafting (CABG). The aims of the study were (1) to identify the clinical profile of the patient subset at highest risk from transfusion and (2) to disclose causative relationship and dose-dependency of transfusion on hospital mortality. METHODS: A prospective observational design was employed on a cohort of 1047 consecutive patients (median age 63.2 ± 9.3, 18.8% female, 30.6% diabetics, 31.9% urgent/emergent, 15.3% with low preoperative left ventricular ejection fraction (LVEF)) who underwent on-pump isolated CABG between January 2004 and December 2007. Univariate and multivariate regression analysis and post-hoc risk stratification, by means of propensity scoring and binary segmentation, were adopted. RESULTS: The following independent risk factors were identified: age, body surface area (BSA), preoperative glomerular filtration rate, preoperative haemoglobin, surgical priority, length of cardiopulmonary bypass, intraoperative haemodilution and early postoperative blood loss. The patient population was stratified in quintiles of transfusional risk, by means of propensity scoring. As to modifiable risk factors, patients in the highest quintiles of risk were those with BSA ( < 1.73, preoperative haemoglobin < 12 g/dl, intraoperative haemoglobin < 8.0 g/dl and those undergoing cardiopulmonary bypass > 90'). Binary segmentation was performed to avoid any association between red cell transfusion and worse outcomes being causative and dose-dependent. A dose-dependent pattern was disclosed, with patients receiving > 5 units being at highest risk. CONCLUSIONS: High exposure to blood transfusions may be prevented by preoperative patient stratification and by the close tailoring of management strategies on planning and implementing surgical timing, as well as by cardiopulmonary bypass technique.

De Santo LS; Amarelli C; Della Corte A; Scardone M; Bancone C; Carozza A; Grassia MG; Romano G

2013-02-01

59

Amitriptyline Intoxication Responded to Cardiopulmonary Resuscitation  

Directory of Open Access Journals (Sweden)

Full Text Available The most severe effects in amitriptiline intoxications are related with central nervous system and cardiovascular system. Amitriptiline intoxication especially with high doses has severe cardiac effects and can result in cardiac arrest. Most favorable responses can be achieved with efficient and prolonged cardiopulmonary resuscitation. We wanted to present a case ingested high dose of amitriptiline for attempt to suicide and responded to prolonged cardiopulmonary resuscitation.

Güldem Turan; Özcan Pi?kin; Gül?en Bulut

2012-01-01

60

Effect of cardiopulmonary bypass on the pharmacokinetics of propranolol and atenolol  

Directory of Open Access Journals (Sweden)

Full Text Available The pharmacokinetics of some ?-blockers are altered by cardiopulmonary bypass (CPB). The objective of this study was to compare the effect of coronary artery bypass graft (CABG) surgery employing CPB on the pharmacokinetics of propranolol and atenolol. We studied patients receiving oral propranolol with doses ranging from 80 to 240 mg (N = 11) or atenolol with doses ranging from 25 to 100 mg (N = 8) in the pre- and postoperative period of CABG with moderately hypothermic CPB (32°C). On the day before and on the first day after surgery, blood samples were collected before ?-blocker administration and every 2 h thereafter. Plasma levels were determined using high-performance liquid chromatography and data were treated by pharmacokinetics-modelling. Statistical analysis was performed using ANOVA or the Friedman test, as appropriate, and P < 0.05 was considered to be significant. A prolongation of propranolol biological half-life from 5.41 ± 0.75 to 11.46 ± 1.66 h (P = 0.0028) and an increase in propranolol volume of distribution from 8.70 ± 2.83 to 19.33 ± 6.52 L/kg (P = 0.0032) were observed after CABG with CPB. No significant changes were observed in either atenolol biological half-life (from 11.20 ± 1.60 to 11.44 ± 2.89 h) or atenolol volume of distribution (from 2.90 ± 0.36 to 3.83 ± 0.72 L/kg). Total clearance was not changed by surgery. These CPB-induced alterations in propranolol pharmacokinetics may promote unexpected long-lasting effects in the postoperative period while the effects of atenolol were not modified by CPB surgery.

M.J.C. Carmona; V.A. Pereira; L.M.S. Malbouisson; J.O.C. Auler Jr.; S.R.C.J. Santos

2009-01-01

 
 
 
 
61

Skin Graft  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Skin graft is one of the most indispensable techniques in plastic surgery and dermatology. Skin grafts are used in a variety of clinical situations, such as traumatic wounds, defects after oncologic resection, burn reconstruction, scar contracture release, congenital skin deficiencies, hair restorat...

Shimizu, Ruka; Kishi, Kazuo

62

Grafting efficiency of synthetic polymers onto biomaterials: a comparative study of grafting-from versus grafting-to.  

UK PubMed Central (United Kingdom)

In the present study, the two grafting techniques grafting-from - by activators regenerated by electron transfer atom transfer radical polymerization (ARGET ATRP) - and grafting-to - by copper(I)-catalyzed azide-alkyne cycloaddition (CuAAC) - were systematically compared, employing cellulose as a substrate. In order to obtain a meaningful comparison, it is crucial that the graft lengths of the polymers that are grafted from and to the substrates are essentially identical. Herein, this was achieved by utilizing the free polymer formed in parallel to the grafting-from reaction as the polymer for the grafting-to reaction. Four graft lengths were investigated, and the molar masses of the four free polymers (21 ? M(n) ? 100 kDa; 1.07 ? ?(M) ? 1.26), i.e. the polymers subsequently employed in the grafting-to reaction, were shown to be in the same range as the molar masses of the polymers grafted from the surface (23 ? M(n) ? 87 kDa; 1.08 ? ?(M) ? 1.31). The molecular weights of the chains grafted from the surface were established after cleavage from the cellulose substrates via size exclusion chromatography (SEC). High-resolution Fourier transform infrared microscopy (FT-IRM) was employed as an efficient tool to study the spatial distribution of the polymer content on the grafted substrates. In addition, the functionalized substrates were analyzed by X-ray photoelectron spectroscopy (XPS), contact angle (CA) measurements, and field-emission scanning electron microscopy (FE-SEM). For cellulose substrates modified via the grafting-from approach, the content of polymer on the surfaces increased with increasing graft length, confirming the possibility to tailor not only the length of the polymer grafts but also the polymeric content on the surface. In comparison, for the grafting-to reaction, the grafted content could not be controlled by varying the length of the preformed polymer: the polymer content was essentially the same for the four graft lengths. Consequently, the obtained results, when employing cellulose as a substrate and under these conditions, suggest that the grafting-from approach is superior to the grafting-to technique with respect to controlling the distribution of the polymeric content on the surface.

Hansson S; Trouillet V; Tischer T; Goldmann AS; Carlmark A; Barner-Kowollik C; Malmström E

2013-01-01

63

Cardiopulmonary resuscitation: a new perspective  

Directory of Open Access Journals (Sweden)

Full Text Available At the present there are principles of cardiopulmonary resuscitation (CPR) which are reflected in the recommendations of the AHA and ESC of 2010. They include strict rules on well-timed and proper closed-chest cardiac massage. According to these rules chest compressions should be repeated at least 100 times per minute at a depth of not less than 5 cm. To comply with the standards is not easy even for skilled staff, operator tiredness quickly leads to decrease in CPR quality. Various mechanical devices for closed-chest cardiac massage are used nowadays. One of them is LUCAS system.In some studies LUCAS system showed an efficacy and safety comparable with manual closed-chest cardiac massage. Design features of the LUCAS device do not disturb other life maintaining activities — defibrillation, mechanical ventilation. The device permeability for X-rays makes possible the use of LUCAS in cath labs, if CPR is needed during the intervention procedure. LUCAS system can serve as an alternative tool for CPR. It can be used in intensive care units, as well as be at the disposal of special emergency teams.

V. A. Sulimov; Yu. V. Gavrilov; E. A. Okisheva

2012-01-01

64

[Cardiopulmonary bypass in cardiac surgery].  

UK PubMed Central (United Kingdom)

Cardiopulmonary bypass (CPB) is a standard procedure in cardiac surgery; however, apart from its therapeutic options a CPB might also initiate systemic and organ-specific complications, such as heart failure, renal and pulmonary dysfunction, impaired coagulation as well as neurological and cognitive dysfunction. The immunological response to the extracorporeal circulation generates systemic inflammation which often meets the definition of systemic inflammatory response syndrome (SIRS). The main inducers of SIRS are contact of blood with the artificial surfaces of the CPB, mechanical stress which affects the blood components and the extensive surgical trauma. Hence, a number of technical and surgical developments aim at reduction of the inflammatory response caused by the CPB. By reason of surgical demands, the majority of cardiothoracic procedures still depend on the use of CPB; however, there is an on-going development of new techniques trying to reduce the surgical trauma and the negative consequences of CPB. Here, minimized systems with biocompatible surfaces have been shown to be effective in attenuating the inflammatory response to CPB. Alternative procedures such as off-pump surgery may help to avoid CPB-associated complications but due to specific limitations will not replace conventional bypass surgery.

Baehner T; Boehm O; Probst C; Poetzsch B; Hoeft A; Baumgarten G; Knuefermann P

2012-10-01

65

Are We Successful in Cardiopulmonary Resuscitation?  

Directory of Open Access Journals (Sweden)

Full Text Available Purpose: In this study, we aimed to determine the success rate of cardiopulmonary resuscitation performed in the patients with diagnosis of cardiac arrest, and demographic characteristics of these patients. Material and Methods: The patients admitted to Adana Numune Education and Research Hospital, Department of Emergency Medicine between 01.01.2011 and 31.12.2012, and who underwent cardiopulmonary resuscitation were included to this study planned as retrospectively. The age, gender, status of judicial cases, causes and time of cardiac arrest, first observed arrest rhythm, the diseases prior to the arrest, means of arrival to emergency department, duration of cardiopulmonary resuscitation, results of cardiopulmonary resuscitation, the name of the hospitalised clinic, the existence of the operation, and outcome of the patients who underwent cardiopulmonary resuscitation in accordance with current advanced life support protocols were recorded in standard data entry form. Results: A total of 290 patients with completely accessible data were included to the study. Most of these patients were men (65.2%). The mean ages were 61 ± 19 years for men, 67 ± 14 years for women (p = 0.018). The most common diagnosis were ischemic heart disease and heart failure according to the analysis of the patient's medical history. 92 patients (31.7%) were brought to the emergency department after death, and all of these patients were unsuccessful following to cardiopulmonary resuscitation. 198 patients (68.3%) had cardiac arrest in the emergency department, and we determined that cardiopulmonary resuscitation application of 102 patients were successful. The most common causes of cardiac arrest were myocardial infarction and heart failure. Mostly first observed rhythm in the monitor was asystole. The response rate of cardiopulmonary resuscitation in patients with ventricular fibrillation and ventricular tachycardia was higher. Most patients were hospitalised to the coronary intensive care unit, and 11 of the 21 patients who underwent percutaneous coronary intervention were discharged from hospital in good health. Total 15 (5%) of all patients included to the study were discharged in good health. Conclusion: The lower rate of success in cardiopulmonary resuscitation showed the presence of defects in all stages of the chain of life, and suggests that some actions should be performed to correct them. [Cukurova Med J 2013; 38(4.000): 601-609

Nalan Kozaci; Mehmet Oguzhan Ay; Ferhat Icme; Abdulkadir Akturk; Salim Satar

2013-01-01

66

Smoking cessation in patients with cardiopulmonary diseases  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: To determine the smoking cessation rates of outpatients with cardiopulmonary disease and the differences between non-cardiopulmonary diseases.Methods: Two hundred and two active smokers with comorbid diseases were prospectively evaluated between September 2004 and January 2008 in this observational study. All of the patients answered Fagerstrom test for nicotine dependence with a regular questionnaire of general characteristics. Behavioral counseling therapies were administered to all of the subjects. Nicotine replacement therapy, bupropion or combination therapies were the pharmacological therapies after running the baseline spirometry and carbon monoxide oximetry tests. Subjects were classified as patients with cardiopulmonary disease (124) and non-cardiopulmonary diseases (78), based on medical history. Student t and Chi-square tests were used for statistical analyses. Results: The age of smoking was similar but total amount of smoked tobacco was higher (p0.05). Conclusion: Results of this analysis confirm that, tobacco dependence is still a severe but necessary condition for the patients with cardiopulmonary diseases. Additionally neither of the treatment protocols was superior to the others.

Zeynep P?nar Önen; Elif ?en; Banu Eri? Gülbay; Ayperi Öztürk; Öznur Akkoca Y?ld?z; Turan Ac?can; Sevgi Saryal; Gülseren Karab?y?ko?lu

2011-01-01

67

"Orpheus" cardiopulmonary bypass simulation system.  

UK PubMed Central (United Kingdom)

In this paper we describe a high-fidelity perfusion simulation system intended for use in the training and continuing education of perfusionists. The system comprises a hydraulic simulator, an electronic interface unit and a controlling computer with associated real-time computer models. It is designed for use within an actual operating theatre, or within a specialized simulation facility. The hydraulic simulator can be positioned on an operating table and physically connected to the circuit of the institutional heart-lung machine. The institutional monitoring system is used to display the arterial and central venous pressures, the ECG and the nasopharyngeal temperature using appropriate connections. The simulator is able to reproduce the full spectrum of normal and abnormal events that may present during the course of cardiopulmonary bypass. The system incorporates a sophisticated blood gas model that accurately predicts the behavior of a modern, hollow-fiber oxygenator. Output from this model is displayed in the manner of an in-line blood gas electrode and is updated every 500 msecs. The perfusionist is able to administer a wide variety of drugs during a simulation session including: vasoconstrictors (metaraminol, epinephrine and phenylephrine), a vasodilator (sodium nitroprusside), chronotropes (epinephrine and atropine), an inotrope (epinephrine) and modifiers of coagulation (heparin and protamine). Each drug has a pharmacokinetic profile based on a three-compartment model plus an effect compartment. The simulation system has potential roles in the skill training of perfusionists, the development of crisis management protocols, the certification and accreditation of perfusionists and the evaluation of new perfusion equipment and/or techniques.

Morris RW; Pybus DA

2007-12-01

68

Expanding the availability of extracorporeal cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

A healthy 14-year-old presented to an emergency department in Alaska, complaining of shortness of breath, chest pain, and 72 hours of malaise and headache. On admission, her blood pressure was 80/50 mm?Hg, and she had cool extremities. Electrocardiography revealed wide-complex ventricular tachycardia. She underwent synchronized electrical cardioversion. Although she initially converted to sinus rhythm, she subsequently became pulseless, with electrocardiographic evidence of ventricular tachycardia. Despite cardiopulmonary resuscitation, she failed to achieve a perfusing rhythm. Cardiovascular surgery consultation was obtained, and she was placed on partial cardiopulmonary bypass during 2 hours of ongoing chest compressions. Cardiopulmonary bypass flow was limited by the small size of her femoral arteries. She remained in refractory ventricular tachycardia. The cardiopulmonary bypass circuit was modified for transportation of the patient via air ambulance 1500 miles to a tertiary medical center that specializes in pediatric heart failure and mechanical cardiopulmonary support. Upon arrival at the tertiary medical center, she underwent carotid artery cannulation to improve total cardiopulmonary support and percutaneous balloon atrial septostomy to facilitate left ventricular decompression. Intravenous immunoglobulin and steroids were administered to treat presumed acute fulminant viral myocarditis. Extracorporeal life support was support was successfully discontinued after 14 days, but she experienced a thromboembolic stroke. The patient was discharged on hospital day 65 with moderate generalized left-sided weakness, but she was able to ambulate with minimal assistance. She subsequently returned to school and is progressing appropriately with her peers. Cardiac function has normalized, and she remains in normal sinus rhythm.

McMullan DM

2013-03-01

69

Cardiopulmonary interactions in acute lung injury.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: Through shared anatomy, pressures, and endothelial connections, the respiratory and cardiovascular systems affect each other in complex but clinically important ways. RECENT FINDINGS: Lung injury has clinically important circulatory effects, especially with regards to right ventricular function. Mechanical ventilation and PEEP produce a host of circulatory consequences, some beneficial, some life-threatening. At the same time, circulatory impairments and treatments can magnify the impact of lung failure. SUMMARY: Cardiopulmonary interactions underpin current views of fluid management and mechanical ventilation. Understanding cardiopulmonary interactions and their physiological basis has direct clinical relevance.

Schmidt GA

2013-02-01

70

Pathophysiology of cardiopulmonary bypass: current issues.  

UK PubMed Central (United Kingdom)

Much of the research related to cardiopulmonary bypass in recent years has been directed toward defining the changes in plasma and blood cells during bypass. In this review, recent information is reexamined for six areas of current interest. These areas are complement activation, immune response, anaphylactic reactions, coagulation, and cerebral dysfunction. Complement may be activated by either the classical or alternate pathway during cardiopulmonary bypass and protamine administration. Membrane oxygenators appear to diminish the degree of complement activation. Complement is a major factor in the whole body inflammatory response; which often accompanies cardiopulmonary bypass. A product of complement activation, C5a- desArg, causes activation and aggregation of granulocytes. Other products of complement activation lead to lysis of blood cells including granulocytes and red cells. Bubble oxygenators appear to have a distinct disadvantage compared to membrane oxygenators regarding infection. Airborne microorganisms are more likely to be entrained into circulating blood with bubble oxygenators than with membrane oxygenators. Bubble oxygenators cause a greater decrease in leukocyte number and function than membrane oxygenators. Anaphylactic reactions have been associated with use of antibiotics, blood products, protamine, and volume expanders during cardiopulmonary bypass. Protamine reactions may be on an immunological basis or due to direct toxicity of the drug. Free radicals including superoxide, hydrogen peroxide, and the hydroxyl radical may be generated during cardiopulmonary bypass and reperfusion. Free radical scavengers including; vitamin E, coenzyme Q, vitamin C, mannitol, and glutathione have been studied. The avoidance of blood transfusion because of risk of transmitted infection including AIDS has become a major goal in cardiac surgery. Factors that correlate with increased transfusion requirement include low hematocrit, female gender, increased age, small body size, low ejection fraction, reoperation, and emergency operation. Heparin resistance due to antithrombin III deficiency is being recognized more commonly. Antithrombin III deficiency may be corrected with fresh frozen plasma. Patients with heparin induced thrombocytopenia may be difficult to manage. Several management protocols are suggested. The most straightforward appears to be the use of aspirin preoperatively and platelet transfusions postoperatively. The incidence of cerebral dysfunction after cardiopulmonary bypass depends on the sensitivity of the test or indicator used. Perioperative stroke is associated with intrinsic cerebrovascular disease and atherosclerosis of the ascending aorta. Retinal angiograms during cardiopulmonary bypass show that microemboli are very common. Cerebroplegia has been shown to extend the period of safe circulatory arrest in animals. Much of the new knowledge concerning cardiopulmonary bypass is the result of close collaboration between cardiac surgeons and nonsurgical scientists.

Utley JR

1990-09-01

71

Pathophysiology of cardiopulmonary bypass: current issues.  

Science.gov (United States)

Much of the research related to cardiopulmonary bypass in recent years has been directed toward defining the changes in plasma and blood cells during bypass. In this review, recent information is reexamined for six areas of current interest. These areas are complement activation, immune response, anaphylactic reactions, coagulation, and cerebral dysfunction. Complement may be activated by either the classical or alternate pathway during cardiopulmonary bypass and protamine administration. Membrane oxygenators appear to diminish the degree of complement activation. Complement is a major factor in the whole body inflammatory response; which often accompanies cardiopulmonary bypass. A product of complement activation, C5a- desArg, causes activation and aggregation of granulocytes. Other products of complement activation lead to lysis of blood cells including granulocytes and red cells. Bubble oxygenators appear to have a distinct disadvantage compared to membrane oxygenators regarding infection. Airborne microorganisms are more likely to be entrained into circulating blood with bubble oxygenators than with membrane oxygenators. Bubble oxygenators cause a greater decrease in leukocyte number and function than membrane oxygenators. Anaphylactic reactions have been associated with use of antibiotics, blood products, protamine, and volume expanders during cardiopulmonary bypass. Protamine reactions may be on an immunological basis or due to direct toxicity of the drug. Free radicals including superoxide, hydrogen peroxide, and the hydroxyl radical may be generated during cardiopulmonary bypass and reperfusion. Free radical scavengers including; vitamin E, coenzyme Q, vitamin C, mannitol, and glutathione have been studied. The avoidance of blood transfusion because of risk of transmitted infection including AIDS has become a major goal in cardiac surgery. Factors that correlate with increased transfusion requirement include low hematocrit, female gender, increased age, small body size, low ejection fraction, reoperation, and emergency operation. Heparin resistance due to antithrombin III deficiency is being recognized more commonly. Antithrombin III deficiency may be corrected with fresh frozen plasma. Patients with heparin induced thrombocytopenia may be difficult to manage. Several management protocols are suggested. The most straightforward appears to be the use of aspirin preoperatively and platelet transfusions postoperatively. The incidence of cerebral dysfunction after cardiopulmonary bypass depends on the sensitivity of the test or indicator used. Perioperative stroke is associated with intrinsic cerebrovascular disease and atherosclerosis of the ascending aorta. Retinal angiograms during cardiopulmonary bypass show that microemboli are very common. Cerebroplegia has been shown to extend the period of safe circulatory arrest in animals. Much of the new knowledge concerning cardiopulmonary bypass is the result of close collaboration between cardiac surgeons and nonsurgical scientists. PMID:2133841

Utley, J R

1990-09-01

72

Temporary Diabetes Insipidus in 2 Men after On-Pump Coronary Artery Bypass Grafting  

Science.gov (United States)

Many complications have been reported after cardiopulmonary bypass. A common physiologic change during the early postoperative period after cardiopulmonary bypass is increased diuresis. In patients whose urine output is increased, postoperative diabetes insipidus can develop, although reports of this are rare. We present the cases of 2 patients who underwent on-pump coronary artery bypass grafting (with cardiopulmonary bypass). Each was diagnosed with diabetes insipidus postoperatively: a 54-year-old man on the 3rd day, and a 66-year-old man on the 4th day. Each patient recovered from the condition after 6 hours of intranasal therapy with synthetic vasopressin (antidiuretic hormone). The diagnosis of diabetes insipidus should be considered in patients who produce excessive urine early after cardiac surgery in which cardiopulmonary bypass has been used.

Uyar, Ihsan Sami; Sahin, Veysel; Akpinar, Besir; Yurtman, Volkan; Abacilar, Feyzi; Okur, Faik Fevzi; Ates, Mehmet

2013-01-01

73

Gum Graft Surgery  

Science.gov (United States)

... Treatments and Procedures › Gum Graft Surgery Gum Graft Surgery Exposed tooth roots are the result of gum ... sensitivity. What are the benefits of gum graft surgery? A gum graft can reduce further recession and ...

74

Cardiopulmonary Resuscitation : The Short Comings in Malaysia  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This short review explores the current status of cardiopulmonary resuscitation in Malaysia and highlights some of the factors that have a negative impact on its rate of success. Absence of a unifying body such as a national resuscitation council results in non-uniformity in the practice and teaching...

Sheng, Chew Keng; Zakaria, Mohd Idzwan; Rahman, Nik Hisamuddin Nik Abdul; Jaalam, Kamaruddin; Adnan, Wan Aasim Wan

75

Cardiopulmonary resuscitation: update, controversies and new advances  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english Cardiopulmonary arrest is a medical emergency in which the lapse of time between event onset and the initiation of measures of basic and advanced support, as well as the correct care based on specific protocols for each clinical situation, constitute decisive factors for a successful therapy. Cardiopulmonary arrest care cannot be restricted to the hospital setting because of its fulminant nature. This necessitates the creation of new concepts, strategies and structures, s (more) uch as the concept of life chain, cardio-pulmonary resuscitation courses for professionals who work in emergency medical services, the automated external defibrillator, the implantable cardioverter-defibrillator, and mobile intensive care units, among others. New concepts, strategies and structures motivated by new advances have also modified the treatment and improved the results of cardiopulmonary resuscitation in the hospital setting. Among them, we can cite the concept of cerebral resuscitation, the application of the life chain, the creation of the universal life support algorithm, the adjustment of drug doses, new techniques - measure of the end-tidal carbon dioxide levels and of the coronary perfusion pressure - and new drugs under research.

Zago, Alexandre C.; Nunes, Cristine E.; Cunha, Viviane R. da; Manenti, Euler; Bodanese, Luís Carlos

1999-03-01

76

Cardiopulmonary bypass line sternal wrapping: technical tips.  

UK PubMed Central (United Kingdom)

Cardiopulmonary bypass line sternal wrapping (SW) is a new approach to sternal care which avoids bone wax and offers mechanical protection and a shield from bacterial contamination, with beneficial effects on sternal healing. Since its introduction in February 2008, the technique has undergone some developments: it is possible to harvest internal thoracic arteries with SW in place and its haemostatic properties have improved.

Aratari C; Manché A; Capestro F; Torracca L

2010-12-01

77

Are We Successful in Cardiopulmonary Resuscitation?  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Purpose: In this study, we aimed to determine the success rate of cardiopulmonary resuscitation performed in the patients with diagnosis of cardiac arrest, and demographic characteristics of these patients. Material and Methods: The patients admitted to Adana Numune Education and Research Hospital, ...

Nalan Kozaci; Mehmet Oguzhan Ay; Ferhat Icme; Abdulkadir Akturk; Salim Satar

78

Results of a survey of the professional activities of 811 cardiopulmonary perfusionists.  

Science.gov (United States)

We queried 811 cardiopulmonary perfusionists in North America on the equipment and techniques they currently use for cardiopulmonary bypass, their professional training, and their income structure. Most cardiac surgical teams use one of four types of bubble oxygenators; only 5% use a membrane oxygenator exclusively. More than 80% monitor the activated clotting time during cardiopulmonary bypass, and 61% confirm the adequacy of heparinization with this test before initiating bypass. Most perfusionists surveyed, 507, are hospital salaried; 117 are employed by cardiac surgeons; and 72 have established a fee for service arrangement. In 1980, reported incomes for cardiopulmonary perfusionists ranged between $12,000 and $110,000, with a mean of $25,000. Only 196 respondents (24%) were graduates of accredited training programs in perfusion technology, but 618 (76%) were board certified in cardiovascular perfusion. This study presents an in-depth survey of the present status of perfusion technology, a discipline which has grown up around the practice of cardiac surgery. PMID:7062750

Miller, D W; Binford, J M; Hessel, E A

1982-03-01

79

Aortic reconstruction with bovine pericardial grafts  

Directory of Open Access Journals (Sweden)

Full Text Available INTRODUCTION: Glutaraldehyde-treated crimped bovine pericardial grafts are currently used in aortic graft surgery. These conduits have become good options for these operations, available in different sizes and shapes and at a low cost. OBJECTIVE:To evaluate the results obtained with bovine pericardial grafts for aortic reconstruction, specially concerning late complications. METHOD: Between January 1995 and January 2002, 57 patients underwent different types of aortic reconstruction operations using bovine pericardial grafts. A total of 29 (50.8%) were operated on an urgent basis (mostly acute Stanford A dissection) and 28 electively. Thoracotomy was performed in three patients for descending aortic replacement (two patients) and aortoplasty with a patch in one. All remaining 54 underwent sternotomy, cardiopulmonary bypass and aortic resection. Deep hypothermia and total circulatory arrest was used in acute dissections and arch operations. RESULTS: Hospital mortality was 17.5%. Follow-up was 24.09 months (18.5 to 29.8 months confidence interval) and complication-free actuarial survival curve was 92.3% (standard deviation ± 10.6). Two patients lately developed thoracoabdominal aneurysms following previous DeBakey II dissection and one died from endocarditis. One "patch" aortoplasty patient developed local descending aortic pseudoaneurysm 42 months after surgery. All other patients are asymptomatic and currently clinically evaluated with echocardiography and CT scans, showing no complications. CONCLUSION: Use of bovine pericardial grafts in aortic reconstruction surgery is adequate and safe, with few complications related to the conduits.

Silveira Lindemberg Mota; Petrucci Jr Orlando; Oliveira Pedro Paulo Martins de; Vieira Reinaldo Wilson; Braile Domingo Marcolino

2003-01-01

80

Brain microvascular function during cardiopulmonary bypass  

Energy Technology Data Exchange (ETDEWEB)

Emboli in the brain microvasculature may inhibit brain activity during cardiopulmonary bypass. Such hypothetical blockade, if confirmed, may be responsible for the reduction of cerebral metabolic rate for glucose observed in animals subjected to cardiopulmonary bypass. In previous studies of cerebral blood flow during bypass, brain microcirculation was not evaluated. In the present study in animals (pigs), reduction of the number of perfused capillaries was estimated by measurements of the capillary diffusion capacity for hydrophilic tracers of low permeability. Capillary diffusion capacity, cerebral blood flow, and cerebral metabolic rate for glucose were measured simultaneously by the integral method, different tracers being used with different circulation times. In eight animals subjected to normothermic cardiopulmonary bypass, and seven subjected to hypothermic bypass, cerebral blood flow, cerebral metabolic rate for glucose, and capillary diffusion capacity decreased significantly: cerebral blood flow from 63 to 43 ml/100 gm/min in normothermia and to 34 ml/100 gm/min in hypothermia and cerebral metabolic rate for glucose from 43.0 to 23.0 mumol/100 gm/min in normothermia and to 14.1 mumol/100 gm/min in hypothermia. The capillary diffusion capacity declined markedly from 0.15 to 0.03 ml/100 gm/min in normothermia but only to 0.08 ml/100 gm/min in hypothermia. We conclude that the decrease of cerebral metabolic rate for glucose during normothermic cardiopulmonary bypass is caused by interruption of blood flow through a part of the capillary bed, possibly by microemboli, and that cerebral blood flow is an inadequate indicator of capillary blood flow. Further studies must clarify why normal microvascular function appears to be preserved during hypothermic cardiopulmonary bypass.

Sorensen, H.R.; Husum, B.; Waaben, J.; Andersen, K.; Andersen, L.I.; Gefke, K.; Kaarsen, A.L.; Gjedde, A.

1987-11-01

 
 
 
 
81

Blood concentrations of cefuroxime in cardiopulmonary bypass surgery.  

UK PubMed Central (United Kingdom)

Objectives Patients with coronary artery bypass graft (CABG) surgery are at risk for severe postoperative infections. Prophylactic cefuroxime may help to reduce this risk, however sufficient concentrations, i.e. above the breakpoint (32 mg/L), are mandatory. The aim of this study is to evaluate the blood concentrations of cefuroxime during and after CABG surgery with cardiopulmonary bypass (CPB) and hypothermia, to determine the concentration of cefuroxime in sternum fluid and to evaluate possible factors of influence. Methods Seventeen patients were enrolled in this study, given 1.5 g cefuroxime at anaesthesia induction and an additional 1.5 g at start CPB. Blood samples were collected at skin incision, start CPB, every 30 min on CPB, end CPB, at wound closure and 1 h after surgery. Cefuroxime concentrations were determined by high performance liquid chromatography. Results In 47 % of the patients the cefuroxime concentration was below the breakpoint at some point during the operation and in 59 % of the patients 1 h after surgery. A statistically significant inverse correlation between estimated glomerular filtration rate and plasma cefuroxime concentrations was found (P = 0.034). Cefuroxime levels in the sternum are not significantly different from blood levels from the radial artery catheter, taken at approximately the same time (P = 0.30). Conclusions The current antibiotic regimen used did not maintain cefuroxime concentrations above the breakpoint throughout the operation, suggesting insufficient antibiotic prophylaxis. Further research to other antibiotic regimes is therefore necessary.

Bertholee D; Ter Horst PG; Hijmering ML; Spanjersberg AJ; Hospes W; Wilffert B

2013-06-01

82

Arterial Hyperoxia During Cardiopulmonary Bypass and Postoperative Cognitive Dysfunction.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the effect of arterial normobaric hyperoxia during cardiopulmonary bypass (CPB) on postoperative neurocognitive function. The authors hypothesized that arterial hyperoxia during CPB is associated with neurocognitive decline at 6 weeks after cardiac surgery. DESIGN: Retrospective study of patients undergoing cardiac surgery with CPB. SETTING: A university hospital. PARTICIPANTS: One thousand eighteen patients undergoing coronary artery bypass graft (CABG) or CABG + valve surgery with CPB who previously had been enrolled in prospective cognitive trials. INTERVENTIONS: A battery of neurocognitive measures was administered at baseline and 6 weeks after surgery. Anesthetic and surgical care was managed as clinically indicated. MEASUREMENTS AND MAIN RESULTS: Arterial hyperoxia was assessed primarily as the area under the curve (AUC) for the duration that PaO2 exceeded 200 mmHg during CPB and secondarily as the mean PaO2 during bypass, as a PaO2 = 300 mmHg at any point and as AUC>150 mmHg. Cognitive change was assessed both as a continuous change score and a dichotomous deficit rate. Multivariate regression accounting for age, years of education, baseline cognition, date of surgery, baseline postintubation PaO2, duration of CPB, and percent change in hematocrit level from baseline to lowest level during CPB revealed no significant association between hyperoxia during CPB and postoperative neurocognitive function. CONCLUSIONS: Arterial hyperoxia during CPB was not associated with neurocognitive decline after 6 weeks in cardiac surgical patients.

Fontes MT; McDonagh DL; Phillips-Bute B; Welsby IJ; Podgoreanu MV; Fontes ML; Stafford-Smith M; Newman MF; Mathew JP

2013-08-01

83

Nerve grafting.  

UK PubMed Central (United Kingdom)

By avoiding tension and securing anatomical neurorrhaphy, regeneration of nerve is obtainable. When the gap exceeds a certain limit, the only way to avoid tension is the use of grafts. Experience in animal experiments and clinical practice has demonstrated that regenerating axons can cross 2 optimal suture lines much more easily than one sub-standard one. For bridging a gap autografts are used, because in autografts the fascicular pattern is preserved and its Swann cells survive. With the interfascicular technique the dissection of the nerve stumps proceeds from normal to abnormal tissues and the epineurium is resected. The coaptation must be exact so that the grafts cover the whole cross sectional area of the fascicle. All this can be achieved by the use of one 10--0 or 11--0 nylon suture. The clinical results show that in the median nerve 82%, in the ulnar 80% and in the radial nerve 92% of good functional results can be obtained. Also in brachial plexus injuries the interfascicular nerve grafting procedure opened new ways. Therefore interfascicular nerve grafting, using autografts in cases of nerve repair, where a gap may occur, currently is the method of choice.

Berger A; Millesi H

1978-06-01

84

Platelet protection by low-dose aprotinin in cardiopulmonary bypass: electron microscopic study.  

UK PubMed Central (United Kingdom)

To evaluate the effect of low-dose aprotinin during cardiopulmonary bypass on platelet function and clinical hemostasis, 30 patients undergoing various cardiopulmonary bypass procedures employing bubble oxygenators were randomized to receive either low-dose aprotinin (2 x 10(6) KIU in the cardiopulmonary bypass priming solution, 15 patients [group A]) or placebo (15 patients [group B]). Blood samples were collected before and after cardiopulmonary bypass to assess platelet count and aggregation on extracellular matrix, which was studied by a scanning electron microscope. On a scale of 1 to 4 preoperative mean platelet aggregation grades were similar in both groups (3.8 +/- 0.5 and 3.5 +/- 0.5 for groups A and B, respectively). Postoperatively, platelet aggregation on extracellular matrix decreased slightly in group A (2.8 +/- 1.3; p < 0.01) and significantly in group B (1.3 +/- 0.5; p < 0.001). Eleven of the 15 patients in group A remained in aggregation grade 3 or 4 compared with none of the group B patients. Platelet count was similar in both groups preoperatively and postoperatively. Total 24-hour postoperative bleeding and blood requirement were lower in the aprotinin group (487 +/- 121 mL and 2.3 +/- 1.0 units) than in the placebo group (752 +/- 404 mL and 6.8 +/- 5.1 units; p < 0.01). These results show that the use of low-dose aprotinin during cardiopulmonary bypass provides improved postoperative hemostasis, which might be related to the protection of the platelet aggregating capacity.

Lavee J; Raviv Z; Smolinsky A; Savion N; Varon D; Goor DA; Mohr R

1993-01-01

85

Platelet protection by low-dose aprotinin in cardiopulmonary bypass: electron microscopic study.  

Science.gov (United States)

To evaluate the effect of low-dose aprotinin during cardiopulmonary bypass on platelet function and clinical hemostasis, 30 patients undergoing various cardiopulmonary bypass procedures employing bubble oxygenators were randomized to receive either low-dose aprotinin (2 x 10(6) KIU in the cardiopulmonary bypass priming solution, 15 patients [group A]) or placebo (15 patients [group B]). Blood samples were collected before and after cardiopulmonary bypass to assess platelet count and aggregation on extracellular matrix, which was studied by a scanning electron microscope. On a scale of 1 to 4 preoperative mean platelet aggregation grades were similar in both groups (3.8 +/- 0.5 and 3.5 +/- 0.5 for groups A and B, respectively). Postoperatively, platelet aggregation on extracellular matrix decreased slightly in group A (2.8 +/- 1.3; p < 0.01) and significantly in group B (1.3 +/- 0.5; p < 0.001). Eleven of the 15 patients in group A remained in aggregation grade 3 or 4 compared with none of the group B patients. Platelet count was similar in both groups preoperatively and postoperatively. Total 24-hour postoperative bleeding and blood requirement were lower in the aprotinin group (487 +/- 121 mL and 2.3 +/- 1.0 units) than in the placebo group (752 +/- 404 mL and 6.8 +/- 5.1 units; p < 0.01). These results show that the use of low-dose aprotinin during cardiopulmonary bypass provides improved postoperative hemostasis, which might be related to the protection of the platelet aggregating capacity. PMID:7678061

Lavee, J; Raviv, Z; Smolinsky, A; Savion, N; Varon, D; Goor, D A; Mohr, R

1993-01-01

86

Effects of massage therapy on sleep quality after coronary artery bypass graft surgery  

Directory of Open Access Journals (Sweden)

Full Text Available INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were randomized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0), during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3) using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5%, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m²) were randomized into control (n = 20) and massage therapy (n = 20) groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006) and Day 2 (p=0.028) in addition, they reported a more effective sleep during all three days (p=0.019) when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.

Flavia Baggio Nerbass; Maria Ignez Zanetti Feltrim; Silvia Alves de Souza; Daisy Satomi Ykeda; Geraldo Lorenzi-Filho

2010-01-01

87

Effects of massage therapy on sleep quality after coronary artery bypass graft surgery.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were randomized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0), during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3) using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5%, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m²) were randomized into control (n = 20) and massage therapy (n = 20) groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006) and Day 2 (p=0.028) in addition, they reported a more effective sleep during all three days (p=0.019) when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.

Nerbass FB; Feltrim MI; Souza SA; Ykeda DS; Lorenzi-Filho G

2010-01-01

88

Effects of massage therapy on sleep quality after coronary artery bypass graft surgery  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english INTRODUCTION: Having poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery. Pain, stress, anxiety and poor sleep quality may be improved by massage therapy. OBJECTIVE: This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery. METHOD: Participants included cardiopulmonary artery bypass graft surgery patients who were random (more) ized into a control group and a massage therapy group following discharge from the intensive care unit (Day 0), during the postoperative period. The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy, respectively. The patients were evaluated on the following mornings (i.e., Day 1 to Day 3) using a visual analogue scale for pain in the chest, back and shoulders, in addition to fatigue and sleep. Participants kept a sleep diary during the study period. RESULTS: Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period, 17 of whom were excluded due to postoperative complications. The remaining 40 participants (male: 67.5%, age: 61.9 years ± 8.9 years, body mass index: 27.2 kg/m² ± 3.7 kg/m²) were randomized into control (n = 20) and massage therapy (n = 20) groups. Pain in the chest, shoulders, and back decreased significantly in both groups from Day 1 to Day 3. The participants in the massage therapy group had fewer complaints of fatigue on Day 1 (p=0.006) and Day 2 (p=0.028) in addition, they reported a more effective sleep during all three days (p=0.019) when compared with the participants in the control group. CONCLUSION: Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep.

Nerbass, Flavia Baggio; Feltrim, Maria Ignez Zanetti; Souza, Silvia Alves de; Ykeda, Daisy Satomi; Lorenzi-Filho, Geraldo

2010-01-01

89

Platelet dysfunction associated with cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

The clinical significance and pathogenesis of the platelet dysfunction following cardiopulmonary bypass were studied in conjunction with the degree of functional impairment associated with the use of membrane and bubble oxygenators. Forty consecutive patients had the following tests preoperatively and postoperatively: complete blood count (CBC), platelet count, prothrombin consumption time, bleeding time, prothrombin time, partial thromboplastin time, fibrinogen, euglobulin clot lysis, fibrin degradation products, and platelet aggregation tests. Six patients were given 14C-serotonin tests before and after operation, and preoperative and postoperative electron micrographs were made of the platelets of 3 patients. The amount of blood lost, the blood transfused, and plasma hemoglobin levels were also measured. Abnormal aggregation of platelets was found, with no difference between the membrane and bubble oxygenators. In vitro aggregation tests with protamine sulfate and hemoglobin solutions, as well as the 14C-serotonin studies and electron micrographs, suggest that platelets acquire storage pool deficiency and an abnormal membrane during cardiopulmonary bypass.

Friedenberg WR; Myers WO; Plotka ED; Beathard JN; Kummer DJ; Gatlin PF; Stoiber DL; Ray JF 3rd; Sautter RD

1978-04-01

90

Platelet dysfunction associated with cardiopulmonary bypass.  

Science.gov (United States)

The clinical significance and pathogenesis of the platelet dysfunction following cardiopulmonary bypass were studied in conjunction with the degree of functional impairment associated with the use of membrane and bubble oxygenators. Forty consecutive patients had the following tests preoperatively and postoperatively: complete blood count (CBC), platelet count, prothrombin consumption time, bleeding time, prothrombin time, partial thromboplastin time, fibrinogen, euglobulin clot lysis, fibrin degradation products, and platelet aggregation tests. Six patients were given 14C-serotonin tests before and after operation, and preoperative and postoperative electron micrographs were made of the platelets of 3 patients. The amount of blood lost, the blood transfused, and plasma hemoglobin levels were also measured. Abnormal aggregation of platelets was found, with no difference between the membrane and bubble oxygenators. In vitro aggregation tests with protamine sulfate and hemoglobin solutions, as well as the 14C-serotonin studies and electron micrographs, suggest that platelets acquire storage pool deficiency and an abnormal membrane during cardiopulmonary bypass. PMID:345986

Friedenberg, W R; Myers, W O; Plotka, E D; Beathard, J N; Kummer, D J; Gatlin, P F; Stoiber, D L; Ray, J F; Sautter, R D

1978-04-01

91

Rescue percutaneous coronary intervention during cardiopulmonary resuscitation.  

Science.gov (United States)

If sudden cardiac arrest occurs during cardiac catheterization, the underlying coronary condition may be defined immediately by coronary angiography. This may, in turn, allow a lifesaving attempt of percutaneous coronary intervention (PCI). We report on two patients with critical proximal disease of the left coronary artery in whom successful PCI during cardiopulmonary resuscitation (CPR) led to the restoration of a spontaneous circulation and long-term survival. PMID:15135200

Azman, Katja Juvan; Gorjup, Vojka; Noc, Marko

2004-05-01

92

Artificial neural network cardiopulmonary modeling and diagnosis  

Energy Technology Data Exchange (ETDEWEB)

The present invention is a method of diagnosing a cardiopulmonary condition in an individual by comparing data from a progressive multi-stage test for the individual to a non-linear multi-variate model, preferably a recurrent artificial neural network having sensor fusion. The present invention relies on a cardiovascular model developed from physiological measurements of an individual. Any differences between the modeled parameters and the parameters of an individual at a given time are used for diagnosis. 12 figs.

Kangas, L.J.; Keller, P.E.

1997-10-28

93

Cardiopulmonary bypass line sternal wrapping: technical tips.  

Science.gov (United States)

Cardiopulmonary bypass line sternal wrapping (SW) is a new approach to sternal care which avoids bone wax and offers mechanical protection and a shield from bacterial contamination, with beneficial effects on sternal healing. Since its introduction in February 2008, the technique has undergone some developments: it is possible to harvest internal thoracic arteries with SW in place and its haemostatic properties have improved. PMID:20826557

Aratari, Carlo; Manché, Alexander; Capestro, Filippo; Torracca, Lucia

2010-09-08

94

Management of cardiopulmonary complications of cirrhosis.  

UK PubMed Central (United Kingdom)

Advanced portal hypertension accompanying end-stage liver disease results in an altered milieu due to inadequate detoxification of blood from splanchnic circulation by the failing liver. The portosystemic shunts with hepatic dysfunction result in an increased absorption and impaired neutralisation of the gastrointestinal bacteria and endotoxins leads to altered homeostasis with multiorgan dysfunction. The important cardiopulmonary complications are cirrhotic cardiomyopathy, hepatopulmonary syndrome, portopulmonary hypertension, and right-sided hydrothorax.

Sawant P; Vashishtha C; Nasa M

2011-01-01

95

Management of Cardiopulmonary Complications of Cirrhosis  

Science.gov (United States)

Advanced portal hypertension accompanying end-stage liver disease results in an altered milieu due to inadequate detoxification of blood from splanchnic circulation by the failing liver. The portosystemic shunts with hepatic dysfunction result in an increased absorption and impaired neutralisation of the gastrointestinal bacteria and endotoxins leads to altered homeostasis with multiorgan dysfunction. The important cardiopulmonary complications are cirrhotic cardiomyopathy, hepatopulmonary syndrome, portopulmonary hypertension, and right-sided hydrothorax.

Sawant, Prabha; Vashishtha, C.; Nasa, M.

2011-01-01

96

ICT Employment  

Science.gov (United States)

This page, from the Mid-Pacific Information and Communications Technology Center, provides some information on careers and employment in the Information and Communications Technology (ICT) industries. The three types of individuals using information and communications technologies include ICT users, enablers and creators. The webpage also includes employment data from a few different agencies including the United States Bureau of Labor Statistics.

2011-08-02

97

Industry Employment  

Science.gov (United States)

This article illustrates projected employment change by industry and industry sector over 2010-20 decade. Workers are grouped into an industry according to the type of good produced or service provided by the establishment for which they work. Industry employment projections are shown in terms of numeric change (growth or decline in the total…

Occupational Outlook Quarterly, 2012

2012-01-01

98

21 CFR 870.4220 - Cardiopulmonary bypass heart-lung machine console.  

Science.gov (United States)

...false Cardiopulmonary bypass heart-lung machine console. 870.4220 Section...4220 Cardiopulmonary bypass heart-lung machine console. (a) Identification. A cardiopulmonary bypass heart-lung machine console is a device...

2009-04-01

99

Employer Branding  

DEFF Research Database (Denmark)

Employer branding er både for den private og den offentlige sektor blevet en måde, de kan imødekomme ændrede arbejdsmarkedsvilkår og organisatoriske udfordringer i en postmoderne og globaliseret verden. Den aktuelle finanskrise har skabt nye udfordringer for organisationer i deres bestræbelser på at tiltrække- og fastholde attraktive medarbejdere. Men hvilken betydning har det, når Grundfos siger ”Mennesket er i fokus”, og hvad siger ”mangfoldighed” om Københavns Kommune som arbejdsplads i relation til employer branding? Er der egentlig sammenhæng mellem tankerne bag employer branding og de eksternt kommunikerede employer brandprodukter. Eller bliver det unikke ved arbejdspladserne ersattet af buzzwords uden substans og inddragelse af ansatte og interessenter? Artiklen har til formål at vurdere disse spørgsmål på baggrund af analyser af to cases med employer branding.

Frimann, SØren; MØnsted, Bolette Rye

2012-01-01

100

Employment Law  

Science.gov (United States)

Ross Runkel is a retired professor of law, and given his long experience with employment and labor law, it seems quite natural that he would be the founder of the site, Employment Law. Along with a team of other equally qualified professionals, he has created this site to serve as a clearinghouse of material about the world of employment law and its many facets. First time visitors may wish to check out his employment law or arbitration blogs, then move on to one of the most popular features, a list of recent and pending cases in the field that have been heard before the US Supreme Court. Additionally, the ÂArticles area contains pieces authored by Runkel and others, including a piece on how to find an employment lawyer and several timely pieces on the National Labor Relations Board.

Runkel, Ross, 1939-

 
 
 
 
101

Bypass grafts to the ankle and foot.  

UK PubMed Central (United Kingdom)

Two hundred forty-three bypasses to paramalleolar arteries were performed in 224 extremities of 208 patients since 1971; 166 were implanted in men (68%) and 77 in women (32%). The median age was 73 years. Gangrene (61%), nonhealing ulcer (15%), rest pain (22%), and trauma (2%) were the indications for bypass. Usual risk factors were noted: diabetes (65%), smoking (51%), heart disease (46%), and hypertension (45%). The extent of occlusive disease dictated three graft configurations: long grafts originating in arteries proximal to the adductor tendon (n = 111), short grafts originating at or below the popliteal artery (n = 88), and jump grafts originating near the distal end of a previous femorodistal bypass (n = 44). The association between diabetes (incidence 80%) and gangrene (75%) in patients with short grafts was statistically significant (p less than 0.01). The 2-year secondary patency rate of long in situ grafts was 92% compared with 72% for other autogenous vein long grafts. The limb salvage rate for all autogenous vein long grafts was 90% at 3 years. The secondary patency rate at 3 years for short grafts was 81% and the limb salvage rate was 80%. There were four amputations with patent grafts. Primary and secondary patency rates of jump grafts were similar (53%), whereas the limb salvage rate was 89% at 2 years. Patency and limb salvage rates of rarely employed nonautogenous conduits were less than 35% at 1 year (long grafts). Bypass grafts to the ankle and foot are effective and durable and should be performed with autogenous vein.

Andros G; Harris RW; Salles-Cunha SX; Dulawa LB; Oblath RW; Apyan RL

1988-06-01

102

Software for interpreting cardiopulmonary exercise tests  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Cardiopulmonary exercise testing (CPET) has become an important modality for the evaluation and management of patients with a diverse array of medical problems. However, interpreting these tests is often difficult and time consuming, requiring significant expertise. Methods We created a computer software program (XINT) that assists in CPET interpretation. The program uses an integrative approach as recommended in the Official Statement of the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) on Cardiopulmonary Exercise Testing. In this paper we discuss the principles behind the software. We also provide the detailed logic in an accompanying file (Additional File 1). The actual program and the open source code are also available free over the Internet at http://www.xint.org. For convenience, the required download files can also be accessed from this article. Additional file 1 XINTlogic. This file provides the detailed logic used by the XINT program. The variable names are described in Table 1. The actual source code may also be read directly simply by opening the source code with a text editor. Click here for file Results To test the clinical usefulness of XINT, we present the computer generated interpretations of the case studies discussed in the ATS/ACCP document in another accompanying file (Additional File 2). We believe the interpretations are consistent with the document's criteria and the interpretations given by the expert panel. Additional file 2 XINTinterpretations. These are the XINT generated reports based on the five examples provided in the ATS/ACCP statement on cardiopulmonary exercise testing 1. Click here for file Conclusion Computers have become an integral part of modern life. Peer-reviewed scientific journals are now able to present not just medical concepts and experimental studies, but actual functioning medical interpretive software. This has enormous potential to improve medical diagnoses and patient care. We believe XINT is such a program that will give clinically useful interpretations when used by the medical community at large.

Ross Robert M; Corry David B

2007-01-01

103

Electrical shock survival after prolonged cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

Electrical shock is typically an untoward exposure of human body to any source of electricity that causes a sufficient current to pass through the skin, muscles or hair causing undesirable effects ranging from simple burns to death. Ventricular fibrillation is believed to be the most common cause of death following electrical shock. The case under discussion is of a young man who survived following electrical shock after prolonged cardiopulmonary resuscitation (CPR), multiple defibrillations and artificial ventilation due to poor respiratory effort. Early start of chest compressions played a vital role in successful CPR.

Ahmad M; Shabbir K

2013-07-01

104

A randomized study of carbon dioxide management during hypothermic cardiopulmonary bypass.  

Science.gov (United States)

Eighty-six patients undergoing coronary artery bypass graft (n = 63) or intracardiac (n = 23) surgery were randomly assigned with respect to the target value for PaCO2 during cardiopulmonary bypass. In 44 patients the target PaCO2 was 40 mmHg, measured at the standard electrode temperature of 37 degrees C, while in 42 patients the target PaCO2 was 40 mmHg, corrected to the patient's rectal temperature (lowest value reached: mean 30.1, SD 1.9 degrees C). Other salient features of bypass management include use of bubble oxygenators without arterial filtration, flows of 1.8-2.4 l.min-1.m-2, mean hematocrit of 23%, and mean arterial blood pressure of approximately 70 mmHg, achieved by infusion of phenylephrine or sodium nitroprusside. Neuropsychologic function was assessed with series of tests administered on the day prior to surgery, just before discharge from the hospital (mean 8.0, SD 5.8 days postoperatively, n = 82), and again 7 months later (mean 220.7, SD 54.4 days postoperatively, n = 75). The scores at 8 days showed wide variability and generalized impairment unrelated to the PaCO2 group or to hypotension during cardiopulmonary bypass. At 7 months no significant difference was observed in neuropsychologic performance between the PaCO2 groups. Regarding cardiac outcome, there were no significant differences between groups in the appearance of new Q-waves on the electrocardiogram, the postoperative creatine kinase-MB fraction, the need for inotropic or intraaortic balloon pump support, or the length of postoperative ventilation or intensive care unit stay. These findings support the hypothesis that CO2 management during cardiopulmonary bypass at moderate hypothermia has no clinically significant effect on either neurobehavioral or cardiac outcome. PMID:2105070

Bashein, G; Townes, B D; Nessly, M L; Bledsoe, S W; Hornbein, T F; Davis, K B; Goldstein, D E; Coppel, D B

1990-01-01

105

A randomized study of carbon dioxide management during hypothermic cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Eighty-six patients undergoing coronary artery bypass graft (n = 63) or intracardiac (n = 23) surgery were randomly assigned with respect to the target value for PaCO2 during cardiopulmonary bypass. In 44 patients the target PaCO2 was 40 mmHg, measured at the standard electrode temperature of 37 degrees C, while in 42 patients the target PaCO2 was 40 mmHg, corrected to the patient's rectal temperature (lowest value reached: mean 30.1, SD 1.9 degrees C). Other salient features of bypass management include use of bubble oxygenators without arterial filtration, flows of 1.8-2.4 l.min-1.m-2, mean hematocrit of 23%, and mean arterial blood pressure of approximately 70 mmHg, achieved by infusion of phenylephrine or sodium nitroprusside. Neuropsychologic function was assessed with series of tests administered on the day prior to surgery, just before discharge from the hospital (mean 8.0, SD 5.8 days postoperatively, n = 82), and again 7 months later (mean 220.7, SD 54.4 days postoperatively, n = 75). The scores at 8 days showed wide variability and generalized impairment unrelated to the PaCO2 group or to hypotension during cardiopulmonary bypass. At 7 months no significant difference was observed in neuropsychologic performance between the PaCO2 groups. Regarding cardiac outcome, there were no significant differences between groups in the appearance of new Q-waves on the electrocardiogram, the postoperative creatine kinase-MB fraction, the need for inotropic or intraaortic balloon pump support, or the length of postoperative ventilation or intensive care unit stay. These findings support the hypothesis that CO2 management during cardiopulmonary bypass at moderate hypothermia has no clinically significant effect on either neurobehavioral or cardiac outcome.

Bashein G; Townes BD; Nessly ML; Bledsoe SW; Hornbein TF; Davis KB; Goldstein DE; Coppel DB

1990-01-01

106

Hydroxyethyl starch versus Ringer solution in cardiopulmonary bypass prime solutions (a randomized controlled trial)  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background In our study we compared the Ringer solution, which is the standard prime solution of our department, with the HES (Hydroxyethyl starch) 130-0.4 solution, which can be a potential alternative prime solution with an indispensable material for the cardio-pulmonary bypass applications. Methods 140 patients undergoing to CABG (Coronary Artery Bypass Graft surgery) were electively enrolled to the study. 1500 ml Ringer solution + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution to start cardiopulmonary by-pass in 70 patients which was defined as group 1. On the other hand, 1500 ml HES 130 - 0.4 + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution in 70 patients in group 2. Results INR (International Normalized Ratio), urea levels and blood platelet counts were significantly different between the groups. INR level was higher in group 1, while blood urea and creatinine levels and platelet count were higher in group 2 at the end of the 12th and 24nd hours postoperatively (p = 0.001). In this study, it was shown that the usage of HES 130-0.4 as a prime solution did not have negative effect on postoperative INR level, platelet count, the need for transfusion and the amount of drainage, despite the negative opinions that similar solutions caused coagulation disorders. Another interesting result of the study was that blood platelet count at 24th hour was statistically significantly higher in group 2 (p = 0.001). Conclusion HES 130-0.4 solution is an alternative colloidal solution which can be used as the prime solution or as a mixture with the crystalloids in cardio-pulmonary bypass applications.

Tiryakio?lu Osman; Y?ld?z Gürdeniz; Vural Hakan; Goncu Tugrul; Ozyaz?c?oglu Ahmet; Yavuz ?enol

2008-01-01

107

Influence of tranexamic acid in postoperative bleeding of cardiac surgery with cardiopulmonary bypass  

Directory of Open Access Journals (Sweden)

Full Text Available OBJECTIVE: To analyze the influence of tranexamic acid in postoperative bleeding of cardiac surgery with cardiopulmonary bypass. METHOD: 51 patients who underwent heart surgery with cardiopulmonary bypass were randomly divided in 2 groups: Group I - control, with 12 coronary artery disease patients and 14 valve disease patients. Group II - Tranexamic acid, with 14 coronary artery disease patients and 11 valve disease patients. The Group I after venous access, received 250 ml of 0.9% normal saline solution as a placebo, Group II received 100 milligram per kilogram of body weight of tranexamic acid diluted in 250 ml of 0.9% normal saline solution. Blood samples were taken and examined at entry to Intensive care unit and after 12, 24 and 36 hours in the postoperative period. The groups were compared concerning factors which might influence the postoperative bleeding and transfusion required: age, gender, creatinine, duration of Cardiopulmonary bypass, hematocrit, platelets and fibrinogen variations, number of saphenous vein grafts performed, mammary artery used and valve replacement or repair. The postoperative bleeding was evaluated from the 1st to 4th hours and the total. Data were analyzed by appropriate statistic methods (Student T-test, X² test and Fischer's test); a p-value of less than 0.05 was the accepted level of significance. RESULTS: Concerning the postoperative bleeding and transfusion required, there was a statistically significant reduction in its average in valve disease patients in Group II. In coronary disease patients there was only a slight tendency. There was no significant statistical difference as far as the thromboembolic or renal complications were concerned. CONCLUSION: In valve disease patients, there was a reduction in bleeding and the need of transfusions of red blood cells, both of which had statistical differences. In coronary disease patients there was only a reduced tendency. The use of tranexamic acid was not related to further thromboembolic complications or renal insufficiency in the assessed groups.

Gonçalves Flávio Donizete; Novaes Fernando Rotatori; Maia Marcelo Alves

2002-01-01

108

Significant performance improvement in dye-sensitized solar cells employing cobalt(III/II) tris-bipyridyl redox mediators by co-grafting alkyl phosphonic acids with a ruthenium sensitizer.  

UK PubMed Central (United Kingdom)

Efficiencies of up to 8.5% for dye-sensitized solar cells employing a ruthenium dye with a cobalt complex redox mediator have been achieved, by using octadecylphosphonic acid (OPA) as a coadsorbent. This success is due to improved electron injection and reduced recombination.

Liu Y; Jennings JR; Wang X; Wang Q

2013-05-01

109

Significant performance improvement in dye-sensitized solar cells employing cobalt(III/II) tris-bipyridyl redox mediators by co-grafting alkyl phosphonic acids with a ruthenium sensitizer.  

Science.gov (United States)

Efficiencies of up to 8.5% for dye-sensitized solar cells employing a ruthenium dye with a cobalt complex redox mediator have been achieved, by using octadecylphosphonic acid (OPA) as a coadsorbent. This success is due to improved electron injection and reduced recombination. PMID:23515476

Liu, Yeru; Jennings, James Robert; Wang, Xingzhu; Wang, Qing

2013-05-01

110

Northern employment  

International Nuclear Information System (INIS)

[en] Hiring practices and policies and employment opportunities that were available in the Beaufort Sea and MacKenzie Delta project for local residents and for people from southern Canada were dealt with in this chapter. Depending on the source, Northern hiring was a mere token, or a genuine and successful effort on the part of the companies to involve the native population and to share with them the benefits of the project. The fact remains that opening up job opportunities for Northerners was not easily attained, and would never have been realized without the involvement of government and community organizations. Government also played a major role in developing policies and training regimes. By the end of exploration operations, the hiring of Northern residents in the oil and gas industry had become a requirement of drilling applications. Training programs were also created to ensure that Northern residents received the means necessary to take advantage of Northern employment opportunities

1997-01-01

111

Acute cardiopulmonary failure from sleep-disordered breathing.  

UK PubMed Central (United Kingdom)

Sleep-disordered breathing (SDB) comprises a diverse set of disorders marked by abnormal respiration during sleep. Clinicians should realize that SDB may present as acute cardiopulmonary failure in susceptible patients. In this review, we discuss three clinical phenotypes of acute cardiopulmonary failure from SDB: acute ventilatory failure, acute congestive heart failure, and sudden death. We review the pathophysiologic mechanisms and recommend general principles for management. Timely recognition of, and therapy for, SDB in the setting of acute cardiopulmonary failure may improve short- and long-term outcomes.

Carr GE; Mokhlesi B; Gehlbach BK

2012-03-01

112

Prueba de ejercicio con análisis de gases espirados/ Cardiopulmonary exercise testing  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish La prueba de ejercicio con análisis de gases espirados (PEAGE) es una herramienta útil tanto en el proceso diagnóstico como pronóstico de pacientes con enfermedades cardiovasculares, pulmonares, neuromusculares e incluso metabólicas. El análisis de la composición del gas espirado y las características de la dinámica ventilatoria, nos dejan ver la manera en que la energía es transformada incluso a nivel celular (crestas mitocondriales), a través de diferentes pr (more) ocesos metabólicos. Mediante la PEAGE, el médico podrá discernir entre las diversas causas de disnea con origen indeterminado. Por otro lado, esta prueba representa un importante apoyo para indicar la realización de un trasplante (cardiaco, pulmonar o ambos) en pacientes con cardiopatía o neumopatía graves. La utilidad de una prueba cardiopulmonar, ha sido también comprobada en deportistas de alto rendimiento y en pacientes con cardiopatías congénitas. En el pasado, el acceso que tenían tanto el médico como el paciente a la realización de una PEAGE era restringido, debido principalmente a la complejidad y altos costos de los equipos. Sin embargo, hoy en día la tecnología se ha simplificado y los costos han disminuido, lo que ha hecho de la PEAGE una alternativa real en el trabajo cotidiano. Abstract in english Cardiopulmonary exercise test is a useful tool in the diagnosis and prognosis of patients with cardiovascular, pulmonary, neuromuscular and even metabolic disorders. The composition and the analysis of expired gas, and the characteristics of ventilatory dynamics, let us see how energy is transformed, within the cells (mitochondrial cristae), through several metabolic processes. Using the cardiopulmonary exercise testing, physicians can distinguish among several causes of (more) dyspnea with undetermined origin. On the other hand, this test represents an important support to indicate the indication of a graft-transplant (heart, lung or both) in patients with severe heart disease, lung disease or both. Cardiopulmonary test has also been used to evaluate high performance athletes and patients with congenital heart disease. In the past, physicians and patients had a restricted access to the performance of a cardiopulmonary exercise testing, mainly due to the complexity and high costs of this technology. Nowadays, this kind of equipment has been simplified and the costs lowered, in consequence this test became a real alternative in daily work.

Ilarraza-Lomelí, Hermes

2012-06-01

113

EMPLOYMENT GUARANTEE”  

Directory of Open Access Journals (Sweden)

Full Text Available Guarantee for one hundred days of employment in every financial year to adult members of any rural household willing to do public work-related unskilled manual work at the statutory minimum wage of Rs.100 per day. The Mahatma Gandhi National Rural Employment Guarantee Act (MNREGA) is an Indian job guarantee scheme, enacted by legislation on August 25, 2005. The scheme provides a legal guarantee for one hundred days of employment in every financial year to adult members of any rural household willing to do public work-related unskilled manual work at the statutory minimum wage of 100 (US$2.17) per day. The Central government outlay for scheme is 40,000 crore (US$8.68 billion) in FY 2010-11. The scheme commenced on February 2, 2006 in 200 districts, was expanded to cover another 130 districts in 2007-2008 and eventually covered all 593 districts in India by April 1, 2008. The outlay was Rs. 110 billion in 2006-2007, and rose steeply to Rs. 391 billion (140% increase in amount with respect to previous 2008-2009 budget) in 2009-2010. Many criticisms have been leveled at the programme, which has been argued to be no more effective than other poverty reduction programmes in India, with key exceptions such as Rajasthan.The first criticism is financial. The MGNREGAis one of the largest initiatives of its kind in the world. The national budget for the financial year 2006-2007 was Rs 113 billion (about US$2.5bn and almost 0.3% of GDP) and now fully operational, it costs Rs. 391 billion in financial year 2009-2010.

DILIP KHANDERAO PATIL

2013-01-01

114

CONTROL CIRCUIT FOR PNEUMATIC CARDIOPULMONARY RESUSCITATOR  

UK PubMed Central (United Kingdom)

A control circuit (14) for a pneumatic cardiopulmonary resuscitator includes a control center, a power supply module for providing power supply and a display for showing working information are fixed on the control center. A display drive chip is provided between the display and the control center. A pressing controller and a breath controller are fixed on the control center. A pressing frequency of the press controller, a ventilation frequency and an oxygen transport amount of breath controller are controlled by the control center. An adjust device fixed on the control center adjusts the pressing frequency, the rate of the pressing frequency and the ventilation frequency, and an oxygen transport amount at a time.

JIANG KEPING

115

Transfusion-associated graft-versus-host disease.  

UK PubMed Central (United Kingdom)

Transfusion-associated graft versus host disease (TA-GVHD) is a fatal complication of transfusion of blood products that usually affects immunocompromised patients. Herein, we present our experience with a diabetic patient who had undergone cardiopulmonary bypass and developed TA-GVHD. The chronological order of events observed were fresh whole-blood transfusion from relatives, fever, rash, liver dysfunction, and pancytopenia. Skin biopsies demonstrated GVHD involvement. The patient died within 3weeks after the transfusions despite prompt treatment. GVHD must be considered in the differential diagnosis if a patient with a recent transfusion history admits with fever, skin rash, abnormal liver function tests, and pancytopenia.

Sunul H; Erguven N

2013-07-01

116

Terumo-Triplex grafts for total arch replacement: analysis of postoperative graft performance.  

Science.gov (United States)

We evaluated the performance of Terumo-Triplex (TRP) with a large-diameter vascular graft sealed with non-biodegradable material in 48 patients who underwent total arch replacement under selective cerebral perfusion between 2004 and 2009. TRP grafts were used in 13 patients (T group), Gelseal graft in 15 (G group), Hemashield graft in 10 (H group) and Intergard graft in 10 (I group). The total tube drainage, time to tube removal, graft dilation ratio and inflammation were evaluated postoperatively. Cardiopulmonary bypass and selective cerebral perfusion times did not differ between groups. Two patients died in hospital. The total drain drainage was significantly lower in the T group (956 ± 156 ml) than in the H (2058 ± 403 ml, p = 0.001) or I (5959 ± 1027 ml, p = 0.01) groups. The time to tube removal was significantly lower in T group and G group than H and I group (T: 3.7 ± 0.4, G: 4.1 ± 0.4, H: 8.3 ± 1.6, I: 18.6 ± 3.6 days, T vs. H, I: p = 0.07, 0.0002, G vs. H, I: p = 0.004, <0.0001). The graft dilation ratio was significantly lower in T group than G group (T: 104 ± 4 vs. 130 ± 7 %, p = 0.001). The max C-reactive protein level was significantly lower in T group (16.2 ± 4.5 mg/dl) than in the G group (19.4 ± 3.2 mg/dl, p = 0.047), H (20.4 ± 4.1 mg/dl, p = 0.048), or I (20.5 ± 4.5 mg/dl, p = 0.013) groups. Maximum body temperature was also lower in the T group (38.2 ± 0.5 °C) than in the G (38.7 ± 0.4 °C, p = 0.011), H (38.9 ± 0.6 °C, p = 0.0087), and I (39.3 ± 0.7 °C, p = 0.0005). Thus, TRP graft might attenuate inflammatory response compared to the other sealed grafts for total arch replacement in patients with aortic arch aneurysm or dissection. PMID:22527980

Ohata, Toshihiro; Ueda, Hideki; Kobayashi, Kazuya; Fukuda, Hirotsugu; Miyamoto, Yuji

2012-04-21

117

Terumo-Triplex grafts for total arch replacement: analysis of postoperative graft performance.  

UK PubMed Central (United Kingdom)

We evaluated the performance of Terumo-Triplex (TRP) with a large-diameter vascular graft sealed with non-biodegradable material in 48 patients who underwent total arch replacement under selective cerebral perfusion between 2004 and 2009. TRP grafts were used in 13 patients (T group), Gelseal graft in 15 (G group), Hemashield graft in 10 (H group) and Intergard graft in 10 (I group). The total tube drainage, time to tube removal, graft dilation ratio and inflammation were evaluated postoperatively. Cardiopulmonary bypass and selective cerebral perfusion times did not differ between groups. Two patients died in hospital. The total drain drainage was significantly lower in the T group (956 ± 156 ml) than in the H (2058 ± 403 ml, p = 0.001) or I (5959 ± 1027 ml, p = 0.01) groups. The time to tube removal was significantly lower in T group and G group than H and I group (T: 3.7 ± 0.4, G: 4.1 ± 0.4, H: 8.3 ± 1.6, I: 18.6 ± 3.6 days, T vs. H, I: p = 0.07, 0.0002, G vs. H, I: p = 0.004, <0.0001). The graft dilation ratio was significantly lower in T group than G group (T: 104 ± 4 vs. 130 ± 7 %, p = 0.001). The max C-reactive protein level was significantly lower in T group (16.2 ± 4.5 mg/dl) than in the G group (19.4 ± 3.2 mg/dl, p = 0.047), H (20.4 ± 4.1 mg/dl, p = 0.048), or I (20.5 ± 4.5 mg/dl, p = 0.013) groups. Maximum body temperature was also lower in the T group (38.2 ± 0.5 °C) than in the G (38.7 ± 0.4 °C, p = 0.011), H (38.9 ± 0.6 °C, p = 0.0087), and I (39.3 ± 0.7 °C, p = 0.0005). Thus, TRP graft might attenuate inflammatory response compared to the other sealed grafts for total arch replacement in patients with aortic arch aneurysm or dissection.

Ohata T; Ueda H; Kobayashi K; Fukuda H; Miyamoto Y

2012-09-01

118

Nicorandil-induced peripheral vasodilatation during cardiopulmonary bypass.  

Science.gov (United States)

Nicorandil is an antianginal agent with actions at epicardial coronary arteries and arterioles, systemic arterioles, and veins. We report our experience with 7 patients taking oral Nicorandil who had severe vasodilation and hypotension requiring significant vasoconstrictor support after cardiopulmonary bypass. Although the mechanism for this phenomenon remains unknown Nicorandil might be interacting with other factors present during cardiopulmonary bypass, as it has relatively mild hemodynamic effects outside this situation. PMID:10320271

Falase, B A; Bajaj, B S; Wall, T J; Argano, V; Youhana, A Y

1999-04-01

119

Nicorandil-induced peripheral vasodilatation during cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Nicorandil is an antianginal agent with actions at epicardial coronary arteries and arterioles, systemic arterioles, and veins. We report our experience with 7 patients taking oral Nicorandil who had severe vasodilation and hypotension requiring significant vasoconstrictor support after cardiopulmonary bypass. Although the mechanism for this phenomenon remains unknown Nicorandil might be interacting with other factors present during cardiopulmonary bypass, as it has relatively mild hemodynamic effects outside this situation.

Falase BA; Bajaj BS; Wall TJ; Argano V; Youhana AY

1999-04-01

120

Aortic posterior wall perforation with automatic aortic cutter during routine off-pump coronary bypass grafting.  

Science.gov (United States)

Aortic complications are very rare during off-pump coronary artery bypass grafting (OPCAB). When they occur, the mortality is high. We report a case of perforation of the posterior aortic wall after punching out the hole in the ascending aorta with an automatic aortic cutter to avoid clamping for the proximal anastomosis during a routine OPCAB procedure. The consequence was a massive hemorrhage, emergency conversion to cardiopulmonary bypass and replacement of the aortic valve and of the ascending aorta. PMID:19692438

Syburra, Thomas; Reuthebuch, Oliver; Graves, Kirk; Genoni, Michele

2009-08-19

 
 
 
 
121

Grafting and curing  

International Nuclear Information System (INIS)

Progress in radiation grafting and curing is briefly reviewed. The two processes are shown to be mechanistically related. The parameters influencing yields are examined particularly for grafting. For ionising radiation grafting systems (EB and gamma ray) these include solvents, substrate and monomer structure, dose and dose-rate, temperature and more recently role of additives. In addition, for UV grafting, the significance of photoinitiators is discussed. Current applications of radiation grafting and curing are outlined. The recent development of photoinitiator free grafting and curing is examined as well as the potential for the new excimer laser sources. The future application of both grafting and curing is considered, especially the significance of the occurrence of concurrent grafting during cure and its relevance in environmental considerations

1998-01-01

122

Skin graft - series (image)  

Science.gov (United States)

... entire body, and acts as a protective barrier. Skin grafts may be recommended for: extensive wounds burns specific surgeries that may require skin grafts for healing to occur. The most common sites ...

123

Endovascular stent-graft management of thoracic aortic diseases  

Energy Technology Data Exchange (ETDEWEB)

The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative care over the last 30 years, the mortality and morbidity of surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of endovascular stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that stent-graft therapy potentially may reduce the operative risk, hospital stay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence.

Dake, Michael D. E-mail: mddake@stanford.edu

2001-07-01

124

Predicting the limits of cerebral autoregulation during cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

BACKGROUND: Mean arterial blood pressure (MAP) targets are empirically chosen during cardiopulmonary bypass (CPB). We have previously shown that near-infrared spectroscopy (NIRS) can be used clinically for monitoring cerebral blood flow autoregulation. The hypothesis of this study was that real-time autoregulation monitoring using NIRS-based methods is more accurate for delineating the MAP at the lower limit of autoregulation (LLA) during CPB than empiric determinations based on age, preoperative history, and preoperative blood pressure. METHODS: Two hundred thirty-two patients undergoing coronary artery bypass graft and/or valve surgery with CPB underwent transcranial Doppler monitoring of the middle cerebral arteries and NIRS monitoring. A continuous, moving Pearson correlation coefficient was calculated between MAP and cerebral blood flow velocity and between MAP and NIRS data to generate mean velocity index and cerebral oximeter index. When autoregulated, there is no correlation between cerebral blood flow and MAP (i.e., mean velocity and cerebral oximetry indices approach 0); when MAP is below the LLA, mean velocity and cerebral oximetry indices approach 1. The LLA was defined as the MAP at which mean velocity index increased with declining MAP to ? 0.4. Linear regression was performed to assess the relation between preoperative systolic blood pressure, MAP, MAP in 10% decrements from baseline, and average cerebral oximetry index with MAP at the LLA. RESULTS: The MAP at the LLA was 66 mm Hg (95% prediction interval, 43 to 90 mm Hg) for the 225 patients in which this limit was observed. There was no relationship between preoperative MAP and the LLA (P = 0.829) after adjusting for age, gender, prior stroke, diabetes, and hypertension, but a cerebral oximetry index value of >0.5 was associated with the LLA (P = 0.022). The LLA could be identified with cerebral oximetry index in 219 (94.4%) patients. The mean difference in the LLA for mean velocity index versus cerebral oximetry index was -0.2 ± 10.2 mm Hg (95% CI, -1.5 to 1.2 mm Hg). Preoperative systolic blood pressure was associated with a higher LLA (P = 0.046) but only for those with systolic blood pressure ? 160 mm Hg. CONCLUSIONS: There is a wide range of MAP at the LLA in patients during CPB, making estimation of this target difficult. Real-time monitoring of autoregulation with cerebral oximetry index may provide a more rational means for individualizing MAP during CPB.

Joshi B; Ono M; Brown C; Brady K; Easley RB; Yenokyan G; Gottesman RF; Hogue CW

2012-03-01

125

Effect of Colloid versus Crystalloid Administration of Cardiopulmonary Bypass Prime Solution on Tissue and Organ Perfusion  

Directory of Open Access Journals (Sweden)

Full Text Available Background: We evaluated the effects of tissue and organ perfusionduring and after coronary artery bypass graft surgery with either colloid(Voluven) or crystalloid (Lactated ringer’s) as prime solution.Methods: In this prospective randomized-controlled trial study, 70patients undergoing on-pump coronary artery bypass graft surgery were randomlyassigned to receive either colloid (Voluven) or crystalloid (Lactated ringer’s)as prime solution, for initiation of cardiopulmonary bypass machine procedure.Tissue and organ perfusion markers including lactate, troponin I, liver andrenal function tests and electrolytes were measured sequentially, beforeinduction (T1) to second days after surgery (T5).Results: With exception of chloride and potassium levels no significantdifferences detected in other measurements, and the laboratory results wereentirely identical in both procedures.Conclusion: There was no significant difference between Voluven® (hydroxyethyl starch, HES 130/0.4) and crystalloid (Lactated ringer’s) as primingsolution on the basis of organ and tissue perfusion tests assessment.

Sh Shahbazi; D Zeighami; E Allahyary; A Alipour; MJ Esmaeeli; M Ghaneie

2011-01-01

126

Bone grafts in dentistry.  

UK PubMed Central (United Kingdom)

Bone grafts are used as a filler and scaffold to facilitate bone formation and promote wound healing. These grafts are bioresorbable and have no antigen-antibody reaction. These bone grafts act as a mineral reservoir which induces new bone formation.

Kumar P; Vinitha B; Fathima G

2013-06-01

127

[Replacement of ascending and transverse aorta using zero-porocity gelatin impregnated graft].  

Science.gov (United States)

Gelatin impregnated Dacron graft was used without preclotting for the replacement of ascending and transverse aorta in 11 cases. The replacement of transverse aorta was performed in six patients with atherosclerotic aortic arch aneurysms and two patients with aortic dissections. The replacement of ascending aorta was performed in two patients with annlo-aortic ectasia and one patient with aortic dissection. Five of 11 patients (45%) needed emergency surgery due to the aortic rupture. Bleeding from the graft was not recognized clinically in all cases during the full heparinized cardiopulmonary bypass ranged from 153 min to 260 min. One patient (9%) with the rupture of transverse aorta died at the 7 th post operative day due to the multiple organ failure. No complication related to the graft was observed in all cases. Zero-porocity gelatin impregnated graft was useful for the replacement of aorta, especially for the replacement of ruptured ascending and transverse aorta in emergency situation. PMID:8336435

Adachi, H; Ino, T; Ide, H; Mizuhara, A; Yamaguchi, A; Kawahito, K; Yoshida, T

1993-07-01

128

[Replacement of ascending and transverse aorta using zero-porocity gelatin impregnated graft  

UK PubMed Central (United Kingdom)

Gelatin impregnated Dacron graft was used without preclotting for the replacement of ascending and transverse aorta in 11 cases. The replacement of transverse aorta was performed in six patients with atherosclerotic aortic arch aneurysms and two patients with aortic dissections. The replacement of ascending aorta was performed in two patients with annlo-aortic ectasia and one patient with aortic dissection. Five of 11 patients (45%) needed emergency surgery due to the aortic rupture. Bleeding from the graft was not recognized clinically in all cases during the full heparinized cardiopulmonary bypass ranged from 153 min to 260 min. One patient (9%) with the rupture of transverse aorta died at the 7 th post operative day due to the multiple organ failure. No complication related to the graft was observed in all cases. Zero-porocity gelatin impregnated graft was useful for the replacement of aorta, especially for the replacement of ruptured ascending and transverse aorta in emergency situation.

Adachi H; Ino T; Ide H; Mizuhara A; Yamaguchi A; Kawahito K; Yoshida T

1993-07-01

129

Coronary Artery Bypass Grafting in a Patient with Unstable Angina Pectoris and Bronchiectasis.  

UK PubMed Central (United Kingdom)

Bronchiectasis is characterized by the abnormal and permanent dilatation of bronchi. Clinical manifestations of bronchiectasis include persistent or recurrent cough, purulent sputum, hemosputum, and hemoptysis. A 75-year-old man with bronchiectasis required coronary bypass grafting for unstable angina pectoris with severe stenosis of the left main trunk. Computed tomography showed fistulae between the dilated bronchial arteries and the left pulmonary artery. Cardiac catheter examination showed signifi cant left-right shunt and left ventricular dilatation. To avoid perioperative massive hemoptysis, embolizations of 2 bronchial arteries and an inferior phrenic artery were performed preceding the coronary artery bypass grafting. Both transcatheter embolization and coronary artery bypass grafting were successfully performed without any complications. Herein, we illustrate a very rare case of bronchiectasis in a patient with unstable angina pectoris who underwent transcatheter embolization for a systemic-pulmonary shunt preceding coronary artery bypass grafting with cardiopulmonary bypass.

Oda T; Yasunaga H; Matsuura Y; Watanabe G; Zaima Y; Takaseya T; Wada Y

2013-01-01

130

Outcome of cardiopulmonary resuscitation - predictors of survival  

International Nuclear Information System (INIS)

To assess the outcomes of patients undergoing cardiopulmonary resuscitation (CPR). Data were collected retrospectively of all adult patients who underwent CPR. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from hospital. Factors associated with survival were evaluated using logistic regression analysis. Of the 159 patients included, 55 (35%) were alive at the end of CPR and 17 (11%) were discharged alive from the hospital. At the end of CPR, univariate logistic regression analysis found the following factors associated with survival: cardiac arrest within hospital as compared to outside the hospital (odds ratio = 2.8, 95% CI = 1.27-6.20, p-value = 0.01), both cardiac and pulmonary arrest as compared to either cardiac or pulmonary arrest (odds ratio = 0.37, 95% CI = 0.19- 0.73, p-value = 0.004), asystole as cardiac rhythm at presentation (odds ratio = 0.47, 95% CI = 0.24-0.93, p-value = 0.03), and total atropine dose given during CPR (odds ratio = 0.78, 95% CI = 0.62-0.97, p-value = 0.02). In multivariate logistic regression, cardiac arrest within hospital (odds ratio = 2.52, 95% CI = 1.06-5.99, p-value = 0.04) and both cardiac and pulmonary arrest as compared to cardiac or pulmonary arrest (odds ratio = 0.44, 95% CI = 0.21-0.91, p-value = 0.03) were associated with survival at the end of CPR. At the time of discharge from hospital, univariate logistic regression analysis found following factors that were associated with survival: cardiac arrest within hospital (odds ratio = 8.4, 95% CI = 1.09-65.64, p-value = 0.04), duration of CPR (odds ratio = 0.91, 95% CI = 0.85-0.96, p-value = 0.001), and total atropine dose given during CPR (odds ratio = 0.68, 95% CI = 0.47-0.99, p-value = 0.05). In multivariate logistic regression analysis cardiac arrest within hospital (odds ratio 8.69, 95% CI = 1.01-74.6, p-value = 0.05) and duration of CPR (odds ratio 0.92, 95% CI = 0.87-0.98, p-value = 0.01) were associated with survival at discharge from hospital. In-hospital cardiopulmonary arrest was associated with better clinical outcomes as compared to outside hospital arrest. Public education is needed to improve clinical outcomes in patients who need CPR outside hospital. (author)

2008-01-01

131

Customized Employment: Practical Solutions for Employment Success.  

Science.gov (United States)

Customized Employment is the voluntary negotiation of a personalized employment relationship between a specific individual and an employer that fulfills the business needs of the employer. The negotiation process addresses areas such as job duties, terms ...

2005-01-01

132

A reappraisal of saphenous vein grafting.  

UK PubMed Central (United Kingdom)

Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary osteoplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy.

Yuan SM; Jing H

2011-01-01

133

A reappraisal of saphenous vein grafting.  

Science.gov (United States)

Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary osteoplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy. PMID:21245602

Yuan, Shi-Min; Jing, Hua

134

A reappraisal of saphenous vein grafting  

Directory of Open Access Journals (Sweden)

Full Text Available Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary ostioplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition, saphenous veins can be a cell source for tissue engineering. We review the versatile roles that saphenous vein grafting has played as well as its current status in therapy.

Yuan Shi-Min; Jing Hua

2011-01-01

135

Acute renal failure after successful cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the frequency and independent predictors of severe acute renal failure in patients resuscitated from out-of-hospital ventricular fibrillation cardiac arrest. DESIGN: A cohort study with a minimum follow-up of 6 months. SETTING: Emergency department of a tertiary care 2200-bed university hospital. PATIENTS AND PARTICIPANTS: Consecutive adult (> 18 years) patients admitted from 1 July 1991 to 31 October 1997 after witnessed ventricular fibrillation out-of-hospital cardiac arrest and successful resuscitation. MEASUREMENTS AND RESULTS: Acute renal failure was defined as a 25% decrease of creatinine clearance within 24 h after admission. Out of 187 eligible patients (median age 57 years, 146 male), acute renal failure occurred in 22 patients (12%); in 4 patients (18%) renal replacement therapy was performed. Congestive heart failure (OR 6.0, 95% CI 1.6-21.7; p = 0.007), history of hypertension (OR 4.4, 95% CI 1.3-14.7; p = 0.02) and total dose of epinephrine administered (OR 1.1, 95% CI 1.0-1.2; p = 0.009) were independent predictors of acute renal failure. Duration of cardiac arrest, pre-existing impaired renal function and blood pressure at admission were not independently associated with renal outcome. CONCLUSIONS: Severe progressive acute renal failure after cardiopulmonary resuscitation (CPR) is rare. Pre-existing haemodynamics seem to be more important for the occurrence of acute renal failure than actual hypoperfusion during resuscitation.

Domanovits H; Schillinger M; Müllner M; Thoennissen J; Sterz F; Zeiner A; Druml W

2001-07-01

136

Cardiopulmonary monitoring in intra-abdominal hypertension.  

UK PubMed Central (United Kingdom)

Cardiopulmonary dysfunction and failure are commonly encountered in the patient with intra-abdominal hypertension (IAH) or abdominal compartment syndrome. Accurate assessment and optimization of preload, contractility, and afterload in conjunction with appropriate goal-directed resuscitation and assessment of fluid responsiveness are essential to restore end-organ perfusion. In patients with IAH, the traditional "barometric" preload indicators such as pulmonary artery occlusion pressure and central venous pressure are erroneously increased. Volumetric monitoring techniques have been proven to be superior in directing the appropriate resuscitation together with targeted abdominal perfusion pressure. If such limitations are not recognized, misinterpretation of the patient's cardiac status is likely, resulting in inappropriate and potentially detrimental therapy. IAH also markedly affects the mechanical properties of the chest wall and consequently also the respiratory function. Altered mechanical properties of the chest wall may limit ventilation, influence the work of breathing, affect the interaction between the respiratory muscles, hasten the development of respiratory failure, and interfere with gas exchange. Pulmonary monitoring is important to understand the relationships between intra-abdominal pressure and chest wall mechanics and the impact of IAH on ventilator-induced lung injury, lung distention, recruitment, and lung edema.

Malbrain ML; Ameloot K; Gillebert C; Cheatham ML

2011-07-01

137

Coronary Artery Bypass Grafting in a Patient with Polyarteritis Nodosa Presenting with Acute Myocardial Infarction and Multiple Coronary Aneurysms.  

UK PubMed Central (United Kingdom)

Polyarteritis nodosa (PAN) is a necrotizing form of vasculitis that affects small- and medium- sized vessels. Cases of ischemic heart disease involving coronary aneurysms in patients with PAN have been reported previously, but there have only been a few reports of coronary artery surgery for PAN-related coronary disease. A 46-year-old female with a history of PAN arrived at our emergency room due to cardiopulmonary arrest. After cardiopulmonary resuscitation, emergent coronary angiography was performed, because an electrocardiogram demonstrated ST segment elevation in leads V1 to V5. Coronary angiography revealed occlusion of the proximal right coronary artery and left anterior descending coronary artery as well as multiple coronary aneurysms. We performed emergent two-vessel coronary artery bypass grafting (the left anterior descending coronary artery and posterolateral branch of the circumflex system were treated with grafts from the left internal mammary artery and saphenous vein graft, respectively) under percutaneous cardiopulmonary support without cardiac arrest. The patient's postoperative course was uneventful, and postoperative coronary angiography revealed that the bypass grafts were patent. A review of the literature and a discussion of this case are also presented.

Kawajiri H; Koh E; Masuda N; Kira H; Yamasaki T

2013-08-01

138

Grafting on polyester fibers  

International Nuclear Information System (INIS)

[en] Acrylic acid (AA) and acrylonitrile (AN) were used to carry out grafting on polyester (PE) fibers using the techniques of initiation by ?-radiation as well as benzoyl peroxide. Extent of grafting depended upon the time, concentration of the initiator, and the monomer as well as on the irradiation dose. AA grafted fibers were rendered more hydrophilic than AN grafted fibers for equivalent amount of grafts. Considerable improvement in dyeability of the PE fibers was possible through grafting. About 50 percent to 100 percent improvement with disperse dyes was observed in case of PE fibers containing 22.4 percent and 9.0 percent graft of AA and AN, respectively. Intense fast dyeing with direct and basic (cationic) dyes was also possible, and the dye content was proportional to the extent of graft introduced in the fiber. The CN groups were reduced to NH2 groups in the AN graft on the fiber. With the increased amount of AA graft, the maxima in the zeta potential curve shifted toward higher acidic pH as greater amounts of alkali were utilized by the --COOH groups in the graft. In this respect, CN groups were less sensitive due to their lesser polarity as compared to the carboxylic groups. Surface charge density (S.C.D.) studies showed that the effective surface area of the fiber decreased with the increase in the amount of graft. Surface conductivity (S.C.) studies revealed that with increase in the number of polar groups (--COOH) on the surface of the fiber, the S.C. increased with the increase in the amount of AA graft. In case of AN grafts, the reduction in effective surface area of the fiber played a more important role than the contribution by the CN groups to surface conductivity. (U.S.)

1975-01-01

139

Melting and glass transition of radiation-induced graft polyethylene  

International Nuclear Information System (INIS)

[en] Melting and glass transition data are reported employing DSC for styrene-grafted high-density polyethylene obtained by ? radiation. Judging from the data of the melting point and the heat of fusion, the grafted polystyrene had no effect on the polyethylene crystallites, but the half-width of the thermogram was observed to increase slightly, showing an effect on the crystallite size distribution. As no effect was observed on the glass transition temperature by grafting, the amorphous region of the polyethylene apparently was not affected. It is suggested, therefore, that the free volume or segmental mobility will not be decreased by radiation-induced grafting. Very few but long grafted chains had negligible effect on the average polyethylene chain length available for segmental motion, and grafted polystyrene should be expected to differ from the styrene homopolymer in thermal motions

1977-01-01

140

Skin graft survival on subcutaneous hinge flaps: an algorithm for nasal reconstruction.  

UK PubMed Central (United Kingdom)

OBJECTIVES/HYPOTHESIS: To assess the survival of full-thickness skin grafts and perichondrial cutaneous grafts when placed on subcutaneous soft tissue flaps used in nasal reconstruction. STUDY DESIGN: Retrospective case series from a secondary-care cutaneous cancer practice. METHODS: Twenty-eight patients with nasal defects secondary to basal cell carcinoma excision were included. Clinical information, including case notes and photography, was obtained and analyzed. Graft survival was assessed in relation to type of graft and subcutaneous soft tissue flap employed for the reconstruction. RESULTS: Overall graft survival was 79%, with 89% and 74% for perichondrial cutaneous graft and full-thickness skin grafts, respectively. Anecdotally, procerus and nasalis flaps were found to yield higher graft survival than cheek fat flaps. CONCLUSIONS: The combination of subcutaneous soft tissue flap and skin graft cover offers a valuable addition to the treatment algorithm for nasal reconstruction following cutaneous malignancy excision.

Almeyda R; van der Eerden P; Vuyk H

2013-03-01

 
 
 
 
141

Has the new USP assay for heparin affected dosage for patients undergoing cardiopulmonary bypass?  

UK PubMed Central (United Kingdom)

In October 2009, the U.S. Pharmacopoeia (USP) changed the monograph for heparin to bring USP units in line with international units for heparin. The result was a 10% decrease in potency as measured by in vitro laboratory tests. This decrease led to questions regarding dosing guidelines. There existed a need for an in vivo study to determine the practical changes that may need to be implemented in regard to heparin administration for cardiopulmonary bypass in the clinical setting. A retrospective study was conducted to determine the heparin dose administered and the corresponding effect on patients undergoing coronary artery bypass grafting surgery using cardiopulmonary bypass. The study compared the heparin dose requirements and activated clotting time (ACT) results using the heparin before and after the USP changes. An analysis of the data was performed to determine the increased heparin dose required to achieve the same effect as before the USP change. This new heparin dosing protocol was instituted at Concord Hospital, Concord, NH. A prospective study was then preformed to verify the effects of the dosing change. In the new heparin group, the postheparin ACT fell by 9.1% (p = .028) and the patients achieving an ACT > 479 seconds fell by 12.8% as compared with the old heparin group. After adjustment of the loading dose calculation for heparin, the prospective study demonstrated the postheparin ACT (p = .684) and the percentage of patients achieving an ACT > 479 seconds (p = 1.000) to be similar to the values obtained before the USP change. An increase of the loading dose of approximately 12% is needed to achieve the patient effects seen before the UPS change.

Anderson DA; Holt DW

2013-06-01

142

Thoracic stent-graft  

Directory of Open Access Journals (Sweden)

Full Text Available The stent-graft is a device constructed from a stent and vascular graft and is inserted by means of an interventional procedure under imaging guidance. In 1986, Balko et al.1 reported the first stentgraft experiment, in which a Z stent covered with polyurethane was inserted into an animal aorta. In the early 1990s, Parodi et al.2 reported clinical introduction of the stent-graft for abdominal aortic aneurysm. In comparison to the abdominal aortic stent-graft, the thoracic stent-graft has several disadvantages, including difficulties associated with the aortic arch curvature and the relatively large caliber of the stent-graft, and the risk of central nervous system or spinal complication. However, the thoracic stentgraft is advantageous because of minimal procedural invasiveness in comparison to surgical graft replacement. In 1994, Dake et al.3 reported transluminal placement of an endovascular stent-graft for thoracic aortic aneurysm, and Kato et al.4 reported use of a stent-graft for aortic dissection and suggested that the stent-graft could be considered an alternative to surgical treatment.

Hyodoh H.

2007-01-01

143

Echocardiographic observations during in hospital cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess echocardiographic observations during in hospital cardiopulmonary resuscitation (CPR) and the utility of this information in the management of cardiac arrest. DESIGN: Echocardiographic system brought to the hospital site of cardiac arrest and applied to patients in conjunction with conventional CPR. SETTING: Large community-hospital with portable echocardiographic system and an alerted cardiology team skilled in this technique. MEASUREMENTS AND MAIN RESULTS: Mechanical asystole was initially observed in 18 (90%) of 20 cardiac arrest patients during CPR, including four patients with severe bradyarrhythmia as the arrest rhythm. The return of ventricular contractions in four of these 18 patients a short time after starting CPR prompted positive inotropic therapy. Ventricular wall motion was noted in two patients with severe bradyarrhythmia (pseudo-electromechanical dissociation) and the causes of cardiac arrest identified as massive pulmonary embolism and hypovolemia, respectively. A gel-like, coalescent echo contrast within the cardiac chambers was observed 20 to 30 mins after CPR in ten patients with unrelenting cardiac arrest and uniformly associated with an adverse outcome. Six patients survived resuscitation but only two patients survived to hospital discharge. CONCLUSIONS: An echocardiographic examination is feasible during CPR and may offer useful information in the management of the individual patients with cardiac arrest. It may depict the proximate cause of cardiac arrest, e.g., pulmonary embolism, cardiac tamponade, or hypovolemia, and signal the return of ventricular contractions in patients with initially absent mechanical activity. The appearance of intracardiac coalescent echo contrast in our patients with unrelenting cardiac arrest was associated with a failed outcome. The role of echocardiographic imaging in the setting of advanced cardiac life support requires further study.

Varriale P; Maldonado JM

1997-10-01

144

Blood transfusion therapy for traumatic cardiopulmonary arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Blood transfusion therapy (BTT), which represents transplantation of living cells, poses several risks. Although BTT is necessary for trauma victims with hemorrhagic shock, it may be futile for patients with blunt traumatic cardiopulmonary arrest (BT-CPA). MATERIALS AND METHODS: We retrospectively examined the medical records of consecutive patients with T-CPA. The study period was divided into two periods: The first from 1995-1998, when we used packed red cells (PRC) regardless of the return of spontaneous circulation (ROSC), and the second from 1999-2004, when we did not use PRC before ROSC. The rates of ROSC, admission to the ICU, and survival-to-discharge were compared between these two periods. RESULTS: We studied the records of 464 patients with BT-CPA (175 in the first period and 289 in the second period). Although the rates of ROSC and admission to the ICU were statistically higher in the first period, there was no statistical difference in the rate of survival-to-discharge between these two periods. In the first period, the rate of ROSC was statistically higher in the non-BTT group than the BTT group. However, for cases in which ROSC was performed and was successful, there were no statistical differences in the rate of admission and survival-to-discharge between the first and second group, and between the BTT and non-BTT group. CONCLUSION: Our retrospective consecutive study shows the possibility that BTT before ROSC for BT-CPA and a treatment strategy that includes this treatment improves the success rate of ROSC, but not the survival rate. BTT is thought to be futile as a treatment for BT-CPA before ROSC.

Moriwaki Y; Sugiyama M; Tahara Y; Iwashita M; Kosuge T; Toyoda H; Arata S; Suzuki N

2013-01-01

145

Bidirectional Glenn shunt without cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To determine the efficacy of bidirectional Glenn shunt (BDG) without cardiopulmonary bypass (CPB). STUDY DESIGN: Quasi experimental study. PLACE AND DURATION OF STUDY: The Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFICNIHD), Rawalpindi. METHODOLOGY: Thirty one patients underwent BDG without CPB between January 2006 to December 2007. Subjects for off pump BDG were those who did not require any intracardiac repair, had good sized branch pulmonary arteries, had acceptable PA pressures (< 16 mm Hg), and did not have any significant atrio-ventricular (AV) valve regurgitation. The off pump BDG was performed using veno-venous shunt between the superior vena cava (SVC) and right atrium (RA) following heparinization. All patients underwent discharge echocardiography to assess BDG patency. Statistical significance was determined using t-test with statistical significance at p < 0.05. RESULTS: There were 18 males and 13 females. All patients survived. Twenty seven (87.09%) patients received BDG and 04 patients (12.90%) received bilateral BDG. Atrial septectomy with inflow occlusion was performed in 5 patients. Antegrade pulmonary blood flow was left in 24 (77.41%) of 31 patients. There was significant improvement in postoperative SpO2 (p = 0.000) in all the cases. There were no postoperative neurologic complications. Sepsis occurred in 2 patients who ultimately recovered. One patient had chylothorax which stopped after three (03) days in ICU. No SVC/PA distortions were noted by discharge echocardiography. Eliminating CPB reduced the cost of the procedure substantially and saved the patients from its inherent complications. CONCLUSION: BDG without CPB is a safe procedure in selected patients. It avoids CPB related problems and is cost effective, with excellent results.

Hussain A; Saleem K; Inam-Ullah; Ahmed I; Younus U; Rashid A

2009-11-01

146

A Correlation Study of Cardiopulmonary Arrests, Cholesterol and Pressures  

Directory of Open Access Journals (Sweden)

Full Text Available This study consisted of cardiopulmonary arrests occurring between January 1990 and December 1991 in a Midwestern City in Kansas, U.S.A., with a population of 300,000. Admission cholesterol levels and hourly barometric pressures were obtained to show if there exists a relationship between cardiopulmonary arrests, cholesterol levels and barometric pressures. Statistical analysis was performed using Pearson-Moment Correlation Coefficient. Scattergrams amongst the dependent variables such as time, age, cholesterol, temperature and each of these dependent variables vs the independent variable, barometric pressure are depicted. Small value of the correlation coefficient in each case indicates no significant linear correlation between sudden changes in barometric pressure, cholesterol level and cardiopulmonary arrests.

S.E. Rider; S.M. Taher

2003-01-01

147

Veno-arterial modified ultrafiltration in children after cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

A method of performing veno-arterial modified ultrafiltration is described that utilizes conventional blood flow through the aortic and venous cannulae. A dual-pump blood cardioplegia console is adapted to aspirate blood from the cardiopulmonary bypass venous line. The blood is ultrafiltered, sent through the cardioplegia heat exchanger, and returned to the aorta via the cardioplegia needle. Veno-arterial modified ultrafiltration has produced no visual evidence of air entrainment in the cardiopulmonary arterial line. This method allows the immediate resumption of cardiopulmonary bypass without the need for the surgeon to recannulate or alter tubing. Thirty-five children underwent veno-arterial modified ultrafiltration; the results show significant increases in postoperative hematocrit, early extubation, and improved rheology.

Buchholz BJ; Bert AA; Price DR; Hopkins RA; Stearns GT

1999-03-01

148

Transport of critically ill children on cardiopulmonary support assistance.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To report two patients helicopter transport on mechanical cardiopulmonary support to a transplant center. SETTING: Cardiac intensive care unit (CICU) and transport helicopter. PATIENTS: A 9 kg and 22 kg children who suffer cardiac deterioration needing air transport on mechanical cardiopulmonary support. INTERVENTIONS AND RESULTS: CPS was initiated to support these patients failing cardiac function. Transport on CPS of these two patients to a transplant institution was accomplished after determining that heart transplantation would be their more likely chance for recovery. CONCLUSION: A cardiac deterioration event that will lead to the need for heart transplantation can be acute and sudden sparing no time for early referral to a transplant center. It is necessary for heart centers to have a plan of action to provide inter-hospital transport on cardiopulmonary support (CPS). This protocol can involve transport by the referral institution, the receiving institution or a third institution.

Eldadah MK; Olsen MC; Fakioglu H; DeCampli WM

2010-03-01

149

Does Obstructive Sleep Apnea Impair the Cardiopulmonary Response to Exercise?  

Science.gov (United States)

Study Objectives: The aim of this study was to evaluate cardiopulmonary exercise performance in lean and obese patients with obstructive sleep apnea (OSA) compared with controls. Design: Case-control study. Setting: The study was carried out in Sao Paulo Sleep Institute, Sao Paulo, Brazil. Patients and Participants: Individuals with similar ages were allocated into groups: 22 to the lean OSA group, 36 to the lean control group, 31 to the obese OSA group, and 26 to the obese control group. Interventions: The participants underwent a clinical evaluation, polysomnography, a maximum limited symptom cardiopulmonary exercise test, two-dimensional transthoracic echocardiography, and spirometry. Measurements and Results: The apnea-hypopnea index, arousal index, lowest arterial oxygen saturation (SaO2) and time of SaO2 Mello-Fujita L; Rios LF; Mendonca ET; Feres MC; Tufik S; Poyares D. Does obstructive sleep apnea impair the cardiopulmonary response to exercise? SLEEP 2013;36(4):547-553.

Rizzi, Camila F.; Cintra, Fatima; Mello-Fujita, Luciane; Rios, Lais F.; Mendonca, Elisangela T.; Feres, Marcia C.; Tufik, Sergio; Poyares, Dalva

2013-01-01

150

Vegetable grafting tool  

UK PubMed Central (United Kingdom)

This utility model provides a vegetable grafting tool, and belongs to gardening vegetable grafting tool. It sets inserted cone (2) on one end of the handle (1) and handle (3) whose top is fixed with tongue shape curved surface knife (4), the other end sets knife rest (6) fixing the double-edge blade (8) and U shape bayonet lock (9), etc. this utility model combines several independent tools rationally, and it can complete the whole work with tools in hand in the whole grafting operation process, thus makes the operation steps reduced, speeds up the grafting, improves the quality of cutting and grafting and saves the labor of operation. The use of which is convenient with lower cost, it's proper to be promoted and applied in the vegetable grafting and seeding production.

XU ZHIHAO SHOU

151

Accelerated intimal hyperplasia in aortocoronary internal mammary vein grafts in minipigs  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background More than 50% of aortocoronary saphenous vein grafts are occluded 10 years after surgery. Intimal hyperplasia is the initial critical step in the progression toward occlusion. Internal mammary veins, which are physiologically prone to less hydrostatic pressure, may undergo an accelerated progression to intimal hyperplasia and thus be suitable for investigation of the mechanisms of aortocoronary vein graft disease. Methods Six minipigs underwent aortocoronary bypass grafting using standard cardiopulmonary bypass and cardioplegic arrest. Mammary vein were grafted in a reversed manner from ascending aorta to left anterior descending coronary artery (LAD). The proximal LAD was ligated, rendering the anterior left ventricle vein graft-dependent. Minipigs were killed after 4 weeks, and vein grafts were harvested. Histological and immunohistological investigation were performed with respect to morphometric analysis, endothelial damage/dysfunction (v-Willebrand-factor (vWF)), smooth muscle cells (?-smooth actin) and proliferation rate (proliferation marker Ki 67). Results Mean intimal area of vein grafts was increased compared to ungrafted mammary veins. Intimal hyperplasia in vein grafts was characterized by massive accumulation of smooth muscle cells with a high proliferation rate and endothelial perturbation. Significant (p = 0.001) intimal hyperplasia of the grafted mammary vein compared to the ungrafted mammary vein was found. These changes were absent in ungrafted mammary veins. Conclusion The present study demonstrates a pig model of aortocoronary vein graft intimal hyperplasia which is characterized by an accelerated progression within internal mammary veins. The model is suitable to investigate the pathophysiology of aortocoronary vein graft intimal hyperplasia as well as therapeutic approaches.

Popov Aron; Dorge Hilmar; Hinz Jose; Schmitto Jan; Stojanovic Tomislav; Seipelt Ralf; Didilis Vassilios; Schoendube Friedrich

2008-01-01

152

Pedicled pelvic bone graft  

International Nuclear Information System (INIS)

[en] The pedicled pelvic bone graft is a new operative technique for the treatment femoral head necrosis. 29 femoral head necrosis were examined by i.a. DSA before a pedicled pelvic bone graft was implanted. 11 pedicled pelvic bone grafts were investigated postoperatively. The pre- and postoperative findings are presented. I.a. DSA is a valuable method for the evaluation of the vascularisation of the femoral head before and after surgery. (orig.)

1990-01-01

153

Synthetic blood vessel grafts  

UK PubMed Central (United Kingdom)

A synthetic blood vessel graft (e.g., for use with a prosthetic heart valve) includes a mounting cuff adjacent at least one end for facilitating attachment of the graft to another structure (e.g., a sewing cuff of a heart valve). The mounting cuff may be sized and shaped to provide good conformance to the target structure to which it may be attached (e.g., the heart valve sewing cuff). The graft is preferably preclotted. Especially for use with a tissue valve (which must be supplied in a packaging solution that would react with a preclotting agent), the graft is preferably supplied separately from the valve.

WOO YI-REN

154

Complications of bystander cardiopulmonary resuscitation for unconscious patients without cardiopulmonary arrest.  

UK PubMed Central (United Kingdom)

BACKGROUND: Insufficient knowledge of the risks and complications of cardiopulmonary resuscitation (CPR) may be an obstructive factor for CPR, however, particularly for patients who are not clearly suffering out of hospital cardiopulmonary arrest (OH-CPA). The object of this study was to clarify the potential complication, the safety of bystander CPR in such cases. MATERIALS AND METHODS: This study was a population-based observational case series. To be enrolled, patients had to have undergone CPR with chest compressions performed by lay persons, had to be confirmed not to have suffered OHCPA. Complications of bystander CPR were identified from the patients' medical records and included rib fracture, lung injury, abdominal organ injury, and chest and/or abdominal pain requiring analgesics. In our emergency department, one doctor gathered information while others performed X-ray and blood examinations, electrocardiograms, and chest and abdominal ultrasonography. RESULTS: A total of 26 cases were the subjects. The mean duration of bystander CPR was 6.5 minutes (ranging from 1 to 26). Nine patients died of a causative pathological condition and pneumonia, and the remaining 17 survived to discharge. Three patients suffered from complications (tracheal bleeding, minor gastric mucosal laceration, and chest pain), all of which were minimal and easily treated. No case required special examination or treatment for the complication itself. CONCLUSION: The risk and frequency of complications due to bystander CPR is thought to be very low. It is reasonable to perform immediate CPR for unconscious victims with inadequate respiration, and to help bystanders perform CPR using the T-CPR system.

Moriwaki Y; Sugiyama M; Tahara Y; Iwashita M; Kosuge T; Harunari N; Arata S; Suzuki N

2012-01-01

155

Cardiopulmonary resuscitation in the pregnant patient: a manikin-based evaluation of methods for producing lateral tilt.  

UK PubMed Central (United Kingdom)

The importance of minimising aortocaval compression during cardiopulmonary resuscitation in late pregnancy is widely accepted. Current European guidelines suggest employing manual displacement of the uterus with left lateral tilt to achieve this. Several methods for producing lateral tilt have been described; however, the optimum method is unknown. By performing simulated cardiopulmonary resuscitation on a manikin, we compared four of these methods: a folded labour ward pillow; a pre-formed foam wedge; a custom-made hard wooden wedge; and the 'human wedge'. Primary outcome measures were maintenance of adequate tilt, stability and effectiveness of chest compressions (rate, depth and adequate release). Overall, the foam and wooden wedges were significantly more stable and reliable at maintaining tilt than the pillow (p < 0.0001); the wooden wedge was more stable and effective than the foam wedge (p < 0.0001). Chest compressions were least effective with the human wedge (p = 0.02). Effectiveness of chest compressions with lateral tilt was comparable to that reported previously in supine manikin studies. We recommend the use of dedicated foam or hard wedges rather than pillows or the human wedge for producing lateral tilt during cardiopulmonary resuscitation.

Ip JK; Campbell JP; Bushby D; Yentis SM

2013-05-01

156

[Heart surgery with cardiopulmonary bypass in patients on chronic dialysis treatment: our experience  

UK PubMed Central (United Kingdom)

METHODS: To determine the mortality and the morbidity of cardiac surgery in patients on chronic hemodialysis, we retrospectively reviewed eighteen adult patients (13 males and 5 females) with a mean age of 54.7 years (range: 30-67 years) who underwent cardiopulmonary bypass procedures between 1987 and 1995. The operations included: isolated coronary artery bypass grafting in 12 patients, coronary artery bypass grafting plus mitral ring annuloplasty in 1 patient, mitro aortic valve replacement in 2 patients, isolated aortic valve replacement in 1 patient, aortic valved conduit implantation in 1 patients and mitral valve replacement plus tricuspid annuloplasty in 1 patient. There were 10 and 3 patients in CCS functional classification III and IV respectively; 1 and 4 patients were in NYHA classification II and III respectively. All of them were hemodialyzed the day before surgery: the average time they had been on hemodialysis was 6.5 years. Anesthesia and the cardiopulmonary bypass (CPB) in these patients required attention in order to provide the optimal fluids and electrolytes balance: particularly intravenously administered fluids were kept to a minimum and drug dosages were reduced to recommended levels for anephric patients. An hemoconcentrator was used in all patients during the CPB and, in the last 4 cases, we used a dialysis filter and a sterilized perfusional solution to reduce the level of potassium and to put off postoperative dialysis. RESULTS: In three patients there were major bleeding problems resulting in reoperation; 5 perioperative deaths occurred: two of them due to myocardial infarction and three due to irreversible low cardiac output state. In our experience there were four late deaths: one patient died four months after surgery for chronic heart failure, another one died twelve months after surgery for dilated cardiomyopathy and two patients died respectively seventeen and seventy two months after discharge for myocardial infarction. Two of the remaining patients reported recurrence of angina while the others achieved symptomatic improvement. CONCLUSIONS: In conclusion, cardiac surgery is performed on chronic renal dialysis patients with high mortality and morbidity and it's indicated only if medical treatment is ineffective. The successful surgical results, obtained with an adequate management between surgeons, anesthesiologists and nephrologists, don't assure the long-term survival of the patients.

Galli R; Nicolini F; Pace Napoleone C; Longo M; Fiorani V; Cattabriga I; Busi T; Santoro A; Piovaccari GC; Grillone G; Branzi A; Pierangeli A

1996-09-01

157

Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: an analysis of the Kids' Inpatient Database*.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Population-based data on pediatric in-hospital cardiopulmonary resuscitation in the United States are scarce. Single-center studies and voluntary registries may skew the estimated prevalence and outcomes. This study aimed to determine the prevalence and outcomes of pediatric cardiopulmonary resuscitation on a national scale. DESIGN: A retrospective analysis of the Healthcare Cost and Utilization Project 2006 Kids' Inpatient Database was performed. Sample weighting was employed to produce national estimates. SETTING: Three thousand seven hundred thirty-nine hospitals in 38 states participating with the Kids' Inpatient Database. PATIENTS: All patients <20 yrs of age hospitalized in participating institutions in 2006. MEASUREMENTS AND MAIN RESULTS: Cardiopulmonary resuscitation was performed in 5,807 (95% confidence interval 5259-6355) children with prevalence of 0.77 per 1,000 admissions. Most patients (68%) were <1 yr old, and 44% were female. On multivariable analysis, cardiopulmonary resuscitation was associated with respiratory failure (odds ratio 41.5, 95% confidence interval 35.4-48.8), myocarditis (odds ratio 36.6, 95% confidence interval 21.9-61.0), acute renal failure (odds ratio 21.6, 95% confidence interval 17.5-26.7), heart failure (odds ratio 3.8, 95% confidence interval 3.0-4.8), and cardiomyopathy (odds ratio 3.8, 95% confidence interval 3.2-4.7). Overall mortality was 51.8% and greater among patients ?1 yr (68%) vs. <1 yr (44%) (odds ratio 2.7, 95% confidence interval 2.3-3.2). Factors associated with mortality among patients receiving cardiopulmonary resuscitation on multivariable analysis included acute renal failure (odds ratio 1.5, 95% confidence interval 1.1-1.9), hepatic insufficiency (odds ratio 1.5, 95% confidence interval 1.01-2.4), sepsis (odds ratio 1.2, 95% confidence interval 1.01-1.4), and congenital heart disease (odds ratio 1.2, 95% confidence interval 1.01-1.5). CONCLUSIONS: Cardiopulmonary resuscitation is performed in approximately one in 1,300 pediatric hospitalizations. Approximately half of patients receiving cardiopulmonary resuscitation do not survive to discharge. Independent risk factors for mortality after receiving cardiopulmonary resuscitation included congenital heart disease, age ?1 yr, acute renal failure, hepatic insufficiency, and sepsis.

Knudson JD; Neish SR; Cabrera AG; Lowry AW; Shamszad P; Morales DL; Graves DE; Williams EA; Rossano JW

2012-11-01

158

Calcar bone graft  

Energy Technology Data Exchange (ETDEWEB)

A canine model was developed to investigate the use of an autogeneic iliac bone graft to treat the calcar deficiency commonly found at the time of revision surgery for femoral component loosening. Five large male mixed-breed dogs had bilateral total hip arthroplasty staged at three-month intervals, and were sacrificed at six months. Prior to cementing the femoral component, an experimental calcar defect was made, and a bicortical iliac bone graft was fashioned to fill the defect. Serial roentgenograms showed the grafts had united with no resorption. Technetium-99 bone scans showed more uptake at three months than at six months in the graft region. Disulfine blue injection indicated all grafts were perfused at both three and six months. Thin section histology, fluorochromes, and microradiographs confirmed graft viability in all dogs. Semiquantitative grading of the fluorochromes indicated new bone deposition in 20%-50% of each graft at three months and 50%-80% at six months. Although the calcar bone graft was uniformly successful in this canine study, the clinical application of this technique should be evaluated by long-term results in humans.

Bargar, W.L.; Paul, H.A.; Merritt, K.; Sharkey, N.

1986-01-01

159

Pear grafting method  

UK PubMed Central (United Kingdom)

The invention discloses a grafting method of a pear tree. The main stem or main branch of pear tree with deterioration of strains and low quality is cut at the place 1 m away from the ground as a stock A branch of the good-quality pear tree with the length less than 15 cm and 2 to 3 sprouts is used, wherein, the bottom of the branch is cut into wedge shape. A slit with the same width as that of a graft is cut on the pear tree as stock. The graft is stably and tightly inserted into the slit of stock. And then a ventilated plastic film is tightly tightened at the grafting place. 2 to 4 grafts are grafted in the four directions according to the size of the stock. The survival rate of grafts grafted by aforementioned method is over 90% the operation is simple and needs no special trainer and the method can quickly improve variety and has high economic benefit.

QIAOYING LI

160

Advances in radiation grafting  

Energy Technology Data Exchange (ETDEWEB)

Graft copolymerization is an attractive means for modifying base polymers because grafting frequently results in the superposition of properties relating to the backbone and pendent chains. Among the various methods for initiating the grafting reaction, ionizing radiation is the cleanest and most versatile method of grafting available. Ion-exchange membranes play an important role in modern technology, especially in separation and purification of materials. The search for improved membrane composition has considered almost every available polymeric material because of its great practical importance. Grafting of polymers with a mixture of monomers is important since different types of chains containing different functional groups are included. A great deal is focused on the waste treatment of heavy and toxic metals from wastewater because of the severe problems of environmental pollution. Functionalized polymers suitable for metal adsorption with their reactive functional groups such as carboxylic and pyridine groups suitable for waste treatment were prepared by radiation grafting method. More reactive chelating groups were further introduced to the grafted copolymer through its functional groups by chemical treatments with suitable reagents. The advances of radiation grafting and possible uses are briefly discussed.

Hegazy, El-Sayed A. E-mail: hegazy_ea@hotmail.com; AbdEl-Rehim, H.A.; Kamal, H.; Kandeel, K.A

2001-12-01

 
 
 
 
161

Advances in radiation grafting  

International Nuclear Information System (INIS)

Graft copolymerization is an attractive means for modifying base polymers because grafting frequently results in the superposition of properties relating to the backbone and pendent chains. Among the various methods for initiating the grafting reaction, ionizing radiation is the cleanest and most versatile method of grafting available. Ion-exchange membranes play an important role in modern technology, especially in separation and purification of materials. The search for improved membrane composition has considered almost every available polymeric material because of its great practical importance. Grafting of polymers with a mixture of monomers is important since different types of chains containing different functional groups are included. A great deal is focused on the waste treatment of heavy and toxic metals from wastewater because of the severe problems of environmental pollution. Functionalized polymers suitable for metal adsorption with their reactive functional groups such as carboxylic and pyridine groups suitable for waste treatment were prepared by radiation grafting method. More reactive chelating groups were further introduced to the grafted copolymer through its functional groups by chemical treatments with suitable reagents. The advances of radiation grafting and possible uses are briefly discussed.

2001-01-01

162

Outcomes of cardiopulmonary resuscitation efforts in a Greek tertiary hospital.  

UK PubMed Central (United Kingdom)

INTRODUCTION: In-hospital cardiac arrest is a leading cause of death and despite recent advances in cardiopulmonary resuscitation, the survival to hospital discharge is poor. The aim of our study was to evaluate the success of resuscitation efforts in a tertiary hospital. PATIENTS AND METHODS: We retrospectively collected and analysed data on all patients in whom cardiopulmonary resuscitation was attempted after in-hospital cardiac arrest in one-year period. RESULTS: 96 cardiac arrest victims were studied. Sustained return of spontaneous circulation was achieved in 15 (15.6%) patients, while all of them survived for 24 h. Training in cardiopulmonary resuscitation, initiation of resuscitation efforts in less than 5 min, and intubation time < 1 min after team arrival were predictive factors associated with restoration of spontaneous circulation. Non-certified residents resuscitated 87 (90.6%) patients with 6 (6.8%) of them achieving return of spontaneous circulation and surviving for 24 h. On the contrary, certified ward residents resuscitated nine (9.3%) patients with 100% immediate and 24-h survival. CONCLUSION: In our hospital, certified providers had remarkably higher successful resuscitation rates for in-hospital cardiac arrest than non-certified providers. This finding suggests that training in cardiopulmonary resuscitation, continuing medical education, and implementation of the existing legislation will result in increased survival.

Chalkias A; Koutsovasilis A; Mystrioti D; Dragoumanos V; Xanthos T

2013-06-01

163

Use of Cardiopulmonary Bypass for Tracheal Resection: A Case Report  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Although ventilatory support can be life-saving, it also has adverse effects, including postintubation tracheal stenosis caused by damage to the larynx and trachea. Cardiopulmonary bypass is generally not used for the surgical management of tracheal stenosis; however, we have found that the use of c...

DeWitt, Robert Chance; Hallman, Charles H.

164

Termination of resuscitation for adult traumatic cardiopulmonary arrest.  

UK PubMed Central (United Kingdom)

The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (ACS-COT) believe that emergency medical services (EMS) systems should have protocols that allow EMS providers to terminate resuscitative efforts for certain adult patients in traumatic cardiopulmonary arrest. This document is the official position of the NAEMSP and ACS-COT.

2012-10-01

165

Challenges encountered with argatroban anticoagulation during cardiopulmonary bypass  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Use of argatroban as an alternative to heparin during cardiopulmonary bypass (CPB) in patients with heparin-induced thrombocytopenia has gained some attention in the past two decades. Dosing of argatroban during CPB is complex due to lack of complete understanding of its pharmacokinetic profile and ...

Agarwal, Shvetank; Ullom, Beth; Al-Baghdadi, Yasser; Okumura, Michael

166

Sliding grafted polymer layers  

CERN Multimedia

We study theoretically the structure of sliding grafted polymer layers or SGP layers. These interfacial structures are built by attaching each polymer to the substrate with a ring-like molecule. Such a topological grafting mode allows the chains to freely slide along the attachment point. Escape from the sliding link is prevented by bulky capping groups. We show that grafts in the mushroom regime adopt mainly symmetric configurations (with comparable branch sizes) while grafts in dense layers are highly dissymmetric so that only one branch per graft participates in the layer. Sliding layers on small colloids or star-like sliding micelles exhibit an intermediate behavior where the number of longer branches participating in the corona is independent of the total number of branches. This regime also exists for sliding surface-micelles comprising less chains but it is narrower.

Baulin, V A; Marques, C M; Baulin, Vladimir A.; Johner, Albert; Marques, Carlos M.

2005-01-01

167

Improved early postoperative outcome for extracardiac Fontan operation without cardiopulmonary bypass: a single-centre experience.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The use of modified extracardiac Fontan operation (ECFO) for total cavo-pulmonary connection allows cardiopulmonary bypass (CPB) to be avoided and seems to improve early postoperative results. We evaluated our experience with the off-pump technique for ECFO. METHODS: Since 2009, the last 17 consecutive patients of 137 (median age 3.2 years, median weight 14.5 kg) in whom no intracardiac surgery was necessary underwent ECFO without CPB. The non-fenestrated graft was connected end-to-side to the pulmonary artery without bypass; subsequently temporary passive inferior vena cava (IVC)-to-atrial bypass was used for the anastomosis between IVC and graft. The perioperative and postoperative course was compared between consecutive paediatric patients operated on using the CPB vs off-pump technique. RESULTS: There was no mortality in the off-pump group, with a total early mortality of 3.0%. Overall operation time for the Fontan operation using the off-pump technique was significantly reduced (160 vs 200 min, P < 0.001). The median Fontan pressure 24 and 48 h postoperatively was significantly lower in the off-pump group (P = 0.002/0.042). Duration of mechanical ventilation (9 vs 14 h, P = 0.016), pleural effusions (4 vs 8 days, P < 0.001) as well as the median intensive care unit (2 vs 4 days, P = 0.013) and hospital stay (median 10 vs 15 days, P < 0.001) was significantly shorter in patients who underwent the off-pump Fontan operation. The necessity of blood transfusions was significantly reduced with the off-pump in comparison with the on-pump technique (14 of 17 vs 34 of 84 patients, P = 0.003). CONCLUSIONS: The ECFO without CPB is an established low-risk surgical procedure that improves the early postoperative course and significantly reduces the use of blood products and the duration of pleural effusions in selected patients.

Ovroutski S; Sohn C; Miera O; Peters B; Alexi-Meskishvili V; Hetzer R; Berger F; Hübler M

2013-05-01

168

N- acetyl-beta-d-glucosaminidase and inflammatory response after cardiopulmonary bypass  

International Nuclear Information System (INIS)

To determine the changes in activity of plasma N-acetyl-beta-D-glucosaminidase, a marker for inflammation as well as renal, pulmonary and cardiac damage and proinflammatory cytokines in patients undergoing coronary artery bypass grafting and find out the relationship between their plasma levels with clinical outcome of patients. N-Acetyl-beta-D-glucosaminidase (NAG) activity and concentrations of tumor necrosis factor-alpha of (TNF alpha), interleukin 6 (IL-6), interleukin 8 (IL8) and granulocyte-macrophage colony stimulating factor (GM-CSF) were monitored in plasma samples of 12 angina patients undergoing coronary artery bypass grafting (CABG), before, immediately after and 5 days post-surgical procedure. Serum glucose concentrations were also monitored in those patients. Patient's clinical condition was monitored during this time period. No significant increase was observed in plasma NAG activity (a marker of inflammation) or in plasma levels of TNF alpha IL-6, IL-8 and GM-CSF immediately after surgery, indicating that cardiopulmonary bypass itself does not produce any significant amount of inflammation immediately after CABG. However, 5 days post surgery, there was a significant increase in plasma NAG activity (p=0.001), TNF alpha (p=0.047) and GM-CSF (p=0.045). There was no relationship between plasma NAG activity and clinical outcome because various parameters of renal, cardiac and pulmonary functions, though slightly affected, remained within the normal limits. Increased levels of NAG and TNF alpha did not affect clinical outcome. However, data suggest that NAG can be a potential marker for inflammation and end organ damage following CABG. An increase in GM-CSF on day 5 following CABG indicates enhanced body's defense mechanism against infection. (author)

2008-01-01

169

The effect of NQO1 polymorphism on the inflammatory response in cardiopulmonary bypass.  

Science.gov (United States)

Cardiopulmonary bypass (CPB) has been associated with systemic inflammatory response syndrome (SIRS). Endothelial dysfunction related to non-laminar flow during CPB is known to play a key role in this complex pathology. Antioxidant response element (ARE) dependent NAD(P)H:quinone oxidoreductase 1 (NQO1) promoter is a regulatory element involved in the anti-inflammatory mechanism in vasculature exposed to non-laminar flow. Mutation of the NQO1 could represent a novel anti-inflammatory effect in CPB. The goal of this study was to demonstrate whether genetic variants of NQO1 affect cytokine release after CPB. Eighteen patients who underwent standard coronary artery bypass grafting (CABG) operation were included in the study. Genotyping for NQO1 was performed. Serum Interleukin-6 (IL-6) levels were measured before induction, during CPB after declamping the aorta, and 24 h after operation. Clinical data were collected respectively. Seven patients were NQO1 T carriers and 11 patients were NQO1 T non-carriers. During CPB, IL-6 concentrations were increased in NQO1 T carriers compared to T non-carriers (p = 0.038). Although ventilation times and blood loss were higher in T carriers these were not statistically significant. Patients with NQO1 T carriers showed significantly higher IL-6 levels during CPB. Non-laminar flow during CPB may diminish the transcriptional activation of the NQO1 in T carriers. Preoperative determination of this novel anti-inflammatory mechanism could be useful to improve operative outcome in CPB. PMID:18098117

Isbir, C Selim; Ergen, Arzu; Tekeli, Atike; Zeybek, Umit; Gormus, Uzay; Arsan, Sinan

2008-06-01

170

Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB), resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG) by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 ± 8 years, mean weight 75.4 ± 11.9 kg and mean body sur (more) face area 1.83 ± 0.19 m²), receiving propranolol before surgery (80-240 mg a day) and postoperatively (10 mg a day). Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9) to 10.6 h (95% CI = 8.2-14.7; P

Carmona, M.J.C.; Malbouisson, L.M.S.; Pereira, V.A.; Bertoline, M.A.; Omosako, C.E.K.; Le Bihan, K.B.; Auler Jr., J.O.C.; Santos, S.R.C.J.

2005-05-01

171

[Management of cardiopulmonary bypass during cardiac surgery for patients with heparin-induced thrombocytopenia].  

UK PubMed Central (United Kingdom)

We experienced 4 cases of open heart surgeries under preoperative diagnosis of heparin-induced thrombocytopenia(HIT). We performed operation with argatroban instead of heparin. The argatroban was administered intravenously with a bolus of 100 ?g/kg. After activated clotting time(ACT)reached over 200 seconds, continuous infusion of argatroban was started, 1~2 ?g/kg/min until the level of ACT over 250 in the case of off-pump coronary artery bypass grafting(OPCAB), with 6~10 ?g/kg/min, or the level of ACT over 400 with the use of cardiopulmonary bypass (CPB). All cases required more than 60 minutes to achieve the target ACT level after starting the argatroban. In 1 case it was impossible to achieve target level of ACT by argatroban alone, and heparin was used concomitantly. In 1 case there was a complication of membrane occlusion of CPB. Open cardiac surgery with the use of argatroban required specific care for coagulation to complete operation.

Kondo T; Hirota M; Hoshino J; Fukada Y; Isomura T

2013-05-01

172

[Management of cardiopulmonary bypass during cardiac surgery for patients with heparin-induced thrombocytopenia].  

Science.gov (United States)

We experienced 4 cases of open heart surgeries under preoperative diagnosis of heparin-induced thrombocytopenia(HIT). We performed operation with argatroban instead of heparin. The argatroban was administered intravenously with a bolus of 100 ?g/kg. After activated clotting time(ACT)reached over 200 seconds, continuous infusion of argatroban was started, 1~2 ?g/kg/min until the level of ACT over 250 in the case of off-pump coronary artery bypass grafting(OPCAB), with 6~10 ?g/kg/min, or the level of ACT over 400 with the use of cardiopulmonary bypass (CPB). All cases required more than 60 minutes to achieve the target ACT level after starting the argatroban. In 1 case it was impossible to achieve target level of ACT by argatroban alone, and heparin was used concomitantly. In 1 case there was a complication of membrane occlusion of CPB. Open cardiac surgery with the use of argatroban required specific care for coagulation to complete operation. PMID:23674032

Kondo, Taichi; Hirota, Masanori; Hoshino, Joji; Fukada, Yasuhisa; Isomura, Tadashi

2013-05-01

173

Surfactant protein B and RAGE increases in the plasma during cardiopulmonary bypass: a pilot study.  

Science.gov (United States)

Surfactant derived protein B (SPB) and plasma receptor for advanced glycation end products (RAGE) have been proposed as markers of lung injury. The former is produced specifically by pneumocytes while RAGE production is present in several body tissues. Cardiopulmonary bypass (CPB) generates a transient lung injury. We measured SPB and RAGE in plasma before surgery and after CPB, as well as 24 h and 48 h later. We analysed plasma samples from 20 subjects scheduled for elective coronary artery bypass grafting. We performed a quantitative analysis of plasma levels of RAGE and SPB mature form (8 kDa) by ELISA and a semi-quantitative analysis of SPB immature form (~ 40 kDa) by Western blotting. Surgery procedures were uneventful. After CPB RAGE median (75th-25th interquartile difference) increased from 633 (539) pg·mL?¹ to 1,362 (557) pg·mL?¹ (p < 0.01), while mature SPB increased from 5,587 (3,089) ng·mL?¹ to 20,307 (19,873) ng·mL?¹ (p < 0.01). RAGE and mature SPB returned to normal values within 48 h. This behaviour was confirmed when RAGE and SPB were normalised for protein content. Parallel changes were observed for immature SPB. Plasma RAGE and SPBs are sensitive and rapid markers of lung distress. PMID:20650982

Agostoni, P; Banfi, C; Brioschi, M; Magrì, D; Sciomer, S; Berna, G; Brambillasca, C; Marenzi, G; Sisillo, E

2010-07-22

174

A novel foldable stent graft  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This dissertation concerns the structural design of medical stent grafts. A new type of an innovative stent graft has been developed. Unlike the conventional stent grafts which consist of a wire mesh and a covering membrane, the proposed stent graft can be made from a single folded sheet of material...

Kuribayashi, Kaori; You, Z.

175

Grafting in Arabidopsis.  

Science.gov (United States)

Grafting provides a simple way to generate chimeric plants with regions of different genotypes and thus to assess the cell autonomy of gene action. The technique of grafting has been widely used in other species, but in Arabidopsis, its small size makes the process rather more demanding. However, there are now several well-established grafting procedures available, which we described here, and their use has already contributed greatly to understanding of such processes as shoot branching control, flowering, disease resistance, and systemic silencing. PMID:24057364

Bainbridge, Katherine; Bennett, Tom; Crisp, Peter; Leyser, Ottoline; Turnbull, Colin

2014-01-01

176

Grafting in Arabidopsis.  

UK PubMed Central (United Kingdom)

Grafting provides a simple way to generate chimeric plants with regions of different genotypes and thus to assess the cell autonomy of gene action. The technique of grafting has been widely used in other species, but in Arabidopsis, its small size makes the process rather more demanding. However, there are now several well-established grafting procedures available, which we described here, and their use has already contributed greatly to understanding of such processes as shoot branching control, flowering, disease resistance, and systemic silencing.

Bainbridge K; Bennett T; Crisp P; Leyser O; Turnbull C

2014-01-01

177

Extracorporeal Versus Conventional Cardiopulmonary Resuscitation After Ventricular Fibrillation Cardiac Arrest in Rats: A Feasibility Trial.  

UK PubMed Central (United Kingdom)

OBJECTIVES:: Extracorporeal cardiopulmonary resuscitation with cardiopulmonary bypass potentially provides cerebral reperfusion, cardiovascular support, and temperature control for resuscitation from cardiac arrest. We hypothesized that extracorporeal cardiopulmonary resuscitation is feasible after ventricular fibrillation cardiac arrest in rats and improves outcome versus conventional cardiopulmonary resuscitation. DESIGN:: Prospective randomized study. SETTING:: University laboratory. SUBJECTS:: Adult male Sprague-Dawley rats. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Rats (intubated, instrumented with arterial and venous catheters and cardiopulmonary bypass cannulae) were randomized to conventional cardiopulmonary resuscitation, extracorporeal cardiopulmonary resuscitation with/without therapeutic hypothermia, or sham groups. After 6 mins of ventricular fibrillation cardiac arrest, resuscitation was performed with drugs (epinephrine, sodium bicarbonate, and heparin), ventilation, either cardiopulmonary resuscitation or extracorporeal cardiopulmonary resuscitation, and defibrillation. Temperature was maintained at 37.0°C or 33.0°C for 12 hrs after restoration of spontaneous circulation. Neurologic deficit scores, overall performance category, histological damage scores (viable neuron counts in CA1 hippocampus at 14 days; % of sham), and microglia proliferation and activation (Iba-1 immunohistochemistry) were assessed. RESULTS:: Extracorporeal cardiopulmonary resuscitation induced hypothermia more rapidly than surface cooling (p < 0.05), although heart rate was lowest in the extracorporeal cardiopulmonary resuscitation hypothermia group (p < 0.05). Survival, neurologic deficit scores, overall performance category, and surviving neurons in CA1 did not differ between groups. Hypothermia significantly reduced neuronal damage in subiculum and thalamus and increased the microglial response in CA1 at 14 days (all p < 0.05). There was no benefit from extracorporeal cardiopulmonary resuscitation versus cardiopulmonary resuscitation on damage in any brain region and no synergistic benefit from extracorporeal cardiopulmonary resuscitation with hypothermia. CONCLUSIONS:: In a rat model of 6-min ventricular fibrillation cardiac arrest, cardiopulmonary resuscitation or extracorporeal cardiopulmonary resuscitation leads to survival with intact neuro outcomes. Twelve hours of mild hypothermia attenuated neuronal death in subiculum and thalamus but not CA1 and, surprisingly, increased the microglial response. Resuscitation from ventricular fibrillation cardiac arrest and rigorous temperature control with extracorporeal cardiopulmonary resuscitation in a rat model is feasible, regionally neuroprotective, and alters neuroinflammation versus standard resuscitation. The use of experimental extracorporeal cardiopulmonary resuscitation should be explored using longer insult durations.

Janata A; Drabek T; Magnet IA; Stezoski JP; Janesko-Feldman K; Popp E; Garman RH; Tisherman SA; Kochanek PM

2013-05-01

178

Employment Specialist Competencies for Supported Employment Programs.  

UK PubMed Central (United Kingdom)

Purpose Supported employment (SE) programs are evidence-based programs offered to people with severe mental illness to facilitate obtaining and keeping competitive work. However, significant variations in individuals' vocational success may be partly explained by differences in their employment specialists' competencies. Aim The main objectives of this study were to develop a questionnaire measuring the behaviors, attitudes and knowledge of employment specialists working in SE programs and to link specific competencies to vocational outcomes. Methods A total of 153 employment specialists working in Canadian and Dutch supported employment programs completed the Behaviors, Attitudes, and Knowledge in Employment Specialists (BAKES) questionnaire and provided information about their clients' vocational outcomes. Results Exploratory Factor Analyses results found 90 items over 12 subscales (e.g., Relationships with employers and supervisors). Regression analyses indicated that the two most useful subscales for predicting vocational success were: (1) Relationships with employers and supervisors, and (2) support and client-centered approach. Conclusion Employment specialists require specific competencies to help people with severe mental illness obtain and maintain competitive employment. Validating the BAKES will better define the broad range of competencies expected for this position, and this tool may facilitate training of employment specialists.

Corbière M; Brouwers E; Lanctôt N; van Weeghel J

2013-10-01

179

The impact of avoiding cardiopulmonary by-pass during coronary artery bypass surgery in elderly patients: the Danish On-pump Off-pump Randomisation Study (DOORS)  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Coronary Artery Bypass Graft operation for ischemic heart disease provides improved quality of life and, in some patients, prolonged survival. Concern has, however, been raised about complications that may be related to the use of cardiopulmonary by-pass (CPB) and aortic cross-clamping. It has been hypothesized that when coronary artery by-pass grafting is performed without the use of CPB, the rate of serious complications is reduced. Methods/Design The trial is designed as an open, randomized, controlled, clinical trial with blinded assessment of end-points. Patients at or above 70 years of age, referred for surgical myocardial revascularisation, are included and randomised to receive coronary artery by-pass grafting either with or without the use of CPB and aortic cross-clamping. Follow-up is performed by clinical, biochemical, electrocardiographic, and angiographic data that are evaluated by independent committees that are blinded with respect to the result of the randomisation. End points include mortality, stroke, myocardial infarction, graft patency, quality of life, and cost-effectiveness. The trial is performed in four different Danish, cardiac surgery centres. Trial registration ClinicalTrials.gov NCT00123981

Houlind Kim; Kjeldsen Bo; Madsen Susanne; Rasmussen Bodil; Holme Susanne; Schmidt Thomas; Haahr Poul; Mortensen Poul

2009-01-01

180

Coronary Artery Bypass Graft  

Medline Plus

Full Text Available ... lower your blood cholesterol can help slow the process that clogs arteries. Exercise and losing weight, under ... the clogged arteries. Coronary Artery Bypass Graft This process of taking blood vessels from one part of ...

 
 
 
 
181

Robotically-assisted coronary artery bypass grafting.  

Science.gov (United States)

Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB), and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB) grafting. Nine patients (16%) were converted to open techniques. The mean total operating time for TECAB was 372 +/- 104 minutes and for MIDCAB was 220 +/- 69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50%) in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results. PMID:20339505

Folliguet, Thierry A; Dibie, Alain; Philippe, François; Larrazet, Fabrice; Slama, Michel S; Laborde, François

2010-03-18

182

Robotically-assisted coronary artery bypass grafting.  

UK PubMed Central (United Kingdom)

Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB), and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB) grafting. Nine patients (16%) were converted to open techniques. The mean total operating time for TECAB was 372 +/- 104 minutes and for MIDCAB was 220 +/- 69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50%) in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results.

Folliguet TA; Dibie A; Philippe F; Larrazet F; Slama MS; Laborde F

2010-01-01

183

Estimation of cerebral blood flow during cardiopulmonary resuscitation in humans.  

DEFF Research Database (Denmark)

Cerebral blood flow (CBF) and cardiac output (CO) were measured during cardiopulmonary resuscitation in patients who were unsuccessfully resuscitated by use of C14-iodoantipyrine injected into the left ventricle. CO varied between 1.3 and 2.2 l/min with mean 1.8 +/- 0.6 l/min (+/- SD) (28 ml/kg/min). The cortical CBF was found between 14 and 211 ml 100 g-1.min-1 with mean 42 ml 100 g-1.min-1 and mean white matter CBF equal to 27 ml 100 g-1.min-1. It is suggested that the external cardiac massage in humans may be of poor efficacy in terms of brain revival. Cortical CBF after long-lasting cardiopulmonary resuscitation showed signs of maldistribution suggestive of a patchy and incomplete perfusion.

Christensen, S F; Stadeager, Carsten Preben

1990-01-01

184

Predicting postoperative cardiopulmonary complications by a test of stair climbing  

International Nuclear Information System (INIS)

Objective: To assess whether a test of stair climbing ability could be used to predict the risk of developing postoperative cardiopulmonary complications in patients undergoing general anesthesia. Design: Cohort study Place and Duration of Study: The Aga Khan University Hospital, Karachi. The duration of the study was from December 2003 to December 2004. Patients and Methods: This study was carried out on consecutive, adult patients presenting for elective thoracic or abdominal surgery under general anesthesia. Pre-operatively, patients were asked to climb a standard staircase. Number of steps climbed was recorded. Those unable to climb stairs due to debilitation cardiac, pulmonary or rheumatologic disease were categorized as 0 stairs climbed. Outcome variables were postoperative cardiopulmonary complications for mortality. Period of follow-up was until hospital discharge. Results: Seventy-eight patients were enrolled; 59 (75.6%) climbed > 1 flight of stairs, 19 (24.3%) climbed 1 flight and 40% in those patients who climbed

2004-12-00

185

Available ventilation monitoring methods during pre-hospital cardiopulmonary resuscitation.  

Science.gov (United States)

High quality cardiopulmonary resuscitation (CPR) in the pre-hospital setting has been associated with improved survival rates during cardiopulmonary arrest (CPA). Recent documentation of hyperventilation associated deterioration in hemodynamics during CPR, suggests that guided or controlled ventilation strategies may contribute to improved hemodynamics and increased survival. This article briefly reviews the mechanical methods, advantages, and disadvantages of the available ventilation monitoring methods currently available for clinical use, with an emphasis on pre-hospital implementation. We recommend that more objective measurement of ventilation during CPR be performed, with emphasis on a strategy for measuring both attempted ventilation frequency (f) and delivered tidal volume (VT). The use of improved thoracic impedance pneumography and capnography are appealing for such monitoring because of the widespread availability, but modifications to existing software and clinical data compared to a clinical standard would be required before general acceptance is possible. Other methods listed may offer advantages over these in select circumstances. PMID:16949719

Terndrup, Thomas E; Rhee, Joongeui

2006-09-01

186

Available ventilation monitoring methods during pre-hospital cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

High quality cardiopulmonary resuscitation (CPR) in the pre-hospital setting has been associated with improved survival rates during cardiopulmonary arrest (CPA). Recent documentation of hyperventilation associated deterioration in hemodynamics during CPR, suggests that guided or controlled ventilation strategies may contribute to improved hemodynamics and increased survival. This article briefly reviews the mechanical methods, advantages, and disadvantages of the available ventilation monitoring methods currently available for clinical use, with an emphasis on pre-hospital implementation. We recommend that more objective measurement of ventilation during CPR be performed, with emphasis on a strategy for measuring both attempted ventilation frequency (f) and delivered tidal volume (VT). The use of improved thoracic impedance pneumography and capnography are appealing for such monitoring because of the widespread availability, but modifications to existing software and clinical data compared to a clinical standard would be required before general acceptance is possible. Other methods listed may offer advantages over these in select circumstances.

Terndrup TE; Rhee J

2006-10-01

187

von Willebrand disease and cardiopulmonary bypass: a case report.  

Science.gov (United States)

The anesthetic management of patients undergoing cardiac surgery on cardiopulmonary bypass can be challenging. Contact of blood with extracorporeal surfaces results in altered coagulational integrity and increased risk of bleeding. Patients with preexisting bleeding disorders are particularly vulnerable. In this article we discuss the anesthetic management of a patient with von Willebrand disease (vWD) undergoing mitral valve replacement on cardiopulmonary bypass. vWD describes a number of different von Willebrand factor disorders, associated with variable degrees of bleeding, which require an individualized approach. The extent of the surgery, the patient-specific vWD coagulopathy, and clinical indicators guided our therapy, which included desmopressin, cryoprecipitate, and vWF/Factor VIII concentrate. PMID:23513326

Teppone-Martin, Oxana L; Zhao, Manxu; Norris, Teresa E

2013-02-01

188

A large saphenous vein graft aneurysm one year after coronary artery bypass graft surgery presenting as a left lung mass.  

UK PubMed Central (United Kingdom)

Aneurysm of a saphenous vein graft (SVG) is a rare but fatal complication of coronary artery bypass graft (CABG) surgery. The development of SVG aneurysms appears usually about 10-20 years after the operation at an estimated rate of <1%. A 68-year-old male was referred to the emergency department after frequent episodes of dyspnea, chest pain and hemoptysis. He previously had CABG surgery one year before. The physical examination was normal. Chest radiogram showed a left pulmonary midzone mass. CT-angiogram demonstrated a large aortic pseudoaneurysm (6.36 x 6.06 cm) in the middle part of the ascending aorta. After sternotomy, the ascending aorta above sinotubular junction near the origin of brachiocephalic artery was resected and replaced with a tube graft. The patient was transferred to ICU with stable hemodynamic status. SVG aneurysm should be considered while encountering mediastinal mass or undiagnosed cardiopulmonary symptoms in patients with a previous history of CABG because of its rarity and overlap of symptoms with other thoracic, pulmonary, and cardiac diseases. Surgery seems to be the treatment of choice to reduce the risk of rupture and embolism.

Abbasi M; Soltani G; Shomali A; Javan H

2009-06-01

189

Cardiopulmonary stress during exercise training in patients with COPD.  

UK PubMed Central (United Kingdom)

Exercise training is an essential component of pulmonary rehabilitation. However, the cardiopulmonary stress imposed during different modalities of exercise training is not yet known. In the present study, the cardiopulmonary stress of a 12-week exercise training programme in 11 chronic obstructive pulmonary disease (COPD) patients (forced expiratory volume in one second 42+/-12%pred, age 69+/-6 yrs) was measured. Pulmonary gas exchange and cardiac frequency (f(C)) of three training sessions were measured with a portable metabolic system at the beginning, mid-term and end of the programme. Symptoms were assessed with Borg scores. The exercise intensity was compared with the recommendations for exercise training by the American College of Sports Medicine (ACSM). Training effects were significant (maximum change in work: 14+/-11 Watts, 6-min walk test: 44+/-36 m). Whole body exercises (cycling, walking and stair climbing) consistently resulted in higher cardiopulmonary stress (oxygen uptake (V'(O(2))), minute ventilation and f(C)) than arm cranking and resistance training. Dyspnoea was higher during cycling than resistance training. Patients exercised for >70% (>20 min) of the total exercise time at >40% of the V'(O(2)) reserve and f(C) reserve ("moderate" intensity according to the ACSM) throughout the programme. The cardiopulmonary stress resistance training is lower than during whole-body exercise and results in fewer symptoms. In addition, exercise testing based on guidelines using a fixed percentage of baseline peak performance and symptom scores achieves and sustains training intensities recommended according to the American College of Sports Medicine.

Probst VS; Troosters T; Pitta F; Decramer M; Gosselink R

2006-06-01

190

Cardiopulmonary bypass line sternal wrapping for protection and haemostasis.  

Science.gov (United States)

Sternal marrow haemostasis is often obtained with the application of bone wax, with potential side effects pertaining to sternal wound healing. We illustrate an alternative technique which also offers some protection to sternal edges. Two lengths of tubing from the discarded cardiopulmonary bypass (CPB) circuit are cut longitudinally on one side. After sternotomy they are placed across each sternal edge and kept in position by two stitches and the spreader blades. They are removed just before sternal closure. PMID:19423510

Aratari, Carlo; Manché, Alexander; Ferretti, Luca; Fusella, Marcella

2009-05-07

191

Cardiopulmonary bypass line sternal wrapping for protection and haemostasis.  

UK PubMed Central (United Kingdom)

Sternal marrow haemostasis is often obtained with the application of bone wax, with potential side effects pertaining to sternal wound healing. We illustrate an alternative technique which also offers some protection to sternal edges. Two lengths of tubing from the discarded cardiopulmonary bypass (CPB) circuit are cut longitudinally on one side. After sternotomy they are placed across each sternal edge and kept in position by two stitches and the spreader blades. They are removed just before sternal closure.

Aratari C; Manché A; Ferretti L; Fusella M

2009-08-01

192

Carinal resection requiring cardiopulmonary bypass in a pregnant patient.  

UK PubMed Central (United Kingdom)

A 35-year-old woman at 13 weeks gestation presented with adenoid cystic carcinoma of the distal left mainstem bronchus with chronic collapse of the left lung requiring carinal pneumonectomy. The extent of the tumor and need for significant retraction during dissection and pneumonectomy resulted in the need for cardiopulmonary bypass. The patient underwent successful left carinal pneumonectomy and subsequently delivered a healthy baby.

Fitzsimons MG; Ng J; Wright C; Mathisen D; Vlahakes G; Albrecht M

2013-09-01

193

Carinal resection requiring cardiopulmonary bypass in a pregnant patient.  

Science.gov (United States)

A 35-year-old woman at 13 weeks gestation presented with adenoid cystic carcinoma of the distal left mainstem bronchus with chronic collapse of the left lung requiring carinal pneumonectomy. The extent of the tumor and need for significant retraction during dissection and pneumonectomy resulted in the need for cardiopulmonary bypass. The patient underwent successful left carinal pneumonectomy and subsequently delivered a healthy baby. PMID:23992710

Fitzsimons, Michael G; Ng, Joshua; Wright, Cameron; Mathisen, Douglas; Vlahakes, Gus; Albrecht, Meredith

2013-09-01

194

[Aesthetic gluteal remodeling by fat grafting].  

UK PubMed Central (United Kingdom)

INTRODUCTION: The most common surgical techniques performed for gluteal augmentation employ gluteal implants. Gluteal augmentation is today a consultation request for many patients. The results can be interesting, but this surgical procedure can provide some complications. Fat grafting is reliable technique to remodel the buttocks. The aim of this study is to describe our experience for buttocks remodeling with fat grafting. METHODS AND TECHNIQUE: A prospective study has been performed, including patients that have been operated for buttocks remodeling with fat grafting in our department during one year. We have recorded the average age and body mass index of each patient, the total volume transferred for each patient, and the postoperator complications (infection, hemorrhage, seroma, fat embolism). The end result was evaluated by the patient and the surgical team using four criteria: very satisfying, satisfying, fair and poor. RESULTS: A prospective study including 24 cases of buttocks remodeling corrected with fat grafting. The average age was 43 years (30 to 65 years) and the average body mass index was 20.4 (18 to 24,2). The average volume transferred for each patient was 280cm(3) (from 140 to 440cm(3)). The patients and the surgical team were very satisfied or satisfied in 87,5% of cases. In this series we had no complications (infection, hemorrhage, fat embolism). We only had one seroma. CONCLUSION: Fat grafting is a reliable technique, simple and safe procedure. Fat grafting is an excellent indication for moderate buttocks remodeling. Surgery for correction of the buttocks may involve more than projection and volume. However, these must be in a balanced proportion with the rest of the body.

Ho Quoc C; Mojallal A; Delay E

2013-06-01

195

Retrenchment in Malaysia: Employer’s Right?  

Directory of Open Access Journals (Sweden)

Full Text Available There are several ways to put a contract of employment to an end. One of them is by way of retrenchment.  Termination of employment by way of retrenchment may be relevant when the employer restructures his business. The focus of this article is to evaluate the application of the principle Last in First Out (LIFO) in the case of retrenchment in Malaysia. This article will also assess to what extent the courts defend the prerogative of the employer to retrench his employee in the case of redundancy.

Hamidah Marsono; Hj. Kamaruzaman Jusoff

2009-01-01

196

Cardiopulmonary Resuscitation Training in Sport Universities: An Italian Survey  

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Full Text Available Background: Physical activity is associated to an increased risk of sudden cardiac death (SCD). Together with primary prevention, prompt recognition and early management of SCD are crucial in order to improve survival rate. During their duty, sport trainers and teachers can play a key role in secondary prevention of cardiac arrest provided they have received an appropriate training in Cardiopulmonary Resuscitation (CPR) during their curricular study. This is usually achieved through a Basic life Support and Defibrillation (BLS-D) Course which in Italy formally enables to Automated External Defibrillator (AED) use. Objective: To investigate the presence, the type and the diffusion of cardiopulmonary resuscitation training in Sport and Exercise Sciences Universities in Italy. Design: Descriptive survey research design was adopted for the study. Setting: The study sample consisted of 32 Italian Universities with Bachelor and Master-Level Degrees in Sport and Exercise Sciences. Methods: Teaching secretary or directly deans/ course presidents were contacted by email or telephone in order to collect information on the availability of BLS-D courses for Sport and Exercise Sciences students during the academic year 2010-2011. Results: The compliance to the survey has been >93%. Only a reduced number of the contacted Universities offered dedicated courses of Cardiopulmonary Resuscitation with license to Defibrillation according to current local regulation. Conclusion: The described situation shows a limit in the generation of a sport trainers’ category highly specialized in cardiac and respiratory emergencies: only 6 Universities organize BLS-D training with official certification.

Andrea Scapigliati; Saverio Giampaoli; Alessia Marsili; Federica Valeriani; Vincenzo Romano Spica

2013-01-01

197

Cardiopulmonary signal sensing from subject wearing body armor.  

UK PubMed Central (United Kingdom)

Continuous wave (CW) Doppler motion sensing radar can detect human physiological signal such as respiration or heart signals at a distance and through barriers. It has been shown that heart rate can be extracted with good accuracy for normally clothed subjects. Such technique could potentially be used to search for survivors in battlefield triage applications. To assess the feasibility of such applications, we investigated Doppler radar of cardiopulmonary signal sensing from subjects wearing body armor vests. This paper presents measurement results of heart signals obtained using CW Doppler radar from a subject wearing body armor vest. Since armor plate reflects most of the RF signal, received signal after reflected from a subject is phase modulated with motion of an armor plate induced by chest motion, rather than directly with chest motion due to cardiopulmonary motion. Two different cases, including supine and seated positions, are chosen for this study, and good sensitivity was obtained in both cases. To the best of author's knowledge, this is the first published result of cardiopulmonary signal detection from a subject wearing a body armor vest.

Park BK; Lubecke V; Boric-Lubecke O; Host-Madsen A

2007-01-01

198

Unaccounted blood loss in operations using cardiopulmonary bypass.  

Science.gov (United States)

Typically, blood loss after operations requiring cardiopulmonary bypass is estimated from the sum of blood on sponges and drapes, in the suction system reservoir, and in chest drainage bottles. Prime of the extracorporeal circuit is usually returned to the patient, but no accounting is made of blood remaining in the circuit. In 50 patients, we examined 25 bubble and 25 membrane oxygenator circuits after completion of cardiopulmonary bypass and after return of all prime to the patients. Saline solution was added to each circuit and recirculated for 3 minutes, after which the volume and hematocrit of the recirculated saline were determined. From these values, we estimated that 92.0 +/- 18.1 mL of red blood cells remained in the bubble oxygenators and 100 +/- 11.6 mL in the membrane oxygenators. This volume of red cells is equivalent to 250 mL of whole blood with 35% hematocrit or 30 grams of hemoglobin at 12 gm% concentration. We conclude that blood loss after operations requiring cardiopulmonary bypass is systematically underestimated by the approximately 250 mL left as red cells on the walls and filters of the extracorporeal circuit after return of all prime to the patient. PMID:9068137

Romagnoli, A; Stafford, T B; Keats, A S

1997-01-01

199

Unaccounted blood loss in operations using cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Typically, blood loss after operations requiring cardiopulmonary bypass is estimated from the sum of blood on sponges and drapes, in the suction system reservoir, and in chest drainage bottles. Prime of the extracorporeal circuit is usually returned to the patient, but no accounting is made of blood remaining in the circuit. In 50 patients, we examined 25 bubble and 25 membrane oxygenator circuits after completion of cardiopulmonary bypass and after return of all prime to the patients. Saline solution was added to each circuit and recirculated for 3 minutes, after which the volume and hematocrit of the recirculated saline were determined. From these values, we estimated that 92.0 +/- 18.1 mL of red blood cells remained in the bubble oxygenators and 100 +/- 11.6 mL in the membrane oxygenators. This volume of red cells is equivalent to 250 mL of whole blood with 35% hematocrit or 30 grams of hemoglobin at 12 gm% concentration. We conclude that blood loss after operations requiring cardiopulmonary bypass is systematically underestimated by the approximately 250 mL left as red cells on the walls and filters of the extracorporeal circuit after return of all prime to the patient.

Romagnoli A; Stafford TB; Keats AS

1997-01-01

200

Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58%) patients, and 42 (28%) were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 mont (more) hs was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT) as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP) prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95% confidence interval [CI] = 2.7-13.6), when the initial rhythm was VF/VT; 9.4 (95% CI = 4.1-21.3), when the time of cerebral cardiopulmonary resuscitation was 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis.

Bartholomay, Eduardo; Dias, Fernando Suparregui; Torres, Fábio Alves; Jacobson, Pedro; Mariante, Afonso; Wainstein, Rodrigo; Silva, Renato; Bodanese, Luiz Carlos

2003-08-01

 
 
 
 
201

Axillobifemoral bypass grafting  

Directory of Open Access Journals (Sweden)

Full Text Available INTRODUCTION Axillo-femoral bypass (AxF) means connecting the axillar and femoral artery with the graft that is placed subcutaneously [1]. Usually, this graft is connected with contralateral femoral artery via one accessory subcutaneous graft, and this connection is known as axillobifemoral bypass (AxFF). This extra-anatomic procedure is an alternative method to the standard reconstruction of aortoiliac region when there are contraindications for general or local reasons. OBJECTIVE The objective of this paper is to show early and late results of AxFF bypass grafting as well as to show the indications for AxFF bypass. METHODS The sample consisted of 37 patients. The procedure was performed in 28 patients who suffered from aortoiliac occlusive disease and who were at high risk due to the comorbidity- in one patient with the rupture of juxtarenal aneurysm of abdominal aorta; in five patients with aortoenteric fistula, in two patients with iatrogenic lesion of abdominal aorta and in one female patient with anus preternaturalis definitivus who was treated for rectovaginal fistula. Donor's right axillary artery was used in 26 cases (70.3%), and donor's left axillary artery was used in 9 cases (29.7%). Dacron graft was used in 34 patients and Polytetrafluo-roethlylene graft was used in three patients. Simultaneously, profundo-plastic was done in four patients and femoro-popliteal bypass was performed in three patients. In five patients who suffered from aortoenteric fistula, simultaneous intervention of gastrointerstinal system has been done, x2 test was used for statistical evaluation and life table method was used for verification of late graft patency. RESULTS The rate of early postoperative mortality was 13.5%. The causes of death were: sepsis -1, MOFS - 3, and infarct myocardium -1. The mean follow up period was 40.1 months, ranging from six months to 17 years. During the follow up period, an early graft thrombosis was identified in two and late graft occlusion was reported in four patients. As the cause of occlusion, the progression of occlusive disease of receptive artery was identified in three patients, while anastomotic neointimae hyperplasia of recipient artery was identified in one patient. Three patients died during the follow up period. As the cause of death, CVI was reported in two patients and malignancy of the urinary tract was fpund in one patient. The other complications were - artery angulation on the level of proximal anastomosis in one patient (Figure 1), false aneurysm in one patient, perigraft seroma in one patient and graft infection in three patients. Life table method has shown that cumulative rate of late graft patency is 80.39% after five years (Graph 1). DISCUSSION Our results were analyzed and compared with the results of the study on 283 patients who had undergone aortobifemoral bypass (AFF) operation due to the aortoiliac occlusive disease. This study was completed in 1995 (18). The results showed that there was no statistically significant differences between AxFF and AFF group (p>0.05), considering early mortality rate and late graft patency (Graph 2). The review of mortality and late patency rate after AxFF bypass grafting in a world well known studies has shown the similar results (Table 1). CONCLUSION The authors suggest that axilobifemoral bypass is indicated when there are contraindications or difficulties to perform anatomic reconstruction due to the abdomen condition (infection, adhesion, comorbidity) as well as in high risk patients with low life expectancy.

Davidovi? Lazar B.; Mitri? Milan S.; Kosti? Dušan M.; Maksimovi? Živan V.; Cvetkovi? Slobodan D.; ?inara Ilijas S.; Dimi? Andreja D.; Ili? Nikola S.

2004-01-01

202

Implantation of a stent graft in the right pulmonary artery enables radical resection of a central endothelial sarcoma of the left pulmonary artery.  

Science.gov (United States)

In a patient with a huge endothelial sarcoma of the left pulmonary artery, we report successful implantation of a stent graft in the right pulmonary artery, including the pulmonary arterial trunk. This preoperative measure enabled a safe and radical left-sided pneumonectomy, including the tumor and the central parts of the left pulmonary artery. No major blood loss occurred, and neither use of a heart-lung machine nor cardiopulmonary bypass was necessary. PMID:23466184

Kissling, Pascal; Brosi, Philippe; Kull, Christof; Toia, Damien; Maurer, Christoph Andreas

2013-03-05

203

Implantation of a stent graft in the right pulmonary artery enables radical resection of a central endothelial sarcoma of the left pulmonary artery.  

UK PubMed Central (United Kingdom)

In a patient with a huge endothelial sarcoma of the left pulmonary artery, we report successful implantation of a stent graft in the right pulmonary artery, including the pulmonary arterial trunk. This preoperative measure enabled a safe and radical left-sided pneumonectomy, including the tumor and the central parts of the left pulmonary artery. No major blood loss occurred, and neither use of a heart-lung machine nor cardiopulmonary bypass was necessary.

Kissling P; Brosi P; Kull C; Toia D; Maurer CA

2013-09-01

204

Alveolar bone grafting  

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Full Text Available In patients with cleft lip and palate, bone grafting in the mixed dentition in the residual alveolar cleft has become a well-established procedure. The main advantages can be summarised as follows: stabilisation of the maxillary arch; facilitation of eruption of the canine and sometimes facilitation of the lateral incisor eruption; providing bony support to the teeth adjacent to the cleft; raising the alar base of the nose; facilitation of closure of an oro-nasal fistula; making it possible to insert a titanium fixture in the grafted site and to obtain favourable periodontal conditions of the teeth within and adjacent to the cleft. The timing of the ABG surgery take into consideration not only eruption of the canine but also that of the lateral incisor, if present. The best time for bone grafting surgery is when a thin shell of bone still covers the soon erupting lateral incisor or canine tooth close to the cleft.

Lilja Jan

2009-01-01

205

Rib grafts in septorhinoplasty.  

UK PubMed Central (United Kingdom)

Autogenous cartilage has generally been considered the gold standard grafting material in reconstructive septorhinoplasty for volume filling and structural support. In the restructuring of the nasal skeleton, autogenous cartilage can be harvested from the nasal septum, the auricle or the rib, but costal cartilage is considered the best graft material in patients requiring major reconstruction. Rib cartilage is an outstanding material in reconstructive septorhinoplasty, especially in revision surgery and when large amounts of tissue are required. This autologous material has a low rate of complications such as resorption, infection and extrusion compared to homografts and alloplastic implants. In the present study, the authors analyze and discuss the use of autogenous rib cartilage in 54 patients who underwent primary and revision septorhinoplasty. Its use is also suggested in cases in which there is a need to have a fair amount of cartilaginous tissue to be grafted for nasal framework reconstruction and respiratory function improvement.

Moretti A; Sciuto S

2013-06-01

206

Rib grafts in septorhinoplasty.  

Science.gov (United States)

Autogenous cartilage has generally been considered the gold standard grafting material in reconstructive septorhinoplasty for volume filling and structural support. In the restructuring of the nasal skeleton, autogenous cartilage can be harvested from the nasal septum, the auricle or the rib, but costal cartilage is considered the best graft material in patients requiring major reconstruction. Rib cartilage is an outstanding material in reconstructive septorhinoplasty, especially in revision surgery and when large amounts of tissue are required. This autologous material has a low rate of complications such as resorption, infection and extrusion compared to homografts and alloplastic implants. In the present study, the authors analyze and discuss the use of autogenous rib cartilage in 54 patients who underwent primary and revision septorhinoplasty. Its use is also suggested in cases in which there is a need to have a fair amount of cartilaginous tissue to be grafted for nasal framework reconstruction and respiratory function improvement. PMID:23853415

Moretti, A; Sciuto, S

2013-06-01

207

Crosslinked grafted PVC obtained by direct radiation grafting  

International Nuclear Information System (INIS)

[en] Direct radiation-induced grafting of 4-vinylpyridine onto both pure and plasticized poly(vinyl chloride) has been studied. The effect of grafting conditions such as solvent, monomer concentration, irradiation dose, and inhibitor concentration on the grafting yield was investigated. The grafting process was enhanced by using distilled water as diluent and higher degrees of grafting were obtained as compared with other solvents used (benzene, methanol, and a mixture of methanol and water). The homopolymerization of 4-vinylpyridine was reduced to a minimum using ammonium ferrous sulfate and the suitable optimum concentration of the inhibitor was found to be 0.25 wt%. It was observed that the degrees of grafting onto plasticized PVC were higher than those onto pure one, at constant grafting conditions. The diffusibility of the monomer solution through the trunk polymers enhanced at higher monomer concentrations. The higher the monomer concentration the higher the degrees of grafting obtained. The dependence of the grafting rate on monomer concentration was found to be 0.15 and 0.4 order for the grafting onto pure and plasticized PVC films, respectively. The gel content in both grafted extracted pure and plasticized PVC films increased with the degree of grafting to reach certain limiting values. (author)

1985-01-01

208

Crosslinked grafted PVC obtained by direct radiation grafting  

Energy Technology Data Exchange (ETDEWEB)

Direct radiation-induced grafting of 4-vinylpyridine onto both pure and plasticized poly(vinyl chloride) has been studied. The effect of grafting conditions such as solvent, monomer concentration, irradiation dose, and inhibitor concentration on the grafting yield was investigated. The grafting process was enhanced by using distilled water as diluent and higher degrees of grafting were obtained as compared with other solvents used (benzene, methanol, and a mixture of methanol and water). The homopolymerization of 4-vinylpyridine was reduced to a minimum using ammonium ferrous sulfate and the suitable optimum concentration of the inhibitor was found to be 0.25 wt%. It was observed that the degrees of grafting onto plasticized PVC were higher than those onto pure one, at constant grafting conditions. The diffusibility of the monomer solution through the trunk polymers enhanced at higher monomer concentrations. The higher the monomer concentration the higher the degrees of grafting obtained. The dependence of the grafting rate on monomer concentration was found to be 0.15 and 0.4 order for the grafting onto pure and plasticized PVC films, respectively. The gel content in both grafted extracted pure and plasticized PVC films increased with the degree of grafting to reach certain limiting values.

Hegazy, E.-S.A.; Dessouki, A.H.; El-Dessouky, M.M.; El-Sawy, N.M.

1985-01-01

209

A survey on training in pediatric cardiopulmonary resuscitation in Latin America, Spain, and Portugal.  

UK PubMed Central (United Kingdom)

OBJECTIVES: To determine how training in pediatric cardiopulmonary resuscitation is provided in the Iberoamerican countries. DESIGN: Survey. SETTING: Latin America, Spain, and Portugal. SUBJECTS: Experts in pediatric cardiopulmonary resuscitation education. RESULTS: A questionnaire was sent to experts in pediatric cardiopulmonary resuscitation training in 21 countries in Latin America, Spain, and Portugal; we received 15 replies. Pediatric cardiopulmonary resuscitation training is not included in medical undergraduate or nursing training in any of these countries and pediatric residents receive systematic cardiopulmonary resuscitation training in only four countries. Basic pediatric life support courses, pediatric advanced life support courses, and pediatric cardiopulmonary resuscitation instructors courses are given in 13 of 15, 14 of 15, and 11 of 15 respondent countries, respectively. Course duration and the number of hours of practical training were variable: basic life support, 5 hrs (range, 4-8 hrs); practical training, 4 hrs (range, 2-5 hrs); advanced life support, 18 hrs (range, 10-30 hrs); and practical training, 14 hrs (range, 5-18 hrs). Only nine countries (60%) had a national group that organized pediatric cardiopulmonary resuscitation training. Thirteen countries (86.6%) had fewer than five centers offering pediatric cardiopulmonary resuscitation training. Respondents considered the main obstacles to the expansion of training in pediatric cardiopulmonary resuscitation to be the shortage of instructors (28.5%), students' lack of financial resources (21.4%), and deficiencies in educational organization (21.4%). CONCLUSIONS: Pediatric cardiopulmonary resuscitation training is not uniform across the majority of Iberoamerican countries, with poor organization and little institutional involvement. National groups should be created in each country to plan and coordinate pediatric cardiopulmonary resuscitation training and to coordinate with other Iberoamerican countries.

López-Herce J; Carrillo A

2011-09-01

210

Water-soluble graft copolymers of starch-acrylamide and uses therefor  

Energy Technology Data Exchange (ETDEWEB)

Graft copolymers having starch as the central chain with grafted side chains of acrylamide or acrylamide-acrylic acid, and a process for preparation of such copolymers in the presence of Ce.sup.+4 or other redox initiators. These copolymers are employed in preparing highly viscous aqueous solutions that are particularly useful in oil recovery from subterranean wells.

Butler, George B. (Gainesville, FL); Hogen-Esch, Thieo E. (Gainesville, FL); Meister, John J. (Dallas, TX); Pledger, Jr., Huey (Gainesville, FL)

1983-08-23

211

[Pathophysiology of intestinal grafts].  

UK PubMed Central (United Kingdom)

Following the introduction of tacrolimus, intestinal transplantation is now a valid option for patients with chronic intestinalfailure. However, its outcome is undermined by the abundant lymphoid component of the graft and the septic nature of the procedure. The heavy immunosuppression necessitated by this transplant, and its non specific nature, creates a risk of infectious and tumoral complications. Several approaches are being tested to improve the immune tolerance of intestinal grafts, both in animals models and in the clinic. The most promising seek to induce specific tolerance while sparing antimicrobial and antitumoral immunity.

Sarnacki S; Goulet O; Brousse N; Cerf-Bensussan N

2012-02-01

212

Cardiopulmonary bypass in man: role of the intestine in a self-limiting inflammatory response with demonstrable bacterial translocation.  

UK PubMed Central (United Kingdom)

BACKGROUND: Cardiopulmonary bypass provokes a systemic inflammatory reaction that, in 1% to 2% of all cases, leads to multiorgan disfunction. The aim of this study was to evaluate the possible role of the intestine in the pathogenesis and development of this reaction. METHODS: Eleven selected patients scheduled for elective coronary artery bypass graft surgery were enrolled in a open, prospective clinical study. Gastric tonometry, chromium-labeled test and double sugar intestinal absorption tests, polymerase chain reaction microbial DNA test, and measurement of cytokines and transcriptional factor (nuclear factor kappaB) activation were performed. RESULTS: During the postoperative period, gastric pH remained stable (range,7.2 to 7.3). The partial pressure for carbon dioxide gradient between the gastric mucosa and arterial blood increased significantly (from 1 to 23 mm Hg), peaking in the sixth postoperative hour. Interleukin 6 increased significantly over basal levels, peaking 3 hours after cardiopulmonary bypass (96.3 versus 24 pg/mL). Nuclear factor kappaB never reached levels higher than those observed after lipopolysaccharide stimulation. Escherichia coli translocation was documented in 10 patients: in eight cases from removal of aortic cross-clamps and in two cases from the first postoperative hour. With respect to basal value (6.4%), the urine collection revealed a significant increase in excretion of the radioisotope during the first 24 hours after surgery (39.1%), although there were no significant variations with the double sugar test. CONCLUSIONS: The results obtained showed a correlation between the damage of the gastrointestinal mucosa, subsequent increased permeability, E coli bacteremia, and the activation of a self-limited inflammatory response in the absence of significant macrocirculatory changes and postoperative complications.

Rossi M; Sganga G; Mazzone M; Valenza V; Guarneri S; Portale G; Carbone L; Gatta L; Pioli C; Sanguinetti M; Montalto M; Glieca F; Fadda G; Schiavello R; Silveri NG

2004-02-01

213

Direct oxymetric peripheral tissue perfusion monitoring during open heart surgery with the use of cardiopulmonary bypass: preliminary experience.  

UK PubMed Central (United Kingdom)

BACKGROUND: Regional hypoperfusion has been associated with the development of postoperative organ dysfunction in cardiac surgery involving cardiopulmonary bypass (CPB). Direct tissue oxymetry is a potentially new method for monitoring the quality of the peripheral tissue perfusion during CPB. The aim of this study was to assess the effects of CPB in skeletal muscle oxygenation when measured in the deltoid muscle by direct oxymetry during perioperative period. METHOD: Seven patients underwent on-pump coronary artery bypass grafting. Direct oxymetry was performed by an optical cathether introduced into the deltoid muscle. Continuous measurement was made during the surgical procedure and the postoperative period. Mean arterial blood pressure, blood flow during CPB, laboratory markers of tissue hypoperfusion, blood gases and body temperature were also recorded. RESULTS: Interstitial muscle tissue oxygen tension (pO(2)) decreased after the introduction to anaesthesia and, more significantly, during CPB. After the disconnection from CPB at the end of the operation, the pO(2) returned to pre-anaesthetic values. During the first hours after admission of the patients to the intensive care unit, the pO(2) progressively decreased, reached a minimum value after four hours, and increased slowly thereafter. There was a significant correlation of pO(2) with mean arterial blood pressure and blood flow during that time. CONCLUSION: The result of this first measurement seems to demonstrate that the standard technique of conducting cardiopulmonary bypass produces low muscle oxygen tension and, thus, little perfusion of skeletal muscle. The data also indicate that both high mean arterial blood pressure and high flow are necessary during CPB to ensure skeletal muscle perfusion. The investigation is continuing.

Lonsky V; Svitek V; Brzek V; Kubicek J; Volt M; Horak M; Mandak J

2011-11-01

214

Numerical analysis of blood flow distribution in 4- and 3-branch vascular grafts.  

UK PubMed Central (United Kingdom)

Trifurcated arch grafts (3-branch grafts) are now being used to repair the thoracic aorta in addition to conventional arch grafts (4-branch grafts). The anatomical shape of the 3-branch graft is different from the original vessel, so it is necessary for clinical application to evaluate blood flow distribution in the graft to assess whether there is adequate blood flow to the target organs. To achieve this, we developed a computational fluid dynamics (CFD) method to evaluate blood flow distribution in the grafts. Aortic blood flow was measured by phase-contrast magnetic resonance imaging (PC-MRI), and flow distribution into the branched vessels was obtained. The MRI image was used to create a patient-specific image model that represents the geometry of the aortic arch. The CFD analysis method was employed to determine a boundary condition of the blood flow analysis in the aorta using a patient-specific image model. We also created simplified models of 4-branch and 3-branch grafts and used our CFD analysis method to compare blood flow distribution among simplified models. It was found that blood flow distribution in the descending aorta was 71.3 % for the 4-branch graft and 67.7 % for the 3-branch graft, indicating that a sum of branching flow in the 3-branch graft was almost the same as the one in the 4-branch graft. Therefore, there is no major concern about implanting a new 3-branch graft. Our CFD analysis method may be applied to estimate blood flow distribution of a newly developed vascular graft prior to its clinical use and provide useful information for safe use of the graft.

Konoura C; Yagi T; Nakamura M; Iwasaki K; Qian Y; Okuda S; Yoshitake A; Shimizu H; Yozu R; Umezu M

2013-06-01

215

Automatic grafting machine for vegetable  

UK PubMed Central (United Kingdom)

There is disclosed an automatic vegetable grafting machine for vegetable grafting. Its stake clamp, which is on the operating platform, is aligned with the center of the graft clamp. The graft clamp's two explorators positions can be adjusted according to the sprout size one leaf of stake sprout is relied to the exploratory, and scion stalk is relied to the exploratory and is a little bent. The stake and the graft incision fold automatically because of the two knives relative positions on knife-carrier slide and the graft scion bending. Wherein, compression lever and support swing link are separately joined with frame by means of gemels the stake clamp swing link and the graft clamp swing link are contacted with cam and are joined with the support by means of gemels, and control opening or shutting of the stake and the graft incision and up-or-down movement of the lifter and the knife carrier. After cutting, the stake and the graft incision ascend along the stake and the scion until the graft stalk is unbend and automatically fold with the stake sprout incision, then the stake clamp and the graft clamp open and graft is completed. The machine has simple structure and high work efficiency of 600 trees per hour.

GAO YINGWU LI

216

Skin grafting of the penis.  

Science.gov (United States)

Penile skin loss may occur after trauma, infection, or as a result of surgical resection. This article reviews indications for reconstruction of the penile skin, skin anatomy, and skin graft physiology. Choice of reconstructive options, skin grafting techniques, and complications of skin grafting are also discussed. PMID:23905942

Thakar, Hema J; Dugi, Daniel D

2013-06-28

217

Cystocele repair with interpositional grafting.  

Science.gov (United States)

This article discusses a systematic approach to the repair of cystoceles using interposition grafting. Surgeons' opinions vary regarding which graft is most appropriate as there are several varieties for mesh interposition. High-grade cystocele repair using the porcine dermis interposition graft is successful and associated with few complications. Cystocele repair is typically low grade and does not require additional surgery. PMID:21353079

Leu, Patrick B; Scarpero, Harriette M; Dmochowski, Roger R

2011-02-01

218

Cystocele repair with interpositional grafting.  

UK PubMed Central (United Kingdom)

This article discusses a systematic approach to the repair of cystoceles using interposition grafting. Surgeons' opinions vary regarding which graft is most appropriate as there are several varieties for mesh interposition. High-grade cystocele repair using the porcine dermis interposition graft is successful and associated with few complications. Cystocele repair is typically low grade and does not require additional surgery.

Leu PB; Scarpero HM; Dmochowski RR

2011-02-01

219

Skin grafting of the penis.  

UK PubMed Central (United Kingdom)

Penile skin loss may occur after trauma, infection, or as a result of surgical resection. This article reviews indications for reconstruction of the penile skin, skin anatomy, and skin graft physiology. Choice of reconstructive options, skin grafting techniques, and complications of skin grafting are also discussed.

Thakar HJ; Dugi DD 3rd

2013-08-01

220

[Hypothermic cardiopulmonary bypass with circulatory arrest of the lower half of the body and selective perfusion of the upper and lower half of the body for thoracic aortic aneurysm operation  

UK PubMed Central (United Kingdom)

A 62-year-old man with thoracoabdominal aortic aneurysm of Crawford type IA and a 61-year-old woman with triple descending thoracic aortic aneurysms were operated on under total cardiopulmonary bypass with hypothermic circulatory arrest of the lower half of the body (rectal temperature of 17-19 C) and low flow selective perfusion of the upper and lower half of the body. Low porosity woven Dacron UBE grafts without preclotting were used for the replacement of the aorta. Postoperative courses were uneventful without paraplegia and angiographic examination revealed excellent hemodynamic results.

Yagyu K; Ezure M; Takeshita M; Ono M; Tanaka O; Furuse A

1994-05-01

 
 
 
 
221

[Hypothermic cardiopulmonary bypass with circulatory arrest of the lower half of the body and selective perfusion of the upper and lower half of the body for thoracic aortic aneurysm operation].  

Science.gov (United States)

A 62-year-old man with thoracoabdominal aortic aneurysm of Crawford type IA and a 61-year-old woman with triple descending thoracic aortic aneurysms were operated on under total cardiopulmonary bypass with hypothermic circulatory arrest of the lower half of the body (rectal temperature of 17-19 C) and low flow selective perfusion of the upper and lower half of the body. Low porosity woven Dacron UBE grafts without preclotting were used for the replacement of the aorta. Postoperative courses were uneventful without paraplegia and angiographic examination revealed excellent hemodynamic results. PMID:8196241

Yagyu, K; Ezure, M; Takeshita, M; Ono, M; Tanaka, O; Furuse, A

1994-05-01

222

Percutaneous cardiopulmonary support in pulmonary embolism with cardiac arrest.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the role of percutaneous cardiopulmonary support (PCPS) for the resuscitation of patients with massive pulmonary embolism (PE) with circulatory collapse. We also compared outcomes for PCPS between patients with massive PE with circulatory collapse and patients with AMI with cardiogenic shock. BACKGROUND: The effectiveness of PCPS for acute myocardial infarction (AMI) complicated with cardiogenic shock has been reported, but there are few reports on the use of PCPS for massive PE with circulatory collapse. METHOD: We studied 12 consecutive patients with massive PE and 16 patients with AMI, who required PCPS for resuscitation either during cardiopulmonary resuscitation (CPR) or after successful CPR. RESULTS: Twelve patients with PE and 16 patients with AMI were identified. There were no differences in age, the Acute Physiology, Age and Chronic Health Evaluation II (APACHE II) score at admission, rate of cardiac arrest on arrival, and time from first circulatory collapse to PCPS between the two groups. However, the proportion of men with PE (33%) was smaller than those with AMI (87%, p<0.05). The duration of PCPS was shorter in PE (38 h) compared with AMI (83 h, p=0.051) patients. The proportion of patients successfully weaned from PCPS (100% vs. 37.5%, p<0.01), survival rate at discharge (83.3% vs. 12.5%, p<0.001) and good neurological outcome (58.3% vs. 6.3%, p=0.004) was significantly higher for PE compared to AMI patients. CONCLUSION: In our small case series, percutaneous cardiopulmonary support (PCPS) had a life saving role in patients with massive PE and cardiac arrest. PCPS was also more effective in patients with massive PE with cardiac arrest than in patients with AMI and cardiac arrest.

Hashiba K; Okuda J; Maejima N; Iwahashi N; Tsukahara K; Tahara Y; Hibi K; Kosuge M; Ebina T; Endo T; Umemura S; Kimura K

2012-02-01

223

2010 cardiopulmonary resuscitation and emergency cardiovascular care guideline  

Directory of Open Access Journals (Sweden)

Full Text Available Modern resuscitative practice has been developing for half a century. Resuscitation guidelines which are published every five years reflected the international consensus and translated to lots of languages, aimed to be reached all over the world. The main outcome is to optimize the return of spontaneous circulation of cardiac arrest victims without neurologic deficit. This review emphasizes the changes and the differences of the procedures between 2005 and 2010 Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care that are commonly performed in our daily practice.

Serkan SENER; Serpil YAYLACI

2010-01-01

224

Potential wrist ligament injury in rescuers performing cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

Wrist pain in rescuers performing chest compressions as part of cardiopulmonary resuscitation has been reported anecdotally and recently in the literature. Studies have indicated that rescuers apply as much as 644 N of force to the victim's chest with each compression, while standards require one hundred compressions per minute. Recent research suggests that forces transmitted through the rescuers' wrists of less than 10% of those seen during the performance of chest compressions significantly strain the scapholunate ligament. Biomechanical research should be performed to further evaluate this possible correlation. Compensation for worker injury maybe involved.

Curran R; Sorr S; Aquino E

2013-04-01

225

Cardiopulmonary complications during pediatric seizures: a prelude to understanding SUDEP.  

UK PubMed Central (United Kingdom)

PURPOSE: Sudden unexpected death in epilepsy (SUDEP) is an important, unexplained cause of death in epilepsy. Role of cardiopulmonary abnormalities in the pathophysiology of SUDEP is unclear in the pediatric population. Our objective was to assess cardiopulmonary abnormalities during epileptic seizures in children, with the long-term goal of identifying potential mechanisms of SUDEP. METHODS: We prospectively recorded cardiopulmonary functions using pulse-oximetry, electrocardiography (ECG), and respiratory inductance plethysmography (RIP). Logistic regression was used to evaluate association of cardiorespiratory findings with seizure characteristics and demographics. KEY FINDINGS: We recorded 101 seizures in 26 children (average age 3.9 years). RIP provided analyzable data in 78% and pulse-oximetry in 63% seizures. Ictal central apnea was more prevalent in patients with younger age (p = 0.01), temporal lobe (p < 0.001), left-sided (p < 0.01), symptomatic generalized (p = 0.01), longer duration seizures (p < 0.0002), desaturation (p < 0.0001), ictal bradycardia (p < 0.05), and more antiepileptic drugs (AEDs; p < 0.01), and was less prevalent in frontal lobe seizures (p < 0.01). Ictal bradypnea was more prevalent in left-sided (p < 0.05), symptomatic generalized seizures (p < 0.01), and in brain magnetic resonance imaging (MRI) lesions (p < 0.1). Ictal tachypnea was more prevalent in older-age (p = 0.01), female gender (p = 0.05), frontal lobe (p < 0.05), right-sided seizures (p < 0.001), fewer AEDs (p < 0.01), and less prevalent in lesional (p < 0.05) and symptomatic generalized seizures (p < 0.05). Ictal bradycardia was more prevalent in male patients (p < 0.05) longer duration seizures (p < 0.05), desaturation (p = 0.001), and more AEDs (p < 0.05), and was less prevalent in frontal lobe seizures (p = 0.01). Ictal and postictal bradycardia were directly associated (p < 0.05). Desaturation was more prevalent in longer-duration seizures (p < 0.0001), ictal apnea (p < 0.0001), ictal bradycardia (p = 0.001), and more AEDs (p = 0.001). SIGNIFICANCE: Potentially life-threatening cardiopulmonary abnormalities such as bradycardia, apnea, and hypoxemia in pediatric epileptic seizures are associated with predictable patient and seizure characteristics, including seizure subtype and duration.

Singh K; Katz ES; Zarowski M; Loddenkemper T; Llewellyn N; Manganaro S; Gregas M; Pavlova M; Kothare SV

2013-06-01

226

Cardiopulmonary and hemodynamic changes in complement activation-related pseudoallergy  

Directory of Open Access Journals (Sweden)

Full Text Available Complement activation-related pseudoallergy (CARPA) is a frequent side effect of intravenous therapies with nanoparticle-containing drugs and biologicals that are recognized by the immune system as foreign. It is an acute infusion reaction dominated by cutaneous and hemodynamic changes, most significantly a cardiopulmonary distress involving major pulmonary hypertension, systemic hypotension and arrhythmias. Because CARPA is unpredictable by conventional allergy tests and it may be life threatening, it can represent a major barrier to the safe therapeutic application of many modern medicines, including liposomal drugs and monoclonal antibodies. This review summarizes and updates the facts and opens questions regarding this phenomenon, with particular focus on its porcine model.

László Dézsi; Gábor Szénási; Rudolf Urbanics; László Rosivall; János Szebeni

2013-01-01

227

Challenges encountered with argatroban anticoagulation during cardiopulmonary bypass  

Science.gov (United States)

Use of argatroban as an alternative to heparin during cardiopulmonary bypass (CPB) in patients with heparin-induced thrombocytopenia has gained some attention in the past two decades. Dosing of argatroban during CPB is complex due to lack of complete understanding of its pharmacokinetic profile and the various elements during CPB that may alter its plasma levels. We report a case where the challenges in dosing argatroban led to failure to provide adequate anticoagulation during CPB, as evidenced by clot formation in the oxygenator, and extensive bleeding in the postoperative period.

Agarwal, Shvetank; Ullom, Beth; Al-Baghdadi, Yasser; Okumura, Michael

2012-01-01

228

Challenges encountered with argatroban anticoagulation during cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Use of argatroban as an alternative to heparin during cardiopulmonary bypass (CPB) in patients with heparin-induced thrombocytopenia has gained some attention in the past two decades. Dosing of argatroban during CPB is complex due to lack of complete understanding of its pharmacokinetic profile and the various elements during CPB that may alter its plasma levels. We report a case where the challenges in dosing argatroban led to failure to provide adequate anticoagulation during CPB, as evidenced by clot formation in the oxygenator, and extensive bleeding in the postoperative period.

Agarwal S; Ullom B; Al-Baghdadi Y; Okumura M

2012-01-01

229

Therapeutic hypothermia after prolonged cardiopulmonary resuscitation for pulseless electrical activity.  

Science.gov (United States)

We report an 18-year-old female patient with cardiac arrest due to pulseless electrical activity caused by a massive pulmonary embolism. Cardiopulmonary resuscitation was continued for more than one hour. Although the initial clinical signs and symptoms suggested poor outcome, immediate intravenous thrombolysis was instituted. After return of spontaneous circulation (75 minutes) the patient was still comatose and mild therapeutic hypothermia (32.5 degrees C) was instituted for brain protection during the first 24 hours. She recovered uneventfully without neurological deficit. Therapeutic hypothermia may be effective for neuroprotection in non-VFcardiac arrest. PMID:17293639

Bartels, M; Tjan, D H T; Reussen, E M; van Zanten, A R H

2007-01-01

230

Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study  

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Full Text Available Abstract Introduction Excessive bleeding (EB) after cardiopulmonary bypass (CPB) may lead to increased mortality, morbidity, transfusion requirements and re-intervention. Less than 50% of patients undergoing re-intervention exhibit surgical sources of bleeding. We studied clinical and genetic factors associated with EB. Methods We performed a nested case-control study of 26 patients who did not receive antifibrinolytic prophylaxis. Variables were collected preoperatively, at intensive care unit (ICU) admission, at 4 and 24 hours post-CPB. EB was defined as 24-hour blood loss of >1 l post-CPB. Associations of EB with genetic, demographic, and clinical factors were analyzed, using SPSS-12.2 for statistical purposes. Results EB incidence was 50%, associated with body mass index (BMI)2, (P = 0.03), lower preoperative levels of plasminogen activator inhibitor-1 (PAI-1) (P = 0.01), lower body temperature during CPB (P = 0.037) and at ICU admission (P = 0.029), and internal mammary artery graft (P = 0.03) in bypass surgery. We found a significant association between EB and 5G homozygotes for PAI-1, after adjusting for BMI (F = 6.07; P = 0.02) and temperature during CPB (F = 8.84; P = 0.007). EB patients showed higher consumption of complement, coagulation, fibrinolysis and hemoderivatives, with significantly lower leptin levels at all postoperative time points (P = 0.01, P P Conclusion Excessive postoperative bleeding in CPB patients was associated with demographics, particularly less pronounced BMI, and surgical factors together with serine protease activation.

Jimenez Rivera Juan J; Iribarren Jose L; Raya Jose M; Nassar Ibrahim; Lorente Leonardo; Perez Rosalia; Brouard Maitane; Lorenzo Jose M; Garrido Pilar; Barrios Ysamar; Diaz Maribel; Alarco Blas; Martinez Rafael; Mora Maria L

2007-01-01

231

Risks for impaired cerebral autoregulation during cardiopulmonary bypass and postoperative stroke.  

UK PubMed Central (United Kingdom)

BACKGROUND: Impaired cerebral autoregulation may predispose patients to cerebral hypoperfusion during cardiopulmonary bypass (CPB). The purpose of this study was to identify risk factors for impaired autoregulation during coronary artery bypass graft, valve surgery with CPB, or both and to evaluate whether near-infrared spectroscopy (NIRS) autoregulation monitoring could be used to identify this condition. METHODS: Two hundred and thirty-four patients were monitored with transcranial Doppler and NIRS. A continuous, moving Pearson's correlation coefficient was calculated between mean arterial pressure (MAP) and cerebral blood flow (CBF) velocity, and between MAP and NIRS data, to generate the mean velocity index (Mx) and cerebral oximetry index (COx), respectively. Functional autoregulation is indicated by an Mx and COx that approach zero (no correlation between CBF and MAP); impaired autoregulation is indicated by an Mx and COx approaching 1. Impaired autoregulation was defined as an Mx ?0.40 at all MAPs during CPB. RESULTS: Twenty per cent of patients demonstrated impaired autoregulation during CPB. Based on multivariate logistic regression analysis, time-averaged COx during CPB, male gender, Pa(CO(2)), CBF velocity, and preoperative aspirin use were independently associated with impaired CBF autoregulation. Perioperative stroke occurred in six of 47 (12.8%) patients with impaired autoregulation compared with five of 187 (2.7%) patients with preserved autoregulation (P=0.011). CONCLUSIONS: Impaired CBF autoregulation occurs in 20% of patients during CPB. Patients with impaired autoregulation are more likely than those with functional autoregulation to have perioperative stroke. Non-invasive monitoring autoregulation may provide an accurate means to predict impaired autoregulation. Clinical trials registration. www.clinicaltrials.gov (NCT00769691).

Ono M; Joshi B; Brady K; Easley RB; Zheng Y; Brown C; Baumgartner W; Hogue CW

2012-09-01

232

LIFEBRIDGE B2T--a new portable cardiopulmonary bypass system.  

UK PubMed Central (United Kingdom)

The LIFEBRIDGE B2T is a new portable cardiopulmonary bypass (CPB) system designed for temporary circulatory support. The LIFEBRIDGE B2T consists of a disposable patient unit with a CPB circuit, a control, and a base unit. The system weighs 20 kg. We used the LIFEBRIDGE B2T in four patients for circulatory support in beating heart coronary artery bypass graft for complete revascularization. The LIFEBRIDGE B2T was connected via femoral cannulation. Concentrations of free hemoglobin (fHb), interleukin (IL)-6, and -8 were measured. For venous blood drainage, 22-24 Fr cannulae and for arterial cannulation, 16-20 Fr cannulae were used. Average extracorporeal circulation (ECC) time was 61 +/- 18 minutes. During circulatory support, the system delivered an arterial blood flow between 3.1 and 4.1 L/min. The negative pressure at the venous drainage was between -79 and -45 mm Hg. During circulatory support, fHb concentration increased from 5.8 +/- 1.7 mg/dL to a maximum of 10.2 +/- 6.2 mg/dL. Also, IL-6 and -8 increased from 2.1 +/- 0.06 to 503.3 +/- 400.7 U/L and 5.9 +/- 0.9 to 66.5 +/- 46.8 U/L, respectively. The LIFEBRIDGE B2T is a new portable and safe circulatory support system. Connected via femoral cannulation, the system provides adequate arterial blood flow and an acceptable negative pressure at the venous cannula. The fHb concentration showed only a moderate increase during ECC.

Krane M; Mazzitelli D; Schreiber U; Garzia AM; Braun S; Voss B; Badiu CC; Brockmann G; Lange R; Bauernschmitt R

2010-01-01

233

Cardiopulmonary bypass alters the pharmacokinetics of propranolol in patients undergoing cardiac surgery  

Directory of Open Access Journals (Sweden)

Full Text Available The pharmacokinetics of propranolol may be altered by hypothermic cardiopulmonary bypass (CPB), resulting in unpredictable postoperative hemodynamic responses to usual doses. The objective of the present study was to investigate the pharmacokinetics of propranolol in patients undergoing coronary artery bypass grafting (CABG) by CPB under moderate hypothermia. We evaluated 11 patients, 4 women and 7 men (mean age 57 ± 8 years, mean weight 75.4 ± 11.9 kg and mean body surface area 1.83 ± 0.19 m²), receiving propranolol before surgery (80-240 mg a day) and postoperatively (10 mg a day). Plasma propranolol levels were measured before and after CPB by high-performance liquid chromatography. Pharmacokinetic Solutions 2.0 software was used to estimate the pharmacokinetic parameters after administration of the drug pre- and postoperatively. There was an increase of biological half-life from 4.5 (95% CI = 3.9-6.9) to 10.6 h (95% CI = 8.2-14.7; P < 0.01) and an increase in volume of distribution from 4.9 (95% CI = 3.2-14.3) to 8.3 l/kg (95% CI = 6.5-32.1; P < 0.05), while total clearance remained unchanged 9.2 (95% CI = 7.7-24.6) vs 10.7 ml min-1 kg-1 (95% CI = 7.7-26.6; NS) after surgery. In conclusion, increases in drug distribution could be explained in part by hemodilution during CPB. On the other hand, the increase of biological half-life can be attributed to changes in hepatic metabolism induced by CPB under moderate hypothermia. These alterations in the pharmacokinetics of propranolol after CABG with hypothermic CPB might induce a greater myocardial depression in response to propranolol than would be expected with an equivalent dose during the postoperative period.

M.J.C. Carmona; L.M.S. Malbouisson; V.A. Pereira; M.A. Bertoline; C.E.K. Omosako; K.B. Le Bihan; J.O.C. Auler Jr.; S.R.C.J. Santos

2005-01-01

234

Improved red blood cell survival after cardiac operations with administration of urea during cardiopulmonary bypass  

International Nuclear Information System (INIS)

The plasma hemoglobin and red blood cell survival (half-life of 51Cr) was studied in 48 patients undergoing single valve replacement or coronary artery bypass graft. Urea or placebo was administered during cardiopulmonary bypass in a prospective, randomized, double-blind manner to test the potential effect on mechanical hemolysis. The mean plasma hemoglobin level at the end of extracorporeal circulation was significantly lower in the urea-treated groups (coronary artery bypass 342 mg/L; valve replacement 364 mg/L) than in the control groups (coronary artery bypass 635 mg/L, valve replacement 518 mg/L. The half-life of 51Cr was significantly longer in the urea-treated patients (coronary artery bypass 18 days; valve replacement 16 days) than in the control groups (coronary artery bypass 12.4 days; valve replacement 12.7 days) but still below the normal reference value (29 +/- 4 days). The plasma hemoglobin returned to near normal values (50 mg/L) the day after operation (day 1) and remained low with no differences between control and urea-treated groups. The total blood hemoglobin was followed for 2 weeks after operation and showed significantly less anemia in the urea-treated group. The lowest mean blood hemoglobin level was noted between days 5 and 9-114 (coronary artery bypass) and 107 (valve replacement) gm/L in the urea-treated patients compared to 92.3 gm/L in the control subjects. The reduction in the severity of the anemia led to less transfusion in the urea-treated patients (approximately 0.5 unit/patient) than in the control subjects (approximately 1 unit/patient) between days 3 and 14.

1985-01-01

235

Improved red blood cell survival after cardiac operations with administration of urea during cardiopulmonary bypass  

Energy Technology Data Exchange (ETDEWEB)

The plasma hemoglobin and red blood cell survival (half-life of /sup 51/Cr) was studied in 48 patients undergoing single valve replacement or coronary artery bypass graft. Urea or placebo was administered during cardiopulmonary bypass in a prospective, randomized, double-blind manner to test the potential effect on mechanical hemolysis. The mean plasma hemoglobin level at the end of extracorporeal circulation was significantly lower in the urea-treated groups (coronary artery bypass 342 mg/L; valve replacement 364 mg/L) than in the control groups (coronary artery bypass 635 mg/L, valve replacement 518 mg/L. The half-life of /sup 51/Cr was significantly longer in the urea-treated patients (coronary artery bypass 18 days; valve replacement 16 days) than in the control groups (coronary artery bypass 12.4 days; valve replacement 12.7 days) but still below the normal reference value (29 +/- 4 days). The plasma hemoglobin returned to near normal values (50 mg/L) the day after operation (day 1) and remained low with no differences between control and urea-treated groups. The total blood hemoglobin was followed for 2 weeks after operation and showed significantly less anemia in the urea-treated group. The lowest mean blood hemoglobin level was noted between days 5 and 9-114 (coronary artery bypass) and 107 (valve replacement) gm/L in the urea-treated patients compared to 92.3 gm/L in the control subjects. The reduction in the severity of the anemia led to less transfusion in the urea-treated patients (approximately 0.5 unit/patient) than in the control subjects (approximately 1 unit/patient) between days 3 and 14.

Roberts, D.; Bake, B.; William-Olsson, G.

1985-01-01

236

Comparative study of pulsatile and nonpulsatile flow during cardio-pulmonary bypass.  

UK PubMed Central (United Kingdom)

The use of nonpulsatile flow during extracorporeal circulation remains popular despite theoretical advantages of pulsatile cardiopulmonary bypass (CPB). Pulsatile CPB is considered to be more physiological than nonpulsatile flow as the pulsatile energy ensures the patency of the vascular bed and mechanical motion of tissue fluid around the cell membrane, improves microcirculation and enhances diffusion. The purpose of this study was to compare the effect of pulsatile and nonpulsatile flow on the coagulation profile, liver and kidney function and also on the haemodynamics in patients undergoing coronary artery bypass grafting on CPB. One hundred patients between 35 and 65 years of age with normal left ventricular function were randomly divided into two equal groups: Pulsatile (P) and nonpulsatile (NP). Haematological parameters, clotting profile, renal parameters, hepatic function tests and haemodynamic variables were measured preoperatively and postoperatively at specific intervals. Surgical, anaesthetic and CPB regimen was standard in all cases. There was a decrease in platelet count during and after CPB in both groups. Coagulation profile and renal function parameters remained similar in both groups except that creatinine clearance was better in group P on the first postoperative day. Urine output was also better in group P. There was no change in liver function tests in both groups. The haemodynamic variables were comparable in both groups. The systemic vascular resistance was higher in group NP postoperatively and oxygen consumption was higher in group P post CPB. In conclusion we did not find any significant difference between pulsatile and nonpulsatile flow during CPB except the creatinine clearance and urine output were better in pulsatile group.

Poswal P; Mehta Y; Juneja R; Khanna S; Meharwal ZS; Trehan N

2004-01-01

237

Vascular graft infections.  

UK PubMed Central (United Kingdom)

Vascular procedures are rarely complicated by infection, but if prosthetic vascular graft infection (PVGI) occurs, morbidity and mortality are high. Several patient-related, surgery-related and postoperative risk factors are reported, but they are not well validated. PVGI is due to bacterial colonisation of the wound and the underlying prosthetic graft, generally as a result of direct contamination during the operative procedure, mainly from the patient's skin or adjacent bowel. There is no consensus on diagnostic criteria or on the best management of PVGI. On the basis of reported clinical studies and our own experience, we advocate a surgical approach combining repeated radical local debridement, with graft preservation whenever possible or partial excision of the infected graft, depending on its condition, plus simultaneous negative-pressure wound therapy (NPWT). In addition, antimicrobial therapy is recommended, but there is no consensus on which classes of agent are adequate for the treatment of PVGI and whether certain infections may be treated by means of NPWT alone. Since staphylococci and Gram-negative rods are likely to be isolated, empirical treatment might include a penicillinase-resistant beta-lactam or a glycopeptide, plus an aminoglycoside, the latter for Gram-negative coverage and synergistic treatment of Gram-positive cocci. Additionally, empirical treatment might include rifampicin since it penetrates well into biofilms.

Hasse B; Husmann L; Zinkernagel A; Weber R; Lachat M; Mayer D

2013-01-01

238

Vascular graft infections.  

Science.gov (United States)

Vascular procedures are rarely complicated by infection, but if prosthetic vascular graft infection (PVGI) occurs, morbidity and mortality are high. Several patient-related, surgery-related and postoperative risk factors are reported, but they are not well validated. PVGI is due to bacterial colonisation of the wound and the underlying prosthetic graft, generally as a result of direct contamination during the operative procedure, mainly from the patient's skin or adjacent bowel. There is no consensus on diagnostic criteria or on the best management of PVGI. On the basis of reported clinical studies and our own experience, we advocate a surgical approach combining repeated radical local debridement, with graft preservation whenever possible or partial excision of the infected graft, depending on its condition, plus simultaneous negative-pressure wound therapy (NPWT). In addition, antimicrobial therapy is recommended, but there is no consensus on which classes of agent are adequate for the treatment of PVGI and whether certain infections may be treated by means of NPWT alone. Since staphylococci and Gram-negative rods are likely to be isolated, empirical treatment might include a penicillinase-resistant beta-lactam or a glycopeptide, plus an aminoglycoside, the latter for Gram-negative coverage and synergistic treatment of Gram-positive cocci. Additionally, empirical treatment might include rifampicin since it penetrates well into biofilms. PMID:23348860

Hasse, Barbara; Husmann, Lars; Zinkernagel, Annelies; Weber, Rainer; Lachat, Mario; Mayer, Dieter

2013-01-24

239

Slicing, skinning, and grafting  

CERN Multimedia

We prove that a Bers slice is never algebraic, meaning that its Zariski closure in the character variety has strictly larger dimension. A corollary is that skinning maps are never constant. The proof uses grafting and the theory of complex projective structures.

Dumas, David

2007-01-01

240

The graft selection for haemodialysis.  

UK PubMed Central (United Kingdom)

BACKGROUND: In patients with chronic renal failure, a major concern is to provide safe and reliable long-term vascular access for haemodialysis. The radiocephalic arteriovenous (AV) fistula remains the first choice vascular access procedure, however the grafts are used in order to obtain vascular access in patients with failed native distal and proximal AV fistulas. The aim of this study was to compare the patency rate of different grafts such as standard wall polytetrafluoroethylene (sPTFE), bovine vein graft, Diastat graft, in these patients. PATIENTS AND METHODS: Four hundred and forty-six AV fistulas were surgically created in 361 patients. Eighty-four out of 361 patients undergoing different graft replacements were retrospectively reviewed. We evaluated the primary patency rates, days between the fistula placement and the last dialysis treatment before thrombosis had occurred, and the secondary patency rate, days between the fistula placement and the last dialysis treatment before the graft was considered completely lost. The graft survival was calculated according to the Kaplan-Meier method. RESULTS: There were 58 (69%) women and 26 (31%) men with a mean age of 54.5 years. The sPTFE (Gore-Tex) graft was used in 41 (41.8%), bovine vein graft (ProCol) in 38 (38.7%) and Diastat vascular grafts in 19 (19.5%) patients. Primary and secondary patency rates for sPTFE graft were 37% and 60%, 68% and 85% for bovine graft and 26% and 42% for Diastat vascular grafts, respectively. CONCLUSIONS: This study demonstrates that the bovine vein graft provides the longest patency rate compared to the other grafts even in patients with multiple failed accesses.

Senkaya I; Aytac II; Eercan AK; Aliosman A; Percin B

2003-11-01

 
 
 
 
241

An initial evaluation of post-cardiopulmonary bypass acute kidney injury in swine.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Acute kidney injury (AKI) post-cardiac surgery is associated with mortality rates approaching 20%. The development of effective treatments is hindered by the poor homology between rodent models, the mainstay of research into AKI, and that which occurs in humans. This pilot study aims to characterise post-cardiopulmonary bypass (CPB) AKI in an animal model with potentially greater homology to cardiac surgery patients. METHODS AND RESULTS: Adult pigs, weighing 50-75 kg, underwent 2.5 h of CPB. Pigs undergoing saphenous vein grafting procedures served as controls. Pre-CPB measures of porcine renal function were within normal ranges for adult humans. The effect of CPB on renal function; a 25% reduction in (51)Cr-EDTA clearance (p=0.068), and a 33% reduction in creatinine clearance (p=0.043), was similar to those reported in clinical studies. CPB resulted in tubular epithelial injury (median NAG/creatinine ratio 2.6 u mmol(-1) (interquartile range (IQR): 0.81-5.43) post-CPB vs 0.48 u mmol(-1) (IQR: 0.37-0.97) pre-CPB, p=0.043) as well as glomerular and/or proximal tubular injury (median albumin/creatinine ratio 6.8 mg mmol(-1) (IQR: 5.45-13.06) post-CPB vs 1.10 mg mmol(-1) (IQR: 0.05-2.00) pre-CPB, p=0.080). Tubular injury scores were significantly higher in kidneys post-CPB (median score 2.0 (IQR: 1.0-2.0) relative to vein graft controls (median score 1.0 (IQR 1.0-1.0), p=0.019). AKI was associated with endothelial injury and activation, as demonstrated by reduced DBA (dolichos biflorus agglutinin) lectin and increased endothelin-1 and vascular cell adhesion molecule (VCAM) staining. CONCLUSIONS: The porcine model of post-CPB AKI shows significant homology to AKI in cardiac surgical patients. It links functional, urinary and histological measures of kidney injury and may offer novel insights into the mechanisms underlying post-CPB AKI.

Murphy GJ; Lin H; Coward RJ; Toth T; Holmes R; Hall D; Angelini GD

2009-11-01

242

Stent-grafts improve secondary patency of failing hemodialysis grafts.  

UK PubMed Central (United Kingdom)

PURPOSE: Failing hemodialysis grafts continue to pose a challenge in the care of patients with end-stage renal disease (ESRD). We review our experience using percutaneous stent-grafts for the treatment of venous outflow stenosis and occlusion in order to assess their efficacy in nonautologous graft salvage. METHODS: This is a retrospective review of patients treated with percutaneous Viabahn® stent-grafts for failing hemodialysis arteriovenous grafts (AVGs), between 6/2006 and 12/2009. All stent-grafts were deployed across the venous anastomosis to address the outflow obstruction. Patency and re-intervention rates were estimated using Kaplan-Meier analysis. RESULTS: Twenty patients had stent-grafts placed. Successful stent-grafting was defined as <30% residual stenosis and the ability to dialyze through the graft post-treatment. Technical success for stent-grafting was 100%. Median follow-up was 23 months (range 3 to 37 months). Stent-graft patency at 6 months: 94.7%, 12 months: 94.7%, 18 months: 82.1%, 24 months: 82.1%, 36 months: 82.1%. Freedom from re-intervention was 69% at 24 months and 50% at 36 months. Two AVGs failed and had to be removed without further interventions, because of complete occlusion and infection. Two patients (10%) required re-intervention for arterial inflow stenosis. One patient (5%) required balloon angioplasty and stenting of stenosis distal to the stent-graft. One patient (5%) developed in-stent stenosis and was treated with placement of a new stent. Graft salvage rate was 80% at 36 months. CONCLUSIONS: Stent-grafts can be successfully used to improve freedom from re-intervention rates and overall patency rates of failing AVGs.

Davila Santini L; Etkin Y; Nadelson AJ; Safa T

2012-01-01

243

Quantification of extracorporeal white cell and platelet deposition in cardiopulmonary bypass: comparison of membrane and bubble oxygenators.  

UK PubMed Central (United Kingdom)

Cardiopulmonary bypass is known to activate both white cells and platelets. The aim of this study was to investigate whether the use of bubble and membrane oxygenators results in different degrees of deposition in the filter and oxygenator of the bypass circuit. Dual-isotope imaging techniques were employed, with white cells labelled with 99Tcm and platelets with 111In, and with subsequent imaging of the filters and oxygenators on a gamma camera fitted with a medium-energy, parallel-hole collimator, relative to a known standard. The percentage white cell oxygenator deposition ranged from 0.011 to 4.91% in the bubble group (n = 20) and was not different from the membrane group (0.001 to 4.22%). Similarly, no difference in platelet deposition was found, with 0.605-45.17% deposited in the bubble oxygenators and 0.001-15.26% deposited in the membrane oxygenators. Filter deposition of both types of cell was substantially lower in both membrane and bubble groups with no difference between groups. The striking feature of the data is the non-normal distribution of the deposition in both types of oxygenator. This study demonstrated that both white cell and platelet deposition in the cardiopulmonary bypass circuit can be quantified using radiolabelled cells. No differences in oxygenator or filter deposition were found in patients randomly allocated to membrane or bubble oxygenation.

Martin W; McQuiston AM; Tweddel AC; Wheatley DJ

1996-05-01

244

Quantification of extracorporeal white cell and platelet deposition in cardiopulmonary bypass: comparison of membrane and bubble oxygenators.  

Science.gov (United States)

Cardiopulmonary bypass is known to activate both white cells and platelets. The aim of this study was to investigate whether the use of bubble and membrane oxygenators results in different degrees of deposition in the filter and oxygenator of the bypass circuit. Dual-isotope imaging techniques were employed, with white cells labelled with 99Tcm and platelets with 111In, and with subsequent imaging of the filters and oxygenators on a gamma camera fitted with a medium-energy, parallel-hole collimator, relative to a known standard. The percentage white cell oxygenator deposition ranged from 0.011 to 4.91% in the bubble group (n = 20) and was not different from the membrane group (0.001 to 4.22%). Similarly, no difference in platelet deposition was found, with 0.605-45.17% deposited in the bubble oxygenators and 0.001-15.26% deposited in the membrane oxygenators. Filter deposition of both types of cell was substantially lower in both membrane and bubble groups with no difference between groups. The striking feature of the data is the non-normal distribution of the deposition in both types of oxygenator. This study demonstrated that both white cell and platelet deposition in the cardiopulmonary bypass circuit can be quantified using radiolabelled cells. No differences in oxygenator or filter deposition were found in patients randomly allocated to membrane or bubble oxygenation. PMID:8736513

Martin, W; McQuiston, A M; Tweddel, A C; Wheatley, D J

1996-05-01

245

Lipid peroxidation and nitric oxide metabolites in sedentary subjects and sportsmen before and after a cardiopulmonary test.  

UK PubMed Central (United Kingdom)

Our aim was to investigate the effects of an exercise test on some indices of oxidative status and endothelial function, in trained and untrained subjects. We examined lipid peroxidation, nitric oxide metabolites (NOx) and their ratio before and after a cardiopulmonary test, using a cycloergometer. We enrolled 60 male subjects who practiced sport unprofessionally, subdivided in two groups (A and B) according to the values of VO2max. Group A included sportsmen with poor or fair aerobic fitness (VO2max <39 ml/Kg/min), group B sportsmen with average to excellent aerobic fitness (VO2max >39 ml/Kg/min). The control group included 19 male sedentary subjects. Lipid peroxidation was evaluated by detection of the thiobarbituric acid-reactive substances (TBARS); the NOx were evaluated employing the Griess reagent. At rest, in comparison with sedentary controls, an increase in TBARS, NOx and TBARS/NOx ratio was found in all sportsmen and partially in the two groups. After the cardiopulmonary test, the increase of TBARS and TBARS/NOx ratio was significantly more evident in sedentary controls than in sportsmen. No variation was observed for NOx in any group. These data suggest that sportsmen are protected against the acute oxidative stress induced by an exercise test, and that protection is not strictly dependent on the aerobic fitness.

Lo Presti R; Canino B; Montana M; Caimi G

2013-01-01

246

[New recommendations in European cardiopulmonary resuscitation guidelines (Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 2000: an International Consensus on Science].  

UK PubMed Central (United Kingdom)

The article presents most important changes in international guidelines for adult cardiopulmonary resuscitation. In this article guideline changes in basic and advanced life support published in Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care--a Consensus on Science are discussed. Major changes in guidelines presented in this article include: pulse check, ventilation technique for rescue breathing, compression technique, abdominal thrust recommendations, precordial thump, universal algorithm changes.

Jakubaszko J; Smereka J; Sehn M

2002-01-01

247

Education for Employment: Realizing Arab Youth Employment  

Science.gov (United States)

The Arab world is "overwhelmingly young", and the human potential throughout the area is tremendous. Recent events across the region have "amplified the social and economic disconnect between skills, jobs, and opportunity." To address this situation, a group of organizations (including the Islamic Development Bank), started the Education for Employment (e4e) initiative. The basic goal of the initiative is to position "education as a major priority to drive improved employment prospects." On their website, visitors can look over a brief summary of their work, and also look over their report from April 2011. The report is based on 200 in-depth interviews and surveys of over 1500 employers and 1500 youth throughout the region. Visitors can download the 150 page report, or view the executive summary here in Arabic or English. The report's chapters include "Perspectives of e4e Stakeholders" and "The e4e Challenge in the Arab World".

248

Graduate Identity and Employability  

Science.gov (United States)

|This paper develops the concept of graduate identity as a way of deepening the understanding of graduate employability. It does this through presenting research in which over 100 employers in East Anglia were asked to record their perceptions of graduates in respect of their employability. The findings suggest a composite and complex graduate…

Hinchliffe, Geoffrey William; Jolly, Adrienne

2011-01-01

249

Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Optimizing blood pressure using near-infrared spectroscopy monitoring has been suggested to ensure organ perfusion during cardiac surgery. Near-infrared spectroscopy is a reliable surrogate for cerebral blood flow in clinical cerebral autoregulation monitoring and might provide an earlier warning of malperfusion than indicators of cerebral ischemia. We hypothesized that blood pressure below the limits of cerebral autoregulation during cardiopulmonary bypass would be associated with major morbidity and operative mortality after cardiac surgery. METHODS: Autoregulation was monitored during cardiopulmonary bypass in 450 patients undergoing coronary artery bypass grafting and/or valve surgery. A continuous, moving Pearson's correlation coefficient was calculated between the arterial pressure and low-frequency near-infrared spectroscopy signals and displayed continuously during surgery using a laptop computer. The area under the curve of the product of the duration and magnitude of blood pressure below the limits of autoregulation was compared between patients with and without major morbidity (eg, stroke, renal failure, mechanical lung ventilation >48 hours, inotrope use >24 hours, or intra-aortic balloon pump insertion) or operative mortality. RESULTS: Of the 450 patients, 83 experienced major morbidity or operative mortality. The area under the curve of the product of the duration and magnitude of blood pressure below the limits of autoregulation was independently associated with major morbidity or operative mortality after cardiac surgery (odds ratio, 1.36; 95% confidence interval, 1.08-1.71; P = .008). CONCLUSIONS: Blood pressure management during cardiopulmonary bypass using physiologic endpoints such as cerebral autoregulation monitoring might provide a method of optimizing organ perfusion and improving patient outcomes from cardiac surgery.

Ono M; Brady K; Easley RB; Brown C; Kraut M; Gottesman RF; Hogue CW Jr

2013-09-01

250

The association of hemodilution and transfusion of red blood cells with biochemical markers of splanchnic and renal injury during cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

BACKGROUND: Hemodilution is the main cause of a low hematocrit concentration during cardiopulmonary bypass. This low hematocrit may be insufficient for optimal tissue oxygen delivery and often results in packed cell transfusion. Our objective in this study was to find a relationship between intraoperative hematocrit and allogeneic blood transfusion on release of postoperative injury markers from the kidneys and the splanchnic area. METHODS: Fifty consecutive patients undergoing coronary artery bypass grafting with cardiopulmonary bypass were included. Systemic tissue hypoxia was assessed by lactate concentrations. Kidney and splanchnic ischemia were assessed by the measurement of N-acetyl-beta-D-glucosaminidase (NAG) and intestinal fatty acid binding protein (IFABP) in urine. Patients were retrospectively placed into groups according to their lowest hematocrit concentration on bypass (<24% or >or=24%). RESULTS: The intraoperative lactate and the postoperative NAG and IFABP concentrations were higher in the low hematocrit group (<24%) than in the high hematocrit group (>or=24%; P < 0.05). Low hematocrit correlated with higher lactate concentrations (R(2) = 0.150, P < 0.01) and with higher NAG concentrations (R(2) = 0.138, P < 0.01) and IFABP concentrations (R(2) = 0.107, P < 0.01) postoperatively. Transfusion of packed cells during cardiopulmonary bypass correlated with higher lactate (R(2) = 0.089, P < 0.05), NAG (R(2) = 0.431, P < 0.01), and IFABP concentrations (R(2) = 0.189, P < 0.01). CONCLUSIONS: The results support the concept that hemodilution below an intraoperative hematocrit of 24% and consequently transfusion of red blood cells is related to release of injury markers of the kidneys and splanchnic area.

Huybregts RA; de Vroege R; Jansen EK; van Schijndel AW; Christiaans HM; van Oeveren W

2009-08-01

251

Leukocyte-Aprotinin Atrial Fibrillation Study (LAFFS): Impact of Aprotinin and Leukofiltration on Atrial Fibrillation, Renal Insufficiency and Encephalopathy Post-Cardiopulmonary Bypass  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Purpose:  Atrial fibrillation remains the leading postoperative complication following cardiopulmonary bypass.  A randomized trial was undertaken to evaluate the effectiveness of leukocyte filtration and aprotinin, applied separately and in combination, on the incidence of post-operative atrial fibrillation.   A secondary component of the study was the impact of these adjunct interventions on post-surgical renal and neurological dysfunction. Methods:  A total of 1,220 patients undergoing primary isolated coronary artery bypass grafting were randomly assigned to one of four treatment groups.  The control group (305 patients) received standard cardiopulmonary bypass with moderately hypothermic (34ºC) cardioplegic arrest.  In the filtration group (310 patients) leukocyte reducing filters were incorporated into the bypass circuit.  The aprotinin group (285 patients) received full Hammersmith dose aprotinin.  The combination therapy group (320 patients) received both aprotinin and leukocyte filtration. Results:  The incidences of atrial fibrillation were 25% in the control group, 16% in the filtration group, 19% in the aprotinin group and 10% in the combination therapy group (P < 0.001).  Renal dysfunction was detected in 3% of the control group, 2% of the filtration group, 8% of the aprotinin group, and 5% of the combination group (P < 0.005).  Neurological dysfunction occurred in 2% of the control group, 2% of the filtration group, 1% of the aprotinin group, and 2% of the combination group (P = n.s.). Conclusions: Combination therapy with aprotinin and leukocyte filtration markedly reduced atrial fibrillation post-cardiopulmonary bypass, and was more effective than the individual treatments.  Aprotinin treatment increased the incidence of renal dysfunction, and the addition of leukocyte filtration partially mitigated this detrimental effect of aprotinin.

Albert H. O-Yurvati; Steven Rodriguez; Glen Bell; Damon Kennedy; Robert T. Mallet

2008-01-01

252

[Modified total arch replacement plus stented elephant trunk implantation in acute type A aortic dissection: open single-branched stent graft placement].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To explore the feasibility of open single-branched stent graft placement for simplified total arch replacement in acute Stanford type A aortic dissection. METHODS: Between June 2008 and September 2009, 23 patients with acute Stanford type A aortic dissection underwent total arch replacement plus open single-branched stent graft placement. When core nasopharyngeal temperature dropped to 68 H, the perfusion to lower body was discontinued. Left common carotid artery was transected at its ostium and its proximal stump closed. The arch was transected at a predetermined line between innominate artery and left common carotid artery. Through a transverse incision, the main stent graft of single-branched stent graft was inserted into true lumen of descending aorta. And the side arm stent graft was positioned into left subclavian artery. The transected stump of arch was reconstructed by inner proximal stent-free Dacron tube of main graft and outer Teflon felt. Subsequently continuous anastomosis was made to a 3-branched Dacron tube graft. RESULTS: Open single-branched stent graft placement was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time, lower body arrest time and selective cerebral perfusion time were (161 ± 32), (97 ± 20), (21 ± 4) and (31 ± 6) min respectively. All patients were discharged from hospital without any complication. Their computed tomographic scans at 3 months postoperatively showed that all stent grafts were fully opened and not kinked. There was neither space nor blood flow surrounding the single-branched stent graft. The false lumen of descending aorta around stent graft closed with thrombus in all cases. CONCLUSION: Open single-branched stent graft placement is a new effective technique for simplified total arch replacement in acute type A aortic dissection. With this technique, the left subclavian artery anastomosis and distal aortic anastomosis at descending aorta can be avoided.

Chen LW; Lu L; Dai XF; Zhang GC; Cao H; Yang GF

2011-12-01

253

Clinical outcomes of coronary revascularization without cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Coronary artery bypass without cardiopulmonary bypass (OPCAB) eliminates the complications related to cardiopulmonary bypass. However, the long-term outcomes of this procedure are largely unknown. METHODS: We sought to investigate the rates of late mortality, stroke, acute myocardial infarction, and target vessel reintervention after OPCAB in a consecutive series of 857 patients who underwent OPCAB between May 1987 and March 1999. RESULTS: Long-term follow-up was obtained for 86% of eligible patients. Actuarial and event-free survival was 89% and 76%, respectively, for a median follow-up period of 2.2 years (range, 0-13.3 years). Risk factors for late mortality were identified with Cox regression analysis. In the multivariate analysis, patient age >75 years (odds ratio, 1.1; 95% confidence interval, 1.0-1.1; P =.01) and an ejection fraction <35% (odds ratio, 2.7; 95% confidence interval, 1.2-6.2; P =.02) emerged as independent predictors of late mortality. CONCLUSION: OPCAB is associated with a low mortality and clinical event rate. Advanced age and depressed ejection fraction may increase mortality after OPCAB.

Stamou SC; Pfister AJ; Jablonski KA; Hill PC; Dullum MK; Bafi AS; Boyce SW; Garcia JM; Lomax TA; Corso PJ

2003-01-01

254

Do Radiologists Want/Need Training in Cardiopulmonary Resuscitation?  

International Nuclear Information System (INIS)

Purpose: Prompt and effective cardiopulmonary resuscitation (CPR) decreases morbidity and mortality following cardiopulmonary arrest. Radiologists are frequently confronted with severely ill patients, who may deteriorate at any time. Furthermore, they have to be aware of life-threatening reactions towards contrast media. This study was designed to assess experience and self-estimation of German-speaking radiologists in CPR and cardiac defibrillation (CD). Material and Methods: 650 German-speaking radiologists were audited by a specially designed questionnaire, which was sent via e-mail. The answers were expected to be re-mailed within a 2-month period. Results: The response rate was 12.6%. 72.8% of the responders had performed at least 1 CPR (range 9.5 ± 13.1) and 37% at least 1 CD. 67.9% had had opportunities to attend training courses, which had been utilized by 41.8% of them. The last training of the responders was more than 2 years ago in 69.2% and more than 5 years ago in 37%. Of all responders 75.6% expressed the need for further education. Conclusion: The small response rate indicates the small importance of CPR in the subpopulation surveyed. The vast majority of the responders, however, showed interest in basic and advanced life support and advocated regular updates. It seems reasonable that radiological Dept. themselves should organize courses in order to cope with their specific situations

2003-01-01

255

Retinal hemorrhage after cardiopulmonary resuscitation with chest compressions.  

UK PubMed Central (United Kingdom)

Retinal hemorrhages in children in the absence of risk factors are regarded to be pathognomonic of shaken baby syndrome or other nonaccidental injuries. The physician must decide whether the retinal hemorrhages in children without risk factors are due to abuse or cardiopulmonary resuscitation with chest compression (CPR-CC). The objective of this study was to determine if CPR-CC can lead to retinal hemorrhages in children. Twenty-two patients who received in-hospital CPR-CC between February 15, 1990, and June 15, 1990, were enrolled. Pediatric ophthalmology fellows carried a code beeper and responded to calls for cardiopulmonary arrest situations. At the scene of CPR-CC, an indirect funduscopic examination was conducted for presence of retinal hemorrhages in the posterior pole. Follow-up examinations were performed at 24 and 72 hours. Of the 22 patients, 6 (27%) had retinal hemorrhages at the time of CPR-CC. Of these 6 patients, 5 had risk factors for retinal hemorrhages. The sixth patient had no risk factors and may have represented the only true case of retinal hemorrhages due to CPR-CC. Retinal hemorrhages are uncommon findings after CPR-CC. Retinal hemorrhages that are found after CPR-CC usually occur in the presence of other risk factors for hemorrhage with a mild hemorrhagic retinopathy in the posterior pole.

Pham H; Enzenauer RW; Elder JE; Levin AV

2013-06-01

256

Retinal hemorrhage after cardiopulmonary resuscitation with chest compressions.  

Science.gov (United States)

Retinal hemorrhages in children in the absence of risk factors are regarded to be pathognomonic of shaken baby syndrome or other nonaccidental injuries. The physician must decide whether the retinal hemorrhages in children without risk factors are due to abuse or cardiopulmonary resuscitation with chest compression (CPR-CC). The objective of this study was to determine if CPR-CC can lead to retinal hemorrhages in children. Twenty-two patients who received in-hospital CPR-CC between February 15, 1990, and June 15, 1990, were enrolled. Pediatric ophthalmology fellows carried a code beeper and responded to calls for cardiopulmonary arrest situations. At the scene of CPR-CC, an indirect funduscopic examination was conducted for presence of retinal hemorrhages in the posterior pole. Follow-up examinations were performed at 24 and 72 hours. Of the 22 patients, 6 (27%) had retinal hemorrhages at the time of CPR-CC. Of these 6 patients, 5 had risk factors for retinal hemorrhages. The sixth patient had no risk factors and may have represented the only true case of retinal hemorrhages due to CPR-CC. Retinal hemorrhages are uncommon findings after CPR-CC. Retinal hemorrhages that are found after CPR-CC usually occur in the presence of other risk factors for hemorrhage with a mild hemorrhagic retinopathy in the posterior pole. PMID:23629401

Pham, Hang; Enzenauer, Robert W; Elder, James E; Levin, Alex V

2013-06-01

257

Home-based mobile cardio-pulmonary rehabilitation consultant system.  

UK PubMed Central (United Kingdom)

Cardiovascular diseases are the most popular cause of death in the world recently. For postoperatives, cardiac rehabilitation is still asked to maintain at home (phase II) to improve cardiac function. However, only one third of outpatients do the exercise regularly, reflecting the difficulty for home-based healthcare: lacking of monitoring and motivation. Hence, a cardio-pulmonary rehabilitation system was proposed in this research to improve rehabilitation efficiency for better prognosis. The proposed system was built on mobile phone and receiving electrocardiograph (ECG) signal from a wireless ECG holter via Bluetooth connection. Apart from heart rate (HR) monitor, an ECG derived respiration (EDR) technique is also included to provide respiration rate (RR). Both HR and RR are the most important vital signs during exercise but only used one physiological signal recorder in this system. In clinical test, there were 15 subjects affording Bruce Task (treadmill) to simulate rehabilitation procedure. Correlation between this system and commercial product (Custo-Med) was up to 98% in HR and 81% in RR. Considering the prevention of sudden heart attack, an arrhythmia detection expert system and healthcare server at the backend were also integrated to this system for comprehensive cardio-pulmonary monitoring whenever and wherever doing the exercise.

Lee HE; Wang WC; Lu SW; Wu BY; Ko LW

2011-01-01

258

Home-based mobile cardio-pulmonary rehabilitation consultant system.  

Science.gov (United States)

Cardiovascular diseases are the most popular cause of death in the world recently. For postoperatives, cardiac rehabilitation is still asked to maintain at home (phase II) to improve cardiac function. However, only one third of outpatients do the exercise regularly, reflecting the difficulty for home-based healthcare: lacking of monitoring and motivation. Hence, a cardio-pulmonary rehabilitation system was proposed in this research to improve rehabilitation efficiency for better prognosis. The proposed system was built on mobile phone and receiving electrocardiograph (ECG) signal from a wireless ECG holter via Bluetooth connection. Apart from heart rate (HR) monitor, an ECG derived respiration (EDR) technique is also included to provide respiration rate (RR). Both HR and RR are the most important vital signs during exercise but only used one physiological signal recorder in this system. In clinical test, there were 15 subjects affording Bruce Task (treadmill) to simulate rehabilitation procedure. Correlation between this system and commercial product (Custo-Med) was up to 98% in HR and 81% in RR. Considering the prevention of sudden heart attack, an arrhythmia detection expert system and healthcare server at the backend were also integrated to this system for comprehensive cardio-pulmonary monitoring whenever and wherever doing the exercise. PMID:22254478

Lee, Hsu-En; Wang, Wen-Chih; Lu, Shao-Wei; Wu, Bo-Yuan; Ko, Li-Wei

2011-01-01

259

Ventilation parameters used to guide cardiopulmonary function during mechanical ventilation.  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: To describe the newly introduced ventilation parameters that are used at the bedside to estimate cardiopulmonary function during positive pressure ventilation (PPV). RECENT FINDINGS: PPV induces right atrial pressure changes over the ventilator cycle. Positive end-expiratory pressure-induced central venous pressure changes and pulse pressure variation have been introduced as parameters that predict fluid responsiveness. Pulse pressure variation seems to be valid even at low tidal volume ventilation. A capnometer can be used to measure low perfusion lung area and to monitor the continuous breath-by-breath cardiac output of ventilated patients. Ultrasound evaluation of the lung parenchyma and diaphragm status is likely to become more popular. To evaluate ventilator settings, functional residual capacity (FRC) measurement and visual lung recruitment estimation via electric impedance tomography (EIT) have been introduced. SUMMARY: The utility of lung ultrasound is expanding. Although the clinical implications of FRC measurement and lung monitoring with imaging tools such as EIT are starting to be realized, their efficacy in severe hypoxic respiratory failure should be evaluated further in well designed clinical trials. To improve the preemptive management of impending respiratory failure, an alarm index that integrates noninvasive cardiopulmonary function parameters should be developed.

Huh JW; Koh Y

2013-06-01

260

Gamma radiation grafted polymers for immobilization of Brucella antigen in diagnostic test studies  

International Nuclear Information System (INIS)

[en] The radiation grafting process has a wide field of industrial applications, and in the recent years the immobilization of biocomponents in grafted polymeric materials obtained by means of ionizing radiations is a new and important contribution to biotechnology. In the present work, gamma preirradiation grafting method was employed to produce acrylics hydrogels onto polyethylene (PE), polyvinyl chloride (PVC) and polystyrene (PS). Two monomers were used to graft the previously mentioned polymers: methacrylic acid (MAAc) and acrylamide (AAm), and several working conditions were considered as influencing the degree of grafting. All these grafted polymers were used to study the possibility of a subsequent immobilization of Brucella antigen (BAg) in diagnostic test studies (ELISA). (author)

1990-01-01

 
 
 
 
261

Longitudinally compliant vascular graft  

UK PubMed Central (United Kingdom)

A longitudinally compliant PTFE graft is provided by compressing at least a portion of a porous PTFE tube along its longitudinal axis and coating at least the outer wall of the compressed portion of the PTFE tube with a biocompatible elastomer for allowing the compressed portion of the tube to be stretched along the longitudinal axis. The PTFE tube is compressed by pulling the tube over a cylindrical mandrel of like diameter and applying a compression force to the tube along its longitudinal axis. The compressed portion(s) is (are) secured against movement upon the mandrel, and a coating of liquified polyurethane or other biocompatible elastomer is then applied over at least the compressed portion(s) of the tube. The elastomeric coating may be applied by dip coating or spray coating techniques. After the elastomeric coating has dried, the completed graft is removed from the mandrel.

DELLA CORNA LINDA V; FARNAN ROBERT C; COLONE WILLIAM M; KOWLIGI RAJAGOPAL R

262

Outcome of in-hospital adult cardiopulmonary resuscitation assisted with portable auto-priming percutaneous cardiopulmonary support.  

UK PubMed Central (United Kingdom)

BACKGROUND: Outcome from in-hospital cardiopulmonary resuscitation (CPR) is still unsatisfactory. CPR assisted with percutaneous cardiopulmonary support (PCPS) is expected to improve the outcome of in-hospital CPR. METHODS: We retrospectively analyzed 83 consecutive cases of adult in-hospital CPR assisted by a portable pre-assembled auto-priming PCPS system (EBS, Terumo, Japan) from January 2004 to December 2007. RESULTS: PCPS was successfully performed in 97.6% of the patients and could be weaned in 57.8% of the patients. The survival-to-discharge rate was 41.0% with an acceptable neurological status in 85.3% of the patients. The 6-month survival was 38.6%. Survival-to-discharge decreased about 1% for each 1 min increase in the duration of CPR. The probability of survival was about 65%, 45%, and 19% when the duration of CPR was 10, 30, or 60 min, respectively. Multivariate analysis adjusted with clinical factors including organ dysfunction severity scores revealed that defibrillation and CPR duration less than 35 min were independent predictors for both survival-to-discharge (odds ratio=8.0, 95% CI=2.8-23.0, p<0.001) and 6-month survival (hazard ratio=3.3, 95% CI=1.9-5.9, p<0.001). CONCLUSIONS: Our results showed that CPR assisted with PCPS results in an acceptable survival-to-discharge rate and mid-term prognosis.

Jo IJ; Shin TG; Sim MS; Song HG; Jeong YK; Song YB; Hahn JY; Choi SH; Gwon HC; Jeon ES; Kim WS; Lee YT; Sung K; Choi JH

2011-08-01

263

Siloxane-grafted membranes  

Energy Technology Data Exchange (ETDEWEB)

Composite cellulosic semipermeable membranes are disclosed which are the covalently bonded reaction product of an asymmetric cellulosic semipermeable membrane and a polysiloxane containing reactive functional groups. The two reactants chemically bond by ether, ester, amide or acrylate linkages to form a siloxane-grafted cellulosic membrane having superior selectivity and flux stability. Selectivity may be enhanced by wetting the surface with a swelling agent such as water.

Friesen, Dwayne T. (Bend, OR); Obligin, Alan S. (Catonville, MD)

1989-01-01

264

Energy and employment  

Energy Technology Data Exchange (ETDEWEB)

This article shows that employment is not really a useful criterium in the selection of energy systems, but rather that very different energy systems have - from the point of view of the national economy - very similar effects on employment. The particularly interesting thing about energy investments with regard to the aspects of employment policy is their periodic curve. Pushing forward the modernisation of the energy industry can, to that extent, fulfil a useful function in employment policy. From the point of view of national economy, it depends whether additional employment results from a project. This question is much more difficult to answer than the allocation of employment effects within a single industry, because estimates can only be made on the basis of an ex-ante-exercise on future market processes. In any such projection, however, impulses from both supply and demand and elimination effects would have to be taken into consideration.

Pfaffenberger, W.

1985-01-01

265

A new cardiopulmonary exercise testing prognosticating algorithm for heart failure patients treated with beta-blockers.  

Science.gov (United States)

In 2004, a cardiopulmonary exercise testing (CPET) prognosticating algorithm for heart failure (HF) patients was proposed. The algorithm employed a stepwise assessment of peak oxygen consumption (VO2), slope of regression relating minute ventilation to carbon dioxide output (VE/VCO2) and peak respiratory exchange ratio (RER), and was proposed as an alternative to the traditional strategy of using a single CPET parameter to describe prognosis. Since its initial proposal, the prognosticating algorithm has not been reassessed, although a re-evaluation is in order given the fact that new HF therapies, such as beta-blocker therapy, have significantly improved survival in HF. The present review, based on a critical examination of CPET outcome studies in HF patients regularly treated with beta-blockers, suggests a new prognosticating algorithm. The algorithm comprises four CPET parameters: peak RER, exertional oscillatory ventilation (EOV), peak VO2 and peak systolic blood pressure (SBP). Compared to previous proposals, the present preliminary attempt includes EOV instead of VE/VCO2 slope as ventilatory CPET parameter, and peak SBP as hemodynamic-derived index. PMID:21450608

Corrà, Ugo; Mezzani, Alessandro; Giordano, Andrea; Caruso, Roberto; Giannuzzi, Pantaleo

2011-03-04

266

A new cardiopulmonary exercise testing prognosticating algorithm for heart failure patients treated with beta-blockers.  

UK PubMed Central (United Kingdom)

In 2004, a cardiopulmonary exercise testing (CPET) prognosticating algorithm for heart failure (HF) patients was proposed. The algorithm employed a stepwise assessment of peak oxygen consumption (VO2), slope of regression relating minute ventilation to carbon dioxide output (VE/VCO2) and peak respiratory exchange ratio (RER), and was proposed as an alternative to the traditional strategy of using a single CPET parameter to describe prognosis. Since its initial proposal, the prognosticating algorithm has not been reassessed, although a re-evaluation is in order given the fact that new HF therapies, such as beta-blocker therapy, have significantly improved survival in HF. The present review, based on a critical examination of CPET outcome studies in HF patients regularly treated with beta-blockers, suggests a new prognosticating algorithm. The algorithm comprises four CPET parameters: peak RER, exertional oscillatory ventilation (EOV), peak VO2 and peak systolic blood pressure (SBP). Compared to previous proposals, the present preliminary attempt includes EOV instead of VE/VCO2 slope as ventilatory CPET parameter, and peak SBP as hemodynamic-derived index.

Corrà U; Mezzani A; Giordano A; Caruso R; Giannuzzi P

2012-04-01

267

A survey of cardiopulmonary bypass perfusion practices in Australia in 1992.  

UK PubMed Central (United Kingdom)

Twenty-four cardiopulmonary bypass (CPB) perfusion units around Australia were surveyed to determine the characteristics of CPB perfusion as practised in Australia in 1992. Twenty completed survey forms were received. Findings were compared with those of a similar study performed by one of the authors for the year 1986. The field of CPB perfusion continues to expand both in terms of numbers of cases and increasing technological complexity. The major technological changes evident are the now clear dominance of membrane over bubble oxygenators and the proliferation of inline SvO2 monitoring devices. The greatest change in practice has been to the virtually universal use of cardioplegia. There remains considerable variation in the composition of the cardioplegia solutions used in the responding units. A range of minimum perfusion pressures for CPB is noted, whereas most units employ similar minimum perfusion flows. Methods of central nervous system and renal protection are mainly hypothermia and diuretics, respectively, with a scattering of other techniques. Staffing of CPB perfusion units is essentially unchanged since 1986 and at least five units had no medical perfusionist appointed in 1992.

Wajon PR; Walsh RG; Symons NL

1993-12-01

268

A survey of cardiopulmonary bypass perfusion practices in Australia in 1992.  

Science.gov (United States)

Twenty-four cardiopulmonary bypass (CPB) perfusion units around Australia were surveyed to determine the characteristics of CPB perfusion as practised in Australia in 1992. Twenty completed survey forms were received. Findings were compared with those of a similar study performed by one of the authors for the year 1986. The field of CPB perfusion continues to expand both in terms of numbers of cases and increasing technological complexity. The major technological changes evident are the now clear dominance of membrane over bubble oxygenators and the proliferation of inline SvO2 monitoring devices. The greatest change in practice has been to the virtually universal use of cardioplegia. There remains considerable variation in the composition of the cardioplegia solutions used in the responding units. A range of minimum perfusion pressures for CPB is noted, whereas most units employ similar minimum perfusion flows. Methods of central nervous system and renal protection are mainly hypothermia and diuretics, respectively, with a scattering of other techniques. Staffing of CPB perfusion units is essentially unchanged since 1986 and at least five units had no medical perfusionist appointed in 1992. PMID:8122740

Wajon, P R; Walsh, R G; Symons, N L

1993-12-01

269

Physical activity patterns of patients with cardiopulmonary illnesses.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The aims of this paper were (1) to describe objectively confirmed physical activity patterns across 3 chronic cardiopulmonary conditions, and (2) to examine the relationship between selected physical activity dimensions with disease severity, self-reported physical and emotional functioning, and exercise performance. DESIGN: Cross-sectional study. SETTING: Participants' home environment. PARTICIPANTS: Patients with cardiopulmonary illnesses: chronic obstructive pulmonary disease (COPD) (n=63), heart failure (n=60), and patients with implantable cardioverter defibrillator (n=60). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Seven ambulatory physical activity dimensions (total steps, percent time active, percent time ambulating at low, medium, and high intensity, maximum cadence for 30 continuous minutes, and peak performance) were measured with an accelerometer. RESULTS: Subjects with COPD had the lowest amount of ambulatory physical activity compared with subjects with heart failure and cardiac dysrhythmias (all 7 activity dimensions, P<.05); total step counts were: 5319 versus 7464 versus 9570, respectively. Six-minute walk distance was correlated (r=.44-.65, P<.01) with all physical activity dimensions in the COPD sample, the strongest correlations being with total steps and peak performance. In subjects with cardiac impairment, maximal oxygen consumption had only small to moderate correlations with 5 of the physical activity dimensions (r=.22-.40, P<.05). In contrast, correlations between 6-minute walk test distance and physical activity were higher (r=.48-.61, P<.01) albeit in a smaller sample of only patients with heart failure. For all 3 samples, self-reported physical and mental health functioning, age, body mass index, airflow obstruction, and ejection fraction had either relatively small or nonsignificant correlations with physical activity. CONCLUSIONS: All 7 dimensions of ambulatory physical activity discriminated between subjects with COPD, heart failure, and cardiac dysrhythmias. Depending on the research or clinical goal, use of 1 dimension, such as total steps, may be sufficient. Although physical activity had high correlations with performance on a 6-minute walk test relative to other variables, accelerometry-based physical activity monitoring provides unique, important information about real-world behavior in patients with cardiopulmonary illness not already captured with existing measures.

Nguyen HQ; Steele BG; Dougherty CM; Burr RL

2012-12-01

270

An Experimental Model of Pediatric Asphyxial Cardiopulmonary Arrest in Rats  

Science.gov (United States)

Objective Develop a clinically relevant model of pediatric asphyxial cardiopulmonary arrest in rats. Design Prospective interventional study. Setting University research laboratory. Subjects Post-natal day (PND) 16-18 rats. Interventions Anesthetized rats were endotracheally intubated and mechanically ventilated, and vascular catheters were inserted. Vecuronium was administered and the ventilator was disconnected from the rats for 8 min, whereupon rats were resuscitated with epinephrine, sodium bicarbonate, and chest compressions until spontaneous circulation returned. Shams underwent all procedures except asphyxia. Measurements and Main Results Asphyxial arrest typically occurred by 1 min after the ventilator was disconnected. Return of spontaneous circulation typically occurred <30 sec after resuscitation. An isoelectric electroencephalograph was observed for 30 min after asphyxia and rats remained comatose for 12-24 h. Survival rate in rats after asphyxia was 75%. Motor function measured using beam balance and inclined plane tests was impaired on d 1 and 2, but recovered by d 3, in rats after asphyxia vs. sham injury (n=9/group; P<0.05). Spatial memory acquisition measured using the Morris-water maze on d 7–14 and 28–35 was also impaired in rats after asphyxia vs. sham injury (total latency 379±28 vs. 501±40 sec, respectfully; n=9/group; P<0.05). CA1 hippocampal neuron survival after asphyxia was 39-43% (n=9/group; P<0.001 vs. sham). DNA fragmentation was detected in CA1 hippocampal neurons bilaterally in separate rats on d 3-7 after asphyxia (n=3-4/group). Neurodegeneration detected using Fluorojade-B was seen in bilateral CA1 hippocampi and layer III cortical neurons 3-7 d after asphyxia, with persistent neurodegeneration in CA1 hippocampus detected up to 5 wks after asphyxia. Evidence of DNA or cellular injury was not detected in sham rats. Conclusions This model of asphyxial cardiopulmonary arrest in PND 17 rats produces many of the clinical manifestations of pediatric hypoxic-ischemic encephalopathy. This model may be useful for the pre-clinical testing of novel and currently available interventions aimed at improving neurological outcome in infants and children after cardiopulmonary arrest.

Fink, Ericka L.; Alexander, Henry; Marco, Christina D.; Dixon, C. Edward; Kochanek, Patrick M.; Jenkins, Larry W.; Lai, Yichen; Donovan, Holly A.; Hickey, Robert W.; Clark, Robert S. B.

2011-01-01

271

Awareness of cardiopulmonary resuscitation in medical-students and doctors in Rawalpindi-Islamabad, Pakistan  

International Nuclear Information System (INIS)

Objective: To assess the level of awareness regarding basic and practical knowledge of cardiopulmonary resuscitation and its importance in the eyes of medical/dental students and doctors. Methods: The cross-sectional study was conducted in medical and dental colleges as well as hospitals of Rawalpindi and Islamabad, Pakistan, from June to September 2011. Non-probability convenience sampling was used and structured questionnaires on basic and practical knowledge of the procedure were distributed. The questionnaire had 26 items related to basic and advanced knowledge of the required skills. Doctors were divided into two groups based on their years of service and practice. Those with less than 5 years' experience were grouped as junior doctors, while rest as senior doctors. Descriptive statistics were employed to analyse the data using SPPS version 17 and Microsoft Excel. Percentages were worked out and the results were interpreted. Result: Of the 1000 questionnaires distributed, 646 (64.6%) were received duly filled and represented the study sample. Of the 646 participants, 34 (5.26%) were dentists, 424 (65.63%) were medical students, 92 (14.24%) were doctors and 96 (14.86%) were dental students. Basic knowledge of doctors was found to be better than that of dentists (n=96; 50% vs. n=8; 23%). Similarly, the advance knowledge of doctors was better than the dentists (n=53; 58% vs. n=11; 31%). The basic knowledge of junior doctors was found to be almost equal to the senior doctors (n=26; 44.75% vs. n=15; 45.5%). The advance knowledge of junior doctors was found to be better than the senior doctors (n=27; 45.37% vs. n=10; 29.48%). Among the students, 157 (37%) of the medical students had basic knowledge of CPR, while 36 (38%) dental students had basic knowledge of the topic. Medical students had more advanced knowledge (n=157; 37%) than dental students (n=34; 35%). Conclusion: The awareness of basic and advance knowledge of cardiopulmonary resuscitation skills in medical/dental students and doctors in Rawalpindi and Islamabad was inadequate. (author)

2012-01-01

272

Awareness of cardiopulmonary resuscitation in medical-students and doctors in Rawalpindi-Islamabad, Pakistan.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To assess the level of awareness regarding basic and practical knowledge of cardiopulmonary resuscitation and its importance in the eyes of medical/dental students and doctors. METHODS: The cross-sectional study was conducted in medical and dental colleges as well as hospitals of Rawalpindi and Islamabad, Pakistan, from June to September 2011. Non-probability convenience sampling was used and structured questionnaires on basic and practical knowledge of the procedure were distributed. The questionnaire had 26 items related to basic and advanced knowledge of the required skills. Doctors were divided into two groups based on their years of service and practice. Those with less than 5 years' experience were grouped as junior doctors, while rest as senior doctors. Descriptive statistics were employed to analyse the data using SPPS version 17 and Microsoft Excel. Percentages were worked out and the results were interpreted. RESULT: Of the 1000 questionnaires distributed, 646 (64.6%) were received duly filled and represented the study sample. Of the 646 participants, 34 (5.26%) were dentists, 424 (65.63%) were medical students, 92 (14.24%) were doctors and 96 (14.86%) were dental students. Basic knowledge of doctors was found to be better than that of dentists (n = 96; 50% vs. n = 8; 23%). Similarly, the advance knowledge of doctors was better than the dentists (n = 53; 58% vs. n = 11; 31%). The basic knowledge of junior doctors was found to be almost equal to the senior doctors (n = 26; 44.75% vs. n = 15; 45.5%). The advance knowledge of junior doctors was found to be better than the senior doctors (n = 27; 45.37% vs. n = 10; 29.48%). Among the students, 157 (37%) of the medical students had basic knowledge of CPR, while 36 (38%) dental students had basic knowledge of the topic. Medical students had more advanced knowledge (n = 157; 37%) than dental students (n = 34; 35%). CONCLUSION: The awareness of basic and advance knowledge of cardiopulmonary resuscitation skills in medical/dental students and doctors in Rawalpindi and Islamabad was inadequate.

Zamir Q; Nadeem A; Rizvi AH

2012-12-01

273

[Heart surgery, cardiopulmonary bypass and inflammatory response. I. Changes in hemostasis and complement  

UK PubMed Central (United Kingdom)

The use of cardiopulmonary bypass for surgical cardiac procedures is characterized by a whole-body inflammatory reaction due to the contact of blood through nonendothelialized surfaces; this stimulates the organism to recognize the cardiopulmonary bypass system as "nonself" and to activate specific (immune) and nonspecific (inflammatory) responses. These responses are then related with postoperative damage to many body systems, like pulmonary, renal or brain dysfunction, excessive bleeding and postoperative sepsis. In this paper, present knowledge on untoward responses of the patient to the use of cardiopulmonary bypass in cardiac surgery is reviewed and discussed, particularly focusing on the perturbation of the hemostasis and of the complement activation system.

Parolari A; Alamanni F; Antona C; Stanghellini M; Sandano S; Spirito R; Repossini A; Sala A; Biglioli P

1996-04-01

274

Are the additional grafts necessary?  

Directory of Open Access Journals (Sweden)

Full Text Available The goals of surgery for spinal deformity are to correct or improve the deformity to get a stable, balanced and fused spine. The long-term success of any procedure for scoliosis depends on a solid arthrodesis. Getting fusion of the instrumented segment with the aid of copious autogenous iliac graft has been the most important goal of treatment. However, harvesting copious graft from teenage iliac bone has its limitation in the quantity of graft, surgical time, and other complications of graft sites. Bone substitute is a promising concept, but there is not ideal bone substitute with all the characteristics of an autogenous bone graft. Several alternative graft materials like tricalcium phosphate, hydroxyapatite, and demineralized bone matrix have osteoinductive properties. Bone morphogenic protein has osteoconductive properties. The limitations with bone substitutes are osteoinduction and osteoconduction properties, sterilization, chances of transmitting infective disease and cost. We consider that the introduction of segmental spinal instrumentation which enables strong and firm correction and fixation of the scoliotic deformity has enabled getting fusion with less graft. We can obtain that quantity of graft after laminae and spinous process decortication. This retrospective study has been done in our hospital from January 2002 to December 2004. A total of 188 patients underwent posterior corrections for adolescent idiopathic scoliosis using segmental fixation by Moss-Miami. No autogenous iliac crest graft was taken or graft substitutes. After meticulous decortication and destruction of facet joints, we used local graft taken from spinous process and laminae. All patients had minimum thirty months follow- up. We have excellent results. Out of these 188 patients, 177 patients have fused spine, no implant failure, no pain, no infection and no loss of correction. Eleven (5.8%) patients underwent re-operation; four among them because of infection, three for symptomatic implants and four due to pseudarthrosis. We consider that the use of local harvesting graft is enough for getting good spondylodesis.

Milinkovi? Z.B.; Krneta O.; Mili?kovi? S.; Doži? D.; ?ur?i? A.

2010-01-01

275

Unusual costochondral bone graft complication.  

UK PubMed Central (United Kingdom)

In hemifacial microsomia, patients with severely hypoplastic mandibles (Pruzansky type III) require replacement of the ramus and condyle unit. Common complications of this procedure include graft fracture and overgrowth of the graft. An uncommon case of osteolysis of the costochondral graft with osteitis of the middle cranial fossa is reported herein. To our knowledge, no such case has been reported in the literature previously. The aim of this report is to present the only known case and to discuss the contributing factors.

Tabchouri N; Kadlub N; Diner PA; Picard A

2013-08-01

276

Fluxometria da artéria torácica interna esquerda na revascularização da artéria descendente anterior com e sem circulação extracorpórea Flowmetry of left internal thoracic artery graft to left anterior descending artery: comparison between on-pump and off-pump surgery  

Directory of Open Access Journals (Sweden)

Full Text Available INTRODUÇÃO: A cirurgia de revascularização do miocárdio (RM) sem circulação extracorpórea (CEC) é uma técnica amplamente utilizada. A fluxometria coronariana é a técnica mais usada para avaliação dos enxertos, porém, poucos estudos comparam os dados fluxométricos na RM com e sem CEC. O objetivo deste estudo foi comparar as variáveis fluxométricas dos enxertos de artéria torácica interna esquerda para a artéria descendente anterior em pacientes submetidos à RM com e sem CEC. MÉTODOS: Entre março e setembro de 2010, foram analisados retrospectivamente 35 pacientes consecutivos, não randomizados, submetidos à RM. Foram alocados 10 pacientes no grupo A (com CEC) e 25 no grupo B (sem CEC). O fluxo médio do enxerto (FME), o índice pulsátil (PI) e a porcentagem de enchimento diastólico (ED) foram obtidos por meio da fluxometria por tempo de trânsito. Foi utilizado o teste exato de Fisher e Mann-Whitney, sendo considerado estatisticamente significante PBACKGROUND: Off-pump coronary bypass grafting (OPCAB) has become a widely used technique. Coronary flowmetry is the most common method employed to assess graft patency, nevertheless, few studies compare flow patterns between ONCAB and OPCAB surgery. The objective of this study was to compare flowmetry data in left internal mammary artery grafts bypasses to the left anterior descendent artery. METHODS: From March to September of 2010, thirtyfive consecutive, non-randomized patients underwent CABG and were retrospectively evaluated. Ten patients were located on group A (On Pump), and twenty-five on group B (Off Pump). The mean graft flow (MGF), pulsatile index (PI) and diastolic filling (DF) were obtained using Transit Time Flowmetry (TTFM). The Fisher exact test, and Mann Whitney test were used, and a P value of < 0.05 was considered to indicate statistical significance. RESULTS: There were no deaths, AMI, re-interventions or PTCA in a 30-day period. The number of bypasses performed per patient was 2.3 ± 0.8 in the OPCAB group, and 2.2 ± 0.6 in the ONCAB group, with no significant difference (P=0.10). The median of mean flow was 23 ml/min on group A, and 25 ml/min on group B (P=0.34). Diastolic filling percentage was 56% on group A, and 56.9% on group B (P=0.86). Pulsatile Index was 2.3 on group A, and 2.2 on group B (P=0.82). CONCLUSIONS: There was no difference between TTFM values (MF, PI and DF) in patients operated with or without cardiopulmonary bypass.

Filinto Marques de Cerqueira Neto; Marco Antonio Vieira Guedes; Leonardo Eugênio Fonseca Soares; Gustavo Santiago Almeida; André Raimundo F. Guimarães; Mauricio Alves Barreto; Emerson Costa Porto; Álvaro Rabelo Júnior

2012-01-01

277

Why employment relations matter  

Digital Repository Infrastructure Vision for European Research (DRIVER)

This paper has its origins in an on-going project labeled Employment Relations Matters. The title captures the double intention: to demonstrate the ways in which employment relations matters and to bring people up to date with the matters that the subject deals with. It is one of three in IRRU's War...

Sisson, Keith

278

Dimensions of Adolescent Employment.  

Science.gov (United States)

Examines positive and negative correlates of adolescent work as a function of work dimensions. Results indicate that concurrent costs and benefits of adolescent employment may depend on dimensions of work as well as adolescent characteristics. Adolescent employment was generally related to subsequent work motivation and nonacademic performance.…

Mael, Fred A.; Morath, Ray A.; McLellan, Jeffrey A.

1997-01-01

279

Does Supported Employment Work?  

Science.gov (United States)

Providing employment-related services, including supported employment through job coaches, has been a priority in federal policy since the enactment of the Developmental Disabilities Assistance and Bill of Rights Act in 1984. We take advantage of a unique panel data set of all clients served by the South Carolina Department of Disabilities and…

Morgan McInnes, Melayne; Ozturk, Orgul Demet; McDermott, Suzanne; Mann, Joshua R.

2010-01-01

280

Recertification in cardiopulmonary resuscitation. A comparison of two teaching methods.  

UK PubMed Central (United Kingdom)

In this study, the authors compare knowledge scores, pass/fail rate, time spent, satisfaction, and skill retention between two teaching methods used in cardiopulmonary resuscitation (CPR) recertification. Seventy subjects were assigned randomly to either traditional or computer method of instruction. Knowledge was evaluated by written examination. Psychomotor skills were evaluated either by a Basic Cardiac Life Support certified instructor (control group) or the computer (experimental group) and reevaluated by an instructor at a 6-month interval. There was no significant difference between the groups in knowledge or performance scores. However, significant differences in time spent, learner satisfaction, and pass/fail rate all favored the traditional method of instruction. These findings conflict with the results of prior studies on the use of the computer interactive learning system.

Fabius DB; Grissom EL; Fuentes A

1994-09-01

 
 
 
 
281

Obliquely inserting vegetable grafting device  

UK PubMed Central (United Kingdom)

The invention discloses an obliquely inserting vegetable grafting device. A graft clamping mechanism and a parental stock punching mechanism are fixed on both sides of a frame through a mounting rack respectively a parental stock growing point removing mechanism and a parental block clamping root pruning mechanism are arranged on the frame between the graft clamping mechanism and the parental stock punching mechanism respectively the parental stock growing point removing mechanism is arranged just behind the parental block clamping root pruning mechanism a graft and parental stock butt joint guide mechanism is arranged on the parental block clamping root pruning mechanism and a graft cutting mechanism is arranged on the frame between the graft clamping mechanism and the parental stock punching mechanism. The device can automatically complete graft clamping, graft cutting, parental block clamping, parental block growing point removing, parental block root pruning, parental block punching and graft and parental block butt joint guiding operations. The device has the characteristics of simple structure, high automatic degree, small operation labor intensity, precise operation, stable quality and high reliability.

JIANPING LI; QIANG LI; JIANZHONG LOU; GULAI LU; LIXING YU; ZHUAN ZHU

282

Operative mortality after conventional versus coronary revascularization without cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Off-pump coronary artery bypass (CABG) is a safe revascularization option with comparable or superior results to the conventional on-pump CABG. However, comparative analysis of the type of surgical approach on the mortality rate is largely unknown. This study sought to investigate whether CABG without cardiopulmonary bypass (off-pump CABG) is associated with lower operative mortality than the conventional on-cardiopulmonary bypass (on-pump) approach. METHODS: From October 1998 to June 2001, off-pump CABG was performed on 2477 patients and on-pump CABG was performed on 3077 patients. The patients undergoing off-pump CABG were randomly matched to on-pump patients via propensity score. Seventy-four percent of the off-pump CABG patients were matched with on-pump patients via propensity scores. A logistic regression model was used to test the difference in the postoperative mortality rate between off-pump CABG and on-pump CABG, controlling the correlation between matched sets. A multiple logistic regression model predicting the risk of mortality adjusted by risk factors of mortality and operation type was computed. RESULTS: Results from the general estimating equation showed that patients who had on-pump CABG were 1.6 (95% confidence intervals (CI)=1.2-2.0, P<0.01) times more likely to die during the first 30 days after surgery than patients who had off-pump CABG. Independent predictors of 30-day mortality identified from the multiple logistic model included on-pump CABG (versus off-pump CABG), advanced age, female gender, carotid artery disease, chronic renal failure, depressed ejection fraction, reoperative CABG, preoperative intraaortic balloon counterpulsation, and recent myocardial infarction. CONCLUSION: Excellent clinical results and a lower operative mortality rate can be achieved with the off-pump CABG technique compared with the conventional on-pump approach.

Stamou SC; Jablonski KA; Garcia JM; Boyce SW; Bafi AS; Corso PJ

2004-09-01

283

Coronary blood flow during cardiopulmonary resuscitation in swine  

International Nuclear Information System (INIS)

Recent papers have raised doubt as to the magnitude of coronary blood flow during closed-chest cardiopulmonary resuscitation. We will describe experiments that concern the methods of coronary flow measurement during cardiopulmonary resuscitation. Nine anesthetized swine were instrumented to allow simultaneous measurements of coronary blood flow by both electromagnetic cuff flow probes and by the radiomicrosphere technique. Cardiac arrest was caused by electrical fibrillation and closed-chest massage was performed by a Thumper (Dixie Medical Inc., Houston). The chest was compressed transversely at a rate of 66 strokes/min. Compression occupied one-half of the massage cycle. Three different Thumper piston strokes were studied: 1.5, 2, and 2.5 inches. Mean aortic pressure and total systemic blood flow measured by the radiomicrosphere technique increased as Thumper piston stroke was lengthened (mean +/- SD): 1.5 inch stroke, 23 +/- 4 mm Hg, 525 +/- 195 ml/min; 2 inch stroke, 33 +/- 5 mm Hg, 692 +/- 202 ml/min; 2.5 inch stroke, 40 +/- 6 mm Hg, 817 +/- 321 ml/min. Both methods of coronary flow measurement (electromagnetic [EMF] and radiomicrosphere [RMS]) gave similar results in technically successful preparations (data expressed as percent prearrest flow mean +/- 1 SD): 1.5 inch stroke, EMF 12 +/- 5%, RMS 16 +/- 5%; 2 inch stroke, EMF 30 +/- 6%, RMS 26 +/- 11%; 2.5 inch stroke, EMF 50 +/- 12%, RMS 40 +/- 20%. The phasic coronary flow signal during closed-chest compression indicated that all perfusion occurred during the relaxation phase of the massage cycle. We concluded that coronary blood flow is demonstrable during closed-chest massage, but that the magnitude is unlikely to be more than a fraction of normal

1984-01-01

284

Coronary blood flow during cardiopulmonary resuscitation in swine  

Energy Technology Data Exchange (ETDEWEB)

Recent papers have raised doubt as to the magnitude of coronary blood flow during closed-chest cardiopulmonary resuscitation. We will describe experiments that concern the methods of coronary flow measurement during cardiopulmonary resuscitation. Nine anesthetized swine were instrumented to allow simultaneous measurements of coronary blood flow by both electromagnetic cuff flow probes and by the radiomicrosphere technique. Cardiac arrest was caused by electrical fibrillation and closed-chest massage was performed by a Thumper (Dixie Medical Inc., Houston). The chest was compressed transversely at a rate of 66 strokes/min. Compression occupied one-half of the massage cycle. Three different Thumper piston strokes were studied: 1.5, 2, and 2.5 inches. Mean aortic pressure and total systemic blood flow measured by the radiomicrosphere technique increased as Thumper piston stroke was lengthened (mean +/- SD): 1.5 inch stroke, 23 +/- 4 mm Hg, 525 +/- 195 ml/min; 2 inch stroke, 33 +/- 5 mm Hg, 692 +/- 202 ml/min; 2.5 inch stroke, 40 +/- 6 mm Hg, 817 +/- 321 ml/min. Both methods of coronary flow measurement (electromagnetic (EMF) and radiomicrosphere (RMS)) gave similar results in technically successful preparations (data expressed as percent prearrest flow mean +/- 1 SD): 1.5 inch stroke, EMF 12 +/- 5%, RMS 16 +/- 5%; 2 inch stroke, EMF 30 +/- 6%, RMS 26 +/- 11%; 2.5 inch stroke, EMF 50 +/- 12%, RMS 40 +/- 20%. The phasic coronary flow signal during closed-chest compression indicated that all perfusion occurred during the relaxation phase of the massage cycle. We concluded that coronary blood flow is demonstrable during closed-chest massage, but that the magnitude is unlikely to be more than a fraction of normal.

Bellamy, R.F.; DeGuzman, L.R.; Pedersen, D.C.

1984-01-01

285

Enhanced external counterpulsation improves cerebral blood flow following cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

BACKGROUND: To investigate the therapeutic value of enhanced external counterpulsation (EECP) on recovery of cerebral blood flow following cardiac arrest (CA) and successful resumption of spontaneous circulation (ROSC) by cardiopulmonary resuscitation. METHODS: CA models were conducted using beagle dogs induced by alternating current. After successful ROSC by cardiopulmonary resuscitation, 16 dogs were randomly divided into the EECP and control group (n = 8 per group). Dogs underwent dynamic contrast-enhanced and diffusion-weighted magnetic resonance imaging at baseline prior to CA and during the 3 days following ROSC. Mean blood pressure, right common carotid artery blood flow, intracranial microcirculation and blood lactate levels were measured. Neurological outcome was assessed by the neurologic deficit score. Hematoxylin-eosin staining and transmission electron microscopy were performed for morphology and microconstruction of the cerebral cortex. RESULTS: The EECP group exhibited a significant elevation in right common carotid artery blood flow, intracranial microcirculation and a substantial decrease in blood lactate levels relative to the control group. Relative cerebral blood flow and volume were higher in the EECP group during the 3 days. Apparent diffusion coefficients were significantly higher in the EECP group on the first and third days. After ROSC, the neurologic deficit score was significantly higher in the control group compared to those in the EECP group during the three days of experiment. The cell swelling of neurons and increase of mitochondrial mass were more pronounced in the control group. CONCLUSION: EECP is beneficial for recovery of cerebral blood flow and attenuation of ischemic cerebral edema following CA and successful ROSC.

Liu R; Liang ZJ; Liao XX; Hu CL; Jiang L; Dai G; Li YQ; Wei HY; Wu GF; Li X

2013-09-01

286

Can a flowchart improve the quality of bystander cardiopulmonary resuscitation?  

UK PubMed Central (United Kingdom)

BACKGROUND: Since the introduction of basic life support in the 1950s, on-going efforts have been made to improve the quality of bystander cardiopulmonary resuscitation (CPR). Even though bystander-CPR can increase the chance of survival almost fourfold, the rates of bystander initiated CPR have remained low and rarely exceed 20%. Lack of confidence and fear of committing mistakes are reasons why helpers refrain from initiating CPR. The authors tested the hypothesis that quality and confidence of bystander-CPR can be increased by supplying lay helpers with a basic life support flowchart when commencing CPR, in a simulated resuscitation model. MATERIALS AND METHODS: After giving written informed consent, 83 medically untrained laypersons were randomised to perform basic life support for 300s with or without a supportive flowchart. The primary outcome parameter was hands-off time (HOT). Furthermore, the participants' confidence in their actions on a 10-point Likert-like scale and time-to-chest compressions were assessed. RESULTS: Overall HOT was 147±30 s (flowchart) vs. 169±55 s (non-flowchart), p=0.024. Time to chest compressions was significantly longer in the flowchart group (60±24 s vs. 23±18 s, p<0.0001). Participants in the flowchart group were significantly more confident when performing BLS than the non-flowchart counterparts (7±2 vs. 5±2, p=0.0009). CONCLUSIONS: A chart provided at the beginning of resuscitation attempts improves quality of CPR significantly by decreasing HOT and increasing the participants' confidence when performing CPR. As reducing HOT is associated with improved outcome and positively impacting the helpers' confidence is one of the main obstacles to initiate CPR for lay helpers, charts could be utilised as simple measure to improve outcome in cardiopulmonary arrest.

Rössler B; Ziegler M; Hüpfl M; Fleischhackl R; Krychtiuk KA; Schebesta K

2013-07-01

287

Cardiopulmonary exercise testing – the gold standard in physical performance assesment  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Cardiopulmonary exercise testing (CPX) is a modern procedure that allows us to evaluate the global performanceof a subject. Because CPX devices are expensive and less popular due to a less amount of specialists in this field, many oflaboratories uses the more common ECG stress tests for physical performance assessment. Aim: to demonstrate theimportance and accuracy of cardiopulmonary exercise testing comparing with traditional maximal electrocardiographic (ECG)stress test without gas exchange analysis. Methods: 18th elite soccer players (age 22.7±6 years, body mass 74.6±9.5 kg,height 175.4±9.8 cm) participated in the study. The subjects accomplished two treadmill effort tests with and without gasanalyses, in 2 consecutive days interval. Results: At the end of the study we noticed a highly significant statistical difference(p<0.0001) between the investigated testing methods. In gas exchange testing method we found a decreased level of all theparameters evaluated comparing to stress ECG: VO2 peak (ml*kg-1*min-1) = 55.4±5.2 vs. 67.8±5.7; AT (ml*kg-1*min-1) =41.2±7.6 vs. 47.4±6.9; VO2/HR (ml) = 23.8±2.5 vs. 23.8±2.5. Conclusions: Asessment of exercise performance based solelyon a maximal stress ECG without gas analyzing is inaccurate. Furthermore, estimation of peak exercise responses based uponcalculation of VO2 peak from peak work rate are inappropriate in sportsman. The study demonstrate once again that CPXremain the most accurate and reliable test for detection of AT and for a comprehensive physical performance assessment andcannot be replace by other surrogate laboratory exercise tests like stress ECG.

Claudiu Avram; Mihaela Oravi?an; Adrian Nagel; Lucian Hoble

2008-01-01

288

Impact of cardiopulmonary bypass on peripheral tissue metabolism and microvascular blood flow.  

UK PubMed Central (United Kingdom)

The aim of this study was to monitor and compare the changes in metabolism and blood flow in the skeletal muscles during cardiac operations performed with cardiopulmonary bypass (CPB) and operations without CPB (off-pump) by means of interstitial microdialysis (Figure 1). Surgical revascularization, coronary artery bypass grafting (CABG), was performed in 40 patients randomized to two groups. Twenty patients (On-Pump Group) were operated on using CPB, 20 patients (Off-Pump Group) were operated on without CPB. Interstitial microdialysis was performed by 2 probes of a CMA 60 (CMA Microdialysis AB, Solna, Sweden) inserted into the patient's deltoid muscle. Microdialysis measurements were performed at 30-minute intervals. Glucose, lactate, pyruvate and glycerol as markers of basic metabolism and tissue perfusion were measured in samples from the first probe, using a CMA 600 Analyzer (CMA Microdialysis AB). Blood flow through the interstitium was monitored by means of dynamic microdialysis of ethanol as a flow-marker in the dialysates taken from the second probe (ethanol dilution technique). Results in both the groups were statistically processed and compared. Both the groups were similar in respect of preoperative characteristics. Dynamic changes of interstitial concentrations of the measured analytes were found in both the patient groups (on-pump vs. off-pump) during the operation. There was no significant difference in dialysate concentrations of glucose and lactate between the groups. Significant differences were detected in pyruvate and glycerol interstitial concentrations, lactate/pyruvate ratio and lactate/glucose ratio between the on-pump vs. off-pump patients. In the Off-Pump Group, pyruvate concentrations were higher and the values of concentrations of glycerol lower. The lactate/pyruvate ratio and the lactate/glucose ratio, indicating the aerobic and anaerobic tissue metabolism status, were lower in the Off-Pump Group. There was no significant difference in dialysate concentrations of ethanol as a flow-marker during the surgery in either of the groups. There was no statistically significant difference between the groups (On-Pump Group vs. Off-Pump Group) comparing the postoperative clinical outcome (ICU stay, ventilation duration, length of hospital stay). The dynamic changes in the interstitial concentrations of the glucose, glycerol, pyruvate and lactate were found in both the groups of patients (On-Pump Group and Off-Pump Group), but there was no difference in local blood flow when the ethanol dilution technique was used. These results showed significantly higher aerobic metabolic activity of the peripheral tissue of patients in the Off-Pump Group vs. the On-Pump Group during the course of cardiac revascularization surgery. Results suggest that extracorporeal circulation, cardiopulmonary bypass, compromises peripheral tissue (skeletal muscles) energy metabolism. These changes have no impact on the postoperative clinical outcome; no significant difference between the groups was found.

Mandak J; Pojar M; Cibicek N; Lonsky V; Palicka V; Kakrdova D; Nedvidkova J; Kubicek J; Zivny P

2008-11-01

289

Impact of cardiopulmonary bypass on peripheral tissue metabolism and microvascular blood flow.  

Science.gov (United States)

The aim of this study was to monitor and compare the changes in metabolism and blood flow in the skeletal muscles during cardiac operations performed with cardiopulmonary bypass (CPB) and operations without CPB (off-pump) by means of interstitial microdialysis (Figure 1). Surgical revascularization, coronary artery bypass grafting (CABG), was performed in 40 patients randomized to two groups. Twenty patients (On-Pump Group) were operated on using CPB, 20 patients (Off-Pump Group) were operated on without CPB. Interstitial microdialysis was performed by 2 probes of a CMA 60 (CMA Microdialysis AB, Solna, Sweden) inserted into the patient's deltoid muscle. Microdialysis measurements were performed at 30-minute intervals. Glucose, lactate, pyruvate and glycerol as markers of basic metabolism and tissue perfusion were measured in samples from the first probe, using a CMA 600 Analyzer (CMA Microdialysis AB). Blood flow through the interstitium was monitored by means of dynamic microdialysis of ethanol as a flow-marker in the dialysates taken from the second probe (ethanol dilution technique). Results in both the groups were statistically processed and compared. Both the groups were similar in respect of preoperative characteristics. Dynamic changes of interstitial concentrations of the measured analytes were found in both the patient groups (on-pump vs. off-pump) during the operation. There was no significant difference in dialysate concentrations of glucose and lactate between the groups. Significant differences were detected in pyruvate and glycerol interstitial concentrations, lactate/pyruvate ratio and lactate/glucose ratio between the on-pump vs. off-pump patients. In the Off-Pump Group, pyruvate concentrations were higher and the values of concentrations of glycerol lower. The lactate/pyruvate ratio and the lactate/glucose ratio, indicating the aerobic and anaerobic tissue metabolism status, were lower in the Off-Pump Group. There was no significant difference in dialysate concentrations of ethanol as a flow-marker during the surgery in either of the groups. There was no statistically significant difference between the groups (On-Pump Group vs. Off-Pump Group) comparing the postoperative clinical outcome (ICU stay, ventilation duration, length of hospital stay). The dynamic changes in the interstitial concentrations of the glucose, glycerol, pyruvate and lactate were found in both the groups of patients (On-Pump Group and Off-Pump Group), but there was no difference in local blood flow when the ethanol dilution technique was used. These results showed significantly higher aerobic metabolic activity of the peripheral tissue of patients in the Off-Pump Group vs. the On-Pump Group during the course of cardiac revascularization surgery. Results suggest that extracorporeal circulation, cardiopulmonary bypass, compromises peripheral tissue (skeletal muscles) energy metabolism. These changes have no impact on the postoperative clinical outcome; no significant difference between the groups was found. PMID:19454562

Mandak, J; Pojar, M; Cibicek, N; Lonsky, V; Palicka, V; Kakrdova, D; Nedvidkova, J; Kubicek, J; Zivny, P

2008-11-01

290

Energy and employment  

Energy Technology Data Exchange (ETDEWEB)

The relationship of energy and employment is an essential ingredient of the current energy-policy debate. Energy, in its various forms, is an almost universal input to the production and consumption of goods and services in modern society, yet little attention is paid to its employment impacts. Far too little attention is being paid to the impact that changes in the sources, uses, and prices of energy will have on the level, location, and structure of employment in the U.S. economy. Unless their consequences are foreseen, energy solutions may have profound and sometimes devastating effects upon regions, industries, and jobs. This study addresses eight areas of this relationship: labor supply and demand in the energy sector; socio-economic impacts of energy development; coal, electricity, and employment; energy as a factor in the production/consumption process; alternative technologies and employment; developing an energy/employment modeling capability; research priorities; and policy recommendations related to energy/employment relationships. 40 references, 7 figures, 22 tables.

Nordlund, W.J.; Robson, R.T.

1980-01-01

291

A Cardiopulmonary Instructor's Perspective on a Standardized Patient Experience: Implications for Cardiopulmonary Physical Therapy Education.  

UK PubMed Central (United Kingdom)

Purpose: Standardized patients (SP) in Doctor of Physical Therapy (DPT) curricula are increasingly used for students to practice developing clinical reasoning, communication, and professional skills in an authentic learning environment. The purposes of this article are to: (1) describe an instructional model that synthesized SPs, Internet-based communities of practice, and reflection to teach clinical reasoning in DPT students; and (2) a cardiovascular and pulmonary physical therapy (CPPT) instructor's perspective on the educational process and student clinical skill development. Summary of Key Points: The model, employed in a course: "Integrative Physical Therapy Practice," enabled the instructor to document student clinical performance and reasoning during an SP interaction. For students, clinical reasoning was illuminated through the model's assessment process. Data collected through the assessment process provided important feedback to the instructor on classroom instructional effectiveness. Conclusions: Examination of student learning experiences enabled the instructor to consider: (1) key aspects of examination and management for persons with cardiovascular or pulmonary disorders, (2) methods for visualizing clinical reasoning, (3) the impact of teaching on student learning, and (4) strategies for teaching CPPT. More research is indicated to investigate pedagogy for the development of clinical reasoning in DPT students.

Cahalin LP; Markowski A; Hickey M; Hayward L

2011-09-01

292

T Cells and Pathogenesis of Hantavirus Cardiopulmonary Syndrome and Hemorrhagic Fever with Renal Syndrome  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We previously hypothesized that increased capillary permeability observed in both hantavirus cardiopulmonary syndrome (HCPS) and hemorrhagic fever with renal syndrome (HFRS) may be caused by hantavirus-specific cytotoxic T cells attacking endothelial cells presenting viral antigens on their surface ...

Terajima, Masanori; Ennis, Francis A.

293

Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Introduction Excessive bleeding (EB) after cardiopulmonary bypass (CPB) may lead to increased mortality, morbidity, transfusion requirements and re-intervention. Less than 50% of patients undergoing re-intervention exhibit surgical sources of bleeding. We studied clinical a...

Jimenez Rivera Juan J; Iribarren Jose L; Raya Jose M; Nassar Ibrahim; Lorente Leonardo; Perez Rosalia; Brouard Maitane

294

Successful management of massive intraoperative pulmonary fat embolism with percutaneous cardiopulmonary support  

Directory of Open Access Journals (Sweden)

Full Text Available We report a patient who sustained catastrophic pulmonary fat embolism, during open reduction, internal fixation (ORIF) of fracture femur? In our opinion, the use of percutaneous cardiopulmonary support with (PCPS), saved the patient from certain death.

Sarkar Suman; Mandal Krutisundar; Bhattacharya Prithwis

2008-01-01

295

Successful management of massive intraoperative pulmonary fat embolism with percutaneous cardiopulmonary support.  

UK PubMed Central (United Kingdom)

We report a patient who sustained catastrophic pulmonary fat embolism, during open reduction, internal fixation (ORIF) of fracture femur. In our opinion, the use of percutaneous cardiopulmonary support with (PCPS), saved the patient from certain death.

Sarkar S; Mandal K; Bhattacharya P

2008-07-01

296

Successful management of massive intraoperative pulmonary fat embolism with percutaneous cardiopulmonary support  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We report a patient who sustained catastrophic pulmonary fat embolism, during open reduction, internal fixation (ORIF) of fracture femur' In our opinion, the use of percutaneous cardiopulmonary support with (PCPS), saved the patient from certain death.

Sarkar, Suman; Mandal, Krutisundar; Bhattacharya, Prithwis

297

Successful management of massive intraoperative pulmonary fat embolism with percutaneous cardiopulmonary support.  

Science.gov (United States)

We report a patient who sustained catastrophic pulmonary fat embolism, during open reduction, internal fixation (ORIF) of fracture femur. In our opinion, the use of percutaneous cardiopulmonary support with (PCPS), saved the patient from certain death. PMID:19742250

Sarkar, Suman; Mandal, Krutisundar; Bhattacharya, Prithwis

2008-07-01

298

Successful management of massive intraoperative pulmonary fat embolism with percutaneous cardiopulmonary support  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We report a patient who sustained catastrophic pulmonary fat embolism, during open reduction, internal fixation (ORIF) of fracture femur? In our opinion, the use of percutaneous cardiopulmonary support with (PCPS), saved the patient from certain death.

Sarkar Suman; Mandal Krutisundar; Bhattacharya Prithwis

299

Randomized study of aprotinin and DDAVP to reduce postoperative bleeding after cardiopulmonary bypass surgery  

Digital Repository Infrastructure Vision for European Research (DRIVER)

BACKGROUND: Patients on cardiopulmonary bypass (CPB) have an increased susceptibility to postoperative bleeding. Previous reports using desmopressin acetate (DDAVP) for the prevention of postoperative bleeding have given contradictory results, whereas the protease inhibitor aprotinin has been shown ...

300

Speaking with Employers.  

Science.gov (United States)

Considers the ways in which a cooperative relationship between the community college president and community employers can help the community college meet the job training needs of local business and industry. (AYC)

Rislov, Sigurd

1979-01-01

 
 
 
 
301

Partial pressure of end-tidal carbon dioxide predicts successful cardiopulmonary resuscitation in the field.  

UK PubMed Central (United Kingdom)

Kolar and colleagues contribute an additional and important incentive for rescuers to utilize end-tidal carbon dioxide tensions as a routine monitor to guide management and decision-making during cardiopulmonary resuscitation. They conclude that below-threshold levels of 14 mmHg (1.5 kPa) measured after 20 minutes of cardiopulmonary resuscitation reliably predict that spontaneous circulation cannot be restored.

Weil MH

2008-01-01

302

Bacillus thuringiensis protein transfer between rootstock and scion of grafted poplar.  

UK PubMed Central (United Kingdom)

Bacillus thuringiensis (Bt) Cry1Ac protein is a toxin against different leaf-eating lepidopteran insects that attack poplar trees. In the present study, the mode of migration of the Bt-Cry1Ac protein within poplar grafts was investigated. Grafting was done using Pb29 (transgenic poplar 741 with cry1Ac genes), CC71 (transgenic poplar 741 with cry3A genes), non-transgenic poplar 741 and non-transgenic Populus tomentosa, either as scion or as rootstock. In order to detect migration of Bt-Cry1Ac protein from one portion of the graft union to different tissues in the grafted plant, ELISA analysis was employed to assess the content of Bt-Cry1Ac protein in the phloem, xylem, pith and leaves of the grafted poplar. To further verify migration of Bt-Cry1Ac protein, Clostera anachoreta larvae, which are susceptible to Bt-Cry1Ac protein, were fed leaves from the control graft (i.e., graft portion that originally did not contain Bt-Cry1Ac protein). The results showed that Bt-Cry1Ac protein was transported between rootstock and scion mainly through the phloem. Migration of Bt-Cry1Ac protein in the grafted union was also evidenced in that the leaves of the control graft did have a lethal effect on C. anachoreta larvae in laboratory feeding experiments.

Wang L; Yang M; Akinnagbe A; Liang H; Wang J; Ewald D

2012-02-01

303

Bacillus thuringiensis protein transfer between rootstock and scion of grafted poplar.  

Science.gov (United States)

Bacillus thuringiensis (Bt) Cry1Ac protein is a toxin against different leaf-eating lepidopteran insects that attack poplar trees. In the present study, the mode of migration of the Bt-Cry1Ac protein within poplar grafts was investigated. Grafting was done using Pb29 (transgenic poplar 741 with cry1Ac genes), CC71 (transgenic poplar 741 with cry3A genes), non-transgenic poplar 741 and non-transgenic Populus tomentosa, either as scion or as rootstock. In order to detect migration of Bt-Cry1Ac protein from one portion of the graft union to different tissues in the grafted plant, ELISA analysis was employed to assess the content of Bt-Cry1Ac protein in the phloem, xylem, pith and leaves of the grafted poplar. To further verify migration of Bt-Cry1Ac protein, Clostera anachoreta larvae, which are susceptible to Bt-Cry1Ac protein, were fed leaves from the control graft (i.e., graft portion that originally did not contain Bt-Cry1Ac protein). The results showed that Bt-Cry1Ac protein was transported between rootstock and scion mainly through the phloem. Migration of Bt-Cry1Ac protein in the grafted union was also evidenced in that the leaves of the control graft did have a lethal effect on C. anachoreta larvae in laboratory feeding experiments. PMID:22372666

Wang, L; Yang, M; Akinnagbe, A; Liang, H; Wang, J; Ewald, D

2012-02-28

304

Electron beam-induced graft copolymerization of vinyl monomers on to polyester fibre  

International Nuclear Information System (INIS)

Electron beam-induced graft copolymerization of acrylic acid on to multifilament PET fibre was carried out by simultaneous method. The fibre was impregnated with acrylic acid at room temperature and the impregnated fibre was irradiated with electron beams in air. The effects of impregnation time, swelling agent, monomer composition, dose, dose rate and grafting temperature have been investigated. Four hour impregnation time was found to be sufficient to obtain the maximum weight percentage of grafting for this system. Among the swelling agents employed, formic acid was found to be the most effective. Some properties of several percentage of grafting have been studied by means of Optical Microscope, X-rays Microanalyzer and Differential Scanning Calorimeter. Optical microscopic observations show that the diameter of graft fibres increases with the increasing percentage of grafting. X-rays microscope analysis shows that the distribution of grafts across the PET cross-sections is more intense at the surface in comparison to the core of the fibres. It is learned from DSC measurements that the melting point of graft fibres decreases slightly as the weight percentage of grafting increases. (author)

1986-01-01

305

LONGITUDINALLY COMPLIANT VASCULAR GRAFT  

UK PubMed Central (United Kingdom)

A longitudinally compliant PTFE graft (20) is provided by compressing at least a portion of a porous PTFE tube (32) along its longitudinal axis (22) and coating at least the outer wall of the compressed portion of the PTFE tube (32) with a biocompatible elastomer for allowing the compressed portion of the tube (32) to be stretched along the longitunal axis (22). The PTFE tube (32) is compressed by pulling the tube (32) over a cylindrical mandrel of like diameter and applying a compression force to the tube (32) along its longitudinal axis (22). The compressed portion(s) is(are) secured against movement upon the mandrel, and a coating (38) of liquified polyurethane or other biocompatible elastomer is then applied over at least the compressed portion(s) of the tube (32). The elastomeric coating (38) may be applied by dip coating or spray coating techniques. After the elastomeric coating (38) has dried, the completed graft (20) is removed from the mandrel.

DELLA CORNA Linda V.; FARNAN Robert Charles; COLONE William Michael; KOWLIGI Rajagopal R.

306

Deficiency of employability capacity  

Directory of Open Access Journals (Sweden)

Full Text Available Young unemployed people have comprised one of the significantly largest groups of the unemployed people in Latvia in recent years. One of the reasons why young people have difficulty integrating into the labour market is the “expectation gap” that exists in the relations between employers and the new generation of workers. Employers focus on capacity-building for employability such individual factors as strength, patience, self-discipline, self-reliance, self-motivation, etc., which having a nature of habit and are developed in a long-term work socialization process, which begins even before the formal education and will continue throughout the life cycle. However, when the socialization is lost, these habits are depreciated faster than they can be restored. Currently a new generation is entering the labour market, which is missing the succession of work socialization. Factors, such as rising unemployment and poverty in the background over the past twenty years in Latvia have created a very unfavourable employability background of “personal circumstances” and “external factors”, which seriously have impaired formation of the skills and attitudes in a real work environment. The study reveals another paradox – the paradox of poverty. Common sense would want to argue that poverty can be overcome by the job. However, the real state of affairs shows that unfavourable coincidence of the individual, personal circumstances and external factors leads to deficit of employability capacity and possibility of marked social and employment deprivation.

Vilka L.; Pelse I.

2012-01-01

307

Protective effect of antioxidants on pulmonary endothelial function after cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

OBJECTIVES: Pulmonary endothelium-dependent vasodilation is impaired after cardiopulmonary bypass. One explanation might be the generation of reactive oxygen species during the period without flow in the pulmonary artery. The aim of the current study was to investigate if treatment with antioxidants could improve pulmonary endothelial function after cardiopulmonary bypass and influence the blood oxidative status. DESIGN: A prospective, randomized, double-blind study. SETTING: The operating room, intensive care unit, and the biochemistry laboratory in University Hospitals. PARTICIPANTS: Patients scheduled for cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: Treatment with vitamin E, vitamin C, allopurinol, and acetylcysteine (n = 12) or placebo (n = 10). MEASUREMENTS AND MAIN RESULTS: The pulmonary reactivity to an infusion of acetylcholine and markers of oxidative stress in blood were measured before and after cardiopulmonary bypass. Sixteen control patients received saline instead of acetylcholine. Before surgery the pulmonary vascular resistance index decreased during infusion of acetylcholine by 24% and 21% in the treatment and placebo groups. After surgery the decrease was 20% and 8%, respectively, (p = 0.422 and p = 0.026) compared with preoperative response. Pulmonary vasodilation induced by acetylcholine was better maintained in the group treated with antioxidants (p = 0.048). In the treatment group, the blood concentrations of early intermediates of lipid peroxidation were higher, but not that of the end products. Glutathione and oxidized glutathione increased after cardiopulmonary bypass in the treatment group. CONCLUSION: The better maintained endothelium-dependent vasodilation after cardiopulmonary bypass in the treatment group indicated that antioxidant therapy reduced endothelial dysfunction.

Angdin M; Settergren G; Starkopf J; Zilmer M; Zilmer K; Vaage J

2003-06-01

308

Coronary revascularization without cardiopulmonary bypass versus the conventional approach in high-risk patients.  

UK PubMed Central (United Kingdom)

BACKGROUND: The premise of coronary revascularization without cardiopulmonary bypass (off-pump coronary artery bypass graft [CABG]) proposes that patient morbidity and, potentially, mortality can be reduced without compromising the excellent results of conventional revascularization techniques (on-pump CABG). High-risk patients may benefit the most from off-pump CABG. The aim of this study was to compare early and mid-term clinical outcomes after off-pump CABG with on-pump CABG in a subset of high-risk patients. METHODS: Between January 1, 2000 and December 31, 2000, 513 high-risk patients with a Parsonnet's risk scores of 20 or higher underwent CABG; 38.6% (n = 198) underwent on-pump CABG, and 61.4% (n = 315) had off-pump CABG. Logistic regression was used to calculate the probability of being selected for on-pump CABG given a set of preoperative risk factors. Propensity scores or the probability of being selected for on-pump CABG were computed. Relative risks, heterogeneity among strata, and interactions between surgery type and the propensity score were assessed by a multivariate Cox proportional-hazards regression for the outcomes mortality and major adverse cardiac events (death, acute myocardial infarction, stroke, reoperative CABG, percutaneous coronary intervention). RESULTS: Operative mortality was lower after off-pump versus on-pump CABG between the two groups after controlling for preoperative risk factors using the propensity score (odds ratio = 2.10; 95% confidence intervals = 1.02 to 4.36, p = 0.04). In the Cox-regression analysis, off-pump CABG was associated with an improved survival rate compared with on-pump CABG (p = 0.03). Off-pump CABG was associated with a comparable event-free survival (p = 0.14) compared with on-pump CABG. CONCLUSIONS: Off-pump CABG can be performed with a reasonably low morbidity and lower early and late mortality in high-risk patients. Off-pump CABG may be a better operative strategy in this subset of patients.

Stamou SC; Jablonski KA; Hill PC; Bafi AS; Boyce SW; Corso PJ

2005-02-01

309

Validation of rotational thromboelastometry during cardiopulmonary bypass: A prospective, observational in-vivo study.  

UK PubMed Central (United Kingdom)

CONTEXT: Rotational thromboelastometry (ROTEM) is a whole blood point-of-test used to assess the patient's coagulation status. Three of the available ROTEM tests are EXTEM, INTEM and HEPTEM. In the latter, heparinase added to the INTEM reagent inactivates heparin to reveal residual heparin effect. Performing ROTEM analysis during cardiopulmonary bypass (CPB) might allow the anaesthesiologist to anticipate the need for blood products. OBJECTIVE: The goal of this study was to validate ROTEM analysis in the presence of very high heparin concentrations during CPB. DESIGN: Prospective, observational trial. SETTING: Single University Hospital. PARTICIPANTS: Twenty patients undergoing coronary artery bypass grafting. MAIN OUTCOME MEASURE: ROTEM analysis was performed before heparin administration (T0), 10?min after heparin (T1), at the end of CPB (T2) and 10?min after protamine (T3). The following tests were performed: EXTEM, INTEM, and HEPTEM. Heparin concentrations were measured at T1 and at the end of bypass (T2). RESULTS: At T1, EXTEM differed from baseline for coagulation time: +26.7?s (18.4 to 34.9, P?0.0001), A10: -2.3?mm (0.5 to 4.0, P?=?0.01) and ? -2° (1.0 to 3.0; P?=?0.0007). At T2, all parameters in EXTEM and HEPTEM related to fibrin-platelet interaction deteriorated significantly compared to T1. At T3, EXTEM and INTEM were comparable to EXTEM and HEPTEM at T2. CONCLUSION: HEPTEM and EXTEM measurements are valid in the presence of very high heparin concentrations and can be performed before protamine administration in patients undergoing cardiac surgery with CPB. TRIAL REGISTRATION: clinicaltrials.gov identifier NCT01455454.

Gronchi F; Perret A; Ferrari E; Marcucci CM; Flèche J; Crosset M; Schoettker P; Marcucci C

2013-07-01

310

Employers' Gas Association (ZPZ)  

International Nuclear Information System (INIS)

Employers' Gas Association (ZPZ) is the institution which main task is to maintain the optimum conditions for dynamic development of its members' activities, their business activities and to maintain the common or individual interests o fits members. To meet this objective, the association: - maintains the interests of association members during discussions with representative authorities, central state administration bodies and the trade unions regarding the economic and social policy and the questions which are to be the subject matter of collective bargaining, conclusion of contracts and the collective agreements of higher force; - is the member of enterprising, negotiating and advisory authorities; - coordinates the procedure and promotes the common interests of its members in relation to the representative authorities and the central state administration bodies, central trade union authorities and in relation to the international organisation of employers and the International Labour Organisation; maintains the commercial and business activities of the members of association; submits the proposals, filling with the courts and makes interventions regarding the preparation of economic and political decisions on the national and international level; engages with the legal entities in the Slovak Republic and enters the foreign international organisations. ZPZ, originally Gas Association (PZ), was founded by the General Assembly on 27th January 1995. It was registered in compliance with the Act No. 83/1990 Coll. on Association of Citizens as amended by the act No. 300/90 Coll., as the organisation of employers with the legal personality. The Employer's Gas Association was a member of the Employers' Associations in Slovak Republic till 31st March 2004, after this date it is represented by the Republican Union of Employers in SR (RUZ SR), which was established to maintain employer's associations interests on more qualitative level. The list of members, representatives of members and officials as well as their activities are presented.

1995-01-00

311

Comparison of Alloderm and mucosal graft in mandibular vestibuloplasty  

Directory of Open Access Journals (Sweden)

Full Text Available "nBackground and Aim: The usage of free gingival grafts for vestibuloplasty is a routine procedure. The free gingival procedure requires harvesting the graft from a donor site which increases morbidity and the risk of surgical complications. In addition, adequate amount of donor tissue may not be available. Acceptable results of Alloderm application as a substitute for autogenous soft tissue grafts are: Not exposing the patient to an additional surgery, no donor site morbidity, unlimited availability, decreasing the bleeding during the surgery, decreasing the surgical complications, and better color match. The aim of this study was to evaluate the maintenance of the vestibular depth in vestibuloplasty with mucosal graft and Alloderm."nMaterials and Methods: Both methods of anterior mandibular vestibuloplasty by Clark, utilizing Alloderm and mucosal grafts, were employed in ten clinical cases. During the surgeries, half the prepared recipient sites received Alloderm, while the remaining half received autografts in a randomized fashion. Immediately, 1, 3, and 6 months postoperatively, the variables of graft rejection, depth of vestibule and the degree of relapse were evaluated. SPSS software was used for analysis of the data and the methods used for "statistical tests" were as follows: Friedman Method, Paired sample t-test, Smirnov-kolmogrove Method. (The statistical significance level was established at P-value<0.05."nResults: The mean difference of the relapse measurements in both methods throughout the survey did not have significant predictive value (P>0.05). Similar results were achieved for the mean difference of depth of the vestibule."nConclusion: In patients undergoing Vestibuloplasty, Alloderm could be material of choice to be utilized as autogenic soft tissue grafts in pre-prosthesis procedures.

Mahmoodhashemi H.; Ghafari Gorakani S.; Akhondi N.

2009-01-01

312

PAI-1 and t-PA/PAI-1 complex potential markers of fibrinolytic bleeding after cardiac surgery employing cardiopulmonary bypass  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Enhanced bleeding remains a serious problem after cardiac surgery, and fibrinolysis is often involved. We speculate that lower plasma concentrations of plasminogen activator inhibitor – 1 (PAI-1) preoperatively and tissue plasminogen activator/PAI-1 (t-PA/PAI-1) complex postoperatively might predispose for enhanced fibrinolysis and increased postoperative bleeding. Methods Totally 88 adult patients (mean age 66?±?10 years) scheduled for cardiac surgery, were enrolled into a prospective study. Blood samples were collected pre-operatively, on admission to the recovery and at 6 and 24 hours postoperatively. Patients with a surgical bleeding that was diagnosed during reoperation were discarded from the study. The patients were allocated to two groups depending on the 24-hour postoperative chest tube drainage (CTD): Group I > 500ml, Group II ? 500ml. Associations between CTD, PAI-1, t-PA/PAI-1 complex and D-dimer were analyzed with SPSS. Results Nine patients were excluded because of surgical bleeding. Of the 79 remaining patients, 38 were allocated to Group I and 41 to Group II. The CTD volumes correlated with the preoperative plasma levels of PAI-1 (r = ? 0.3, P = 0.009). Plasma concentrations of preoperative PAI-1 and postoperative t-PA/PAI-1 complex differed significantly between the groups (P Conclusions Lower plasma concentrations of PAI-1 preoperatively and t-PA/PAI-1 complex postoperatively leads to higher plasma levels of D-dimer in association with more postoperative bleeding after cardiac surgery.

Ozolina Agnese; Strike Eva; Jaunalksne Inta; Krumina Angelika; Bjertnaes Lars J; Vanags Indulis

2012-01-01

313

Modification of synthetic fibers by radiation-induced grafting  

International Nuclear Information System (INIS)

The present report describes studies to modify properties of synthetic fibers by radiation-induced grafting technique. This technique was employed since it is considered to be generally applicable to the grafting of a radically polymerizable monomer onto fiber. Three synthetic fibers were used mainly in the present studies; (1) polyester fiber which is ranked as the first in the amount of production in the synthetic fibers at present and is expected to increase in its importance in the future, (2) poly (vinyl chloride) fiber which is inexpensive and fire-retardant, and (3) polyethylene fiber which is not yet used in apparel at present. In order to perform the grafting, the following two methods were studied; one is to graft monomer uniformly in the fiber preventing homopolymerization of the monomer outside of the fiber, and the other to graft monomer only on the fiber surface. Using these methods, the following experiments were carried out and fairly good results as expected were obtained. (1) In the case of polyester fiber it was intended to make this more hydrophilic and fire-retardant. (2) Concerning to poly(vinyl chloride) fiber experiments were carried out to make the fiber more hydrophilic and simultaneously more heat-resistant. (3) In the case of polyethylene fiber, target was fire-retardance and heat-resistance. (author)

1981-01-01

314

Early psychosis and employment.  

UK PubMed Central (United Kingdom)

BACKGROUND: Employment may be an important factor in helping patients with early psychosis to recover rapidly and to avoid involvement in disability and welfare programs. METHODS: This study followed 351 patients with early psychoses, either primary psychoses or substance-induced psychoses, for two years to examine their patterns of competitive employment in relation to service use, psychosocial outcomes, and disability and welfare payments. RESULTS: Workers differed from non-workers at baseline and over two years. At baseline, they had better educational and employment histories, were more likely to have substance-induced psychoses rather than primary psychoses, were less likely to have drug dependence, had fewer negative symptoms, and had better psychosocial adjustment. Over two years, baseline psychosocial differences persisted, and the workers used fewer medications, mental health services, and disability or welfare payments. CONCLUSIONS: Employment predicts less service use and fewer disability claims among early psychosis patients. Thus, greater attention to supported employment early in the course of illness may reduce federal insurance costs and disability payments.

Drake RE; Xie H; Bond GR; McHugo GJ; Caton CL

2013-05-01

315

Left Coronary Ostial Stenosis after the Modified Bentall Using a Long Interposed Coronary Graft in a Patient with Pectus Excavatum.  

UK PubMed Central (United Kingdom)

A 26-year-old man presented chest oppression. He had pectus excavatum associated with Loeys-Dietz syndrome and a history of redo aortic root replacement with the modified Bentall technique using an 8-mm long interposed graft to the left coronary ostium. Coronary angiography revealed severe stenosis of both left coronary ostium and proximal left anterior descending artery, which was supposed to be resulted from thrombosis in the interposed graft. The left coronary system was bypassed through a left thoracotomy, which was suitable in this patient because the pectus excavatum would prevent harvest of the left internal thoracic artery through re-median sternotomy and to avoid potential sternal reentry injury of the heart. Although the left anterior descending artery was easily accessed under off-pump technique, exposure and anastomosis of the circumflex coronary artery was more difficult than expected without cardiopulmonary bypass as the pectus excavatum and adhesion of the heart prevented anterior shift and rotation of the heart.

Kato Y; Hattori K; Motoki M; Takahashi Y; Nishimura S; Shibata T

2013-02-01

316

Evaluation of graft patency by intravenous digital subtraction angiography after vascular reconstruction  

Energy Technology Data Exchange (ETDEWEB)

Intravenous digital subtraction angiography (IVDSA) was employed to evaluate graft patency after reconstructive vascular surgery in 45 cases with various vascular diseases. IVDSA offered equally valuable information about the patency of the graft, compared with conventional arteriography. In the peripheral vascular disease, IVDSA readily demonstrated patency or occlusion of the graft, even in the complex one, and the result of evaluation by IVDSA correlated well with that inferred by postoperative change in ankle pressure index measured by Doppler ultrasound technique. In the aortic disease, IVDSA was effective to rule out stenosis or leakage at the anastomotic site of the graft, and was also useful in the detection of the patency of the reconstructed inferior mesenteric artery after surgery for abdominal aortic aneurysm. The procedure in IVDSA is simple and safe, and it can be performed on an outpatient basis. IVDSA is a reliable and valuable approach in the evaluation of the graft patency after reconstructive vascular surgery. (author).

Kuribayashi, Sachio; Ootaki, Makoto; Watabe, Tsuneya; Matsuyama, Seiya

1985-01-01

317

Graft copolymerisation of methyl-methacrylate on to natural rubber latex  

International Nuclear Information System (INIS)

[en] In MG latex (natural rubber latex grafted with polymethyl methacrylate) preparations, the percentage of graftings were found to be influenced by the monomer concentrations. And the percentage of methyl metharylate grafted on natural rubber latex was improved by prior latex treatment with urea. Tensile strengths and elongation at breaks of the MG lattices were found to decrease with the increased in the percentage of the monomer grafted on the latex. Whereas, their moduli increased with the increased in the percentage of graftings. The irradiation dose employed in the MG latex preparations produces moderately vulcanized MG latex. These were exhibited by the low tensile readings. However, the tensile properties were improved by vulcanization process. It could be carried out either when the MG lattices were in the latex form or cast films form

1995-01-01

318

Graft healing in anterior cruciate ligament reconstruction.  

UK PubMed Central (United Kingdom)

Graft healing within the bone tunnel after anterior cruciate ligament (ACL) reconstruction is still a complex, poorly understood biological process that is influenced by multiple surgical and postoperative variables. However, remarkable advances in knowledge of this process have been made based primarly on animal models. According to the findings of this review, some surgical and postoperative variables are known to directly affect time-course and quality of graft-tunnel healing. The type of graft, graft motion, and fixation methods have shown to directly affect time-course and quality of graft-tunnel healing. Therefore, the application of early and aggressive rehabilitation protocols should be cautious when using soft-tissue graft, allografts, and direct or aperture type of fixation for ACL reconstruction. With regard to graft placement, several cadaveric models showed biomechanical advantages of a more anatomical graft location; however, there are no studies that explore the relationship between graft placement and healing process. The precise effect of graft tensioning, graft/tunnel diameter disparity, and graft length within the bone tunnel in the graft healing process remains unclear and requires more research. To enhance graft-tunnel healing, tissue-engineering approaches, including the use of growth factors, mesenchymal stem cells, and periosteum graft augmentation, have been tested on animal models. These have shown promising results in terms of enhancement of bone-graft healing rate.

Ekdahl M; Wang JH; Ronga M; Fu FH

2008-10-01

319

Brain emboli distribution and differentiation during cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Cardiopulmonary bypass (CPB) is a lifesaving practice in cardiac surgery, but its use frequently is associated with cerebral injury and neurocognitive dysfunctions. Despite the involvement of numerous factors, microembolism occurring during CPB seems to be one of the main mechanisms leading to such alterations. The aim of the present study was to characterize the occurrence of cerebral microembolism with reference to microembolic amount, nature, and distribution in different combinations of cardiac procedures and CPB on the microembolic load. DESIGN: A retrospective observational clinical study. SETTING: A single-center regional hospital. PARTICIPANTS: Fifty-five patients undergoing elective cardiac surgery with CPB. INTERVENTIONS: Bilateral detection of the patients' middle cerebral arteries using a multifrequency transcranial Doppler. MEASUREMENTS AND MAIN RESULTS: Patients were divided into 3 groups depending on the CPB circuit used (open, open with vacuum, or closed). There was a significant difference between the number of solid and gaseous microemboli (p<0.001), with the solid lower than the gaseous ones. The number of solid microemboli was affected by group (p< 0.05), CPB phase (p<0.001), and laterality (p<0.01). The number of gaseous microemboli was affected only by group (p<0.05) and CPB phase (p<0.001). Generally, the length of CPB phase did not affect the number of microemboli. CONCLUSIONS: Surgical procedures combined with CPB circuits, but not the CPB phase length, affected the occurrence, nature, and laterality of microemboli.

Zanatta P; Forti A; Minniti G; Comin A; Mazzarolo AP; Chilufya M; Baldanzi F; Bosco E; Sorbara C; Polesel E

2013-10-01

320

Clinical model for ethical cardiopulmonary resuscitation decision-making.  

UK PubMed Central (United Kingdom)

BACKGROUND: Decisions to withhold cardiopulmonary resuscitation (CPR) for future cardiac arrest continue to be problematic, with a lack of consistency in how doctors approach this decision. AIMS: To develop a clinical model that can be used in education to improve consistency in CPR decision-making. METHODS: A qualitative study, using semistructured interviews with a total of 33 senior doctors, junior doctors and nurses from two Melbourne hospitals explored how decisions to withhold CPR are made. Interviews explored: issues arising; how doctors learn to make these decisions; how they deal with disagreement and their experiences of performing CPR. The transcripts were coded and analysed thematically. RESULTS: Three major themes were identified: CPR as a life-and-death decision; good and bad dying; and trust. The research also defined the two elements to a CPR decision: (i) technical and (ii) ethical. CONCLUSIONS: Applying ethical principles commonly used in medicine, a model for ethical CPR decision-making has been developed that identifies four patient groups, each with a different discussion aim. This approach simplifies the complexities of the CPR decision, providing a structured way to teach CPR decision-making to doctors and thereby achieve greater consistency in the decisions made.

Hayes B

2013-01-01

 
 
 
 
321

Tendencias en resucitación cardiopulmonar Trends in cardiopulmonary resuscitation  

Directory of Open Access Journals (Sweden)

Full Text Available Menos del 10% de las personas que sufren una parada cardíaca son resucitados con éxito y regresan a sus hogares para vivir vidas productivas. Nuevos enfoques de la resucitación podrían modificar de forma sustancial este resultado tan triste. Cuatro tendencias en resucitación cardiopulmonar (RCP) parecen tener el mayor potencial para mejorar el pronóstico: los sistemas para la prevención de la parada cardíaca mediante reconocimiento precoz de los signos de alarma e intervención oportuna; el cambio hacia una resucitación orientada hacia el flujo sanguíneo, enfatizando la realización ininterrumpida de una RCP de alta calidad con un papel limitado de la ventilación; la importancia creciente de la tecnología guiando las intervenciones en resucitación, mejorando el proceso humano de toma de decisiones, y el empleo de la hipotermia.Less than 10% of those individuals who suffer an episode of sudden cardiac arrest are successfully resuscitated and return home to live productive lives. New approaches to cardiac resuscitation could substantially improve such dismal outcome. Four current trends in cardiopulmonary resuscitation (CPR) have the greatest potential for improving outcome: the development of systems that can prevent cardiac arrests through recognition of early warning signs and timely intervention; a shift towards a flow-based resuscitation emphasizing the delivery of high-quality uninterrupted CPR limiting the role of ventilation; the growing role of technology in driving resuscitation interventions, incrementally enhancing the human decision-making process, and the use of hypothermia.

Raúl-Jaime Gazmuri; Jesús-Andrés Álvarez-Fernández

2009-01-01

322

Tendencias en resucitación cardiopulmonar/ Trends in cardiopulmonary resuscitation  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Menos del 10% de las personas que sufren una parada cardíaca son resucitados con éxito y regresan a sus hogares para vivir vidas productivas. Nuevos enfoques de la resucitación podrían modificar de forma sustancial este resultado tan triste. Cuatro tendencias en resucitación cardiopulmonar (RCP) parecen tener el mayor potencial para mejorar el pronóstico: los sistemas para la prevención de la parada cardíaca mediante reconocimiento precoz de los signos de alarma e (more) intervención oportuna; el cambio hacia una resucitación orientada hacia el flujo sanguíneo, enfatizando la realización ininterrumpida de una RCP de alta calidad con un papel limitado de la ventilación; la importancia creciente de la tecnología guiando las intervenciones en resucitación, mejorando el proceso humano de toma de decisiones, y el empleo de la hipotermia. Abstract in english Less than 10% of those individuals who suffer an episode of sudden cardiac arrest are successfully resuscitated and return home to live productive lives. New approaches to cardiac resuscitation could substantially improve such dismal outcome. Four current trends in cardiopulmonary resuscitation (CPR) have the greatest potential for improving outcome: the development of systems that can prevent cardiac arrests through recognition of early warning signs and timely intervent (more) ion; a shift towards a flow-based resuscitation emphasizing the delivery of high-quality uninterrupted CPR limiting the role of ventilation; the growing role of technology in driving resuscitation interventions, incrementally enhancing the human decision-making process, and the use of hypothermia.

Gazmuri, Raúl-Jaime; Álvarez-Fernández, Jesús-Andrés

2009-02-01

323

Review article: heparin sensitivity and resistance: management during cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Heparin resistance during cardiac surgery is defined as the inability of an adequate heparin dose to increase the activated clotting time (ACT) to the desired level. Failure to attain the target ACT raises concerns that the patient is not fully anticoagulated and initiating cardiopulmonary bypass may result in excessive activation of the hemostatic system. Although antithrombin deficiency has generally been thought to be the primary mechanism of heparin resistance, the reasons for heparin resistance are both complex and multifactorial. Furthermore, the ACT is not specific to heparin's anticoagulant effect and is affected by multiple variables that are commonly present during cardiac surgery. Due to these many variables, it remains unclear whether decreased heparin responsiveness as measured by the ACT represents inadequate anticoagulation. Nevertheless, many clinicians choose a target ACT to assess anticoagulation, and interventions aimed at achieving the target ACT are routinely performed in the setting of heparin resistance. Treatments for heparin resistance/alterations in heparin responsiveness include additional heparin or antithrombin supplementation. In this review, we discuss the variability of heparin potency, heparin responsiveness as measured by the ACT, and the current management of heparin resistance.

Finley A; Greenberg C

2013-06-01

324

[Cardiopulmonary exercise testing in occupational medical fitness examination and assessment].  

UK PubMed Central (United Kingdom)

Medical expert opinion by occupational physicians and pneumologists has two main objectives: making a diagnosis with probability bordering on certainty and clarifying a causal relationship to a present or former occupational exposure to irritant toxic, allergenic or fibrosing dusts, gases, welding fumes or mineral fibres. Especially for conditions that are associated with exertional dyspnea, the diagnosis at rest using spirometry, body plethysmography, pulmonary function test, blood gas analysis, electrocardiogram and echocardiography is of limited use. This paper identifies the indications for cardiopulmonary exercise testing (CPET) in occupational medicine, explains the related measurements and their differential diagnostic value with special consideration of the flow-volume curve under exercise as well as the alveolar-arterial oxygen gradient. Diagnostic statements on the relevance of oxygen uptake measured at continuous and peak load compared to the wattage ascertained on the bicycle ergometer are presented. Characteristic CPET findings are explained in terms of their differential diagnostic significance. Furthermore, the importance of CPET for the assessment of occupational disease-related functional loss (clinical proportions in the reduction of working capacity) is shown.

Preisser AM; Ochmann U

2011-11-01

325

[Cardiopulmonary exercise testing in occupational medical fitness examination and assessment].  

Science.gov (United States)

Medical expert opinion by occupational physicians and pneumologists has two main objectives: making a diagnosis with probability bordering on certainty and clarifying a causal relationship to a present or former occupational exposure to irritant toxic, allergenic or fibrosing dusts, gases, welding fumes or mineral fibres. Especially for conditions that are associated with exertional dyspnea, the diagnosis at rest using spirometry, body plethysmography, pulmonary function test, blood gas analysis, electrocardiogram and echocardiography is of limited use. This paper identifies the indications for cardiopulmonary exercise testing (CPET) in occupational medicine, explains the related measurements and their differential diagnostic value with special consideration of the flow-volume curve under exercise as well as the alveolar-arterial oxygen gradient. Diagnostic statements on the relevance of oxygen uptake measured at continuous and peak load compared to the wattage ascertained on the bicycle ergometer are presented. Characteristic CPET findings are explained in terms of their differential diagnostic significance. Furthermore, the importance of CPET for the assessment of occupational disease-related functional loss (clinical proportions in the reduction of working capacity) is shown. PMID:22083292

Preisser, A M; Ochmann, U

2011-11-14

326

Cefazolin concentrations in serum during cardiopulmonary bypass surgery.  

Science.gov (United States)

The objective of the study was to investigate possible changes in cefazolin serum levels induced by cardiopulmonary bypass (CPB). Six cardiac male patients who underwent cardiac surgery requiring CPB took part in the study. Cefazolin 2 g was intravenously infused over 60 min before anesthesia and blood samples were taken at appropriate times after drug administration (0, 0.25, 0.5, 1, 4, 6, 8 h), 2 min before and 5 min after the beginning and 2 min before and 5 min after the end of CPB. Drug serum concentrations were determined by means of a microbiological method. Five minutes after the start of CPB, cefazolin serum levels decreased on average by 46.6% and remained steadily low until 5 min after the end of CPB. Then, they rose on average by 37.3% at 4 h and then declined slowly until the last sampling at 8 h. Cefazolin serum concentrations were low during CPB but remained in a potentially effective range for antimicrobial prophylaxis for this surgery. PMID:15921027

Miglioli, P A; Merlo, F; Calabrò, G B; Allerberger, F; Fille, M

2005-01-01

327

Attitudes to bystander cardiopulmonary resuscitation in Japan in 2010.  

UK PubMed Central (United Kingdom)

BACKGROUND: Early initiation of bystander cardiopulmonary resuscitation (CPR) improves the chances of successful resuscitation and survival. The aim of the present study was to identify the attitudes of Japanese subjects toward bystander CPR and to compare them with those observed in previous studies in 1998 and 2006. METHODS AND RESULTS: Participants were asked about their willingness to perform CPR in 5 different scenarios and their willingness to perform chest compression (CC) plus mouth-to-mouth ventilation (MMV) versus CC alone. A total of 2,785 individuals completed the questionnaire, including high school students, teachers, medical nurses, and medical students, whose characteristics were not statistically different from those in the previous studies. Only 15-30% of participants were likely to perform CC plus MMV, especially on a stranger or a trauma victim; these percentages in nurses and medical students were significantly lower than those in the previous studies. But 50-100% of them were likely to perform CC alone, consistent with the results obtained in 2006. The reasons for the unwillingness among laypeople to perform CC plus MMV were inadequate knowledge and/or doubt regarding whether they could perform the techniques effectively, while health-care providers reported a fear of disease transmission. CONCLUSIONS: Most participants are unlikely to perform CC plus MMV, especially on a stranger or trauma victim, but are more likely to perform CC alone, as also found in the previous studies.

Taniguchi T; Sato K; Fujita T; Okajima M; Takamura M

2012-01-01

328

Retention of cardiopulmonary resuscitation skills after initial overtraining.  

UK PubMed Central (United Kingdom)

The authors have examined cardiopulmonary resuscitation (CPR) skills retention in a police force initially trained to instructor level performance skills as defined by the 1977 American Heart Association Instructor Manual. In 1977, the entire Winnipeg Police Force received a basic 8-h course of CPR training with recording manikins. Each training session was followed by a written test and a performance test on the recording manikin using instructor level tape criteria as the standard. Between 12 and 18 months later, 116 personnel were randomly selected for retesting. The first min of one-man CPR on the two tapes was compared. Retention was expressed as a percentage, i.e., retest score/training score x 100. Retention scores were as follows: knowledge, 76%; assessment skills, 83%; call for help, 85%; numbers of adequate ventilations, 100%; numbers of adequate compressions, 97%. Total assessment time and incidence of potentially injurious performance were the same. Deliverate overtraining of highly motivated and mature nonmedical basic rescuers results in satisfactory skills retention for at least 1 year.

Tweed WA; Wilson E; Isfeld B

1980-11-01

329

An ultrafiltration technique for directly reinfusing residual cardiopulmonary bypass blood.  

UK PubMed Central (United Kingdom)

Given the shortages of banked blood, the risks of transfusion reactions, disease transmissions, and transfusion errors, we perfusionists must find ways to avoid blood transfusions. At the end of any given bypass run, there is residual blood left in the bypass circuit, the perfusionist must get this blood back to the patient. Most commonly either a cell saver or a hemoconcentrator (HC) has been used, in some fashion, to reinfuse residual circuit blood. The ideal method should: 1) be simple; 2) raise the hematocrit (HCT); 3) allow for changes in the patient's volume status; and 4) not compromise the integrity of the cardiopulmonary bypass (CPB) circuit allowing for rapid re-institution of CPB. We describe a technique in which residual CPB circuit blood is pumped through an HC directly to the patient via a 3/16-inch diameter line into a 16-gauge intravenous needle positioned in a peripheral or central vein. This allows the perfusionist to give back concentrated blood that is protein-rich while maintaining the above criteria.

Smigla GR; Lawson DS; Shearer IR; Jaggers J; Milano C; Welsby I

2004-09-01

330

An ultrafiltration technique for directly reinfusing residual cardiopulmonary bypass blood.  

Science.gov (United States)

Given the shortages of banked blood, the risks of transfusion reactions, disease transmissions, and transfusion errors, we perfusionists must find ways to avoid blood transfusions. At the end of any given bypass run, there is residual blood left in the bypass circuit, the perfusionist must get this blood back to the patient. Most commonly either a cell saver or a hemoconcentrator (HC) has been used, in some fashion, to reinfuse residual circuit blood. The ideal method should: 1) be simple; 2) raise the hematocrit (HCT); 3) allow for changes in the patient's volume status; and 4) not compromise the integrity of the cardiopulmonary bypass (CPB) circuit allowing for rapid re-institution of CPB. We describe a technique in which residual CPB circuit blood is pumped through an HC directly to the patient via a 3/16-inch diameter line into a 16-gauge intravenous needle positioned in a peripheral or central vein. This allows the perfusionist to give back concentrated blood that is protein-rich while maintaining the above criteria. PMID:15559739

Smigla, Greg R; Lawson, D Scott; Shearer, Ian R; Jaggers, James; Milano, Carmelo; Welsby, Ian

2004-09-01

331

The successful use of cardiopulmonary support for a transected bronchus.  

UK PubMed Central (United Kingdom)

A 20-year-old male was involved in a motor vehicle accident and computed tomography revealed a completely transected right mainstem bronchus. An Emergency Department (ED) right anterior thoracotomy was necessary soon after arrival at our institution secondary to acute desaturation that was unresponsive to ventilator and chest tube management. This allowed direct intubation and ventilation of the right middle and lower lobes directly through the thoracotomy incision, which stabilized the patient for transport to the operating room. Once there, percutaneous cardiopulmonary support (CPS) was initiated to allow primary surgical repair of the transected bronchus. Post surgery, the patient was transported to the surgical intensive care unit on CPS which he required for an additional two days. The patient eventually did well and was discharged home. To our knowledge this is the first successful reported case of using the Avalon Elite dual lumen veno-venous cannula for CPS in a patient with complete right main-stem bronchus transection and bilateral pulmonary contusions.

Walker JL; Wiersch J; Benson C; Young HA; Dearmond DT; Johnson SB

2012-01-01

332

Phenylephrine does not reduce cerebral perfusion during canine cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Gaseous microemboli during cardiopulmonary bypass (CPB) could injure the blood-brain barrier so that cerebral vasoconstriction would result from infusing alpha-agonist drugs, such as phenylephrine. Cerebral blood flow (radioactive microspheres) and metabolism were measured in seven dogs after rewarming from 150 min hypothermic CPB with bubble oxygenators used to produce gaseous microemboli. Phenylephrine (40 micrograms/min) was infused directly into the brachiocephalic artery so that aortic pressure before (80 +/- 2 mm Hg) and during (79 +/- 3 mm Hg) the infusion did not change. Neither blood flow to the cerebral hemispheres (P = 0.960), cerebellum (P = 0.854), and brainstem (P = 0.694) nor the cerebral metabolic rate for oxygen (P = 0.862) differed when values obtained before and after 30 min of phenylephrine infusion were compared. Cerebral vascular resistance was also unchanged by phenylephrine, being 1.22 +/- 0.10 mm Hg.mL-1.min-1 x 100 g-1 before infusion and 1.25 +/- 0.17 mm Hg.mL-1.min-1 x 100 g-1 during infusion (P = 0.849). Phenylephrine does not cause cerebral vasoconstriction after rewarming from hypothermic CPB, a finding which suggests that the blood-brain barrier is preserved during bypass.

Johnston WE; DeWitt DS; Vinten-Johansen J; Stump DA; Prough DS

1994-07-01

333

A baboon model for hematologic studies of cardiopulmonary bypass.  

Science.gov (United States)

Objective investigation of new inhibitors of blood protein or cellular systems that are activated during cardiopulmonary bypass (CPB) is impeded by the absence of a satisfactory animal model. Because most baboon hematologic proteins immunologically cross-react with those used for human assays, we developed a robust, reusable baboon model of CPB. Blood samples were obtained from adult baboons at six time intervals before, during, and after 60 minutes of partial CPB at 37 degrees C with peripheral cannulas. Both membrane (n = 7) and bubble oxygenators (n = 7) were investigated. We measured platelet and white blood cell counts; platelet response to adenosine diphosphate and release of beta-thromboglobulin; fibrinopeptide A, prothrombin fragment F1.2, thrombin-antithrombin complex, D-dimer, and plasmin-antiplasmin complex; activated complement (C3b/c and C4b/c); elastase-alpha1 proteinase inhibitor complex; and bleeding times. Adherent glycoprotein IIIa antigen in Triton X-100 washes of the perfusion circuit was also measured. Markers of baboon platelet, complement, and neutrophil activation and thrombosis significantly increased during CPB with bubble oxygenator systems but did not change appreciably in membrane oxygenator circuits. Markers of fibrinolysis, D-dimer, and plasmin-antiplasmin complex did not change with either oxygenator. The baboon model of CPB, when a bubble oxygenator is used, is a robust, reusable animal model for evaluating inhibitors of platelet, complement, and neutrophil activation and thrombosis during and after CPB. PMID:9358080

Hiramatsu, Y; Gikakis, N; Gorman, J H; Khan, M M; Hack, C E; Velthuis, H T; Sun, L; Marcinkiewicz, C; Rao, A K; Niewiarowski, S; Colman, R W; Edmunds, L H; Anderson, H L

1997-10-01

334

Washin and washout of isoflurane during cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

To help decide when an inhalational agent should be discontinued during cardiopulmonary bypass (CPB), its rate of washin and washout must be known. Isoflurane one per cent was administered to 14 patients undergoing CPB and isoflurane blood concentrations were measured to determine the time course of washin and washout of this agent. Bubble oxygenators were used for seven patients and membrane oxygenators for the remaining seven. During the administration of isoflurane, isoflurane blood concentrations rose slowly and did not reach a steady state during the time available for washin. Isoflurane blood concentrations decreased by at least 50 per cent within two minutes of turning off the vaporizer, and by 15 minutes the concentration had dropped by 75 per cent. There was a tendency for more rapid elimination of isoflurane in patients undergoing rewarming during this period. There did not appear to be an important difference between bubble and membrane oxygenators in the rate of washin and washout of isoflurane. Within 15 minutes of turning off the vaporizer only 25 per cent of the original blood concentration of isoflurane will remain. The anaesthetist must decide what concentration of isoflurane is acceptable during separation from CPB. Knowledge of the time course of isoflurane washout will allow more accurate determination of when to discontinue its administration in order to reach an acceptable concentration by the time separation from CPB occurs.

Henderson JM; Nathan HJ; Lalande M; Winkler MH; Dubé LM

1988-11-01

335

Phenylephrine does not reduce cerebral perfusion during canine cardiopulmonary bypass.  

Science.gov (United States)

Gaseous microemboli during cardiopulmonary bypass (CPB) could injure the blood-brain barrier so that cerebral vasoconstriction would result from infusing alpha-agonist drugs, such as phenylephrine. Cerebral blood flow (radioactive microspheres) and metabolism were measured in seven dogs after rewarming from 150 min hypothermic CPB with bubble oxygenators used to produce gaseous microemboli. Phenylephrine (40 micrograms/min) was infused directly into the brachiocephalic artery so that aortic pressure before (80 +/- 2 mm Hg) and during (79 +/- 3 mm Hg) the infusion did not change. Neither blood flow to the cerebral hemispheres (P = 0.960), cerebellum (P = 0.854), and brainstem (P = 0.694) nor the cerebral metabolic rate for oxygen (P = 0.862) differed when values obtained before and after 30 min of phenylephrine infusion were compared. Cerebral vascular resistance was also unchanged by phenylephrine, being 1.22 +/- 0.10 mm Hg.mL-1.min-1 x 100 g-1 before infusion and 1.25 +/- 0.17 mm Hg.mL-1.min-1 x 100 g-1 during infusion (P = 0.849). Phenylephrine does not cause cerebral vasoconstriction after rewarming from hypothermic CPB, a finding which suggests that the blood-brain barrier is preserved during bypass. PMID:8010425

Johnston, W E; DeWitt, D S; Vinten-Johansen, J; Stump, D A; Prough, D S

1994-07-01

336

Washin and washout of isoflurane during cardiopulmonary bypass.  

Science.gov (United States)

To help decide when an inhalational agent should be discontinued during cardiopulmonary bypass (CPB), its rate of washin and washout must be known. Isoflurane one per cent was administered to 14 patients undergoing CPB and isoflurane blood concentrations were measured to determine the time course of washin and washout of this agent. Bubble oxygenators were used for seven patients and membrane oxygenators for the remaining seven. During the administration of isoflurane, isoflurane blood concentrations rose slowly and did not reach a steady state during the time available for washin. Isoflurane blood concentrations decreased by at least 50 per cent within two minutes of turning off the vaporizer, and by 15 minutes the concentration had dropped by 75 per cent. There was a tendency for more rapid elimination of isoflurane in patients undergoing rewarming during this period. There did not appear to be an important difference between bubble and membrane oxygenators in the rate of washin and washout of isoflurane. Within 15 minutes of turning off the vaporizer only 25 per cent of the original blood concentration of isoflurane will remain. The anaesthetist must decide what concentration of isoflurane is acceptable during separation from CPB. Knowledge of the time course of isoflurane washout will allow more accurate determination of when to discontinue its administration in order to reach an acceptable concentration by the time separation from CPB occurs. PMID:3203453

Henderson, J M; Nathan, H J; Lalande, M; Winkler, M H; Dubé, L M

1988-11-01

337

A baboon model for hematologic studies of cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

Objective investigation of new inhibitors of blood protein or cellular systems that are activated during cardiopulmonary bypass (CPB) is impeded by the absence of a satisfactory animal model. Because most baboon hematologic proteins immunologically cross-react with those used for human assays, we developed a robust, reusable baboon model of CPB. Blood samples were obtained from adult baboons at six time intervals before, during, and after 60 minutes of partial CPB at 37 degrees C with peripheral cannulas. Both membrane (n = 7) and bubble oxygenators (n = 7) were investigated. We measured platelet and white blood cell counts; platelet response to adenosine diphosphate and release of beta-thromboglobulin; fibrinopeptide A, prothrombin fragment F1.2, thrombin-antithrombin complex, D-dimer, and plasmin-antiplasmin complex; activated complement (C3b/c and C4b/c); elastase-alpha1 proteinase inhibitor complex; and bleeding times. Adherent glycoprotein IIIa antigen in Triton X-100 washes of the perfusion circuit was also measured. Markers of baboon platelet, complement, and neutrophil activation and thrombosis significantly increased during CPB with bubble oxygenator systems but did not change appreciably in membrane oxygenator circuits. Markers of fibrinolysis, D-dimer, and plasmin-antiplasmin complex did not change with either oxygenator. The baboon model of CPB, when a bubble oxygenator is used, is a robust, reusable animal model for evaluating inhibitors of platelet, complement, and neutrophil activation and thrombosis during and after CPB.

Hiramatsu Y; Gikakis N; Gorman JH 3rd; Khan MM; Hack CE; Velthuis HT; Sun L; Marcinkiewicz C; Rao AK; Niewiarowski S; Colman RW; Edmunds LH Jr; Anderson HL 3rd

1997-10-01

338

Does transfusion of residual cardiopulmonary bypass circuit blood increase postoperative bleeding? A prospective randomized study in patients undergoing on pump cardiopulmonary bypass  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Objective: Homologous blood transfusion after open heart surgery puts a tremendous load on the blood banks. This prospective randomized study evaluates the efficacy of infusing back residual cardiopulmonary bypass (CPB) circuit i.e., pump blood as a means to reduce homologous transfusion aft...

Duara Rajnish; Misra Manoranjan; Bhuyan Ritwick; Sarma P; Jayakumar Karunakaran

339

Learning Disabilities and Employment.  

Science.gov (United States)

This book provides information on preparing individuals with learning disabilities for the challenges of employment and outlines the rights of those with learning disabilities in the workplace. Introductory chapters in Part 1 include: "Life after School: Challenges in the Workplace" (Paul J. Gerber); "The New Economy in the 21st Century:…

Gerber, Paul J., Ed.; Brown, Dale S., Ed.

340

Policies for full employment  

DEFF Research Database (Denmark)

European unemployment is too high, and employment is too low. Over 7½ per cent of Europe's workforce is unemployed, and only two thirds of people aged 15-64 are in work. At the Lisbon summit two years ago the heads of government set the target that by 2010 the employment rate should rise from 64 per cent to at least 70 per cent. And for older workers between 55 and 64 the employment rate should rise from 38 per cent to at least one half. These are ambitious targets. They will require two big changes: more people must seek work, and among those seeking work a higher proportion must get a job. So we need higher participation, and (for full employment) we need a much lower unemployment rate. Can it be done? A mere glance at the experience of different European countries shows that it can. As Table 1 shows, four E.U. countries already exceed the overall target for 2010 (Britain, Denmark, the Netherlands and Sweden). And seven of the 15 countries in the E.U already have lower unemployment than the United States (the previous four plus Austria, Ireland and Luxembourg).

de Koning, Jaap; Layard, Richard

2004-01-01

 
 
 
 
341

Technology and employment  

Energy Technology Data Exchange (ETDEWEB)

The influence of technology on today's high unemployment picture is discussed. Employment in the high-technology sector is seen by some to be a panacea for workers who have lost their jobs due to irreversible structural causes. Some federal, regional, state, and local efforts being made to ease structural adjustment are included. 28 references, 2 figures, 3 tables.

Cooper, M.H.

1983-07-22

342

Total aortic arch replacement with a novel four-branched frozen elephant trunk graft: first-in-man results.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The combined disease of the aortic arch and the proximal descending aorta remains a surgical challenge. With the 'frozen elephant technique', the ascending aorta, along with the aortic arch, is replaced conventionally and an endovascular stent graft is placed into the descending aorta in the antegrade manner through the open aortic arch, thereby potentially allowing for a 'single-stage' operation. The purpose of this study was to assess the feasibility of a novel four-branched hybrid graft (Vascutek, Scotland). METHODS: From April 2010 to August 2011, 34 patients (25 males, age 60 ± 14 years) were operated on [14 aneurysms, 20 dissections (18 acute)]. Ten of these patients had undergone previous cardiac operations. The collapsed endoprosthesis was deployed in the descending aorta through the opened aortic arch. A sewing collar between the graft segments simplified the 'distal' anastomosis. The four-branched graft segment allowed the replacement of the aortic arch and supra-aortic vessels individually. Concomitant procedures were performed if necessary. RESULTS: There were three deaths within the 30 postoperative days. All of them were of AADA patients. The mean cardiopulmonary bypass time was 254 ± 53 min, aortic cross clamp time was 148 ± 48 min and circulatory arrest time was 48 ± 22 min. Aortic valve-sparing root surgery was performed in 12 patients, Bentall procedure in four, CABG in three and mitral valve repair in two. In one patient, a secondary endovascular extension of the stent graft was necessary to reach the landing zone. In all others, postoperative CT-Scans confirmed the desired results. CONCLUSIONS: The graft adds to the 'frozen elephant trunk' concept for treating the arch and proximal descending aorta. Early experience demonstrates an excellent 30-day survival. Combining the frozen elephant with a four-branched arch graft increases the armament of the surgeon in the treatment of complex and diverse aortic arch pathology.

Shrestha M; Pichlmaier M; Martens A; Hagl C; Khaladj N; Haverich A

2013-02-01

343

Preirradiation grafting VBTAC onto HDPE films  

International Nuclear Information System (INIS)

HDPE films irradiated to 200 kGy in N2 were grafted with vinyl benzyltrimethylammonium chloride (VBTAC) to synthesize a strong base anion-exchange membrane. Comonomer grafting technique was used owing to the difficulty of direct graft polymerization of VBTAC onto polyethylene. Dimethylaminoethyl methacrylate (DMAEMA), a relative weak acid monomer, was selected as a co-monomer to promote graft polymerization of VBTAC. The grafting conditions, as well as the compositions of grafted films were investigated. The distribution of grafted basic group in polymer substrate was measured by an X-ray microanalyzer. (authors)

2008-01-01

344

Characterization of neonatal aortic cannula jet flow regimes for improved cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

During pediatric and neonatal cardiopulmonary bypass (CPB), tiny aortic outflow cannulae (2-3 mm inner diameter), with micro-scale blood-wetting features transport relatively large blood volumes (0.3 to 1.0 L/min) resulting in high blood flow velocities (2 to 5 m/s). These severe flow conditions are likely to complement platelet activation, release pro-inflammatory cytokines, and further result in vascular and blood damage. Hemodynamically efficient aortic outflow cannulae are required to provide high blood volume flow rates at low exit force. In addition, optimal aortic insertion strategies are necessary in order to alleviate hemolytic risk, post-surgical neurological complications and developmental defects, by improving cerebral perfusion in the young patient. The methodology and results presented in this study serve as a baseline for design of superior aortic outflow cannulae. In this study, direct numerical simulation (DNS) computational fluid dynamics (CFD) was employed to delineate baseline hemodynamic performance of jet wakes emanating from microCT scanned state-of-the-art pediatric cannula tips in a cuboidal test rig operating at physiologically relevant laminar and turbulent Reynolds numbers (Re: 650-2150 , steady inflow). Qualitative and quantitative validation of CFD simulated device-specific jet wakes was established using time-resolved flow visualization and particle image velocimetry (PIV). For the standard end-hole cannula tip design, blood damage indices were further numerically assessed in a subject-specific cross-clamped neonatal aorta model for different cannula insertion configurations. Based on these results, a novel diffuser type cannula tip is proposed for improved jet flow-control, decreased blood damage and exit force and increased permissible flow rates. This study also suggests that surgically relevant cannula orientation parameters such as outflow angle and insertion depth may be important for improved hemodynamic performance. The jet flow design paradigm demonstrated in this study represents a philosophical shift towards cannula flow control enabling favorable pressure-drop versus outflow rate characteristics.

Menon PG; Teslovich N; Chen CY; Undar A; Pekkan K

2013-01-01

345

Results of coronary artery bypass grafting in myocardial bridging of left anterior descending artery.  

UK PubMed Central (United Kingdom)

BACKGROUND: We aimed to evaluate the graft patency rate following coronary artery bypass grafting (CABG) to the left anterior descending artery (LAD) with proximal myocardial bridging (MB). While MB is generally a benign coronary abnormality, ischemia, stunning, and sudden death have been reported. In symptomatic patients with proximal LAD systolic compression of >50%, positive for ischemic noninvasive testing and noneffective optimal medical therapy, coronary intervention could be indicated. Few studies of CABG in myocardial bridging have been reported. The influence of high flow in coronaries with MB on graft patency is cause for concern. METHODS: We retrospectively studied 39 patients operated on for isolated MB of proximal LAD with >50% systolic compression. All patients were severely symptomatic despite optimal medical therapy and positive noninvasive tests for myocardial ischemia. CABG was performed through the midsternotomy with cardiopulmonary bypass and cardioplegia. Patients were divided into two groups: in 20 patients, LAD was bypassed with left internal mammary artery (LIMA) (Group 1) and in 19 patients with saphenous vein graft (SVG) (Group 2). All patients underwent follow-up coronary angiography. RESULTS: Demographics and degree of systolic compression of the LAD were similar in both groups. There was no mortality or major morbidity. Freedom from angina was 68% in Group 1 and 94% in Group 2 at 18 months postoperatively (p = 0.58). Twelve LIMA grafts and three SVGs were found occluded (p = 0.002). CONCLUSIONS: LIMA patency in myocardial bridging of the LAD can be low. SVGs should be considered in cases of CABG for myocardial bridging.

Bockeria LA; Sukhanov SG; Orekhova EN; Shatakhyan MP; Korotayev DA; Sternik L

2013-05-01

346

Repair of acute type A aortic dissections using open replacement with triple-branched stent grafts.  

UK PubMed Central (United Kingdom)

BACKGROUND: Total arch replacement to treat type A aortic dissection is a complex procedure. To simplify the procedure, we used a triple-branched stent graft for total aortic arch replacement. METHODS: Between February 2010 and June 2011, 27 patients (mean age, 52.7 ± 11.5 years), with acute type A aortic dissection underwent open surgical placement of a triple-branched stent graft for total arch reconstruction. RESULTS: All patients were discharged from the hospital. Mean cardiopulmonary bypass time was 160.5 ± 25.2 minutes, aortic cross-clamp time was 85.5 ± 18.4 minutes, and lower body arrest time was 30.2 ± 11.8 minutes. The mean drainage after the operation was 560 ± 120 mL, and the mean blood transfusion was 500 ± 150 mL. The mean length of stay after surgery was 13.5 ± 3.2 days. The mean follow-up time was 19.3 ± 7.6 months (range, 18 to 33 months). Follow-up was 100%. Endoleaks occurred in 3 patients after the operation, and 1 of them died 9 months after the operation. Follow-up computed tomography scans at 3 months showed the elimination of a false lumen in 24 patients. CONCLUSIONS: Using triple-branched stent grafts for total arch reconstruction in acute type A aortic dissections may be an effective technique to eliminate flow in the false lumen.

Pan J; Li QG; Zhou Q; Wang Q; Wu Z; Wang DJ

2013-08-01

347

Bone Grafts (Periodontal Regenerative Surgery)  

Science.gov (United States)

Bone Grafts (Periodontal Regenerative Surgery) What Is It? What It's Used For Preparation How It's Done Follow-Up Risks When To ... Before your surgery, you need to have basic periodontal treatment called scaling and root planing. You also ...

348

Variability in surgeons' perioperative practices may influence the incidence of low-output failure after coronary artery bypass grafting surgery.  

UK PubMed Central (United Kingdom)

BACKGROUND: Postoperative low-output failure (LOF) is an important contributor to morbidity and mortality after coronary artery bypass grafting surgery. We sought to understand which pre- and intra-operative factors contribute to postoperative LOF and to what degree the surgeon may influence rates of LOF. METHODS AND RESULTS: We identified 11 838 patients undergoing nonemergent, isolated coronary artery bypass grafting surgery using cardiopulmonary bypass by 32 surgeons at 8 centers in northern New England from 2001 to 2009. Our cohort included patients with preoperative ejection fractions >40%. Patients with preoperative intraaortic balloon pumps were excluded. LOF was defined as the need for ?2 inotropes at 48 hours, an intra- or post-operative intraaortic balloon pumps, or return to cardiopulmonary bypass (for hemodynamic reasons). Case volume varied across the 32 surgeons (limits, 80-766; median, 344). The overall rate of LOF was 4.3% (return to cardiopulmonary bypass, 2.6%; intraaortic balloon pumps, 1.0%; inotrope usage, 0.8%; combination, 1.0%). The predicted risk of LOF did not differ across surgeons, P=0.79, and the observed rates varied from 1.1% to 10.2%, P<0.001. Patients operated by low-rate surgeons had shorter clamp and bypass times, antegrade cardioplegia, longer maximum intervals between cardioplegia doses, lower cardioplegia volume per anastomosis or minute of ischemic time, and less hot-shot use. Patients operated on by higher LOF surgeons had higher rates of postoperative acute kidney injury. CONCLUSIONS: Rates of LOF significantly varied across surgeons and could not be explained solely by patient case mix, suggesting that variability in perioperative practices influences risk of LOF.

Likosky DS; Goldberg JB; DiScipio AW; Kramer RS; Groom RC; Leavitt BJ; Surgenor SD; Baribeau YR; Charlesworth DC; Helm RE; Frumiento C; Sardella GL; Clough RA; MacKenzie TA; Malenka DJ; Olmstead EM; Ross CS

2012-09-01

349

Bone grafting options in children.  

UK PubMed Central (United Kingdom)

STUDY DESIGN: Retrospective review of the literature. OBJECTIVE: To review the current literature as well as recent trends in bone grafting techniques available for children. SUMMARY OF BACKGROUND DATA: The currently accepted gold standard in bone grafting for adolescent idiopathic scoliosis (AIS) is autogenous iliac crest. Due to questions concerning complications such as donor site pain, other options have been explored, including various allograft sources, demineralized bone matrix, and bone morphogenetic protein. METHODS: A review of the current medical literature was completed and additional case examples are presented. RESULTS: A review of the literature reveals that up to 31% of patients have persistent pain at 2 years post surgery when autogenous iliac crest bone graft is harvested. Allograft supplementation of local autograft has been demonstrated in the literature to be as effective as autogenous iliac crest bone grafting in contributing to a successful posterior spinal fusion in patients with AIS. Modern demineralized bone matrix formulations have been found in both animal models as well as in a recent retrospective clinical review to contribute to a successful posterior spinal fusion in AIS. Bone morphogenetic protein has been shown to contribute to a successful posterior spinal fusion in complex pediatric spinal deformity patients. At 2 years follow-up, patients who underwent a posterior instrumented spinal fusion that was not augmented with any bone graft appear to have successful spinal fusions. CONCLUSION: Although autogenous iliac bone graft remains the benchmark to which bone grafting materials are compared, other options including the placement of no bone graft at all provides similar fusion rates in patients with AIS.

Betz RR; Lavelle WF; Samdani AF

2010-08-01

350

Process for grafted vine cultivation  

UK PubMed Central (United Kingdom)

The invention refers to agriculture, in particular to viticulture and may be applied in the production of planting material. The process includes carrying out of plantage plowing at a depth of 30 cm and planting in the constant place of the unrooted shortened cuttings. The result of the invention consists in increasing the yield of the grafted material and in reducing the expenses in the creation of grafted vine mother material nurseries. Claims: 1

BUCATARU PETRU

351

Radiation Induced Graft Copolymerization of Polyvinyl Alcohol  

International Nuclear Information System (INIS)

In order to improve the properties of polyvinyl alcohol films and fibres, the graft copolymerization of various vinyl monomers to polyvinyl alcohol films by gamma ray irradiation was investigated. When thin films of polyvinyl alcohol were irradiated in a large excess of styrene no graft copolymerization was observed. With films containing more than 5% water the grafting proceeded smoothly. The highest value of styrene grafted was about 1,000% at a dose of 7X106r. The presence of water in the monomer solution was found to increase considerably the amount of grafted monomer. Methyl methacrylate behaved similarly to styrene in the grafting to polyvinyl alcohol films, the presence of a certain amount of water being essential. The efficiency of the grafting of methyl methacrylate was generally larger than that of the grafting of styrene. The highest value of the grafted methyl methacrylate was 4,000% and obtained at a dose of 5 X 105 r. Some experiments were carried out with acrylonitrile and vinyl acetate but compared with styrene and methyl methacrylate the efficiencies of the grafting of these monomers were not so high. The degree of swelling of the graft copolymers of polyvinyl-alcohol-styrene or methyl methacrylate in organic solvents was measured at 30oC. The relation between the degree of swelling and the percentage of monomer grafted was given by (degree of swelling %) = k (monomer grafted %)n. For polymers grafted with styrene n = 1, but for those grafted with methyl methacrylate n

1960-01-01

352

Bilateral internal thoracic artery grafting.  

UK PubMed Central (United Kingdom)

The effectiveness of the left internal mammary artery graft to the anterior descending coronary artery as a surgical strategy has been shown to improve the survival rate and decrease the risk of adverse cardiac events in patients undergoing coronary bypass surgery. These clinical benefits appear to be related to the superior short and long-term patency rates of the internal thoracic artery graft. Although the advantages of using of both internal thoracic arteries (ITA) for bypass grafting have taken longer to prove, recent results from multiple data sets now support these findings. The major advantage of bilateral ITA grafting appears to be improved survival rate, while the disadvantages of complex ITA grafting include the increased complexity of operation, and an increased risk of wound complications. While these short-term disadvantages have been mitigated in contemporary surgical practice, they have not eliminated. Bilateral ITA grafting should be considered the procedure of choice for patients undergoing coronary bypass surgery that have a predicted survival rate of longer than ten years.

Lytle BW

2013-07-01

353

Grafting machine for vine cuttings or other vegetable varieties and a grafting method  

UK PubMed Central (United Kingdom)

Grafting machine (10) and relative grafting method for vine cuttings or other vegetable varieties (13) obtained by coupling together through grafting a first wood, or graft (11), provided with at least a bud (11a) at one end, and a second wood or vine (12), wherein said grafting machine (10) comprises at least a grafting group (16), able to automatically perform the grafting of at least one graft (11) and at least one vine (12), a first automatic feed and separation group (14), able to position at least one graft (11) at a time in correspondence with a zone predisposed for grafting associated with the grafting group (16), and a second automatic feed and separation group (15) able to position at least one vine (12) at a time in correspondence with said zone predisposed for grafting.

D'Andrea Giancarlo Via Pietro Zorutti 21; Bisutti Alessandro Via Trieste 19/B; Ronzani Giuseppe Via Luchini 1

354

No effect of L-arginine supplementation on pulmonary endothelial dysfunction after cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

BACKGROUND: Acetylcholine is an endothelium-dependent vasodilator through the L-arginine-nitric oxide pathway. After ischemia-reperfusion this effect is attenuated, also demonstrated in the pulmonary circulation after cardiopulmonary bypass. Administration of L-arginine has been shown to have a protective effect on endothelial function in reperfusion injury. The aim of the current study was to test the possible effect of L-arginine on the acetylcholine reactivity in the pulmonary circulation after cardiopulmonary bypass. METHODS: Thirty-five patients with ischemic and/or valvular heart disease were investigated in a randomized, double-blinded, placebo-controlled study. The patients were divided into three groups. Group 1: high dose L-arginine (n=10), group 2: low dose L-arginine (n=10), group 3: placebo, no L-arginine, (n=15). The acetylcholine reactivity was tested with measurements of pulmonary vascular resistance before surgery and 1, 2 and 3-4 h after cardiopulmonary bypass. RESULTS: After cardiopulmonary bypass an attenuation of the acetylcholine reactivity over time was observed in all groups, with no differences between groups. CONCLUSION: In the current study L-arginine had no protective effect on the pulmonary endothelium after cardiopulmonary bypass, measured as reactivity to an infusion of acetylcholine.

Angdin M; Settergren G; Liska J; Astudillo R

2001-04-01

355

Urinary hepcidin: an inverse biomarker of acute kidney injury after cardiopulmonary bypass?  

UK PubMed Central (United Kingdom)

PURPOSE OF REVIEW: In this review, we discuss the potential role of urinary hepcidin, a 2.8-kDa hormonal regulator of iron metabolism, as a biomarker of acute kidney injury (AKI) after cardiopulmonary bypass. RECENT FINDINGS: Hepcidin is one of the novel biomarkers of AKI that have been identified using hypothesis-free, proteomic analysis of urine or plasma in patients who develop AKI. Collectively, these markers promise a new era for the early diagnosis and treatment of AKI in the ICU and an understanding of their biological role may also provide mechanistic insights into the pathogenesis of AKI. Although data confirming the association between urinary hepcidin and AKI are as yet limited, we believe hepcidin is of particular interest because hepcidin may be a biomarker specific to cardiopulmonary bypass-associated AKI; as a central regulator of iron metabolism, hepcidin could play a biological role in the pathogenesis of AKI after cardiopulmonary bypass; and hepcidin displays an intriguing negative association with AKI, in that a smaller increase in hepcidin from baseline after cardiopulmonary bypass appears to predict greater chance of developing AKI. SUMMARY: Smaller increases in urinary hepcidin, a central regulator of iron metabolism, may be associated with greater risk of AKI after cardiopulmonary bypass. Further research is required to establish the significance and nature of this association.

Prowle JR; Westerman M; Bellomo R

2010-12-01

356

Complement activation during cardiopulmonary bypass. Comparison of bubble and membrane oxygenators.  

UK PubMed Central (United Kingdom)

A prospective randomized trial involving 91 patients undergoing cardiopulmonary bypass compared the effects of bubble oxygenators (with and without methylprednisolone sodium succinate) and membrane oxygenators on complement activation and transpulmonary sequestration of leukocytes. Patients were divided as follows: Group I, 30 patients, bubble oxygenator; Group II, 31 patients, bubble oxygenator and methylprednisolone sodium succinate (30 mg/kg); Group III, 30 patients, membrane oxygenator. In Group I, C3a increased from 323 +/- 171 ng/ml during cardiopulmonary bypass to 1,564 +/- 785 ng/ml at 25 minutes after bypass (p less than 0.0001). A significant decrease in C3a was found in Groups II and III compared to Group I (p less than 0.0001). C5a did not change significantly during cardiopulmonary bypass in any group. Reestablishment of pulmonary circulation at the end of bypass produced significant transpulmonary leukocyte sequestration in Group I; the median cell difference was 1,700/microliter. Transpulmonary sequestration was significantly (p less than 0.0001) less in Group II (median cell difference = 200/microliter) and in Group III (median cell difference = 400/microliter) than in Group I. We conclude that cardiopulmonary bypass with a bubble oxygenator alone initiates significantly (p less than 0.0001) more C3a activation and leukocyte sequestration than when methylprednisolone sodium succinate (30 mg/kg) is given 20 minutes before the start of cardiopulmonary bypass with a bubble oxygenator or when a silicone membrane oxygenator is used.

Cavarocchi NC; Pluth JR; Schaff HV; Orszulak TA; Homburger HA; Solis E; Kaye MP; Clancy MS; Kolff J; Deeb GM

1986-02-01

357

Complement activation during cardiopulmonary bypass. Comparison of bubble and membrane oxygenators.  

Science.gov (United States)

A prospective randomized trial involving 91 patients undergoing cardiopulmonary bypass compared the effects of bubble oxygenators (with and without methylprednisolone sodium succinate) and membrane oxygenators on complement activation and transpulmonary sequestration of leukocytes. Patients were divided as follows: Group I, 30 patients, bubble oxygenator; Group II, 31 patients, bubble oxygenator and methylprednisolone sodium succinate (30 mg/kg); Group III, 30 patients, membrane oxygenator. In Group I, C3a increased from 323 +/- 171 ng/ml during cardiopulmonary bypass to 1,564 +/- 785 ng/ml at 25 minutes after bypass (p less than 0.0001). A significant decrease in C3a was found in Groups II and III compared to Group I (p less than 0.0001). C5a did not change significantly during cardiopulmonary bypass in any group. Reestablishment of pulmonary circulation at the end of bypass produced significant transpulmonary leukocyte sequestration in Group I; the median cell difference was 1,700/microliter. Transpulmonary sequestration was significantly (p less than 0.0001) less in Group II (median cell difference = 200/microliter) and in Group III (median cell difference = 400/microliter) than in Group I. We conclude that cardiopulmonary bypass with a bubble oxygenator alone initiates significantly (p less than 0.0001) more C3a activation and leukocyte sequestration than when methylprednisolone sodium succinate (30 mg/kg) is given 20 minutes before the start of cardiopulmonary bypass with a bubble oxygenator or when a silicone membrane oxygenator is used. PMID:3511328

Cavarocchi, N C; Pluth, J R; Schaff, H V; Orszulak, T A; Homburger, H A; Solis, E; Kaye, M P; Clancy, M S; Kolff, J; Deeb, G M

1986-02-01

358

UNREGISTERED EMPLOYMENT IN TURKEY  

Directory of Open Access Journals (Sweden)

Full Text Available It is vital for the Government- as a whole of organized institutions and associations- to be aware of economic and social developments in its borders. That the economy of the government is registered and therefore presence of reliable statistical information have important effects on the functions which the government undertakes such as for whom and how much commodity and service it will produce, how to finance the expenditures for these products, in the light of which data that the policies to be produced will be drown for economic and social life, and how to create social peace and free competition environment. Informal economy is an important problem of underdeveloped and developing countries and just as the developed countries. Unregistered employment constitutes the major step of informal economy in all countries because informal economic actions are executed thanks to unregistered employment. In case that the individuals do not perform unregistered actions, it cannot be mentioned about informal economy. In this paper, the reasons of unregistered employment in Turkey, its effects and comparison with the world will be dealt with.

Hakk Mumin Ay

2008-01-01

359

Environment, employment and development  

International Nuclear Information System (INIS)

It is generally recognised that the question of sustainable development is a global problem, emphasizing the increasingly interdependent nature of relationships among nations. Solutions to the problem are as much political as they are economic and technological. Notwithstanding the deepening and widening of the debate on sustainable development, its implications for employment - a major concern of the ILO under its World Employment Programme - have remained largely unexplored. This volume, therefore, has a very modest objective, namely to place the employment question on the policy agenda in the context of the current debate on environment and development. The design of environmental policies should allow for the differences that exist between countries with a high level of development and technological dynamism and those with a low level of development and low technological capability. One must also recognize the costs imposed by adjustment and the consequent distributional impact. In the long term, technology choice plays a crucial role in promoting sustainable development in both industrialized and developing countries. It is not only environment-friendly technologies that need to be developed and diffused; in the case of the least developed countries, technological transformation needs to be accelerated in order to minimise their dependence on natural resources for economic growth. Refs, figs and tabs.

1992-01-01

360

The effect of intravenous magnesium sulfate on serum levels of N-terminal pro-brain natriuretic peptide (NT pro-BNP) in elective CABG with cardiopulmonary bypass.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Nowadays, many patients undergo coronary artery bypass grafting (CABG) with a cardiopulmonary bypass (CPB); while a number of therapeutic agents have been used to suppress its related inflammatory process. Magnesium sulfate (MgSO4) solution has been used as an anti-inflammatory agent. Among the cardiac biomarkers, N-terminal pro brain natriuretic peptide (NT Pro-BNP) is one of the most widely recognized. We performed this study to assess the effect of MgSO4 solution on NT Pro-BNP levels in patients undergoing CABG with CPB. MATERIALS AND METHODS: In a double-blind clinical trial, after IRB approval for ethical considerations, during a 12-month period, 88 adult patients aged 40-70 years qualified for the study after inclusion and exclusion criteria were considered. After random allocation of the patients between the two groups, anesthesia, surgical procedure, cardiopulmonary bypass (CPB) methods, and postoperative care were made as similar as possible; however, one group received a MgSO4 infusion (15 mg/kg/h) and the other group saline (placebo). Pre- and post-operative levels of NT Pro-BNP were assessed using an electrochemical luminescence immunoassay in an Elecsys 2010 (Roche, Indianapolis, IN, USA). The results were compared using a Student's t-test. A P value less than 5 % was considered significant. RESULTS: The MgSO4 group had shorter postoperative mechanical ventilation, lower postoperative morphine requirements and lower postoperative pain scores. Also, 24 h postoperative NT Pro-BNP levels were significantly lower in the MgSO4 group. CONCLUSION: Administration of MgSO4 in elective CABG with CPB can decrease the postoperative NT Pro-BNP levels; also, it decreases their time of postoperative mechanical ventilation.

Dabbagh A; Bastanifar E; Foroughi M; Rajaei S; Keramatinia AA

2013-10-01

 
 
 
 
361

A human factors analysis of cardiopulmonary bypass machines.  

Science.gov (United States)

The practice of cardiovascular surgery demands daily interface with sophisticated technologies including most commonly the cardiopulmonary bypass (CPB) machine. Although other industries have recognized the importance of considering human factors in the design of machines to reduce operator error, the evolution of the CPB machine over the past half-century has been characterized by incremental modifications of component parts with attention principally to mechanical efficiency and biocompatibility, but with little awareness of the impact of design changes on the human user. As a first step in the redesign of a safer pump, systematic observations of perfusionists during 10 adult and pediatric cases were conducted by staff cardiac surgeons and by human factors experts. Observations were classified according to accepted ergonomics principles. Perfusionists also performed usability evaluations and provided feedback concerning the design and functionality of bypass machines. Problems identified clustered around several usability themes. Issues with displays (8% of total comments) included location, legibility, format, and integration. Multiple problems with controls (11% of total comments) including location, sensitivity, and shape were identified, as were issues with audible alarms (6% of total comments). Component integration (14% of comments) and work-space design (21% of comments) were suboptimal as well. Procedural and communication issues (21% of comments) related to pump utilization, rather than pump design, were also identified, which stemmed from a lack of standardized operating room practices. Clinical issues (14% of comments) surrounding care of the patient were also identified but were not further analyzed, because these comments did not pertain to the design of the perfusion pump. Our observations confirmed the hypothesis that opportunities exist to incorporate usability and ergonomics insights into CPB machine design to optimize the human/technology interface. Such fundamental design considerations may improve the safety of the conduct of CPB and, consequently, outcomes after cardiovascular surgery. PMID:19681301

Wiegmann, Douglas; Suther, Thomas; Neal, James; Parker, Sarah Henrickson; Sundt, Thoralf M

2009-06-01

362

Recommendations on ambulance cardiopulmonary resuscitation in basic life support systems.  

UK PubMed Central (United Kingdom)

AbstractAim. Cardiopulmonary resuscitation (CPR) during ambulance transport can be a safety risk for providers and can affect CPR quality. In many Asian countries with basic life support (BLS) systems, patients experiencing out-of-hospital cardiac arrest (OHCA) are routinely transported in ambulances in which CPR is performed. This paper aims to make recommendations on best practices for CPR during ambulance transport in BLS systems. Methods. A panel consisting of 20 experts (including 4 North Americans) in emergency medical services (EMS) and resuscitation science was selected, and met over two days. We performed a literature review and selected 33 candidate issues in five core areas. Using Delphi methodology, the issues were classified into dichotomous (yes/no), multiple choice, and ranking questions. Primary consensus between experts was reached when there was more than 70% agreement. Questions with 60-69% agreement were made more specific and were submitted for a second round of voting. Results. The panel agreed upon 24 consensus statements with more than 70% agreement (2 rounds of voting). The recommendations cover the following: length of time on the scene; advanced airway at the scene; CPR prior to transport; rhythm analysis and defibrillation during transport; prehospital interventions; field termination of resuscitation (TOR); consent for TOR; destination hospital; transport protocol; number of staff members; restraint systems; mechanical CPR; turning off of the engine for rhythm analysis; alternative CPR; and feedback for CPR quality. Conclusion. Recommendations for CPR during ambulance transport were developed using the Delphi method. These recommendations should be validated in clinical settings.

Hock Ong ME; Shin SD; Sung SS; Tanaka H; Huei-Ming M; Song KJ; Nishiuchi T; Leong BS; Karim SA; Lin CH; Ryoo HW; Ryu HH; Iwami T; Kajino K; Ko PC; Lee KW; Sumetchotimaytha N; Swor R; Myers B; Mackey K; McNally B

2013-10-01

363

Hitos sobre el test cardiopulmonar de ejercicio Cardiopulmonary exercise test  

Directory of Open Access Journals (Sweden)

Full Text Available El test cardiopulmonar de ejercicio TCPE (CPET en la literatura anglosajona) evalúa aspectos dinámicos de la la fisiología cardiorespiratoria, en contraste, las pruebas funcionales estáticas no reproducen la condición activa de un individuo. No obstante su complejo montaje e interpretación, en el último decenio ha habido un creciente interés en aplicarlo en la detección de mecanismos de disnea. Al respecto, la curva flujo/volumen dinámica permite demostrar limitación de flujos e hiperinflación dinámica, también esta prueba permite profundizar en el análisis del intercambio gaseoso en ejercicio. La utilidad de estas pruebas en la evaluación funcional pre-operatoria compleja es destacada. Dada su alta reproducibilidad, el TCPE continúa siendo un alto referente en pruebas cardíacas de esfuerzo. Publicaciones cardiológicas enfatizan su valor pronóstico como indicador de sobrevida, seguimiento de terapias y enlistado para trasplante en insuficiencia cardíaca congestiva, utilizando parámetros máximos y submáximos. Entre los primeros el consumo cumbre o punta de oxígeno, y en los submáximos el equivalente ventilatorio de anhídrido carbónico y el consumo de oxígeno en el umbral lácticoCardiopulmonary exercise test (CPET) evaluates cardiorespiratory function in dynamic conditions, in contrast to static pulmonary function tests which can not reproduce the dynamic situation of an individual. Despite its complex implementation there has been growing interest in CPET in evaluating the mechanisms of dyspnoea With this respect dynamic flow/volume curve is useful in identifying expiratory airflow limitation and dynamic hyperinflation. Besides gas exchange analysis during exercise deepens the quality of information in that subject. Its utility for decision making in complex perioperative evaluation can not be overemphasized. Considering its high reproducibility, this method is a highly valuable tool in cardiac stress testing. Several publications in Cardiology emphasize its value in diagnosis, follow up, prognosis and enlisting for transplant in congestive heart failure. Remarkably useful are maximal and submaximal indices obtained during exercise, such as peak oxygen consumption among the maximals, and carbon dioxide equivalent and oxygen consumption at lactic threshold, among the submaximal indicators

RODRIGO SOTO F; IVAN CAVIEDES S

2008-01-01

364

Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation  

DEFF Research Database (Denmark)

BACKGROUND: Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during individual training. AIMS: To compare a VAM (ResusciAnne CPR skills station, Laerdal Medical A/S, Norway) with IF training in CPR using a bag-valve-mask (BVM) in terms of skills retention after 3 months. METHODS: Forty-three second year medical students were included and CPR performance (ERC Guidelines for Resuscitation 2005) was assessed in a 2 min test before randomisation to either IF training in groups of 8 or individual VAM training. Immediately after training and after 3 months, CPR performance was assessed in identical 2 min tests. Laerdal PC Skill Reporting System 2.0 was used to collect data. To quantify CPR performance a scoring system based on the Cardiff test was used. Groups were compared with a Mann Whitney rank sum test. RESULTS: There was no statistically significant difference between the two groups when considering change in overall CPR performance score from before training to 3 months after training (P=0.12). However, the IF group performed significantly better than the VAM group in the total score, both immediately after (P=0.0008) and 3 months after training (P=0.02). This difference was primarily related to the BVM skills. CONCLUSION: Skill retention in CPR using a bag-valve-mask was better after 3 months when training with an instructor than with an automated voice advisory manikin Udgivelsesdato: 2008/10

Isbye, Dan L; HØiby, Pernilla

2008-01-01

365

Medical students teaching cardiopulmonary resuscitation to middle school Brazilian students.  

UK PubMed Central (United Kingdom)

BACKGROUND: Diseases of the circulatory system are the most common cause of death in Brazil. Because the general population is often the first to identify problems related to the circulatory system, it is important that they are trained. However, training is challenging owing to the number of persons to be trained and the maintenance of training. OBJECTIVES: To assess the delivery of a medical-student led cardiopulmonary resuscitation (CPR) training program and to assess prior knowledge of CPR as well as immediate and delayed retention of CPR training among middle school students. METHODS: Two public and two private schools were selected. CPR training consisted of a video class followed by practice on manikins that was supervised by medical students. Multiple choice questionnaires were provided before, immediately after, and at 6 months after CPR training. The questions were related to general knowledge, the sequence of procedures, and the method to administer each component (ventilation, chest compression, and automated external defibrillation). The instructors met in a focus group after the sessions to identify the potential problems faced. RESULTS: In total, 147 students completed the 6-month follow-up. The public school students had a lower prior knowledge, but this difference disappeared immediately after training. After the 6-month follow-up period, these public school students demonstrated lower retention. The main problem faced was teaching mouth-to-mouth resuscitation. CONCLUSIONS: The method used by medical students to teach middle school students was based on the see-and-practice technique. This method was effective in achieving both immediate and late retention of acquired knowledge. The greater retention of knowledge among private school students may reflect cultural factors.

Ribeiro LG; Germano R; Menezes PL; Schmidt A; Pazin-Filho A

2013-08-01

366

Voice advisory manikin versus instructor facilitated training in cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

BACKGROUND: Training of healthcare staff in cardiopulmonary resuscitation (CPR) is time-consuming and costly. It has been suggested to replace instructor facilitated (IF) training with an automated voice advisory manikin (VAM), which increases skill level by continuous verbal feedback during individual training. AIMS: To compare a VAM (ResusciAnne CPR skills station, Laerdal Medical A/S, Norway) with IF training in CPR using a bag-valve-mask (BVM) in terms of skills retention after 3 months. METHODS: Forty-three second year medical students were included and CPR performance (ERC Guidelines for Resuscitation 2005) was assessed in a 2 min test before randomisation to either IF training in groups of 8 or individual VAM training. Immediately after training and after 3 months, CPR performance was assessed in identical 2 min tests. Laerdal PC Skill Reporting System 2.0 was used to collect data. To quantify CPR performance a scoring system based on the Cardiff test was used. Groups were compared with a Mann Whitney rank sum test. RESULTS: There was no statistically significant difference between the two groups when considering change in overall CPR performance score from before training to 3 months after training (P=0.12). However, the IF group performed significantly better than the VAM group in the total score, both immediately after (P=0.0008) and 3 months after training (P=0.02). This difference was primarily related to the BVM skills. CONCLUSION: Skill retention in CPR using a bag-valve-mask was better after 3 months when training with an instructor than with an automated voice advisory manikin.

Isbye DL; Høiby P; Rasmussen MB; Sommer J; Lippert FK; Ringsted C; Rasmussen LS

2008-10-01

367

Isoflurane prevents neurocognitive dysfunction after cardiopulmonary bypass in rats.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Postoperative cognitive dysfunction occurs frequently after cardiac surgeries with cardiopulmonary bypass (CPB). Available data from rat CPB models are conflicting. However, none of them was designed to investigate the role of isoflurane (the main anesthetic in all of these studies) in the neurocognitive dysfunction after CPB. Isoflurane has documented neuroprotective effects so the present authors hypothesized that isoflurane prevents the neurocognitive dysfunction in rats after CPB. DESIGN: A prospective, interventional study. SETTING: A university research laboratory. PARTICIPANTS: Male Sprague-Dawley rats. INTERVENTIONS: Male Sprague-Dawley rats were divided into 5 groups: the isoflurane CPB group, the animals were anesthetized with isoflurane and underwent 60 minutes of normothermic CPB; the chloral hydrate CPB group, the animals were anesthetized with chloral hydrate and underwent 60 minutes of normothermic CPB; the isoflurane sham group, the animals were subjected only to cannulation and the same duration of anesthesia but no CPB; the chloral hydrate sham group, the animals received only cannulation and the same duration of anesthesia but no CPB; and the naive group, the animals received no treatment. The neurocognitive function of all rats was measured on days 4 to 6 (short-term) and 31 to 33 after CPB (long-term). After the behavior tests, the animals were sacrificed, and the brain was harvested for the measurement of acetylcholinesterase (AChE) and choline acetyltransferase protein levels. MEASUREMENTS AND MAIN RESULTS: Short-term (days 4-6 after CPB) learning and memory were impaired after CPB when the animals were anesthetized with chloral hydrate. When isoflurane was used, the learning and memory did not change after CPB. No long-term (days 31-33 after CPB) neurocognitive changes were found after CPB. AChE decreased significantly after isoflurane anesthesia regardless of whether CPB was performed. CONCLUSIONS: Isoflurane prevented the neurocognitive dysfunction induced by CPB, which might involve the cerebral cholinergic system.

Li W; Zheng B; Xu H; Deng Y; Wang S; Wang X; Su D

2013-06-01

368

The effects of sodium bicarbonate during prolonged cardiopulmonary resuscitation.  

UK PubMed Central (United Kingdom)

BACKGROUND: This study was performed to determine the effects of sodium bicarbonate injection during prolonged cardiopulmonary resuscitation (for >15 minutes). METHODS: The retrospective cohort study consisted of adult patients who presented to the emergency department (ED) with the diagnosis of cardiac arrest in 2009. Data were retrieved from the institutional database. RESULTS: A total of 92 patients were enrolled in the study. Patients were divided into 2 groups based on whether they were treated (group1, n = 30) or not treated (group 2, n = 62) with sodium bicarbonate. There were no significant differences in demographic characteristics between groups. The median time interval between the administration of CPR and sodium bicarbonate injection was 36.0 minutes (IQR: 30.5-41.8 minutes). The median amount of bicarbonate injection was 100.2 mEq (IQR: 66.8-104.4). Patients who received a sodium bicarbonate injection during prolonged CPR had a higher percentage of return of spontaneous circulation, but not statistical significant (ROSC, 40.0% vs. 32.3%; P = .465). Sustained ROSC was achieved by 2 (6.7%) patients in the sodium bicarbonate treatment group, with no survival to discharge. No significant differences in vital signs after ROSC were detected between the 2 groups (heart rate, P = .124; systolic blood pressure, P = .094). Sodium bicarbonate injection during prolonged CPR was not associated with ROSC after adjust for variables by regression analysis (Table 3; P = .615; odds ratio, 1.270; 95% confidence interval: 0.501-3.219) CONCLUSIONS: The administration of sodium bicarbonate during prolonged CPR did not significantly improve the rate of ROSC in out-of-hospital cardiac arrest.

Weng YM; Wu SH; Li WC; Kuo CW; Chen SY; Chen JC

2013-03-01

369

Cardiopulmonary bypass does not alter canine enflurane requirements.  

Science.gov (United States)

This study determined the effect of cardiopulmonary bypass (CPB) on canine enflurane minimum alveolar concentration (MAC). Fourteen dogs were anesthetized with enflurane in N2O and O2, and after tracheal intubation, the N2O was discontinued. Femoral arterial and pulmonary arterial catheters were placed, and MAC was determined with the tail-clamp method. CPB was initiated via the femoral artery-vein route, with additional venous return obtained from an external jugular vein. Partial CPB was used in the first 10 dogs. In 4 dogs, a membrane oxygenator (group 1) was used, and in the next 6 dogs a bubble oxygenator (group 2) was used. In 4 additional dogs (group 3), using bubble oxygenators, total CPB was achieved by occlusion of the pulmonary artery via a left thoracotomy. The CPB circuit was primed with Ringer's lactate, and circuit blood flows were 70-125 ml.kg-1.min-1, with mean arterial pressures maintained at 50-110 mmHg. MAC was determined again after termination of CPB. In 10 dogs, MAC was also measured during CPB. In 5 dogs MAC was measured after administration of protamine. MAC in all 14 dogs did not change (2.2 +/- 0.3 vs. 2.3 +/- 0.3). MAC remained constant in group 1 (2.4 +/- 0.3 vs. 2.3 +/- 0.4), group 2 (2.2 +/- 0.2 vs. 2.3 +/- 0.3), and group 3 (2.2 +/- 0.1 vs. 2.3 +/- 0.1). Similarly, MAC was unchanged during CPB (2.2 +/- 0.2 vs. 2.2 +/- 0.2) and after protamine (2.3 +/- 0.2 vs. 2.2 +/- 0.3). Temperature was 38.3 +/- 1.2 prebypass and 37.9 +/- 0.9 postbypass.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1599117

Antognini, J F; Kien, N D

1992-06-01

370

Cardiopulmonary bypass does not alter canine enflurane requirements.  

UK PubMed Central (United Kingdom)

This study determined the effect of cardiopulmonary bypass (CPB) on canine enflurane minimum alveolar concentration (MAC). Fourteen dogs were anesthetized with enflurane in N2O and O2, and after tracheal intubation, the N2O was discontinued. Femoral arterial and pulmonary arterial catheters were placed, and MAC was determined with the tail-clamp method. CPB was initiated via the femoral artery-vein route, with additional venous return obtained from an external jugular vein. Partial CPB was used in the first 10 dogs. In 4 dogs, a membrane oxygenator (group 1) was used, and in the next 6 dogs a bubble oxygenator (group 2) was used. In 4 additional dogs (group 3), using bubble oxygenators, total CPB was achieved by occlusion of the pulmonary artery via a left thoracotomy. The CPB circuit was primed with Ringer's lactate, and circuit blood flows were 70-125 ml.kg-1.min-1, with mean arterial pressures maintained at 50-110 mmHg. MAC was determined again after termination of CPB. In 10 dogs, MAC was also measured during CPB. In 5 dogs MAC was measured after administration of protamine. MAC in all 14 dogs did not change (2.2 +/- 0.3 vs. 2.3 +/- 0.3). MAC remained constant in group 1 (2.4 +/- 0.3 vs. 2.3 +/- 0.4), group 2 (2.2 +/- 0.2 vs. 2.3 +/- 0.3), and group 3 (2.2 +/- 0.1 vs. 2.3 +/- 0.1). Similarly, MAC was unchanged during CPB (2.2 +/- 0.2 vs. 2.2 +/- 0.2) and after protamine (2.3 +/- 0.2 vs. 2.2 +/- 0.3). Temperature was 38.3 +/- 1.2 prebypass and 37.9 +/- 0.9 postbypass.(ABSTRACT TRUNCATED AT 250 WORDS)

Antognini JF; Kien ND

1992-06-01

371

Cardiopulmonary resuscitation during spaceflight: examining the role of timing devices.  

UK PubMed Central (United Kingdom)

INTRODUCTION: The majority of International Space Station (ISS) astronauts represent nonmedical professions. In order to serve as Crew Medical Officers (CMO), future crewmembers receive 40-70 h of medical training within 18 mo before missions, including cardiopulmonary resuscitation (CPR) per the Guidelines of the American Heart Association. CPR compliance with the Guidelines is known to vary even among trained clinicians, let alone minimally trained caregivers (e.g., bystanders, nonphysician astronauts). The purpose of this study was to evaluate the effect of timing devices, including audible metronomic tones, on CPR performed by nonmedical personnel, specifically 40 astronaut analogues trained in a fashion and within a timeframe similar to an ISS astronaut. METHODS: Twenty bystander pairs performed two-perso