Low myocardial temperatures are associated with postoperative conduction defects after coronary artery bypass surgery.

The incidence and significance of postoperative conduction defects after coronary artery bypass surgery were investigated prospectively in 181 patients. Several pre- and perioperative variables, especially the temperature in three regions of the myocardium, were recorded as explanatory variables. The incidence of conduction defect(s) in the immediate postoperative electrocardiogram (ECG) was 55.8%, and 35.9% of the patients had a conduction defect when leaving hospital. Two patients had a permanent third degree atrioventricular (AV) block. Five pacemakers were implanted. Left main coronary artery stenosis was more common (P < 0.01), and the perioperative myocardial temperatures (P < 0.05-0.01) were lower in patients with conduction defects. These patients had also low postoperative cardiac output more often (P < 0.001), their creatine kinase myocardial (MB) fraction values were higher (P < 0.01), and they stayed in hospital longer (P < 0.05). Right bundle branch block had no significant association with the studied variables.

Procaine and timing of aortic declamping affect ventricular reperfusion fibrillation.

Both ventricular fibrillation and electric defibrillation are detrimental to the myocardium. Therefore, we studied the effect of procaine hydrochloride during crystalloid cardioplegia and the effect of performing all central anastomoses before aortic declamping in an attempt to prevent ventricular reperfusion fibrillation during coronary bypass operation. Seventy-four patients were randomised, first to receive procaine hydrochloride or saline during cardioplegia, and secondly, to have central anastomoses performed before and after aortic declamping. In patients receiving procaine in cardioplegic solution (n = 37), the mean ventricular fibrillation time was shorter (27 +/- 79 sec. vs 205 +/- 161 sec., P < 0.0001), the proportion of patients spontaneously achieving stable rhythm was higher (67.6% vs 13.5%, P < 0.0001) and the mean number of defibrillations was lower (0.3 +/- 0.7 vs 2.4 +/- 1.7, P < 0.0001) than in patients receiving placebo (n = 37). Although the aortic occlusion time was longer (112 +/- 28 min vs 91 +/- 26 min, P = 0.0015) in patients with central anastomoses made during cardiac arrest (n = 35) and the mean fibrillation time was shorter (53 +/- 87 sec. vs 173 +/- 179 sec., P = 0.0006) than compared with patients with central anastomoses made after declamping the aorta (n = 39), the mean number of defibrillations (1.2 +/- 1.7 vs 1.4 +/- 1.7, P = 0.59) and the cardiopulmonary bypass time (138 +/- 29 min vs. 132 +/- 34 min, P = 0.47) were not statistically different between these groups. There were no differences in arrhythmias, conduction defects or postoperative recovery between the study groups. We conclude that both procaine hydrochloride during cardioplegia and the performance of central anastomoses of vein grafts during aortic occlusion effectively reduce reperfusion ventricular fibrillation.

Ruptured massive aneurysm of the deep femoral artery.

Atherosclerotic aneurysm of the deep femoral artery is extremely rare. We report an 88-year-old man, who was admitted to the hospital because of acute pain and massive swelling in the right groin. Angiography and ultrasonography demonstrated an uncommonly large ruptured deep femoral artery aneurysm (10.5 x 10.1 cm). At operation the aneurysm was resected accompanied by an autogenous venous graft replacement. This case and others reported in the literature indicate operative treatment in all, even in symptomless deep femoral artery aneurysms in order to avoid serious complications.

Reperfusion ventricular fibrillation and electric countershocks during coronary artery bypass operations--association with postoperative CK-MB release.

Reperfusion ventricular fibrillation during coronary artery bypass surgery is common and electric shocks are often needed to terminate it. Both the fibrillation and the reversing electric shocks are potentially detrimental to the myocardium. In 61 aortocoronary bypass patients with uncomplicated clinical course (no difficulties in weaning from bypass, no ECG changes and no inotropic medication), serial creatine kinase-MB values were recorded. Evaluated explanatory variables were patient age, ejection fraction, aortic occlusion time, perfusion time, number of peripheral anastomoses and of anastomoses to marginal branches, myocardial fibrillation time before aortic cross-clamping, after cross-clamping prior to cardiac arrest and after declamping, and number of defibrillations. The results indicated that reperfusion fibrillation times up to 10 minutes are not harmful, provided that left ventricular decompression is carried out. Too early and thus numerous defibrillations raise creatine kinase-MB levels and probably also damage the myocardium, and therefore should be avoided.

Diagnosis of genital human papillomavirus (HPV) lesions in the male: correlation of peniscopy, histology and in situ hybridisation.

OBJECTIVE: To assess the diagnostic criteria of genital HPV lesions in male sexual partners of HPV infected women. METHODS: Peniscopically directed biopsy specimens (from 693 lesions in 300 men) were examined on light microscopy and in situ hybridisation (ISH) for HPV types 6,11,16,18,31,33 and 42. The predictive value of different histological criteria for ISH positivity was also evaluated using stepwise logistic regression analysis. RESULTS: Flat HPV lesions were most accurately predicted by the punctuation pattern on peniscopy, giving the concordance between peniscopy and histology between peniscopy and histology of 79.5% (66/83) and that between peniscopy and ISH of 56.6% (47/83). Diffuse acetowhite pattern disclosed a typical HPV lesion in only 17.8% (13/73), and HPV DNA was found in 11.0% (8/73) of cases. Of the 114 biopsy specimens from peniscopically healthy areas adjacent (0.5-1 cm) to the lesions, 93.0% (106/114) were normal on light microscopy, and HPV DNA was found in only 2.6%. Penile intraepithelial neoplasia (PIN) lesions were most frequently ISH positive, 81.1% (30/37), 50% showing HPV 16 and/or 18 DNA. Lesions classified as HPV-suspicious or nonspecific on light microscopy were HPV DNA-positive in 16.9% (11/65) and 8.1% (13/160), the frequency of high-risk HPV types being 3.1% and 1.3%, respectively. In logistic regression analysis, koilocytosis was the most powerful predictor of ISH-positivity in the flat lesions (without PIN), the risk ratio being 3.7. CONCLUSION: No conclusive peniscopic criteria for male HPV infections could be established, making histological evaluation mandatory. Care should be exercised in interpreting as HPV lesions the cases devoid of koilocytosis, HPV typing being essential in confirming the diagnosis in doubtful cases.

Vocal cord paralysis caused by a cyst in extraglandular thyroid tissue. Case report.

A 37-year-old woman presented with hoarseness two days after developing pain while undergoing physiotherapy for tension in her neck. Computed tomography showed a probably benign mass near to the left lobe of the thyroid, which was found at operation to be attached to the recurrent laryngeal nerve. The nerve was dissected free, the tumour removed, and the patient and her voice recovered fully. Histological examination confirmed a benign cyst in extraglandular thyroid tissue and the patient is well two years later.