Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The clinic of such injuries is characterized by marked local manifestations (solid progressive edema of the injured limb leading frequently to decompensated ischemia) and a high incidence of acute renal insufficiency. Hemostatic disorders are manifested in hyperkalemia, hyponatremia, hypocalcemia, cell-extracell transfer of electrolytes, metabolic disorders in the myocardium, as evidenced by EEG findings. It is the authors' opinion that therapeutic measures should be aimed at liquidation of the progressive edema (hypothermia, fasciotomy), prevention of acute renal insufficiency and correction of metabolic disorders.
Vestn Khir Im I I Grek 1976 Dec
PMID:[Postural crush syndrome]. 101 97

Hypothermia was induced intermittently in a patient to combat hyperpyrexia. The electrocardiogram taken during the hypothermic phase displayed typical abnormalities and consisted of: pronounced sinus bradycardia, marked prolongation of the Q-T interval, muscle tremor artifact, and the characteristic "Osborn wave." Spontaneous rewarming resulted in disappearance of the electrocardiographic alterations, underscoring the functional and reversible nature of the abnormalities.
South Med J 1976 Dec
PMID:Induced hypothermia: electrocardiographic abnormalities. 101 69

1. Renal function was measured in seven normo thermic (38 degrees C) and seven hypothermic (27 degrees C) dogs. 2. The glomerular filtration rate was 60 per cent lower in the hypothermic animals, and the renal blood flow as 51 per cent lower. The intrarenal distribution of blood flow was measured by the uptake of 86Rb from the blood into different regions of the kidney. Hypothermia reduced flow by 34 per cent in the outer cortex, 72 per cent in the inner cortex, 61 per cent in the outer medulla and 69 per cent in the inner medulla. 3. Radioautography indicated a high blood flow to an area of the outer medulla of hypothermic kidneys, which may indicate medullary blood flow "shunting". 4. The results have been discussed in relation to a number of clinical and experimental observations.
Clin Sci Mol Med 1976 Dec
PMID:Distribution of blood flow in the hypothermic (27 degrees C) dog kidney. 107 Apr 22

Two different operative techniques for aorta-coronary bypass grafting were utilized in two comparable groups of patients. In one group (155 patients) distal anastomoses were carried out with the aorta cross-clamped and myocardial protection provided by profound local hypothermia (clamped group). In a second group (149 patients) distal anastomoses were carried out with the aorta unclamped and the left ventricle fibrillating and vented (unclamped group). Mortality rates were similar in the two groups (0.6 per cent in clamped group versus 1.3 per cent in unclamped group). The incidence of perioperative infarction was 15 per cent in the unclamped group and 8 per cent in the clamped group (p less than 0.05). Postoperative serum glutamic oxaloacetic transaminase (SGOT) and lactic dehydrogenase (LDH) levels were significantly higher for the first 4 postoperative days in the unclamped group than in the clamped group. Hemodynamic studies in a subset of each group revealed no important differences in left ventricular function in the immediate postoperative period. The data demonstrate that in patients undergoing aorta coronary bypass grafting, performance of distal anastomoses with aortic cross-clamping and profound local hypothermia results in less intraoperative myocardial injury than performance of distal anastomoses in the perfused, fibrillating, and vented left ventricle.
J Thorac Cardiovasc Surg 1975 Dec
PMID:The superiority of aortic cross-clamping with profound local hypothermia for myocardial protection during aorta-coronary bypass grafting. 108 Nov 70

Dissatisfaction with the high morbidity and mortality of traditional methods of handling massive gastrointestinal hemorrhage has led to the exploration of means other than surgical to attain hemostasis. Some, such as selective arterial infusion of surgical Pituitrin, have quickly won general acceptance in hospitals where facilities and interested personnel are available. Others, such as alkalinization, have become popular because of their inherent simplicity. Systemic hypothermia, requiring intensive patient care, has not been without considerable risk of significant complications. Iced saline lavage has never been subjected to critical evaluation. It is possible that the emptying of the stomach through mechanical destruction of the intragastric clot by repeated irrigations, reducing the antral stimulation by relief of distension, may be as important as the temperature of the solution in the stomach. Gastric irrigations with norepinephrine solutions have awaited the results of physiologic studies showing that the cardiovascular and renal effects of injected levarterenol are avoided, and that permanent damage to the gastrointestinal mucosa does not result. Trials have been confined largely to very poor-risk patients, and the hemostasis that has resulted has not been explainable, in all cases, on the basis of the physiologic activity of the agent (e.g., control of bleeding from tumor vessels). Evacuation of gastric content prior to introduction of the norepinephrine solution seems important. Lower gastrointestinal bleeding from benign disease has also responded to advances in applied pharmacology, with intra-arterial infusion of surgical Pituitrin again coming into progressively wider use. Intraperitoneal instillation of norepinephrine has also proved useful, even in patients who have adhesions from prior surgery or inflammatory disease, but closer monitoring of blood pressure and urine output are necessary because some of this solution is absorbed by the parietal peritoneum and not deactivated by the liver before entering the systemic circulation. Taken together, selective arterial infusion of vasopressin and topical application of norepinephrine can be considered complementary rather than competitive therapies. Because of the more extensive experience with selective angiographic infusion, it should be the first choice in institutions where it is readily available. For patients in whom arterial puncture is inadvisable, and where angiography is not readily available, topically applied norepinephrine becomes the treatment of preference. We have demonstrated effectiveness of intraperitoneal norepinephrine in a patient in whom selective arterial infusion of surgical Pituitrin had failed. And the reverse would probably also hold true on occasion. Pharmacologic techniques represent a therapeutic advance, reducing the frequency with which surgical intervention becomes mandatory. But they are not a substitute for surgery...
Compr Ther 1975 Dec
PMID:Massive gastrointestinal hemorrhage. 108 29

Four patients are reported in whom the aortic arch and variable portions of the ascending and descending aorta were replaced with a prosthesis. In three patients the preoperative diagnosis was dissecting aneurysm of the aortic arch and in one an arteriosclerotic aneurysm of the aortic arch was present. A combination of surface cooling and cardiopulmonary bypass was utilized to produce total body hypothermia. Arch replacement was carried out during a period of total circulatory arrest. Cardiopulmonary bypass was then utilized to warm the patient and resuscitate the heart. The average duration of cerebral ischemia was 43 minutes and the average duration of myocardial ischemia was 74 minutes. The average lowest esophageal temperature was 14 degrees C., and the average lowest rectal temperature was 18 degrees C. Three patients are alive and well 4 to 13 months following surgery. One patient died 4 days postoperatively of pulmonary insufficiency. This experience indicates that by utilizing total body hypothermia and circulatory arrest aortic arch replacement can be carried out with an acceptable mortality rate. Corrective surgery could be offered to patients with life-threatening enlarging aneurysms of the aortic arch.
J Thorac Cardiovasc Surg 1975 Dec
PMID:Prosthetic replacement of the aortic arch. 118 83

In order to assess the long-term effects of cardiopulmonary bypass (CPB) in combination with pupular methods of myocardial protection, 37 dogs were placed on CPB for 100 minutes with the use of a bubble oxygenator without hemodilution. A separate group (I) of eight normal dogs served as a control for assessment of hemodynamic changes. The operative groups were as follows: II, continuous coronary perfusion with an empty, beating heart for 60 minutes at 35 degrees C.; III, hypothermic anoxic arrest (aortic occlusion) for 60 minutes with topical cold saline lavage (4 degrees C.); IV, anoxic arrest for 60 minutes at 35 degrees C. Subgroups of Groups III and IV received intracoronary perfusion with Ringer's lactate or Sacks' solution during aortic occlusion and were compared with those animals receiving no perfusion. Survival in Groups II and III was significantly better than in Group IV (82 and 92 per cent vs. 45 per cent). Coronary perfusion with Ringer's lactate or Sack's solution did not influence survival. The 23 survivors from all groups underwent left heart catheterization and LV cineangiography 5 months after operation. All three operative groups had significant elevation of LVEDP and depression of maximum developed dp/dt when compared with normal dogs. Ejection fraction was significantly depressed in Groups III and IV, and there was evidence of left ventricular hypokinesia and/or akinesia in all three operative groups. Differences in function between Groups II, III, and IV were not significant. The use of intracoronary solutions during anoxic arrest did not significantly influence these functional alterations. Evidence of subendocardial fibrosis was found in each of the operative groups, with the most marked changes found in the normothermic arrest group. Moderate fibrosis was present, however, in some survivors in both the continuous coronary perfusion and topical hypothermic arrest groups. These data indicate that although survival is greatly enhanced when coronary artery perfusion or topical hypothermia is used, neither method prevents chronic deterioration in ventricular function nor the development of subendocardial fibrosis.
J Thorac Cardiovasc Surg 1975 Dec
PMID:Long-term morphologic and hemodynamic evaluation of the left ventricle after cardiopulmonary bypass. A comparison of normothermic anoxic arrest, coronary artery perfusion, and profound topical cardiac hypothermia. 118 84

Ischemic contracture of the left ventricle ("stone heart") is a recognized complication of prolonged periods of interruption of the coronary circulation during open-heart surgery. We have examined the effects of moderate hypothermia (28 degrees C.) and preoperative beta-adrenergic blockade (propranolol, 0.5 mg. per kilogram; 1.0 mg. per kilogram) on contracture development during ischemic arrest of the heart. Four groups of 8 dogs each were placed on total cardiopulmonary bypass, and ischemic arrest of the heart was produced by cross-clamping the ascending aorta and venting the left ventricle. Intramyocardial carbon dioxide tension was continuously monitored by mass spectrometry. When anaerobic energy production ceased, as indicated by a final plateau in the intramyocardial carbon dioxide accumulation curve, the ischemic arrest was terminated and the contractile state of the heart observed. These results are given in the text. We conclude that beta-adrenergic blockade delays, but does not prevent, the onset of ischemic contracture of the left ventricle under normothermic conditions. Moderate hypothermia appears to prevent this complication completely.
J Thorac Cardiovasc Surg 1975 Dec
PMID:Ischemic contracture of the left ventricle. Production and prevention. 118 87

Moderate hypothermia is one of the methods utilized for myocardial protection when the aortic root is cross-clamped but not opened. A combination of low-pressure, low-flow retrograde coronary sinus perfusion (RCSP) with oxygenated blood at moderate hypothermia (29 degrees C.) was demonstrated to yield significantly better protection to left ventricular function in dogs than does moderate hypothermia alone. Ventricular function was recorded before and after 1 hour of aortic cross-clamping at identical preloads and heart rates. Aortic pressure was returned to a level as close to base line as possible by constriction of the descending aorta. The average mean aortic pressure of the animals perfused retrograde at 29 degrees C. was returned to within 4 per cent of base line. By contrast, in the animals protected with moderate hypothermia alone, the pressure could be returned only to a level which was 37 per cent lower than base line. In animals protected with moderate hypothermia alone, cardiac output dropped 62 per cent, left ventricular stroke work (LVSW) 75 per cent, and peak dp/dt 44 per cent. In the animals protected with RCSP and moderate hypothermia, the cardiac output dropped 6 per cent, LVSW 9 per cent, and peak dp/dt 5 per cent. The differences in the changes noted between these two groups were significant for LVSW and dp/dt at a level of p less than 0.01 and for cardiac output and aortic pressure at a level of p less than 0.05. These results suggest that RCSP may be indicated when moderate hypothermia is otherwise chosen to be the sole source of myocardial protection.
J Thorac Cardiovasc Surg 1975 Dec
PMID:Drip retrograde coronary sinus perfusion for myocardial protection during aortic cross-clamping. 118 88

Depressed postoperative myocardial performance (low output syndrome) requiring inotropic drugs or balloon counterpulsation is due to subendocardial ischemic damage. Before July, 1972, we needed inotropic drugs in 30 to 52 per cent of 189 patients undergoing coronary revascularization or aortic or mitral valve replacement in whom we used ischemic arrest, profound topical hypothermia, and ventricular fibrillation. The mortality rate ranged from 10 to 17 per cent. Our experimental studies show that morbidity and death in such cases are caused by ischemic injury to the heart resulting from inadequate myocardial protection during bypass. Based on these experimental studies, we have, since July, 1972, employed the following principles clinically: (1) Maintain beating empty heart whenever possible; (2) maintain adequate coronary perfusion pressure (less than 80 mm. Hg); (3) avoid extreme hemodilution; (4) avoid ventricular fibrillation; (5) avoid prolonged hypothermic arrest, limiting ischemic periods to less than 15 minutes; (6) repay myocardial ischemic oxygen debt with total (vented) bypass; and (7) optimize DPTI/TTI (supply/demand ratio) pre- and postoperatively. These principles were followed in 189 consecutive operations, and postoperative inotropic drugs were needed in only 12. The principles were violated in 4 of the 12 patients (6 per cent), and 5 others had identifiable causes of myocardial depression; low output syndrome was unexplained in only 3 patients (1.7 per cent).
J Thorac Cardiovasc Surg 1975 Dec
PMID:Depressed postoperative cardiac performance. Prevention by adequate myocardial protection during cardiopulmonary bypass. 118 89


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>