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  • 1
    ISSN: 1436-2813
    Keywords: heart transplantation ; size disparity ; heart rate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To assess the feasibility and function of small donor hearts for large recipients, small donor hearts were orthotopically transplanted into large recipients. Thirty adult mongred dogs were used to form donor-recipient (D-R) combinations with the D-R heart weight ratio ranging from 0.47 to 1.78. In the D-R heart weight ratio of 0.8 or above (mean 1.11, Group I), the successful transplantation rate was 57 per cent, while it was 81 per cent in cases of less than 0.8 (mean 0.67, Group II) (no statistical difference). In 10 dogs (5 with D/R heart weight ratio ≧0.8, 5 with 〈0.8) a recovery rate in cardiac function of the transplanted small heart was studied 2 hours following transplantation. There was no significant difference, hemodynamically in the normal range of left atrial pressure (LAP) between the two groups. The close relationship between cardiac output (CO) and volume load in the range of 10 to 15 mmHg of LAP was transformed to a linear function in the over 0.8 group. It was technically and hemodynamically possible to transplant small dog hearts to larger recipients up to the D-R heart weight ratio of 0.47. The importance of an adequate heart rate for the increase of CO in transplanted smaller donor hearts was emphasized.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1436-2813
    Keywords: abdominal aortic aneurysm ; high-risk patient ; aneurysmectomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In an attempt to define the preoperative risk factors that predictably influence mortality after aneurysmectomy, this study reviews the surgical management of abdominal aortic aneurysms in a series of 110 consecutive patients who underwent elective resection. The preoperative risks to be added to the present study included pulmonary insufficiency, renal dysfunction, advanced age of over 80 years, ischemic heart disease, and associated other diseases such as thoracic aneurysms, atherosclerosis of the limbs and malignant tumors. Forty-six patients had one of these risk factors (one-risk group), 17 had two (two-risk group), and 9 had three (three-risk group). The operative mortality rates were 4.2 per cent for the high-risk patients and 0 per cent for the patients at no risk. As the number of risk factors increased, aneurysm repair was associated with an increased operative mortality; being 2.2 per cent in the one-risk group, 5.9 per cent in the two-risk group and 11.1 per cent in the three-risk group. The common risk factor in patients who died after aneurysmectomy was pulmonary insufficiency which induced prolonged periods of assisted ventilation. Thus, the optimal management of high-risk patients, particularly those with pulmonary insufficiency, may reduce the mortality after aneurysmectomy.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1436-2813
    Keywords: abdominal aortic aneurysm ; bronchogenic carcinoma ; same operation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A 69-year-old man successfully underwent simultaneous repair of an abdominal aortic aneurysm and resection of bronchogenic carcinoma during the same operation. Pulmonary lobectomy was performed following complete closure of the abdomen after aneurysmectomy to prevent any contamination. If the patients are carefully selected, an operation for abdominal aortic aneurysm and bronchogenic carcinoma can be safely performed with the advantage of treating both lesions simultaneously and thus sparing the patients from having to undergo the physical and psychosomatic pain, as well as the risk, of a second operation.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1436-2813
    Keywords: hepatic hemorrhage ; pregnancy ; CO2 angiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report herein a case of spontaneous subcapsular hepatic hemorrhage which occurred in a 33-year-old woman 1 day after she had been delivered of her second child by cesarean section following an uneventful pregnancy. She complained of right upper quadrant pain on the 1st postoperative day, and computed tomography (CT) showed subcapsular low-density masses in both liver lobes, while extravasation was demonstrated by CO2 intraarterial digital subtraction angiography (IADSA). The hemorrhage was successfully controlled by transcatheter arterial embolization (TAE). However, on the 3rd day after TAE, an exploratory laparotomy was performed to establish an exact diagnosis to explain the persistent abdominal pain and abnormal liver function tests. Subcapsular hematomas in both lobes were confirmed and no visible laceration was present. The patient recovered gradually by spontaneous absorption of the hematomas and was discharged on the 22nd postoperative day. Spontaneous hepatic hemorrhage associated with pregnancy is a very rare complication, and establishing a correct diagnosis and initiating appropriate therapy are essential for this life-threatening disease.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1436-2813
    Keywords: Key Words: penetrating atherosclerotic ulcer ; bacterial infection ; mycotic aneurysm ; in situ reconstruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Staphylococcus epidermidis , and histological study subsequently showed penetrating atherosclerotic ulcers (PAU) involving all layers of the aortic wall and marked neutrophilic infiltration with abscess formation inside the ulcer. Atherosclerotic aortic lesions such as PAU are considered susceptible to bacterial infection, which may lead to the formation of an aneurysm after destruction of the vessel wall. Hence, elderly hypertensive patients, being at high risk for such aortic pathology, require careful studies performed to assess the aorta. The usefulness of computed tomographic (CT) scans to determine the presence of PAU or surrounding inflammation should be borne in mind even when a small mycotic aneurysm exists.
    Type of Medium: Electronic Resource
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