Early results of CABG operation in 110 patients

Coronary artery bypass grafting (CABG) operations were performed in 110 consecutive patients. Most of them had extensive triple-vessel disease or left main coronary artery disease. Internal mammary artery (IMA) was used as a graft in 65 patients. Valvular replacement or valvuloplasty were performed in 8 patients and ventricular aneurysmectomy in 10 patients including post infarction VSD repaired in 1 patient simultaneously. Angina pectoris was relieved in all patients except one died from acute renal failure postoperatively. The IMA could be used safely and efficiently in nearly all patients. Using very fine technique, we suggested good exposure, and hemostasis to handle IMA. The key factor of success in CABG operation was complete revascularization by passing all significant stenosis larger than 1 mm diameter in all coronary artery branches.     

Early and long-term results of direct PTCA in patients with acute myocardial infarct

A review of the literature suggests that direct PTCA for acute myocardial infarction is indicated and feasible in 90-95% of unselected, consecutive patients; direct PTCA is reported to be successful in > 90% of procedures. This results in a hospital mortality of 3-7% for unselected patients and a 4% re-infarction rate. A recent meta-analysis of direct PTCA vs i.v. thrombolysis in patients with acute infarction demonstrates a lower mortality after PTCA (4.4% vs 6.5%, p = 0.02) as well as lower mortality/re-infarction rate (7.2% vs 11.9%, p < 0.001). Mortality in the 1st year after discharge is < 5% with about half of the fatalities being due to cardiac causes. Patients presenting with or developing cardiogenic shock in the acute infarct phase experience a 20-50% acute mortality. Mortality rests at < 10% in these patients in the first year after discharge. In conclusion, (1) direct PTCA is feasible without additional risks in patients with acute myocardial infarction, (2) angiographic and clinical success rates of direct PTCA are favorable and superior to i.v. thrombolysis in the hands of expert operators, and (3) referral to an institution providing the option of immediate, direct PTCA must be considered in the patient with acute infarction but contraindication(s) to i.v. thrombolysis.     

Early and late results of surgical treatment in patients with primary mediastinal germ cell tumors]

A group of 37 patients--20 (54%) men and 17 (46%) women--aged 2-65, mean 31.6 years, was treated between 1978 and 1995 for different kinds of primary mediastinal germ cell tumours. In 14 (37.8%) of them a mature solid teratoma was diagnosed, in 13 (35.1%)--dermoid cyst, in 5 (13.5%)--malignant teratoma, in 1 (2.7%)--immature teratoma, in 4 (10.8%)--seminoma. Mediastinal tumour was removed completely in 30 (81.1%) patients, partially in 7 (18.9%). Out of 37 patients, 3 (8.1%) died during postoperative time. Out of 26 patients discharged after surgical removal of mature teratomas, all are alive and have been followed-up for 10 years (17 patients) or 5 years (6 patients). Out of 8 discharged after surgical removal of malignant neoplasm, 3 are alive and all of them had primary mediastinal seminoma. One of them has survived 17 years after complete resection, and two patients--7.5 years and 2 years after partial resection and radiotherapy. Mean survival time is 4 years and 2 months for all patients with malignant neoplasm.     

Early and late results of surgical repair of truncus arteriosus

Ninety-two patients had corrective operation for truncus arteriosus between 1967 and 1975. During the first 30 days after surgery, 23 patients died. No significant differences appear between early mortality and sex, type of truncus, variations in pulmonary arterial anatomy, truncal valve regurgitation, associated anomalies, previous operation, or duration of extracorporeal circulation. Greater risk is probably encountered with the higher but still operable levels of pulmonary resistance. Reoperation has been required in three patients. Fifty-nine percent of survivors are symptom-free, with all but two of the remainder (38%) being in NYHA functional class II. The late result is suggestively less satisfactory in patients with significant preoperative truncal valve regurgitation. Some late complications related to deterioration of the earlier aortic homograft conduit may be avoided by use of a porcine valve Dacron conduit. The current operative mortality of 9%, and the well-being of 97% of surviving patients suggest the continued advisability of recommending operation for appropriate patients.     

Early and late results of the Bentall operation for annulo-aortic ectasia

Our experience is reported with 20 consecutive patients undergoing the Bentall operation during the past 10 years for ascending aortic aneurysms with aortic regurgitation due to idiopathic medical necrosis with a resultant annulo-aortic ectasia. Concomitant aortic dissection was present in 45% of the patients. In the earlier period from 1972 to 1976, the operative and hospital mortality rates were 40%, and it was reduced to 0% (p less than 0.08) in the later period from 1977 to 1981. Operative survivors showed the mean clinical improvement from the NYHA class 3.0 to 1.3. The LVEDP and the left ventricular dimension were significantly reduced toward normal (p less than 0.05 and p less than 0.001). The actuarial survival rate at 6 years after operation was 71% in this series. The Bentall operation can now be performed with a low risk, and can improve the clinical and hemodynamic states significantly. However, in patients with chronic type I aortic dissection, a false lumen remained patent after surgery regardless of the types of graft-distal aorta anastomosis. The fate of the remaining dissection is undetermined, but some may require further surgery.     

Predictors of CABG within one year of successful PTCA: a retrospective, case-control study

BACKGROUND: We previously have established characteristics predictive of the need for coronary artery bypass grafting (CABG) over many years after successful percutaneous transluminal coronary angioplasty (PTCA). In this study, we examined the factors associated with the need for CABG within 1 year of successful PTCA, and the recent impact of newer, catheter-based technologies. METHODS: From January 1982 through December 1995, 234 patients underwent CABG within 1 year of a successful "index" PTCA at our hospital. Emergency operations within 12 hours of index PTCA were excluded. These cases were matched with 234 controls who underwent a successful index PTCA but did not require a subsequent CABG during the next year. Cases were matched by the date of their index PTCA, and 1-year follow-up was complete for all patients. RESULTS: Before index PTCA there were no differences between the groups in terms of age, sex, diabetes, prior myocardial infarction, ejection fraction, duration of anginal symptoms, hypertension, hyperlipidemia, family history, or obesity (all nonsignificant). At index PTCA the cases had a greater mean number of lesions measuring 70% or greater compared with the controls (2.8 versus 1.8, respectively; p < 0.0001). The cases were more likely to have critical (70% or greater) proximal left anterior descending artery, proximal first obtuse marginal artery, and right posterior descending artery stenoses. The use of stents or atherectomy devices was not significantly more common among the controls (21% of controls versus 17.1% of cases; p = 0.35). Complete revascularization was achieved in significantly fewer of the cases than the controls (91 versus 156, respectively; p < 0.0001). The cases underwent CABG at a mean of 3 months (86% within 6 months) after PTCA. Among those who had a diagnostic catheterization, 52% of the patients had both restenosis of a dilated lesion and progression of other disease. Only 5 of 75 patients who had restenosis of a dilated lesion had a stent or an atherectomy device used at index PTCA. Of note, 13% (30 of 234) required an emergency operation, with an overall operative mortality rate of 3% (7 of 234). CONCLUSIONS: Although the likelihood of local restenosis is decreased by newer interventional techniques, the need for CABG within 1 year after successful PTCA is not diminished. The number of critical lesions and their location are the best predictors of the need for early CABG. If early post-PTCA CABG is to be avoided, patients who cannot be completely revascularized by PTCA should be revascularized by CABG.     

Early results of coronary artery bypass using a radial artery bypass]

OBJECTIVE: To evaluate the electrical resistance to current conduction of different guidewires used routinely in endourology and thus determine the risk of short circuits between the active electrode and the guide. MATERIALS AND METHODS: Using a standard resistance meter, the electrical resistance of four different types of guidewires was measured. Pure stainless-steel, polytetrafluoroethylene (PTFE)-painted, PTFE-sheathed and hydrogel-sheathed guidewires were tested, both when new and after mechanical abrasion of the external layer to reproduce their condition after use. RESULTS: The pure stainless-steel guidewire had no resistance to electrical current. The electrical insulation of the PTFE-painted guidewires was poor and was eliminated by mechanical abrasion of the paint. New PTFE-sheathed and hydrogel-sheathed guidewires had a safe electrical resistance (> 10 K omega) but this insulation was easily eliminated by mechanical abrasion of the external layer. CONCLUSIONS: To minimize the risk of electrosurgical adverse effects during a guidewire-assisted endoscopic procedure, the operator should preferably use a new guidewire for each procedure, use sheathed guidewires and ensure that the guidewire is in good condition, or cover it with a ureteric catheter, before applying current.     

Optimal ("stent-like") acute angiographic results pursuable by traditional PTCA

OBJECTIVES: This study was undertaken: 1) to assess the efficacy of traditional PTCA in affording "optimal" initial dilatation (OID) of coronary stenoses (as assessed by on-line quantitative angiography) defined as a post-procedure residual lumen narrowing < or = 20%; 2) to determine clinical and angiographic correlates of these types of successes. BACKGROUND: Recent reports have shown that acute angiographic results achieved by traditional PTCA, resembling those obtainable by elective stenting, carry low risks of restenosis. However, safety and the ability of conventional PTCA to consistently provide acute stent-like results are still practically unknown. PATIENTS AND METHODS: Using a "standardized" procedural protocol intended to optimize acute angiographic results, 878 consecutive non-selected patients, 750 men and 128 women aged 29-78 years (mean 60.5 yrs) underwent PTCA on 1054 lesions. Compliant balloons reaching nominal dimensions at 6 atm and predicted balloon-artery ratios of 0.92-1.05 (mean 1.02) were used. An inflation pressure of 5 atm was gradually and slowly applied initially (usually sufficient to reach the point of plaque fracture). Inflation times of 60 seconds and step-increases in inflation pressure of 1 atm were subsequently utilized, until a large lumen with smooth contours (the nearest to normal) or any wall damage were detected by angiographic tests performed at each step. Inflations were stopped when, even in the presence of sub-optimal dilatation, the inflation pressure of 14 atm was reached (which usually corresponded to an effective balloon/artery ratio < 1.15). RESULTS: Overall traditional primary successes were 830 (94.5%) for patients and 1001 (95%) for lesions. Major complications, without mortality, were 24 (2.7%). CABS was necessary in 17 patients (1.9%) while acute myocardial infarction occurred in 7 patients (0.8%). OID was obtained in 65.4% of the treated lesions: 77.9% in type A, 73.9% in B1, 54.0% in B2 and 32.5% in C lesion subgroups of the AHA/ACC classification scheme. Multivariate analysis showed that no clinical variables significantly influenced OID. Lesion-related variables such as chronic occlusion, diffuse disease, length > 10 mm, heavily calcified and markedly angulated lesions emerged as (negative) determinants of success. CONCLUSIONS: Acute stent-like angiographic results are obtainable by conventional PTCA in a consistent percentage of eligible coronary lesions. Following a safe modality of balloon-stress application in performing angioplasty, probability of safely achieving OID of coronary stenoses is related to specific angiographic lesion characteristics.     

Early and late results of replacement of the ascending aorta and/or aortic arch using selective cerebral perfusion

From 1987 to 1994, 116 patients received replacement of the ascending and/or aortic arch using selective cerebral perfusion. They were 82 male and 34 female, with average age of 64 years. There were 63 dissecting and 53 true aneurysms. Extent of replacement was: ascending aorta in 13, aortic root in 2, aortic arch in 93, and aortic root and complete arch in 8. Aortic arch replacements were composed of: 29 partial proximal aortic arch replacements, 44 complete aortic arch replacements, and 20 partial distal aortic arch replacements. Nineteen (16.4%) hospital deaths occurred. Univariate testing of pre-, intra-, and post-operative variables followed by stepwise logistic regression analyses identified elderly, ischemic heart disease, postoperative neurologic complication, cardiac dysfunction, renal failure, and massive bleeding as factors having independent association with hospital mortality. Neurologic complication was found in 10 patients (8.6%), and risk factor for this complication was preoperative peripheral vascular disease. Follow-up of hospital survivors documented an overall cumulative 5-year survive rate of 69%. There was no significant difference between dissection and true aneurysms in 5-year survive ratios, which were 63% and 82%, respectively. During follow-up periods, 18 patients died. Half of these cases were vascular deaths, caused by rupture, sudden death and secondary operation. Univariate analyses followed by stepwise Cox testing indicated that chronic obstructive pulmonary disease and a history of postoperative massive bleeding were associated with decreased later survival. Our experience suggests that selective cerebral perfusion is a safe technique for the repair of ascending aorta and/or aortic arch problems. High-risk subgroups of patients with these aortic problems can be identified by risk factors. Aggressive and careful management is necessary for such subgroups to improve early and late survival rates.     

Early and late selection in unconscious information processing.

In four experiments, we investigated whether masked stimuli in priming experiments are subjected to early or to late selection. In Experiment 1, participants classified four target-pictures as being small or large. In line with early selection accounts, prime-pictures with a different perceptual appearance as the experienced targets did not elicit congruency effect. In Experiment 2, 40 targets all depicting animals were presented. Results were in line with late selections assumptions because novel animal primes but not novel primes from different semantic categories yielded congruency effects. In Experiment 3, the targets were chosen such that there is a second semantic feature that covaried with the required response. Here, novel primes picturing small animals did not influence target responses with regard to the instructed size classification, but with regard to their affiliation to the category animal. In Experiment 4, small and large pictures from two categories were presented. Category match did not influence priming, ruling out that feature overlap contaminated the former results. The results indicate that participants’ prestimulus expectations determine in which stage in the processing-stream masked stimuli are selected. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early and late epileptic crisis following cerebral hemisphere ischemia

INTRODUCTION: There is no agreement as to the frequency and characteristics of epileptic seizures (ES) associated with cerebrovascular disease (CVD). OBJECTIVE: To analyze the presence of early (Se) and late (SI) ES, factors related to these, prognosis and conversion to epilepsy. PATIENTS AND METHODS: We made a retrospective study of 386 patients with cerebral hemisphere ischemia (100 TIA and 286 infarcts). Follow-up was 29.69 +/- 13.92 months. Two groups were defined: a) Patients without ES, and b) patients with ES. Those occurring within 15 days of the episode of ischemia were considered to be Se and the others Sl. We studied the prognosis (modified Rankin scale on discharge from hospital) and mortality. RESULTS: Twenty three patients (6%) had crises (18 Se and 5 Sl). The commonest type was simple partial motor crises (13 or 56.5%) followed by generalized tonic-clonic crises (9 or 39.1%) which predominated in the Se group. There were 6 solitary crises (Se) and 17 (73.9%) recurrences (66.6% of the Se and 100% of the Sl) (p = 0.049). There was an association between the presence of a family history of epilepsy (p < 0.001) and increased risk factors for epilepsy and CVD, particularly previous ictus and cardiopathy respectively (p = 0.034). No patient with TIA or lacunar infarct had ES. Extensive infarcts showed and increased tendency to the associated with hemorrhagic transformation, involvement of the cortex (p < 0.001) and cardioembolic incidents (p = 0.025). They had a worse prognosis, led to more disability (p < 0.001) and earlier mortality (38.4%) (during the first three months) (p = 0.015). These factors were associated (p < 0.001). CONCLUSIONS: Postischemic cerebral seizures are frequent and have a high recurrence rate, especially in patients with extensive infarcts involving the cortex and these of embolic origin. The prognosis is worse when crises occur early.     

Postoperative urine retention and late results following incontinence surgery

Percutaneous cystostomy using a fine calibre (9 Charriere) plastic trocar and cannula has been used in 51 male patients in the early weeks following spinal cord injury. The results are satisfactory. Of the last ten patients none has been catheterised per urethram; eight of these patients are now passing urine satisfactorily using a condom urinal.