This retrospective study compared the immediate post-operative (first month) and mid-term (up to 5 years post-operation) results of 22 patients with isolated ventricular septal defects who underwent surgical correction with bovine pericardium with 57 similar patients who received a polytetrafluoroethylene (PTFE) patch. There were no cases of early (in the first month) mortality in either group and the 3-month post-operative echocardiographical studies showed no evidence of calcification or aneurysm formation around the patch. Recurrent ventricular septal defects due to dehiscence of the patch occurred in the early follow-up period in four patients who had the PTFE patch but this was not statistically significant. Annual echocardiographical examination revealed some calcification in both groups. We conclude that although there are no significant differences between the two materials in outcome after ventricular septal defects closure, we prefer bovine pericardium because of its handling characteristics, elasticity and the lower risk of endocarditis.
Haemorrhagic shock, a leading cause of mortality, frequently accompanies cardiac interventions. The administration of small volumes of hypertonic saline solutions and crystalloid solutions may reduce the severity and duration of shock, and result in a decrease in adverse outcomes. Under general anaesthesia, hypotension was induced in 12 healthy dogs. After 30 min, dogs received either hypertonic saline solution or lactated Ringer's solution for fluid, resuscitation. In both groups, decreases in haemodynamic variables were observed during the shock period. Following resuscitation, increases in haemodynamic variables were observed. This increase lasted longer in dogs receiving hypertonic saline. In both groups, haematocrit and oxygen content values decreased after resuscitation and lactate levels increased. During resuscitation, lactate levels decreased. Sodium and osmolarity increased with resuscitation, then subsequently decreased. In conclusion, in a model of haemorrhagic shock, the administration of hypertonic saline solutions provides haemodynamic stability and tissue oxygenation more rapidly.
The purpose of this study was to assess the viability and dilator response of the saphenous vein segments harvested during cardiac surgery. The saphenous veins were incubated with either normal saline (group A) or papaverine solutions (group B). The viability of saphenous vein endothelial cells was assessed by counting the number of total cells. Maximal endothelium-dependent vasodilator response to acetylcholine was also investigated. Cell viability of vein samples was decreased after 4 hours of incubation with normal saline (34 +/- 6.5%) as compared to solution containing papaverine (92 +/- 3.7%). By 24 hours, the viabilities of the endothelial cells incubated with saline and papaverine solutions were 22 +/- 4.5% and 87 +/- 5%, respectively.There was significant difference in vasodilatation responses to acetylcholine between saline-incubated and papaverine-incubated groups. By 4 hours of incubation, the relaxation response to acetylcholine significantly deteriorated in group A when compared to the initial value (P < 0.001). Furthermore, the decrease in this vasorelaxation response has also continued throughout the observation period and the values obtained by 24 hours were observed to be significantly lower than those obtained at the end of 4 hours (P < 0.01). In contrast, although a decrease was noticed in group B over time, this decrease was not statistically significant (P, not significant). We thus conclude that the use of papaverine solution improves endothelial cell viability and is associated with preservation of the maximal endothelial-dependent vasodilator response of a vein segment.
Drug-induced myopathy, also named Nicolau syndrome, is a well-known phenomenon following intramuscular injection of certain agents, most commonly reported with penicillin or diclofenac. The mechanism responsible for the pathology is proposed to be incidental administration of the drug into the small arterioles. In this report, we present a Nicolau syndrome-like case that developed following accidental injection of a local anesthetic agent into the femoral artery during coronary angiography.
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