[Antibiotic pretreatment of heart valve prostheses]

Bacterial endocarditis on cardiac valvular prosthesis is still a frequent and dangerous complication: septicemia, embolism, valvular dysfunction and mortality. To prevent these complications, intraoperative treatment of prosthesis, by immersion in antibiotic solution, was performed in 1262 patients. The postoperative results have been compared with results of a nontreated group. The incidence of endocarditis in the treated group was 1.3%, in non-treated cases 5.45%. The cases of early endocarditis, was 0.08% of total cases of complications in the treated patients group; and 4.54% in the nontreated patient group. This study's results, confirm the utility of valvular prosthesis antibiotic treatment in cardiac surgery.

Phase II study of the therapeutic efficacy and safety of the new antimycotic sertaconazole in the treatment of superficial mycoses caused by Candida albicans

The activity of 7-chloro-3-[1-(2,4-dichlorophenyl)-2-(1H-imidazol-1-yl)ethoxy-methyl] benzo[b]thiophene (sertaconazole, FI-7045, CAS 99592-32-2) was studied in a randomized parallel double-blind clinical trial on 20 patients suffering from superficial mycosis caused by Candida albicans (confirmed microscopically and microbiologically). The patients were divided into two groups; one received sertaconazole 1% cream (10 patients) and the other received sertaconazole 2% cream (10 patients), over a period of 28 days. Clinical, microscopic and microbiological parameters were evaluated. Analytical parameters such as the appearance of possible undesirable effects (both local and general) were also monitored. The cure was total for 19 out of the 20 patients, demonstrating high efficacy. There were no relapses of infection in any of the cured patients. No local or general effects were recorded during the trial. The analytical parameters remained within normal limits. The clinical and microbiological cure, absence of relapses and the non-existence of local and general undesirable effects indicate that sertaconazole may represent an important advance in the therapy of superficial mycosis caused by Candida albicans.

[Effectiveness of topical selective decontamination, without systemic antibiotic prophylaxis, in prevention of pulmonary infection in intensive care]

Forty-seven patients admitted in our general ICU and treated with Selective Digestive Decontamination (SDD) without any systemic antibiotic prophylaxis, were prospectively studied and compared with an historical group of 50 non treated subjects. The 2 groups were no different as to underlying disease, age, sex and prognostic index (SAPS). In the treated group was recorded an important and statistically significant reduction in the incidence of pneumonia and in the frequency of pulmonary infections caused by enterobacteriaceae and pseudomonceae. Gram-positive identification in tracheal aspirates was not significantly different in the two groups as well as the incidence of "early pneumonia". In the treated group, a sharp decrease of the total amount of fever-days through ICU stay was observed. The antibiotic consumption resulted to be an overall 28.3% lower in the group treated with, SDD with particular regard to broad-spectrum ones.

[Iatrogenic disease in hemophilia and Von Willebrand's disease]

From a group of 115 children with hereditary haemorrhagic disease, nine suffered avoidable accidents or incidents during their treatment, these nine patients represent 8.6% of the cases. The observed complications included a giant cervical hematoma and hemomediastinum after a puncture of the internal jugular vein; an encephalic lesion associated with descompressive craneotomy; a hemophilic pseudo cyst associated with inappropriate treatment of a tibial fracture; acute bleeding and shock after surgery for tonsillectomy and circumcision; subdural hygroma after a subdural puncture; giant hematoma and acute anemia secondary to a venous dissection; permanent dyslexia after inappropriate puncture; giant hematoma and acute anemia secondary to a venous dissection; permanent dyslexia after inappropriate management of intracranial bleeding; bleeding and acute anemia after surgical drainage of a prepucial hematoma and a joint hematoma of the left knee after synovectomy and application of a prosthesis.

Effect of 4-aminopyridine on cardiovascular functions in the dog

The drug 4-aminopyridine (4-AP) at a dose of 0.2 mg . kg-1 body weight intravenously is an effective antagonist of non-depolarizing neuromuscular blockade. We studied its cardiovascular effects in the canine heart using a right-heart bypass with extracorporeal circulation in seven dogs. This study demonstrates that 4-aminopyridine significantly augments arterial blood pressure, left ventricular dp/dt maximum, as well as left ventricular pressure at dp/dt mx. The highest values were obtained between two and 20 minutes after administration of 4-AP. Left ventricular end-diastolic pressure diminished slightly, but this was not statistically significant. Although the exact mechanism of action of 4-AP is not known, its positive inotropic effects may be of value in the reversal of non-depolarizing neuromuscular blockade in patients with impaired myocardial function of diverse aetiologies and it would be contra-indicated in patients with arterial hypertension and/or coronary artery disease.

[Radical correction of the tetralogy of Fallot: 122 cases]

In 122 patients with Fallot tetralogy total correction was performed. 18 were previously operated with palliative surgery. The results were the following: hospital mortality: 8,5%; very good or good improvement: 78%; satisfactory in 13,5%.

[Surgery of ventricular aneurysms and akinetic zones]

Operation was performed in 180 patients with post-infarction ventricular aneurysm (12 cases) or akinesia (92 cases). Simultaneously in 2 cases mitral valve replacement was performed and in 2 cases ruptured ventricular septum was treated by patch. The results are reported and discussed.

[504 implantations of aortic valve prostheses]

The results in 504 patients operated with aortic valve replacement are reported. In 153 patients other associated valvular diseases or complications were present. The mortality in non complicated case was 3%. The long term mortality (1--14 years) was 4%. The results and indications are discussed.

Effect of sodium bicarbonate on canine left ventricular function

Left ventricular performance was evaluated in seven canine right heart bypass preparations during and after the intraauricular administration of sodium bicarbonate (100 ml, 1100 Osm, 60 mEq). Under conditions of constant cardiac input and left ventricular volume, sodium bicarbonate produced mild and brief left ventricular depression, as manifested by a decline of left ventricular dp/dt with simultaneous rise of left ventricular end-diastrolic and left atrial pressures. These findings occurred as aortic impedance fell. Identical results accrued in paced and unpaced preparations. The data lends credence to the proposition that a sudden rise in blood pCO2 produces increased transport of CO2 across the cardiac membranes with intracellular acidosis. However, the data is also compatible with hyperosmolality induced contractile depression. Possible clinical implications are discussed.

Effects of ketamine on canine cardiovascular function

Left ventricular contractility was assessed before and during the peak effect of ketamine in eight canine right heart bypass preparations. Myocardial contractility was defined in terms of maximum left ventricular dp/dt, the ejection fraction, and left ventricular end-diastolic and left atrial pressures at constant heart rate and cardiac inflow. Ketamine produced significant decreases in contractility and there were some indications of a dose-response pattern. The action of ketamine was dependent partly on changes in arterial pressure, as the drug caused a mild but sustained vasodilatation which was not dose-dependent. These data offer further evidence of a small and transient negative inotropic effect of ketamine.

[Megaloblastic anemia in the recovery of the malnourished child]

With the purpose of analyzing the evolution in weight before and after treatment of megaloblastic anemia with folic acid, we studied the clinical changes and the evolution in weight in 8 malnourished children who developed this type of anemia during their recovery. Seven out of the 8 cases were less than 20 months of age; 5 of them came from mothers who had had five or more pregnancies; in 7 a history of diarrhea of prolonged course was presented and 2 cases had been given sodium diphenylhydantoin. Increase in weight before treatment of anemia with folic acid was lesser than the one for the days following treatment in seven of the patients. Simultaneously, an important change in behavior was appreciated, without being possible to atribute this change or the increase in weight to a quantitative change favorable to the ingestion of proteins and calories.

Ascending aorta-right pulmonary artery anastomosis in children with complex cardiac malformations. Long-term results in 30 cases

In this report, we shall analyze the results obtained with palliative treatment in 30 patients with congenital heart disease who were operated upon at the University Hospital of Caracas during the period 1968 to 1972. In all cases, an ascending aorta-right pulmonary artery anastomosis was performed. Although we believe that the Blalock-Taussig and Potts shunt are satisfactory operations in some cases, at the present time we prefer the aorta-right pulmonary branch anastomosis in Fallots tetralogy and other congenital heart diseases such as single ventricle. In Fallot's tetralogy, particularly, this procedure provides better results, because the anastomosis can be closed through the aorta when these patients are later subjected to total correction with extracorporeal circulation.

[The clinical problem of hereditary hemorrhagic diseases developing prolonged bleeding time]

Thirty-two patients with hereditary hemorrhagic diseases and a platelet functional abnormality were set apart from our group of patients with hereditary hemorrhagic diseases, and their symptoms, signs and hematological examinations were collected; the initial events and the age of the patients when they were obsserved, the main hemorrhagic manifestations during their clinical course, the clinical severity of the disorders, the survival of the patients and the laboratory test for hemostasis useful to make the diagnosis, were evaluated. In reference to bleeding time, thirty patients had abnormal bleeding time, but the other two had normal bleeding time.