No abstract available
Cardiovascular System* ; Receptors, Adrenergic*

BACKGROUND: The intraoperative TEE is frequently used as a preoperative diagnostic technique and for intraoperative assessment of surgical results. However, the clinical studies regarding assessment of mitral prostheses in the immediate postbg>ass period by TEE have been few, and there is no comparative data between curved(Sorin Bicarbon) and rotatable flat(ATS) bileaflet mechanical prostheses. The purpose of this study is to compare forward flow hemodynamics and complications including regurgitation between Sorin Bicarbon and ATS mitral prostheses by using Doppler and color-flow imaging TEE. METHOD: 23 patients with Sorin Bicarbon(Group I) and 16 patients with ATS(Group II) were studied by transesophageal Doppler echocardiography in the operating room. We measured the peak velocity & gradient, mean velocity 8c gradient and mitral valve area by pressure halt-time method after replacement of mitral prosthesis using Doppler echocardiography and determined the paravalvular regurgitation using color-How imaging. All transesophageal studies were performed about 20 minutes after termination of the cardiopulmonary bypass. RESULTS: There were no statistical differences(p<0.05) between the two groups in Doppler parameters. Mean transmitral gradient of Group [(2.31.2mmHg) was same as Group II. Mean mitral valve area(same as effective oriface area) calculated by pressure half-time method was 3.1+/-0.6 vs 3.0+0.9cm in Group I vs II. There was one prosthetic malfunction in Group II whose peak and mean gradient were 13 and 5mmHg respectively, and the mitral valve area was 2.8cm. Paravalvular and transvalvular regurgitation were not seen in both groups in operating room. CONCLUSION: In this study, we evaluated functional differences between curved(Sorin Bicarbon) vs flat(ATS), bileaflet mechanical prostheses in MVR by using Doppler and color flow imaging TEE. We conclude that both valves provided excellent hemodynamic profiles and there were no significant functional differences between them. Valve-related mechanical complications in both will need further studies.
Cardiopulmonary Bypass ; Echocardiography, Doppler* ; Hemodynamics ; Humans ; Mitral Valve* ; Operating Rooms ; Prostheses and Implants*

BACKGROUND: Since hydroxyethyl starch has colloidal properties closely approximating those of human albumin, it is considered to be a good plasma volume expander. Pentastarch is a hydroxyethyl starch similar to hetastarch, but with lower average molecular weight and molar substitution ratio. These characteristics result in enhanced enzymatic hydrolysis, faster renal elimination and less effect on coagulation. This study was designed to evaluate the safety and clinical efficacy of 10% pentastarch in priming fluid for cardiopulmonary bypass compared with that of 5% albumin. METHODS: Thirty- two adult patients undergoing elective cardiac surgery were randomized into two groups. Sixteen patients received 500 ml of 10% pentastarch and sixteen patients received 100 ml of 20% albumin in a bloodless priming solution for cardiopulmonary bypass. The fluid balance, coagulopathy and organ functions(cardiac, pulmonary and renal) were evaluated at several time intervals. RESULTS: There were no differences between the two groups in operation and bypass time, chest tube drainage and blood usage. The measured prothrombin time, partial thromboplastin time and platelet count of pentastarch group were not significantly different from those of the albumin group at each time interval(p<0.05). We did not find any differences of statistical significance in hemodynamic data, serum osmolarity, pulmonary shunt and BUN between the two groups(p<0.05). CONCLUSIONS: Our study suggests that 10% pentastarch can be used safely and effectively as cardiopulmonary bypass prime in cardiac surgery.
Adult ; Cardiopulmonary Bypass* ; Chest Tubes ; Colloids ; Drainage ; Heart ; Hemodynamics ; Humans ; Hydrolysis ; Hydroxyethyl Starch Derivatives* ; Molar ; Molecular Weight ; Osmolar Concentration ; Partial Thromboplastin Time ; Plasma Volume ; Platelet Count ; Prothrombin Time ; Starch ; Thoracic Surgery ; Water-Electrolyte Balance

PURPOSE: The purpose is to evaluate the CT or MRI findings to help in the differentiation between benign and malignant meningiomas. MATERIAL AND METHODS: The CT and MRI findings of 8 patients with surgically proven malignant meningioma were reviewed. Four cases of 8 malignant meningiomas and 18 cases of 27 benign lesions were studied with a 1.5T or 0.5T MRI. Radiologic analysis was focused on the heterogeneity of tumor, grade of peritumoral edema, presence of cystic degeneration and calcification, tumoral enhancement pattern, dural enhancement, and tumoral border. RESULT: Histologic types of malignant meningioma were meningotheliomatous (n=4), papillary(n=1), fibroblastic(n=l), angioblastic(n=l), and sarcomatous(n=l). Tumoral Heterogeneity was seen in 8 of 8 malignant lesions(100%) and 8 of 27 benign ones(30%). (p<0.01) Marked peritumoral edema was seen in 8 of 8 malignant lesions(100%) and 2 of 27 benign ones. (7.3%)(p<0.01) Most of malignant lesions(6 of 8 cases, 75%) showed ill defined border. Calcification was not present in malignant lesions in contrast with benign ones (14 of 27 cases, 52%). (p<0.05) No statistical significance was noted in cystic degeneration, dural tail like enhancement or tumoral enhancement pattern between malignant and benign meningiomas. MRI signal intensity of malignant meningiomas was homogeneously or heterogeneously hypointense on T1WI, heterogeneously isointense or hypointense on T2WI and heterogeneous or mixed on Gd-DTPA enhancement study. CONCLUSION: The CT or MRI findings such as heterogeneity, ill defined tumoral border, marked peritumoral edema, and absence of calcification may suggest the possibility of malignancy in meningioma.
Edema ; Gadolinium DTPA ; Humans ; Magnetic Resonance Imaging* ; Meningioma* ; Population Characteristics

BACKGROUND: The Amplified Mycobacterium tuberculosis Direct Test (AMTDT) has been developed for the direct detection of M. tuberculosis complex in respiratory specimens. Traditional methods for diagnosis of extrapulmonary tuberculosis such as the acid-fast bacilli (AFB) stain have their well-known limitations. We investigated the usefulness of the AMTDT for a wide range of non-respiratory specimens to establish early diagnosis of extrapulmonary tuberculosis. METHODS: 346 specimens (219 urine, 117 pleural fluid, 6 ascitic fluid, 2 lymph node, 1 gastric aspirate, and 1 pus specimens) from 340 patients referred from November 1997 to September 1998 were tested by the AMTDT. The AMTDT results were evaluated by comparing with clinical diagnosis and smear results. RESULTS: The overall sensitivity, specificity, and positive and negative predictive values of the AMTDT were 82.9%, 93.8%, 64.2%, and 97.6%, respectively. There were no difference in sensitivity and specificity between pleural fluid and urine specimens. In 31 specimens from tuberculosis patients concurrently tested with AMTDT and stain, 15 were only AMTDT positive and 4 were only stain positive. Among the results considered to be false positive, 47.2% of cases were shown as being less than 150,000 relative light units (RLU). In 30 specimens from tuberculosis patients during or after treatment, all six of the patients with reactivation or aggravation were AMTDT positive, and one case was considered to be false positive. CONCLUSIONS: Our study demonstrates the efficacy of the AMTDT in diagnosing extrapulmonary tuberculosis. Prudent interpretation of the AMTDT's results is recommended in case of that being less than 150,000 RLU.
Ascitic Fluid ; Diagnosis ; Early Diagnosis ; Humans ; Lymph Nodes ; Mycobacterium tuberculosis* ; Mycobacterium* ; Polymerase Chain Reaction ; Sensitivity and Specificity ; Suppuration ; Tuberculosis

As the mitral valve disease becomes long-standing, the patient may develop pulmonary hypertension. It was reported that after surgical correction, the elevated pulmonary vascular resistance(PVR) would fall quickly in association with the fall in left atrial pressure(LAP). This study was performed to evaluate the changes in mean pulmonary artery pressure(PAP) and PVR immediately after mitral valve replacement(MVR). Fifty six patients undergoing mitral valve replacement(MVR) were divided into two groups on the basis of the presence or absence of significant pulmonary hypertension, defined as a resting mean pulmonary arterial pressure greater than 30mmHg. After induction of anesthesia, PAP, PVR, cardiac output(CO) were measured and compared with values in postbypass period. PAP and PVR were significantly decreased(PAP from 39.64+/-1.88 to 29.18+/-1.65 mmHg, P 0.001, PVR from 6.16+/-1.14 to 3.53+/-0.62 units, P<0.05) in Group II(PAP> or = 30mmHg, n=23), whereas not changed in Group I(PAP30 mmHg, n=33)(P<0.05). Persistance of an elevated PVR may cause right ventricular failure and low-output syndrome, so that an attempt to reduce the PVR is needed postoperatiavely. This study demonstrated that the PAP and PVR fall significantly after MVR especially in patients with severe pulmonary hypertension.
Anesthesia ; Arterial Pressure* ; Humans ; Hypertension, Pulmonary ; Mitral Valve* ; Pulmonary Artery ; Vascular Resistance*

This study was designed to investigate the effect of preoperative collection of blaod and acute normovolemic hemodilution(ANH) on the requirement of homologous transfusion, perioperative blood loss and hematological parameters in patients undergoing open heart surgery. Ninety two adult patients for elective open heart surgery were randomly assigned to one of three groups. Group I, ANH group, had blood withdrawn to a hematocrit of 33%o after induction of anesthesia(n =54). In Group II preoperative collection of blood in accordance with hospital protocol and ANH were performed(n=16). Ciroup III was control group(n=22). Autologous blood was replaced post bypass. The patients whose hematocrit fell below 25% were transfused with homologous blood. The use of homologous transfusion was 2.2+/-0.4 units in group I, 0.1+/-0.1 units in group II and 4.1+/-0.8 units in group III. Requirement of homologous transfusion in group II was reduced compared with group II and III with statistical significance(P<0.05). There was statistical significance between group I and group III(P<0.05) in homologous transfusion. Postoperative blood loss was 760.7+/-74.6 ml in group I, 675.6+101.5 ml in group II and 819.3+/-91.3 rnl in group III. There was no statistical significance among 3 groups. There was no difference in hematocrit or platelet count, and total blood loss on immediately post surgery or on day 1. Our data show that preoperative collection of blood and ANH can reduce the amount of homologous transfusion.
Adult ; Heart* ; Hematocrit ; Hemodilution* ; Humans ; Platelet Count ; Postoperative Hemorrhage ; Thoracic Surgery*

Blood transfusions in open heart surgery become increasingly dangerous in recent years because of hepatitis and the AIDS virus. For this reason, blood saving methods must be considered when assessing the quality of cardiac surgery. To evaluate different blood saving methods, seventy two patients undergoing open heart surgery were divided into 3 groups. Aprotinin group(group I, n=35) and aprotinin with acute normovolemic hemodilution group (group II, n=15) were compared with prospective control group (group III, n=22). We administered the serine protease inhibitor aprotinin in high dosage(loading dose of 4mg/kg and maintaing dose of 1mg/kg/hr) to group I, and II patients. Acute normovolemic hemodiluation(ANH) was done before heparinization in group II. One to three units of blood could be withdrawn with a desired hematocrit of 30%. After an extracorporeal circulation (ECC), autologous transfusion was undertaken. Hematocrit, platelet count, and partial thromboplastin time(PTT) were measured immediately after induction, during bypass and at the intensive care unit. Amount of blood loss was measured in 12 and 24 hours after arrival at an intensive care unit. Amount of homologous transfusion was counted in postbypass period and 12 hours after arrival at an intensive care unit. Hematocrit was elevated in group II(p<0.05) after ECC Platelet counts were elevated and partial thromboplastin time was prolonged in group II in postbypass period and 12 hours after arrival at an intensive care unit compared with group I and III. Postoperative blood loss was 560.4+/-272.5cc in group I, and 282.0+/-98.6cc in group II, 819.3+/-428,0cc in group III. The use of homologus transfusion(packed red cells and fresh frozen plasma) in group I could be reduced by 49 & 66% and group II by 73 & 84% compared with group III. In conclusion our study suggests that administration of high-dose aprotinin is effective in reducing intraoperative and postoperative bleeding and therefore reduces transfusion requirement. In addition, combination of ANH and aprotinin can further reduce homologous blood usage.
Aprotinin* ; Blood Transfusion ; Extracorporeal Circulation ; Heart* ; Hematocrit ; Hemodilution* ; Hemorrhage ; Heparin ; Hepatitis ; HIV ; Humans ; Intensive Care Units ; Partial Thromboplastin Time ; Platelet Count ; Postoperative Hemorrhage ; Prospective Studies ; Serine Proteases ; Thoracic Surgery* ; Thromboplastin

This study was designed to evaluate the possibility of esmolol to attenuate the cardiovascular reflex due to the induction of general anesthesia, tracheal intubation and/or surgical stimulations during open heart surgery. Esmolol was infused continuously to each patient by 150 ug/kg/min from 2 minutes prior to the completion of the induction of anesthesia and then by 75 ug/kg/min throughout the skin-incision. In patients undergoing coronary bypass grafts, esmolol group of 5 individuals did not show any significant change in hemodynamics in contrast to the control group of 5 individuals, which showed singificant decreases in systolic and mean arterial pressure(p<0.05). The plasma concentrations of the catecholamines in the esmolol group were not significantly different from those in control. In patients undergoing valve replacement, esmolol group did not show any significant difference in hemodynamics from control. The plasma concentrations of the catecholamines in the esmolol group were not changed by the anesthetic and surgical procedures in contrast to the control group, which showed 3 times increase (p<0.05) in norepinephrine level and 8 times increase (p<0.05) in epinephrine level. The results of these experiments demonstrate that esmolol can suppress the hemodynamic refiex and catecholamine-release due to the stimulations of anesthetic and surgical procedures under the general anesthesia by a high concentration of fentanyl, and that esmolol can be administered safely to attenuate the hazardous sympathetic reflexes.
Anesthesia ; Anesthesia, General ; Catecholamines ; Epinephrine ; Fentanyl ; Heart* ; Hemodynamics* ; Humans ; Intubation ; Norepinephrine ; Plasma ; Reflex ; Thoracic Surgery ; Transplants

BACKGROUND: Systemic arterial hypotension is relatively common following initiation of cardiopulmonary bypass (CPB). Decreased blood viscosity is induced by acute normovolemic hemodilution (ANH) and by the use of crystalloid oxygenator prime. The purpose of this paper is to study the effect of ANH on mean arterial pressure, perfusion flow index and PaO2/FiO2 upon initiation of CPB, and on homologous blood usage during CPB in coronary artery bypass grafting (CABG) surgery. METHODS: We reviewed 30 patients constituting an ANH group, and 30 patients in a control group who had undergone CABG surgery within the past 2 years. In the ANH group, 1 or 2 units of fresh autologous whole blood were sequestrated following induction of anesthesia. We compared mean arterial pressure, perfusion flow index, PaO2/FiO2, and hematocrit on the initiation of CPB, and homologous blood usage during and post CPB periods between the groups. RESULTS: Upon initiation of CPB, hematocrit in the ANH group was significantly less than in the control group, but there was no significant difference in mean arterial pressure, perfusion flow index or PaO2/FiO2 between the groups. The use of homologous blood during CPB in the ANH group was not significantly higher than in the control group. CONCLUSIONS: Acute intraoperative normovolemic hemodilution in CABG surgery was safely performed without significant hypotension and increased homologous blood usage during CPB.
Anesthesia ; Arterial Pressure ; Blood Viscosity ; Cardiopulmonary Bypass* ; Coronary Artery Bypass* ; Coronary Vessels* ; Hematocrit ; Hemodilution* ; Humans ; Hypotension ; Oxygen ; Oxygenators ; Perfusion