ABSTRACT
In 35 ASA group I and II patients we investigated the influence of haemodynamic changes induced by increasing concentrations of halothane (from 0.0 to 0.6% halothane in 70% N20) on parameters of transesophageal echocardiography (TEE). Measurements by TEE were taken in manual and automatic boundary detection mode. In manual mode the left ventricular endsystolic area (ESA) increased significantly (+16.3%) and the fractional area change (FAC) decreased significantly (-14.9%). There was no significant change of left ventricular end diastolic area (EDA). In the automatic mode there was a significant increase of ESA and EDA (+13.8%; +6.0%) and a significant decrease of FAC (-10.9%). Peak ejection rate (PER) and peak filling rate (PFR) which were also assessed in automated mode decreased significantly (-10.0%; -5.7%) under halothane. No change occurred with manually determined left ventricular endsystolic wall stress (LVEWS). The endsystolic quotient decreased significantly both in manual and automated mode during halothane (-28.3%; -29.9%). No significant difference existed between TEE measurements under apnoea versus under controlled ventilation (except for EDA in automated mode). We conclude that there is no need for apnoea conditions for TEE measurements. In conclusion, TEE proves a useful monitoring system in anesthesia which enables the investigator to assess the negative inotropic effect of halothane. Problems in its practical usage are due to the wide variation of TEE measurements.
Subject(s)
Anesthesia, General , Anesthetics, Inhalation , Echocardiography, Transesophageal/drug effects , Halothane , Hemodynamics/drug effects , Adult , Aged , Anesthetics, Inhalation/pharmacokinetics , Female , Halothane/pharmacokinetics , Humans , Male , Middle Aged , Monitoring, Intraoperative , Myocardial Contraction/drug effects , Stroke Volume/drug effectsABSTRACT
OBJECTIVE: Left ventricular end-diastolic wall stress (EDWS) ist an index for left ventricular preload. Utilising transoesophageal echocardiography, left ventricular dimensions can be obtained by two-dimensional (2d-) as well as M-Mode measurements, and each can be combined with pulmonary capillary wedge pressure (PCWP) for the calculation of EDWS. In the present examination, both methods were compared with regard to their technical accomplishment and reproducibility under clinical conditions. METHODS: EDWS was obtained in 24 ventilated patients by 2d-echocardiography (2d-EDWS) and M-mode-echocardiography (M-EDWS) before and after a change in PCWP by 3mmHg. In 12 patients, volume therapy with hydroxyethylstarch (HAES) was started when PCWP < 11 mmHg; in another 12 patients, continuous intravenous administration of nitroglycerine was begun, when PCWP > 14 mmHg. 2d-EDWS and M-EDWS were compared and their relation to thermodilution stroke volume and stroke work index analysed. RESULTS: 2d-EDWS and M-EDWS correlated well in both groups (HAES: r = 0.91; NITRO: r = 0.93), with M-EDWS being systematically lower than 2d-EDWS. The relative difference between 2d-EDWS and M-EDWS, and their mean value--calculated as the mean per cent error--was 11.2%. Directional changes in preload were reflected in all patients by 2d-EDWS and M-EDWS in accordance. Both correlated better with stroke volume and stroke work index than PCWP. Determination of 2d-EDWS showed better inter- and intraobserver variability in the echocardiographic measurements. CONCLUSIONS: With regard to direction and quantity, changes of preload as seen with echocardiographic EDWS were according reflected by the 2d- and the M-mode technique. Determination of 2d-EDWS compared to M-EDWS was superior in reproducibility and more useful for the estimation of stroke volume changes.
Subject(s)
Diastole/physiology , Echocardiography, Transesophageal , Hemodynamics/physiology , Myocardial Contraction/physiology , Ventricular Function, Left/physiology , Adult , Aged , Critical Care , Diastole/drug effects , Echocardiography , Female , Hemodilution , Hemodynamics/drug effects , Humans , Male , Middle Aged , Myocardial Contraction/drug effects , Nitroglycerin/administration & dosage , Postoperative Complications/diagnostic imaging , Postoperative Complications/therapy , Pulmonary Wedge Pressure/drug effects , Pulmonary Wedge Pressure/physiology , Reproducibility of Results , Respiration, Artificial , Stroke Volume/drug effects , Stroke Volume/physiology , Ventricular Function, Left/drug effectsABSTRACT
The results of a prospective follow-up study comprising 52 patients with central tumours of the lung submitted to endoluminal irradiation are reported. Additional external irradiation was possible in 30 patients (group A), but not in 22 patients (group B). Satisfactory immediate results were observed, together with a one-year survival rate of 39.3% (group A) and 12.5% (group B).
Subject(s)
Brachytherapy/instrumentation , Bronchoscopes , Carcinoma, Squamous Cell/radiotherapy , Lung Neoplasms/radiotherapy , Neoplasm Recurrence, Local/radiotherapy , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Iridium Radioisotopes/therapeutic use , Male , Middle Aged , Radiotherapy DosageABSTRACT
We report about 50 patients with inoperable bronchus tumors treated since March 1986 in a prospective non randomized study with high dose rate iridium-192 afterloading (AL) irradiation in 140 applications. 26 patients were treated combined with external irradiation. 32 were treated before with laser therapy, one with chemotherapy (small cell carcinoma). The actuarial survival rate (Kaplan-Meier) was 26% after 36 weeks for all patients; 38% for combined endoluminal and external irradiation and 9% for patients treated with AL alone. Death was caused by the local tumor in 85%. In 41% lethal bleeding was seen.
