G. William-Olsson

Hospital Mortality and Long-term Survival in Relation to Preoperative Function in Elderly Patients with Bronchogenic Carcinoma

During an eight-year period, 82 patients 70 years of age or older were operated on for bronchogenic carcinoma. Hospital mortality was 15.9%, and five-year survival was 32%. Results of preoperative dynamic spirometry and bicycle ergometry were predictive for post-operative six-week mortality but not for long-term survival.

Influence of allopurinol on cardiac complications in open heart operations

During cardiac operations, the heart is subjected to total ischemia and reperfusion, causing serious operative and postoperative complications such as arrhythmias, heart failure, and infarctions that may be partly due to free radical generation. Thus, allopurinol was tested to see if it could reduce cardiac complications during open heart operations. Ninety patients undergoing elective coronary artery bypass grafting were studied prospectively. Fortyfive patients were treated with allopurinol and 45 patients acted as controls. Treatment requiring arrhythmias in the allopurinol group was 6.6% compared with 33.3% in the control group (p less than 0.01). The percentage of patients requiring inotropes was significantly lower in the allopurinol group than in the control group (4.4% versus 26.6%; p less than 0.01). Perioperative myocardial infarction did not occur in the allopurinol group but was seen in 8 patients (17.7%) in the control group. Intraaortic balloon pumping was used in 5 control patients (11.1%) but not in the allopurinol group. This study shows that allopurinol decreases significantly the incidence of cardiac complications in open heart operations.

Thermographic Demonstration of Uneven Myocardial Cooling in Patients with Coronary Lesions

Low temperature is an important factor in protecting the myocardium during an operation on the heart. This can be difficult to accomplish if the cold cardioplegic solution is hindered by occlusions or stenosis of the coronary arteries. We used thermography to study myocardial temperature during infusion of cold cardioplegic solution. Slow cooling was recorded distal to coronary stenosis or occlusions, thereby indicating insufficient protection of the myocarium in these areas.

Cutaneous microcirculation and blood rheology following cardiopulmonary bypass: laser Doppler flowmetric and blood cell rheologic studies

In 23 patients undergoing coronary artery bypass grafting, measurements of cutaneous blood flow were made with laser doppler flowmetry. Simultaneously blood was sampled for measurement of red cell filtration rate (RFR) and plasma-white cell filtration rate (P-WFR). The cutaneous blood flow showed significant overall reduction postoperatively. When the saphenous vein or internal mammary artery was used as bypass graft, the reduction in skin blood flow at the sites from which the vessels were taken was significantly greater than in contralateral, undisturbed sites. RFR and P-WFR were also significantly reduced postoperatively, and these changes showed significant concomitance with the fall in laser doppler flow (LDF%). On postoperative day 6 there was some improvement in LDF% and RFR but further slight deterioration in P-WFR. The study indicated that surgical trauma locally reduces cutaneous blood flow and that trauma to blood cells following cardiopulmonary bypass can contribute to this reduction.

Association between pulmonary dysfunction and reduced red cell deformability following cardiopulmonary bypass

Fifty-six patients undergoing open-heart surgery were monitored for red cell trauma during cardiopulmonary bypass (CPB), using a standard red cell microfiltration method. The average red cell deformability was reduced by 38%. Respirator time was shorter in the patients with lesser degrees of red cell trauma, and vice versa. After extubation, the tendency to hypercapnia was greatest in the patients with most red cell trauma during CPB. Hypoxic tendencies in the first 24 postextubation hours were comparably distributed among all levels of red cell trauma.

Association between arrhythmias and reduced red cell deformability following cardiopulmonary bypass

In 56 patients undergoing open-heart surgery, trauma to the red cells (reduced deformability) during cardiopulmonary bypass (CPB) was monitored by estimating reduction in red cell filtration rate (RFR). Treatment-requiring arrhythmias (atrial tachyarrhythmia and ventricular tachycardia) appearing more than 24 hours postoperatively were associated with RFR reduction after CPB. The incidence of arrhythmia was 31% in the patients with less than 25% fall in RFR, 53% in those with greater than 25% fall and 81% when the RFR reduction was greater than 75%. RFR fall preceded appearance of arrhythmia.

Insulin Sensitivity and Glucose Uptake in the Course of Surgical Treatment for Valvular Aortic Stenosis

The dose-response relationship between plasma insulin and systemic glucose uptake was studied before, one hour after and 6 months after valvular surgery in 11 patients with valvular aortic stenosis. The immediate effect of valvular surgery was a dramatic rightward shift of the dose-response curve and a decrease in glucose uptake at peak insulin activity. From a comparison between the preoperative and the 6-month postoperative dose-response curves it is concluded that the patients had adapted metabolically to the preoperative haemodynamic situation with increased insulin sensitivity.

Effect of valvular aortic stenosis on insulin sensitivity.

18 patients with valvular aortic stenosis were given an i.v. glucose tolerance test and an i.v. insulin tolerance test before and 4-36 months after valve replacement. Insulin and C-peptide response to the glucose challenge was smaller preoperatively whereas the glucose response was the same pre- and postoperatively. The effect on blood glucose of the i.v. insulin challenge was more pronounced preoperatively. It is concluded that insulin sensitivity was increased preoperatively and it is suggested that this was a metabolic adaptation to the haemodynamic situation in aortic stenosis, which may have implications for preoperative glucose-insulin-potassium treatment.