Energy stores and metabolites in chronic reversibly and irreversibly dysfunctional myocardium in humans.

OBJECTIVES: Our goal was to study metabolic energy stores and lactate content in chronic reversibly and irreversibly dysfunctional myocardium. BACKGROUND: It is unknown whether metabolism is deranged in chronic reversibly and irreversibly dysfunctional myocardium in humans. Semiquantitative histological examinations have shown altered mitochondrial morphology and glycogen accumulation in dysfunctional regions. METHODS: We studied 25 patients with a mean ejection fraction of 38 +/- 9% scheduled for coronary artery bypass surgery. Regional perfusion and metabolism were assessed by positron emission tomography, and regional function was assessed by echocardiography. Perioperative myocardial biopsies were obtained from a control region and from a dysfunctional region. We analyzed biopsies for contents of noncollagen protein (NCP), ATP, ADP, AMP, glycogen and lactate. Six months after surgery we assessed wall motion by echocardiography to group patients in those with (n = 11) and without (n = 14) functional improvement. RESULTS: Reversibly dysfunctional myocardium had reduced perfusion (0.59 +/- 0.16 vs. 0.69 +/- 0.20 ml/g/min, p < 0.05), similar glucose-tracer uptake (92 +/- 12 and 95 +/- 14%), ATP/ADP ratio (2.4 +/- 1.1 and 2.4 +/- 0.7), glycogen content (631 +/- 174 and 632 +/- 148 nmol/microg NCP) and lactate levels (59 +/- 27 and 52 +/- 29 nmol/microg NCP) compared with control regions. Irreversibly dysfunctional regions (n = 14) had severely reduced perfusion (0.48 +/- 0.15 vs. 0.72 +/- 0.12 ml/g/min, p < 0.001) and glucose-tracer uptake (52 +/- 16 vs. 94 +/- 15%, p < 0.001), reduced ATP/ADP ratio (1.5 +/- 0.9 vs. 2.3 +/- 0.9, p < 0.05), similar glycogen content (579 +/- 265 vs. 593 +/- 127 nmol/microg NCP) and increased lactate levels (114 +/- 52 vs. 89 +/- 24 nmol/microg NCP, p < 0.01) compared with control regions. CONCLUSIONS: Contents of metabolic energy stores and lactate in chronic reversibly dysfunctional myocardium were preserved. In contrast, energy stores were depleted in myocardium without functional recovery after revascularization.

[Interpleural bupivacaine (Marcain) in the treatment of pain in a patient with chronic pancreatitis]. / Interpleural bupivakain (Marcain) som smertebehandling hos en patient med kronisk pancreatitis.

A case of long-term relief of pain after interpleural blockade with bupivacaine in a patient suffering from severe chronic pancreatitis is reported.

[Continuous spinal analgesia. A review]. / Kontinuerlig spinal analgesi. En oversigt.

Continuous spinal analgesia is a recognized method of analgesia for surgical interventions which was originally described in 1907. A brief historical review is presented with a description of the current technique. Emphasis is laid on comparison with other regional techniques, particularly single-shot analgesia and epidural analgesia. A review is presented of the current knowledge about technique, particularly the equipment, analgesic agents, advantages and disadvantages and indications and contraindications. it is concluded that continuous spinal analgesia probably offers certain advantages, particularly cardiovascular stability. However, the lack of randomized comparisons of the various techniques make further clinically controlled investigations necessary to illustrate this.

[Coronary bypass surgery without heart-lung-machine. First experiences and results after two years]. / Koronar bypasskirurgi uden hjerte-lunge-maskine. Første erfaringer og resultater efter to år.

Results and experiences two years after the introduction of off-pump coronary artery bypass (OPCAB) are presented. The material includes 95 patients, where 24 patients had a high preoperative risk due to unstable angina, concomitant diseases or relative contraindications to conventional bypass surgery. Per- and postoperative course was characterized by low morbidity with ultra fast track recovery, no detectable levels of coronary enzyme release in the majority of patients, no reoperations for bleeding and early discharge from the hospital. There were two in-hospital deaths, both patients from the high risk group, where one patient died due to a preoperative myocardial infarction, while the other death was not related to cardiac disease. Follow-up results were fully satisfactory, where 86% of the patients were free from anginal symptoms three months after surgery. As a consequence of these positive experiences, OPCAB surgery is offered to an increasing number of patients, currently 25% of our CABG procedures.

Blood flow in the radial artery before and after arterial puncture.

A study was carried out on seven patients to determine whether sub-clinical changes occurred in the blood flow in the radial artery following uncomplicated arterial puncture. An ultrasonic technique was used, and it was demonstrated that no changes take place in the blood flow, measured 15 min after puncture.

Epidural blockade in the treatment of preterm labour.

A case of premature labour induced by necrosis in a fibromyoma followed by laparotomy is described. Unsuccessful treatment with ritodrine was followed by successful treatment with epidural analgesia. The possible role of a sympathetic blockade is discussed.

Treatment of pancreatic pain with interpleural bupivacaine: an open trial.

This study comprised 12 patients admitted for interpleural catheter treatment of chronic pancreatic pain. After the insertion of a left-sided interpleural catheter, 20 ml of bupivacaine 0.5% plain was given, followed by top-ups of 10-20 ml bupivacaine 0.5% as needed. Catheters were left in situ for 12-30 h. Immediate pain relief was achieved in all patients. Five patients had only a single blockade offering pain relief for a median of 33 days. One patient suffering from pancreatic carcinoma remained pain-free until death 45 days later. Seven patients returned for a second blockade after a median of 10 days. After this second blockade long-lasting pain relief was achieved in three patients for 70, 105 and 145 days. Two patients experienced pain relief lasting 11-14 days, while in two patients only a short-lived effect was observed, 3-8 days. Unimportant pneumothorax occurred in one patient. No cardiovascular or respiratory side-effects were recorded. We consider interpleural blockade an alternative worth further investigations in the future in the treatment of patients suffering from chronic pancreatic pain.

Per- and postoperative changes in the concentration of serum thyreotropin under general anaesthesia, compared to general anaesthesia with epidural analgesia.

In 18 patients scheduled for lower intraabdominal surgery (hysterectomy), changes in thyreotropin (TSH) thyroxine (T4), triiodothyronine (T3) binding of thyroid hormones to plasma proteins (T3-uptake) and glucose in serum were evaluated. In eight patients afferent neurogenic impulses from the surgical area were blocked (Th4-S5) with bupivacaine 0.5% infused continuously into the epidural space from the start of the operation until 6 h postoperatively. All patients received general anaesthesia with thiopentone, pethidine, pancuronium and nitrous-oxide plus oxygen. The patients receiving epidural analgesia had no increase in plasma-TSH, compared to the other group, which had a significant (P less than 0.05) increase peroperatively. The patients receiving epidural analgesia were pain-free and the normal stress-induced increase in plasma-glucose was abolished. Concerning T3 we found a significant decrease in both groups and a steady level of T4- and T3-uptake without significant fluctuations. Thus it can be concluded that the effects of surgical trauma on plasma-TSH concentration are markedly similar to the effects of other anterior pituitary hormones, i.e. HGH, prolactin and ACTH.

Intrapleural administration of 0.5% plain bupivacaine compared to 0.5% epinephrine: a hemodynamic and ventilatory study.

The ventilatory and hemodynamic effects of 20 ml 0.5% intrapleural bupivacaine with and without 5 micrograms/ml epinephrine were studied. Ten patients scheduled for intrapleural block in the treatment of chronic visceral pain had a left-sided intrapleural catheter inserted. In a double-blind, crossover design they received 20 ml 0.5% bupivacaine with and without 5 micrograms/ml epinephrine. Forced vital capacity, vital capacity, and forced expiratory volume in one second were measured before and 30 minutes after the injection. Mean blood pressure, heart rate, and cardiac output were recorded before the injection and at five-minute intervals for 30 minutes. Vital capacity, forced vital capacity, and forced expiratory volume in one second were unchanged in both groups. There were no differences in any of the pulmonary function tests between the groups. When data from both groups are pooled, vital capacity shows a decrease of 7% (p less than 0.05). No changes in heart rate or mean blood pressure were seen in either group. Bupivacaine without epinephrine did not affect the cardiac output, whereas bupivacaine with epinephrine resulted in a rise in cardiac output of 15% at 15 and 20 minutes after the injection. We did not find any major effects of intrapleural injection of 20 ml 0.5% bupivacaine with and without 5 micrograms/ml epinephrine on ventilatory capacity or cardiovascular function in patients treated for chronic visceral pain.

Electroacupuncture and postoperative pain.

We studied 20 otherwise healthy women undergoing lower abdominal surgery. Immediately after wound closure, while still anaesthetized, they received either electroacupuncture (EA) or no further treatment. They were allowed pethidine for postoperative analgesia by patient-controlled infusion pump. Signs of postoperative distress (pain, nausea, drowsiness) were evaluated after 2 and 6 h by visual analogue scale scores. The group receiving EA consumed half the quantity of pethidine as that used used by the no treatment group. Two patients in the EA group had no postoperative analgesia in the first 2 h. There was no difference in the assessments of postoperative distress between groups. No patient was aware of having received EA or not.