Gudmund Semb

Effect of Dopamine and Calcium on Lipolysis and Myocardial Ischemic Injury following Acute Coronary Occlusion in the Dog

Ischemic myocardial injury was quantified as the sum of S-T segment elevations in epicardial electrocardiogram recordings (ΣS-T) following acute coronary artery occlusions in 17 dogs. ΣS-T rose from 3 ± 1 mv to 26 ± 4 mv (P < 0.001) following occlusion. Myocardial contractility was similarly stimulated by intravenous infusions of dopamine or calcium. At reocclusions of the coronary artery, ΣS-T increased to 73 ± 12 mv (P < 0.001) with dopamine and to 41 ± 7 mv (P < 0.001) with calcium; the difference was statistically significant (P < 0.005). Arterial concentrations of free fattv acids (FFAa) were raised from 248 ± 33 μEq/liter to 888 ± 161 μEq/liter (P < 0.005) with dopamine, but administration of calcium did not influence FFAa. After inhibition of lipolysis with β-pyridyl carbinol, no difference in ΣS-T or FFAa was observed; the mean values were 31 ± 4 mv for ΣS-T and 144 ± 13 μEq/liter for FFAa. Myocardial lipolysis was suggested in three experiments in which β-pyridyl carbinol reduced ΣS-T with dopamine, although FFAa remained unchanged. These measurements suggest that dopamine-induced lipolysis contributes significantly to the enlargement of ischemic injury in the myocardium following acute coronary artery occlusion, probably due to the metabolic stimulation of myocardial oxygen requirements. Test doses of dopamine given to seven patients raised FFAa by 225 ± 87 μEq/liter (P < 0.03).

Early use of corticosteroids in severe closed chest injuries: a 10-year experience

Because of the controversy about the treatment of injured patients with steroids, each doctor treating closed chest injuries at Ullevål Hospital, Oslo, has been free to decide whether to use steroids. However, if steroids were to be used, early administration was recommended. Thus, on admission methylprednisolone 30 mg/kg body weight was given to 107 patients having at least four rib fractures or a flail chest. The dose was repeated after 8 and 16 hours. The patients treated with steroids were compared with 159 patients not receiving steroids, but who otherwise were treated identically. Three-quarters of the patients had multiple injuries and 219 patients (82 per cent) had intrathoracic injuries such as pneumothorax (39 per cent), haemothorax (37 per cent) or contusion of the lung (59 per cent). Forty-six patients (17 per cent) were in shock on admission. Most patients could be managed with intravenous infusion, oxygen, relief of pain and chest drains. Early thoracotomy was performed in 10 patients and 91 patients needed artificial ventilation. Analysis of the two groups of patients revealed a significantly lower hospital mortality of 11.2 per cent for those treated with steroids as against 23.3 per cent for those without. Comparison of the two groups demonstrated no differences which could explain the difference in mortality. The mean Injury Severity Score (ISS) was 24.0 for the steroid treated group and 21.4 for the control group. The steroid treatment was not associated with any increase in the incidence of infection. The present analysis indicates that steroids, when given early, may improve the clinical course of patients sustaining severe closed injuries of the chest.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of bubble release from various types of oxygenators. An in vivo investigation.

The present study compares the creation of free gas bubbles in five different bubble oxygenators and one membrane oxygenator, by use of Doppler ultrasound technique. The study was carried out on groups of male patients undergoing coronary artery bypass surgery. The results show that the bubble oxygenators produce a considerable amount of free gas bubbles, with variances based on type. The membrane oxygenator showed virtually no counts at all.

Effect of High-Dose Ampicillin and Cloxacillin on Bleeding Time and Bleeding in Open-Heart Surgery

To determine if platelet dysfunction caused by high doses of penicillin compounds is of practical importance in patients with additional haemostatic defects perioperatively, a study was made of patients undergoing open-heart surgery. They were randomly assigned to prophylactic treatment with ampicillin 8 g plus cloxacillin 4 g daily for three days, or with cephalothin 8 g daily for three days. Fifty patients in each group were evaluated. The median bleeding time preoperatively and on days 1 and 4 postoperatively did not differ between the groups. The bleeding time was prolonged beyond the normal range in eight patients of the ampicillin/cloxacillin group and in three of the cephalothin group (p less than 0.05). Prolonged bleeding time was not associated with lower platelet count or greater blood loss. The total blood loss and the amounts of transfused blood, platelets and cryoprecipitate were all greater in the ampicillin/cloxacillin group, but the difference was not statistically significant. Combined use of ampicillin and cloxacillin in open-heart surgery is associated with increased bleeding, but the increase is without practical importance.

Surgical Treatment of Left Ventricular Aneurysm: Analysis of Risk Factors, Morbidity and Mortality in 205 Cases

Left ventricular aneurysm was surgically treated in 205 patients during the decade 1975-1984. The patients had had one to five myocardial infarctions, the latest days to years (mean 32 months) preoperatively and 92% were in NYHA functional class III or IV. The main indications for surgery were angina (47%), congestive heart failure (38%) and arrhythmia (15%). The 176 anterior, 23 posterior and six combined aneurysms were treated with resection (130 cases) or plication (75). The early mortality was 5%. Univariate analysis identified arrhythmia, concomitant valve replacement and need for intra-aortic balloon pumping (IABP) as significant risk factors, and multivariate analysis revealed the indication for surgery and need for IABP as the only independent predictors of total mortality. The survival rates 5 and 10 years postoperatively were respectively, 74% and 60%. At follow-up after 1/2-10 years, almost 90% of the surviving patients had improved functional status. Left ventricular aneurysm thus can be surgically treated with low mortality rate and good functional result.

The origin of creatine kinase BB occurring in serum during aortocoronary bypass surgery

The serum concentration of creatine kinase (CK)-BB during and after coronary bypass surgery was measured by a sensitive and highly specific radioimmunoassay technique. All patients showed a distinct and temporary increase in CK-BB concentration shortly after the start of operation. Our results indicate that this increase has no connection with damage of the heart or the brain. Most probably the BB isoenzyme is liberated mainly from the saphenous vein as a consequence of the surgical manipulations during the heart operation.

ANEURYSM OF THE LEFT ATRIAL APPENDAGE

A case of an aneurysm of the left atrial appendage with an intact pericardium, the 5th case reported in available literature, is described. The patient suffered from attacks of tachyarrhythmias occurring after giving birth to a child. The diagnosis was suggested at routine chest X-ray examination and later confirmed by right heart angiography. Surgical removal of the aneurysm should have cured the lesion, but was declined by the patient, who died of metastasis from a breast carcinoma. The angiographic diagnosis was confirmed at autopsy and the pericardium was intact.

Myocardial Infarction after Aortocoronary Bypass Surgery. The Incidence in 187 Consecutive Patients and the Late Postoperative Significance

The incidence of postoperative acute myocardial infarction (AMI) was studied by serial postoperative ECG recordings in 187 patients, who underwent aortocoronary bypass surgery at Ulleval Hospital during the years 1971 to 1975. The occurrence of postoperative AMI was related to serial serum enzyme analyses and to short-and long-term prognoses.ECG signs of postoperative AMI were found in 10 patients (5.3%) and of possible AMI in 12 patients (6.4%). The location of the infarcts was inferior in 7 of the 10 patients with AMI. Only 1 of the patients died postoperatively. In the others the recovery was uneventful.S-GOT/ASAT and S-LDH/LD values were significantly higher in patients with ECG changes compatible with postoperative AMI than in patients with uncertain or no ECG findings. Maximal S-GOT/ASAT value more than 100 U/l was found in 8 out of 9 patients with postoperative AMI, in whom serum enzyme levels were measured, and in 6 out of 12 patients with possible AMI. The combination of postoperative ECG signs o...

The Appearance of Rheumatic Mitral Stenosis in Cineangiography Related to Surgical Treatment

Left ventricular cineangiography was performed in 44 patients suffering from rheumatic mitral stenosis. Rheumatic mitral stenosis of the funnel type is angio-graphically a diagnostic entity, involving interesting aspects in the evaluation of candidates for surgery and the surgical procedure of choice. The correlation between the angio-graphic, surgical and cardiological findings is satisfactory. When rheumatic mitral stenosis of the funnel type is present, commissurotomy and recommissurotomy are not safer treatment for the patient, and the long-term effect does not exceed 4 years. Improvement of cardiac function, as evaluated by clinical examination 6 months after operation, is better in patients treated with mitral valvular replacement, even if hospital mortality is considered, than in the patients operated on with commissurotomy or recommissurotomy.

Functional evaluation of aortocoronary bypass surgery by exercise testing.

Exercise stress test was performed prior to and after aortocoronary bypass surgery in 91 male patients in an attempt to quantitate the change of physical capacity after operation and to correlate this to clinical improvement and late shunt angiography. The mean maximal work load was significantly higher after than prior to surgery in all groups. In average the maximal work load increased 65%. No difference was found between patients who were operated on for stable angina pectoris and those with unstable angina or impending myocardial infarction. Patients, who subjectively were without symptoms or much better after surgery, had a higher maximal work load after operation than those who were subjectively less improved or worse. In a sub-group of patients the maximal oxygen consumption was calculated in per cent of normal values for the age. The mean maximal oxygen consumption increased from 59% prior to surgery to 76% of normal values after surgery.