To determine whether patients are less likely to receive an inappropriate procedure in countries that devote fewer resources to health care than does the United States, we studied how appropriately coronary angiography and coronary artery bypass surgery were performed in the Trent region of the United Kingdom. The medical records ...

A patient is described with chylothorax after harvesting the left internal thoracic artery for coronary artery bypass surgery. Conservative treatment with a medium chain triglycerides diet and tube thoracostomy was not only unsuccessful, but also resulted in the complications of malnutrition and empyema. We recommend early surgical treatment of chylothorax ...

The process of applying a practice guideline to a patient requires a great deal of clinical data. AAPT (Appropriateness-Assessment Processing from Text) is an experimental computer program that can assess the appropriateness of coronary-artery bypass grafting surgery (CABG) in patients with coronary-artery disease (CAD) and chronic stable angina from the ...

Coronary artery bypass surgery can be performed without cardiopulmonary bypass (CPB). Bleeding obscuring the operative field and hemodilution of shed blood with irrigating saline are some of the drawbacks of this technique. We report the use of a newly developed surgical blower-humidifier (custom made [Research Medical, Inc.]) for improved visualization ...

Preoperative normovolemic hemodilution (PNH) has been proposed for patients scheduled to undergo aortic surgery. Coronary artery disease is frequent in these patients. The aim of the study was to assess the effect of PNH on hemodynamics and segmental wall motion (SWM) evaluated by transesophageal echocardiography in such patients. Twenty patients ...

The effect of extubation within the first postoperative hour was evaluated in 13 patients (mean +/- SD age 59 +/- 6 years) undergoing elective coronary artery bypass surgery without active systemic hypothermia. The mean cardiopulmonary bypass time was 50 +/- 14 minutes. Postoperative improvements in cardiac index and oxygen uptake ...

A 37-year-old man sustained occlusion of the right coronary artery after a bicycle accident with blunt chest trauma over the left scapula. Acute coronary angiography was performed because of chest pain and ST-segment elevation. Despite surgically successful acute revascularization the patient developed a transmural inferior wall infarction. Coronary artery occlusion ...

Sodium nitroprusside is widely used in the treatment of hypertension after coronary artery bypass surgery despite its toxicity and its deleterious effect on the coronary circulation. The aim of this study was to compare the safety and effectiveness of nicardipine with sodium nitroprusside in a randomized study. Nicardipine and sodium ...

Although many technological advances have been made in surgical materials, nylon is still the main suture material use for microvascular surgery. This study sought to evaluate polydioxanone (PDS) sutures for use in microvascular anastomoses. Twenty-eight male Sprague-Dawley rats were used in this experiment. Spatula-type needles with 9-0 PDS suture were ...

A 58-year-old woman with aortic valve regurgitation and bilateral ostial coronary artery stenosis due to non-specific aortitis is presented. Four months after aortic valve surgery and venous bypass surgery, orificial occlusion or high grade stenosis of the bypass grafts occurred. Repeat coronary arteriography was followed by cardiac arrest and emergency ...

The management and outcome of open-heart surgery in 31 patients requiring chronic hemodialysis because of end-stage renal failure are reviewed. The reasons for surgery were coronary artery disease (20 cases), mitral valvulopathy (5, including 3 with tricuspid insufficiency), aortic valvulopathy (5, including 2 with coronary artery disease) and perforation of ...

The usefulness of color Doppler flow mapping for estimating the severity of femoropopliteal lesions was compared with that of angiography in 35 patients (70 extremities). Sonography depicted significant (greater than 40% luminal narrowing) arterial lesions in 45 of 47 lower extremities in which such lesions were present (sensitivity, 0.96 [95% ...

In 1989, a survey on perioperative antibiotic prophylaxis was conducted in 2,739 surgical (general surgical, orthopedic, traumatologic, and cardiothoracic) departments of German hospitals. In all, 889 (32.5%) questionnaries were returned. Regarding the choice of antibiotic and the duration of prophylaxis the respective rates of correct statements were as follows: 32.6% ...

The pharmacokinetics of prophylactic antibodies may differ in cardiac and aortic aneurysm surgery for at least two reasons: aortic aneurysm surgery generally entails a greater blood volume loss and replacement, and aortic aneurysm surgery usually does not require extracorporeal cardiopulmonary bypass. We prospectively studied two different cefamandole dosing regimens in ...

Two weeks after coronary artery bypass surgery, a 43-year-old man was readmitted with fever, pneumonia, left pleural effusion, and pericarditis. Echocardiography showed a localized posterior pericardial effusion, pericardial thickening, and bulging of the ventricular septum toward the left ventricle. Right-sided catheterization indicated pericardial constriction. Effusive-constrictive pericarditis was confirmed at surgery. ...

Thoracic impedance at 2.5 (TI2.5) and 100 kHz (TI100), central venous pressure (CVP), and body fluid balance were recorded together with rectal temperature and arterial haematocrit in 15 consecutive patients subjected to coronary artery bypass grafting. I.v. fluid and blood were administered in an excess of 3.18 (1.38-9.35) 1 during ...

The neurologic complications of coronary artery bypass surgery have been well documented, with a reported incidence of 61% in one large study. Most injuries to the peripheral nervous system involve the brachial plexus. We report the first case of a spinal accessory nerve lesion after coronary bypass surgery. The patient ...

Arterial hypertension is common after coronary artery-bypass grafting (CABG) surgery and may lead to postoperative complications. Therefore, the effects of the calcium antagonist isradipine were studied in 10 postoperative CABG patients who had a mean arterial pressure (MAP) above 100 mm Hg. Isradipine, given as a continuous infusion, reduced MAP ...

Activated polymorphonuclear leukocytes (PMN) secrete lysosomal enzymes, eicosanoids and toxic oxygen metabolites. In cardiac surgery patients, we measured arterial plasma levels of PMN and L1 (calprotectin), a prominent granulocyte protein, during cardiopulmonary bypass (CPB). The myocardial arterio-venous gradients were evaluated during reperfusion after cold cardioplegic arrest (n = 10). The ...

Anatomical characteristics of the radial a. were compared to those of the internal thoracic a., considered as a gold standard in coronary surgery. The length, the diameter, the collateral distribution and the wall thickness of these two arteries were studied comparatively. In addition, a comparative histological analysis was carried out. ...

A total of 29 patients with coronary artery disease (CAD) were investigated with 15-(p-[123I] iodophenyl)pentadecanoic acid (123I-IPPA) and sequential single photon emission tomography (SPET). Of these, 19 were studied after aorto-coronary bypass graft surgery. Some 13 patients without evidence of CAD served as a control group. Two SPET studies (early ...

Recently a thermocoagulator using hot air has been developed. It has been used for haemostatic purposes in a number of cases of liver, pulmonary and retroperitoneal cancer surgery. An experimental animal study was undertaken to evaluate the use of the thermocoagulator during cardiac surgery. Since the thermocoagulator produces coagulation necrosis, ...

The majority of the 26 technology assessment articles from the Coronary Artery Surgery Study (CASS) follow the original purpose of the registry and evaluate the therapeutic capabilities of coronary artery bypass graft surgery. However, these registry data have also been used to identify risk factors for cardiovascular disease, to test ...

A 2-year audit of the Southampton Vascular Unit showed marked discrepancies in workload from nationally accepted figures. All forms of reconstructive surgery except emergency aortic aneurysm grafting were performed more frequently than expected. The vascular population is elderly and at high risk from major surgery. Mortality was appreciable in all ...

Myocardial infarction is a major cause of operative mortality following abdominal aortic surgery. For this reason, routine coronary angiography and, if indicated, coronary revascularization prior to aneurysm repair is recommended. Nevertheless, some controversy still exists concerning the risks of aneurysm rupture and myocardial ischemic events when repair or coronary surgery ...

Neuropsychiatric complications are well known risks of open heart surgery. In this regard cerebral damage is caused either by microembolism or insult from low perfusion pressure as a consequence of extracorporeal circulation. It seems probable that monitoring of the quantitative electroencephalography (QEEG) during the surgical procedure can help minimize the ...

Cardiovascular collapse due to pulmonary hyperinflation was noted in a patient with chronic obstructive pulmonary disease following median sternotomy for cardiac surgery. Treatment included bronchodilator therapy to reduce airway obstruction, limitation of minute ventilation, and increasing time available for exhalation. High inspiratory flow rates and expiratory retard may be beneficial.

Fear of the acquired immune deficiency syndrome and other blood-transmitted diseases has created a revival of autologous transfusion during cardiac surgery. The present report is of 200 patients undergoing cardiopulmonary bypass during cardiac surgery in whom phlebotomy was performed via the sideport of the introducer for the pulmonary artery catheter ...

A total of 63 cardiac lipomas have been reported to date. Although most of these rare tumors cause no symptoms, a few can have a detrimental effect on myocardial function as well as displacing and encasing the coronary arteries. This case of a cardiac lipoma was initially seen in 1982. ...

This paper examines coronary artery disease and coronary artery bypass graft (CABG) surgery from a critical medical anthropological perspective. It explores the issue of why an expensive, individualistic, and mechanistic treatment for the symptoms of coronary artery disease (CABG surgery) has come to be so widely used to treat a ...

Since modern vascular surgery started with the discovery of heparin and the development of modern vascular grafts including autogenous saphenous vein, the speciality has been technologically driven. At the outset, vascular surgery depended almost entirely on the development of specialized clamps, instruments, and tools to permit decisive attack on the ...

In 96 consecutive patients undergoing primary femoropopliteal bypass grafting, the runoff was evaluated with a new grading system, based on findings at intraoperative postreconstruction serial angiography. This concept, which takes foot vessel involvement into account in patients with only one patent crural artery, is a modification of the traditional method ...

The entity of Wolff-Parkinson-White Syndrome and coronary sinus diverticula when the bypass tract is posteroseptal in location has been described recently. The presence of this diverticulum may complicate arrhythmia surgery and could potentially add to the risk of catheter ablation. We describe a case of Wolff-Parkinson-White Syndrome in which the ...

Two case reports are described of acute anaphylactoid reactions following the administration of protamine to reverse the anticoagulation effect of heparin in patients undergoing coronary artery bypass graft surgery. The administration of cimetidine seemed to reverse the anaphylactoid reaction after conventional treatment with epinephrine, H1 receptor blocker, and steroids had ...

This study was performed to determine the procedural characteristics and in-hospital complications associated with failed percutaneous transluminal coronary angioplasty that necessitates coronary artery bypass graft surgery. The study population consisted of 316 patients from 1980 to 1986; 202 patients (64%) had emergency coronary artery bypass graft surgery and the remainder ...

Coronary artery bypass surgery (CABS) has been regionalized in the province of Ontario since the introduction of the procedure in the 1970s. The authors examined the effect of regionalization on the age-adjusted surgery rates in the 38 counties of southern Ontario and found that county surgical rates were not related ...

A series of patients undergoing coronary artery bypass surgery was studied prospectively to see if angiographic evidence of cerebrovascular disease proved predictive of the incidence of neuropsychological deficit 8 days or 8 weeks after surgery. In 47 patients, intravenous digital subtraction angiography was carried out preoperatively to assess the presence ...

4 different methods of colonic anastomosis, single and double layer inversion and eversion, were performed on cowcalves. Hypervascularization of neovascularized arterioles at the cut ends of colon were visualized on the 7th day by all techniques. The arterioles, later one, tended to reorganise towards normalcy. Inversion technique showed better vascularization ...

In a randomized, double-blind study, 38 patients undergoing elective pulmonary surgery were given N-acetylcysteine (Fabrol, Ciba-Geigy) in recommended dosage (200 mg X 3) or placebo. The prophylactic effect on postoperative bronchopulmonary complications was evaluated from arterial blood-gas analyses and chest radiography. The alveolo-arterial oxygen difference increased substantially and similarly in ...

The purpose of this study was to investigate the impact of a supportive-educative telephone program on the levels of knowledge and anxiety of patients undergoing coronary artery bypass graft surgery during the first 6 weeks after hospital discharge. With a posttest-only control group design, the first 74 patients scheduled, between ...

A prospective study of 79 coronary artery bypass surgery patients has been undertaken to determine the cerebral consequences of this form of surgery. Thirty comparative major vascular and thoracic non-cardiopulmonary bypass patients have also been studied. Detailed neurological, neuropsychological and cerebral blood flow investigations were undertaken preoperatively and at 8 ...

A case of postoperative anaerobic mediastinitis after coronary artery bypass grafting is reviewed. One of the causative organisms, Bacteroides oralis, has never previously been described as a pathogen causing mediastinitis after median sternotomy incision. There was associated Bacteroides fragilis bacteremia. Only three cases of Bacteroides species mediastinitis after open heart ...

The Coronary Artery Surgery Study (CASS) was a prospective, randomized evaluation of the value of coronary artery bypass grafting compared with medical therapy for stable, mildly symptomatic coronary artery disease. Also, the CASS registry collected clinic information and follow-up data from 24,959 nonconsecutive patients undergoing cardiac catheterization from 1974 to ...

Coronary artery bypass grafting and other cardiac procedures are proving their efficacy, and the demand for surgical correction of coronary artery disease will increase in the future. Physician assistants will benefit from this development because cutbacks in surgical residencies, reductions in the number of available foreign medical graduates, and imposition ...

The purpose of this study was to explore the experiences of patients who have had coronary artery bypass graft surgery (CABGS). Semistructured interviews using descriptive and contrast questions were done with a convenience sample of five married Anglo men. The sampling frame spanned time from 4 days to 3 years ...

Hypercholesterolemia is an important determinant of progressive atherosclerosis in both vein grafts and native vessels after coronary artery bypass surgery. We demonstrated that nearly half of all patients admitted for coronary bypass have elevated cholesterol levels before surgery. Of these, half are unaware of the elevations in cholesterol level, and ...

The nonreversed saphenous venous graft in coronary surgery gives better match of diameters at the aortic as well as at the coronary anastomosis. The destruction of the valves is necessary and special valvulotomes are used. This preliminary report of a new technique in coronary surgery must be followed by long ...

Based on animal data it has been hypothesised that lungs may regulate systemic fibrinolysis. To test this hypothesis 12 patients undergoing infrarenal aortic reconstruction due to arteriosclerotic disease were evaluated for influence of the respiratory pattern on release of tissue plasminogen activator (t-PA) and its inhibitor (PAI) in systemic and ...

A patient with a preoperative diagnosis of myxoedema had triple vessel coronary artery bypass surgery. The perioperative and postoperative course was essentially uneventful. The most appropriate management of a patient with coronary artery disease who has concomitant myxoedema is first to improve myocardial blood flow by relieving coronary obstruction and ...

From July 1974 to May 1979, 573 black persons in the Coronary Artery Surgery Study (CASS) underwent coronary angiography. Compared with 23,008 white persons, larger percentages of black men and women were current smokers and reported a history of systemic hypertension. Despite the presence of chest pain, larger percentages of ...