ABSTRACT
In patients with acute transient myocardial ischaemia, changes in left ventricular filling produce alterations in transmitral diastolic flow velocity and isovolumic relaxation time. In this study a scoring system derived from isovolumic relaxation time and indices from transmitral flow velocity was used to evaluate perioperative transient myocardial ischaemia. Fifty three patients with known coronary artery disease or at risk were studied. Ischaemic events were assessed using Doppler transoesophageal echocardiography midoesophageal left ventricular four-chamber view planes. Diastolic Doppler ratios of peak early to atrial peak (E/A), deceleration time, deceleration rate and isovolumic relaxation time were scored using standard methods. An evaluation of peri-operative ischaemic events could be important for patients with a non-ischaemic cause for abnormal segmental wall motion, as the use of a two-dimensional scoring system has limitations. Acute changes in the Doppler ratio of peak early to atrial peak must be interpreted cautiously during surgery. Diastolic dysfunction commonly occurs during ischaemia and recognition of this may alter the approach to monitoring as well as to treatment.
Subject(s)
Diastole , Myocardial Ischemia/diagnosis , Adult , Aged , Echocardiography, Transesophageal , Female , Humans , Male , Middle Aged , Monitoring, IntraoperativeABSTRACT
257 patients suffering from cervical cancer (stage I and II according to FIGO classification) were included in this retrospective study. All of them underwent radical surgery between 1978 and 1987, including pelvic lymphadenectomy. In addition to conventional follow-up procedures, isotope nephrograms (ING) were performed as a routine measure. ING curves reflect renal function and serve as a highly sensitive qualitative parameter of urine flow. It may therefore be used as indirect indicator of pathologic changes in the small pelvis, such as recurrent disease. Follow-up period was between 3 and 10 years. Chi-square test was used to determine the probability of correlation between the evidence of pathologic ING-curves (yes/no) and a) lymph node status (pos/neg), b) patients, who underwent adjuvant radiotherapy (yes/no), or c) patients, who revealed recurrent disease (yes, no). All of the subgroups showed significant positive correlation. Pathological ING curves appeared a) in 61% of patients having a positive lymph node status (n = 66, p = 0.001), in 88% of patients, who developed recurrent disease (n = 56, p = 0.001) and in 44% of patients, who received adjuvant irradiation therapy (n = 131, p = 0.05). The high degree of sensitivity of ING concerning urinary tract obstruction seems to justify the routine use of this method in the follow-up of these patients. It should help to identify impaired renal function in good time.
