RESUMEN
From fall 1994 to December, 2000, total 73 reconstructions of iliofemoral lesions (predominately of atherosclerotic origin) were fulfilled in 70 elderly patients. Long-term outcomes (to 5 years of follow-up) of iliofemoral surgical interventions for 2B-4 grade lower limb ischemia were assessed. The first group (mean age 74.5) included patients with extra-anatomic reconstructions (31), control group (mean age 70.1) comprised "direct" iliofemoral bypass (42 procedures). Intervention extend was determined by diagnostic data (Doppler ultrasonography, duplex scanning, angiography) and severity of concomitant pathology. Elderly cohort of patients is especially vulnerable to multilevel atherosclerotic lesions, thus practically in all cases distal anastomosis was formed with deep femoral artery eliminating its stenosis. Cumulative rate of fatal outcome toward the end of 2000 in the first group was somewhat higher then in control. Causes of deaths in the first group were characterized by greater variety, while in control one half of deaths was related to acute coronary insufficiency. In survivors of the first group recurrent lower limb ischemia occurred in 3 cases, in 2 of them resulting in amputation. In control lower limb ischemia relapsed in 6 patients with subsequent limb amputation in 4 of them for thrombosis of iliofemoral bypass. Toward the end of 2000 patent grafts numbered 54.2% in the first group and 71.9% in control, rate of limb salvage - 87.5% and 82.5%, respectively. High risk of lethal outcome in elderly patients with multifocal atherosclerotic lesions and severe comorbidities during standard iliofemoral reconstructions permit to consider extra-anatomic bypass as one of possible surgical solutions, that enables to achieve good clinical and functional results, to save a limb without expansion of procedure invasiveness.
Asunto(s)
Anastomosis Quirúrgica , Arteriopatías Oclusivas/fisiopatología , Arteriopatías Oclusivas/cirugía , Arteria Femoral/fisiopatología , Arteria Femoral/cirugía , Arteria Ilíaca/fisiopatología , Arteria Ilíaca/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , HumanosAsunto(s)
Síndrome de Inmunodeficiencia Adquirida/transmisión , Portador Sano , VIH , Trasplante/efectos adversos , Adulto , Trasplante de Médula Ósea/efectos adversos , Trasplante de Córnea/efectos adversos , VIH/inmunología , VIH/aislamiento & purificación , Anticuerpos Anti-VIH/análisis , Homosexualidad , Humanos , Trasplante de Riñón/efectos adversos , Masculino , Persona de Mediana Edad , Trastornos Relacionados con Sustancias/complicaciones , Donantes de TejidosRESUMEN
Ten test subjects were catheterized and exposed to head-up and head-down tilts at 10, 30 and 75% for 5 min each to measure blood pressure in the upper bulb of the internal jugular vein and right atrium. Blood acid-base equilibrium, hemoglobin content and oxygen saturation were also determined. In the head-up position at 75 degrees the jugular pressure decreased, remaining positive (2.8 mm Hg) in most cases, whereas the atrial pressure fell down to reach the subatmospheric level. In the hea-down position the jugular pressure increased in proportion to the tilt angle, amounting to 32,2 mm Hg at 75 degrees; the atrial pressure changed in a different fashion: in 7 cases it increased and in 3 cases decreased. Throughout the test the oxygen arteriovenous difference in the brain and the acid-base equilibrium in the outflowing blood remained essentially unchanged. This reflects autoregulation of the cerebral blood flow and its adequacy to metabolic requirements.
Asunto(s)
Circulación Cerebrovascular , Corazón/fisiología , Venas Yugulares/fisiología , Postura , Adulto , Función Atrial , Cateterismo Cardíaco , Cateterismo , Hemodinámica , Humanos , Masculino , Presión VenosaRESUMEN
Before and after 5-day head-down tilting (-4.5 degrees) blood pressure was measured in different cardiovascular compartments by the technique of selective catheterization: the upper bulb of the internal jugular vein, superior and inferior venae cavae, hepatic, renal and iliac veins, right atrium and right ventricle, coronary sinus, pulmonary and radial arteries. After exposure the pressure in extrathoracic vessels increased by 1.4 mm Hg on the average: in the internal jugular vein it rose by 1.7 mm Hg whereas in the iliac vein by 1.0 mm Hg. The blood pressure in the intrathoracic vessels of the systemic circulation increased, as a rule, by no more than 0.5--0.8 mm Hg. This elevation was characteristic of diastolic regions of the pressure curve (x- and y-collapse). The pressure in pulmonary vessels--pulmonary artery and left atrium--showed a trend for a decrease of 1.3 mm Hg. The factors that may be responsible for the dissimilar changes of pressure in different cardiovascular compartments under the influence of short-term simulated weightlessness are discussed.
Asunto(s)
Reposo en Cama , Presión Sanguínea , Fenómenos Fisiológicos Cardiovasculares , Salud , Postura , Adulto , Cateterismo , Diástole , Humanos , Masculino , Sístole , Factores de Tiempo , Presión Venosa , IngravidezRESUMEN
Five healthy male volunteers were subjected to graded exercise tests on a bicycle ergometer (600 kpm/min for 8 minutes) with simultaneous catheterization of the right cardiac ventricle and radial artery, first before immobilization and them after five-day bed rest in the head-down posture (the foot bed end was elevated 4.5 degrees). After immobilization, during exercise the stroke index did not increase, the tachycardia was more marked, the indicators of right ventricular contractility increased [+ max dp/dt, mas (dp/dt) /P, --mas dp/dt], the arterial pressure decreased, and the lactic acid level in mixed venous blood rose. Possible causes of haemodynamic and metabolic alterations, occurring in healthy volunteers during graded exercise following short-term hypokinesis, are discussed.