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  • 1
    Electronic Resource
    Electronic Resource
    The Patient With an Automatic Implantable Cardioverter Defibrillator (1993)
    Oxford, UK : Blackwell Publishing Ltd
    Journal of the American Academy of Nurse Practitioners 5 (1993), S. 0 
    Details
    ISSN: 1745-7599
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Sudden cardiac death is the leading cause of death in the United States. A relatively new technology used to treat ventricular dysrhythmias that lead to sudden cardiac death is the automatic implantable cardioverter defibrillator. This device uses patches on the heart to deliver an energy current to convert lethal dysrhythmias. The nurse practitioner can expect to encounter these devices when seeing patients for a variety of diagnoses. This article will serve as a resource for clinical management and patient education.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1745-7599.1993.tb00873.x
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  • 2
    Electronic Resource
    Electronic Resource
    Load-insensitive measurements from an isolated perfused biventricular working rat heart (1997)
    Springer
    Journal of biomedical science 4 (1997), S. 111-119 
    Details
    ISSN: 1423-0127
    Keywords: Rat heart, biventricular ; Elastance ; Pressure-length loops
    Source: Springer Online Journal Archives 1860-2000
    Topics: Biology , Medicine
    Notes: Abstract To determine whether a rat heart model can provide load-insensitive measurements of cardiac function, a recently developed biventricular perfused preparation was tested. Using 29 Sprague-Dawley rat hearts perfused with modified Krebs-Henseleit buffer, ventricles functioned simultaneously with adjustable independent preload (venous reservoirs) and afterload (compliance chambers). Ultrasonic crystal pairs provided continuous left (LV) and right ventricular (RV) short-axis dimensions. LV and RV pressure-length loops (loop area = work) were generated from paired intraventricular pressure and short-axis dimensions. Load-insensitive measurements were obtained from the slopes (elastance) and x-intercepts (L0) of regression lines generated from the end-systolic coordinates of these pressure-length loops over ranges of RV and LV preloads. Measurements were made after 15 min of stable function and after 20 min of warm (37°C) ischemia. During perturbations in LV afterload, there were linear changes in dP/dt, but loop work remained relatively unchanged. RV dP/dt and work varied little with physiologic ranges of afterload. Increased RV afterload had little effect on LV function. Ischemia affected LV function more than RV function using these measurements. Elastance, however, increased after ischemia with diastolic ‘creep’ (increased L0) for both ventricles. Load-insensitive and other sophisticated hemodynamic measurements are possible with this new preparation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02255601
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  • 3
    Electronic Resource
    Electronic Resource
    Clinical spectrum of paraesophageal herniation (1992)
    Springer
    Digestive diseases and sciences 37 (1992), S. 537-544 
    Details
    ISSN: 1573-2568
    Keywords: paraesophageal herniation ; gastroesophageal hiatus ; surgical repair
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Paraesophageal herniation is a potentially devastating condition of the gastroesophageal hiatus commonly manifesting in patients of advanced age with other significant medical problems. Surgical treatment is generally indicated to avoid catastrophe related to gastric volvulus. The operative approach utilized should be individualized to the patient's pathophysiologic condition rather than attempting to apply a single repair for all patients with this heterogeneous clinical problem.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01307577
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  • 4
    Electronic Resource
    Electronic Resource
    In vitro evaluation of five commercially available perfusion systems (1994)
    Springer
    The international journal of angiology 3 (1994), S. 128-133 
    Details
    ISSN: 1615-5939
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract An in vitro experiment was designed to examine and compare pump durability and stability, and hematologic derangements induced by four centrifugal pumps and one roller pump on fresh, unpooled citrated bovine blood. Pumps tested included St. Jude Medical Lifestream (n=7), Medtronic Bio-Pump® (n=7) and Carmeda Bio-Pump® (n=7), Sarns (n=7) centrifugal pump, and Sarns roller pump (n=7). Identical circuits consisted of equal inflow and outflow lengths of 3/8″ tubing connecting a 1 liter (L) reservoir to a pump head or roller region. Pump flow was controlled at 4.5 ± 0.3 L/min. All circuits (0.1 L lactated Ringer's solution prime + 1 L blood) were tested for 24 h. Blood samples were drawn hourly for hours 1–6, every other hour for hours 8–12, and then at hour 24. Parameters monitored included pH, fibrinogen, plasma free hemoglobin (free Hb), lactate dehydrogenase (LDH), and platelet counts. Over the 24-h period, platelet counts decreased similarly among the perfusion systems. Free Hb and LDH rose significantly with the Sarns roller and centrifugal pumps after five hours of pumping. No significant changes in fibrinogen or pH were detected. Pump speed required to maintain flow with the Bio-pumps was significantly faster than with the Sarns and St. Jude Medical pumps. The authors conclude that these perfusion systems function reliably and satisfactorily during the first 4 h in an in vitro circuit. All centrifugal pumps were less hostile to red blood cells than the roller pump. Under these experimental conditions, the Sarns centrifugal pump caused more hemolysis than the other three centrifugal systems tested. There was no apparent advantage to the Carmeda Bio-Pump (heparin bonded) circuit in this trial.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02014930
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  • 5
    Electronic Resource
    Electronic Resource
    Continuous warm blood cardioplegia: A randomized prospective clinical comparison (1996)
    Springer
    The international journal of angiology 5 (1996), S. 212-218 
    Details
    ISSN: 1615-5939
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Seventy-eight patients undergoing isolated coronary artery bypass grafting (CABG) were randomized to receive one of two myocardial preservation techniques. Control patients (C) (n=38) had myocardial protection by moderate systemic hypothermia, topical cold saline, and myocardial arrest with antegrade dilute blood/cold potassium cardioplegia with subsequent intermittent retrograde solution every 10–15 minutes during the period of aortic cross-clamping. The experimental group (warm blood, WB) (n=40) had myocardial protection at systemic normothermia, myocardial arrest with antegrade high potassium, and warm blood cardioplegia with subsequent continuous retrograde low potassium warm blood cardioplegia throughout aortic cross-clamping. The two groups were similar preoperatively. After aortic declamping, all WB patients developed a spontaneous rhythm. Only three (7.5%) required intraoperative defibrillation compared with 23 (61%) C patients,p〈0.0001. The cross-clamp time per graft was greater with WB,p=0.003. The postoperative need for inotropes, cardiac pacing, incidence of ventricular dysrhythmia, chest tube drainage, and hospital stay did not differ between groups. Perioperative myocardial infarction occurred in 2 WB and 0 C patients (p=0.25). Mortality was not different between groups (WB=1, C=2,p=0.89). It is possible to perform CABG with continuous warm blood cardioplegia with low morbidity and mortality. However, no clear advantage was demonstrated over standard techniques that allow the technical ease of a bloodless field. The metabolic and physiologic significance of spontaneous resumption of sinus rhythm upon aortic declamping remains to be elucidated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02044260
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  • 6
    Electronic Resource
    Electronic Resource
    Persistence of heparin-dependent antiplatelet antibody (1996)
    Springer
    The international journal of angiology 5 (1996), S. 201-203 
    Details
    ISSN: 1615-5939
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Heparin-induced thrombocytopenia is an immune-mediated response that has been associated with bleeding and thromboembolic complications. We test all cardiac surgery patients who experience thrombocytopenia, resistance to heparin, or have complications of increased bleeding or thrombosis with platelet aggregation assay for heparin-dependent antiplatelet antibody (HAAb). Due to the morbidity and mortality associated with reexposure to heparin in this population, we wished to investigate the length of time patients remain positive for HAAb postoperatively. Over a 10-year period (1982–1992), 97 patients tested positive for HAAb following open heart surgery. Of 66 survivors, 43 were available for follow-up and were contacted for repeat HAAb testing. Patients were retested from 1 to 126 months (median 17) postoperatively. Eleven of 43 patients (26%) remained positive for HAAb from 3 months to 12.5 years after initial diagnosis. Conversion from a positive to negative HAAb as early as 4 weeks was also observed. We conclude that the time to conversion to a negative HAAb test is highly variable. All patients who test positive for HAAb should have repeat HAAb testing before reexposure to heparin regardless of the time interval.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02044258
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  • 7
    Electronic Resource
    Electronic Resource
    Differential gene expression of extracellular matrix components in dilated cardiomyopathy (1996)
    New York, N.Y. : Wiley-Blackwell
    Journal of Cellular Biochemistry 63 (1996), S. 185-198 
    Details
    ISSN: 0730-2312
    Keywords: extracellular matrix ; remodeling ; collagenase ; collagen ; dilated cardiomyopathy ; congestive heart disease ; end-stage heart failure ; matrix metalloproteinase ; tissue inhibitor of metalloproteinase ; differential display mRNA analysis ; gene expression ; Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology , Chemistry and Pharmacology , Medicine
    Notes: Extracellular matrix metalloproteinases (MMPs) are activated in dilated cardiomyopathic (DCM) hearts [Tyagi et al. (1996): Mol Cell Biochem 155:13-21]. To examine whether the MMP activation is occurring at the gene expression level, we performed differential display mRNA analysis on tissue from six dilated cardiomyopathy (DCM) explanted and five normal human hearts. Specifically, we identified three genes to be induced and several other genes to be repressed following DCM. Southern blot analysis of isolated cDNA using a collagenase cDNA probe indicated that one of the genes induced during DCM was interstitial collagenase (MMP-1). Northern blot analysis using MMP-1 cDNA probe indicated that MMP-1 was induced three- to fourfold in the DCM heart as compared to normal tissue. To analyze posttranslational expression of MMP and tissue inhibitor of matrix metalloproteinase (TIMP) we performed immunoblot, immunoassay, and substrate zymographic assays. TIMP-1 and MMP-1 levels were 37 ± 8 ng/mg and 9 ± 2 ng/mg in normal tissue specimens (P 〈 0.01) and 2 ± 1 ng/mg and 45 ± 11 ng/mg in DCM tissue (P 〈 0.01), respectively. Zymographic analysis demonstrated lytic bands at 66 kDa and 54 kDa in DCM tissue as compared to one band at 66 kDa in normal tissue. Incubation of zymographic gel with metal chelator (phenanthroline) abolished both bands suggesting activation of neutral MMP in DCM heart tissue. TIMP-1 was repressed approximately twentyfold in DCM hearts when compared with normal heart tissue. In situ immunolabeling of MMP-1 indicated phenotypic differences in the fibroblast cells isolated from the DCM heart as compared to normal heart. These results suggest disruption in the balance of myopathic-fibroblast cell ECM-proteinase and antiproteinase in ECM remodeling which is followed by dilated cardiomyopathy. © 1996 Wiley-Liss, Inc.
    Additional Material: 9 Ill.
    Type of Medium: Electronic Resource
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