pyrophosphate and Postoperative-Complications

The major value of hot-spot imaging of the myocardium is its ability to define areas of necrosis rather than areas of diminished blood flow or cellular function. Applications of hot-spot imaging include the diagnosis and quantitation of myocardial infarction, myocarditis, and cardiac transplant rejection. The two agents in clinical use, 99mTc-Pyrophosphate and radiolabeled antimyosin, are discussed.

Topics: Animals; Antibodies; Coronary Disease; Diphosphates; Graft Rejection; Heart Transplantation; Humans; Myocardial Infarction; Myocarditis; Myocardium; Myosins; Necrosis; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Animals; Arthropathy, Neurogenic; Calcium Pyrophosphate; Cartilage, Articular; Cholesterol; Chondrocalcinosis; Crystallization; Diphosphates; Disease Models, Animal; Durapatite; Hand; Hemochromatosis; Humans; Hydroxyapatites; Knee Joint; Menisci, Tibial; Ochronosis; Osteoarthritis; Postoperative Complications; Radiography; Shoulder Joint; Uric Acid

To evaluate the role of recombinant human erythropoietin in reducing the need for homologous blood transfusion during operations by studying its effect on the recovery of postoperative anaemia.. Randomised controlled trial.. University hospital, Japan.. 10 patients with gastric cancer undergoing distal gastrectomy.. 5 Patients were given erythropoietin 200 IU/kg/day together with ferric pyrophosphate 40 mg/day intravenously for seven days before operation and 14 days afterwards, and 5 were given ferric pyrophosphate 40 mg/day alone (control group).. Packed cell volume, haemoglobin concentration, and white and red cell counts.. There was no significant change in packed cell volume after the operation in the erythropoietin group, but in the control group it dropped from a mean (SD) of 0.378 (0.074) before operation to 0.329 (0.068) on day 1 (p < 0.05). Haemoglobin concentrations were significantly higher in the erythropoietin group than the control group on day 7 (mean (SD) 137 (14) compared with 110 (19) p < 0.05), and on day 10 (140 (9) compared with 108 (15) p < 0.01) after operation.. Erythropoietin prevented postoperative anaemia after gastrectomy as judged by packed cell volume, haemoglobin concentration, and red cell count. Erythropoietin given before and after operation therefore has the potential to reduce the need for homologous blood transfusion during and after major operations.

Topics: Adult; Aged; Anemia; Blood Cell Count; Diphosphates; Erythropoietin; Female; Gastrectomy; Hematocrit; Hemoglobins; Humans; Iron; Male; Middle Aged; Pilot Projects; Postoperative Care; Postoperative Complications; Preoperative Care; Recombinant Proteins; Stomach Neoplasms; Time Factors

Topics: Alanine Transaminase; Coronary Artery Bypass; Creatine Kinase; Diphosphates; Echocardiography; Electrocardiography, Ambulatory; Humans; Isoenzymes; Myocardial Infarction; Postoperative Complications; Prospective Studies; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Coronary Artery Bypass; Diphosphates; Humans; Myocardial Infarction; Postoperative Complications; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

The aim of this prospective study was to document postoperative myocardial infarction (PMI) by technetium pyrophosphate scan using single-photon emission computed tomography (TcPPi-SPECT) in 28 patients undergoing elective coronary bypass grafting (CABG). The relationships of intraoperative electrocardiographic myocardial ischemia, hemodynamic responses, and pharmacological requirements to this incidence of PMI were correlated. Radionuclide cardioangiography and TcPPi-SPECT were performed 24 h preoperatively and 48 h postoperatively. A standard high-dose fentanyl anesthetic protocol was used. Twenty-five percent of elective CABG patients were complicated with PMI, as documented by TcPPi-SPECT with an infarcted mass of 38.0 +/- 5.5 g. No significant difference in demographic, preoperative right and left ventricular function, number of coronary vessels grafted, or aortic cross-clamp time was observed between the PMI and non-PMI groups. The distribution of patients using preoperative beta-adrenergic blocking drugs or calcium channel blocking drugs was found to have no correlation with the outcome of PMI. As well, no significant differences in hemodynamic changes or pharmacological requirements were observed in the PMI and non-PMI groups during prebypass or postbypass periods, indicating careful intraoperative control of hemodynamic indices did not prevent the outcome of PMI in these patients. However, the incidence of prebypass ischemia was 39.3% and significantly correlated with the outcome of positive TcPPi-SPECT, denoting a 3.9-fold increased risk of developing PMI. Prebypass ischemic changes in leads II and V5 were shown to correlate with increased CPK-MB release (P less than 0.05) and tends to occur more frequently with lateral myocardial infarction.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Coronary Artery Bypass; Coronary Disease; Diphosphates; Female; Hemodynamics; Humans; Intraoperative Period; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Radionuclide Ventriculography; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed, Single-Photon

The internal mammary artery, when used as a conduit for coronary artery bypass, offers a better long-term patency rate and survival rate than the saphenous vein; however, its utility has been limited. Among other factors, the availability of only two internal mammary arteries for anastomosis has been a major limitation. In an attempt to overcome this limitation, we constructed sequential internal mammary artery grafts in 87 patients. In 49 patients (Group I), only one internal mammary artery was used for sequential anastomosis. In another 31 patients (Group II), one internal mammary artery was used for sequential anastomosis and the other was used for single end-to-side anastomosis. Both internal mammary arteries were used in seven patients (Group III) for the construction of sequential anastomoses. Postoperatively, 64 patients were evaluated by exercise stress tests. None of these patients had a positive stress test although seven patients (11%) had electrocardiographic changes that were considered equivocal. Coronary angiography was performed in 35 of the 87 patients, with 92 vein grafts and 90 internal mammary artery anastomotic sites evaluated within 1 year of operation. A total of 83 vein grafts and 84 internal mammary artery anastomotic sites evaluated within 1 year of operation. A total of 83 vein grafts and 84 internal mammary artery anastomoses were found to be patent. Thus the patency rate for vein grafts was 90% and for internal mammary artery grafts, 93%. During the follow-up period (8 to 52 months), three patients died and one was lost to follow-up. Among the remaining patients, 79 had complete relief from symptoms, three had minimal symptoms, and one patient obtained no relief from symptoms. Based on these results, we have concluded that the extended use of internal mammary artery, constructing sequential anastomoses, is technically feasible and provides adequate perfusion to the area of myocardium supplied by such grafts.

Topics: Adult; Aged; Coronary Angiography; Coronary Artery Bypass; Coronary Disease; Diphosphates; Exercise Test; Female; Graft Occlusion, Vascular; Humans; Internal Mammary-Coronary Artery Anastomosis; Male; Middle Aged; Myocardial Infarction; Myocardial Revascularization; Postoperative Complications; Radionuclide Imaging; Saphenous Vein; Technetium; Technetium Tc 99m Pyrophosphate

Two hundred twelve patients who underwent isolated coronary bypass graft surgery were prospectively evaluated for perioperative ischemic injury. All patients underwent preoperative and postoperative testing with technetium 99m pyrophosphate first-pass ventriculography combined with myocardial uptake scans, 12-lead electrocardiography, and serial creatinine phosphokinase MB determination. Fifteen percent of the patients had ischemic injury with at least two test results positive, but only 4 percent had positive results of all three tests. No single test proved adequate. Enzyme levels were highly sensitive and had value as a screening test. The electrocardiogram was specific but only moderately sensitive. The single best test was the radionuclide scan with good sensitivity and no false-positive results. All three tests are required to rigorously diagnose ischemic injury.

Topics: Coronary Artery Bypass; Coronary Disease; Creatine Kinase; Diphosphates; Electrocardiography; Humans; Isoenzymes; Myocardial Contraction; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Saphenous Vein; Technetium; Technetium Tc 99m Pyrophosphate

Strict electrocardiographic, enzymatic, scintigraphic, and hemodynamic criteria for perioperative myocardial infarction (MI) were defined and related to serial assessments of left ventricular performance during rest and exercise in patients seen early and late after coronary artery bypass graft operation. Global left ventricular performance was determined by radionuclide ventriculography from which changes in the pattern of serial postoperative ejection fractions (EF) were obtained. Patients were divided into two groups based on the presence or absence of perioperative MI, and were matched in pairs on the basis of preoperative EF and extent as well as location of coronary artery obstructions. The results indicate that neither short- nor long-term depression in resting EF occurred subsequent to perioperative MI. However, an exercise-related increase in EF eight months postoperatively was depressed in patients who had perioperative MI compared with those who did not. Patients with new Q waves and abnormal postoperative elevation in serum levels of the myocardial isoenzyme of creatine kinase (CK-MB) had a greater early decrease in EF compared with patients without evidence of perioperative MI. However, seven days after operation, the EF in both groups returned to preoperative levels. Patients with abnormal technetium 99m-pyrophosphate scintigrams had changes in perioperative EF similar to those in patients without MI. The presence of low cardiac output syndrome immediately after operation was associated with immediate and short-term decreases in EF, which were not seen in any of the other patient subgroups.

Topics: Cardiac Output, Low; Coronary Artery Bypass; Creatine Kinase; Diphosphates; Electrocardiography; Female; Heart; Heart Ventricles; Humans; Isoenzymes; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Stroke Volume; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Acute Disease; Coronary Circulation; Diphosphates; Heart Ventricles; Humans; Myocardial Infarction; Postoperative Complications; Prognosis; Radioisotopes; Technetium; Technetium Tc 99m Pyrophosphate; Tetracyclines; Thallium; Time Factors; Tomography, Emission-Computed

Serial electrocardiography, technetium-99m pyrophosphate scintigraphy and measurement of myocardial creatine kinase (CK2) and lactic dehydrogenase isoenzyme activity (specifically the LD1 to LD2 ratio) were evaluated prospectively in 26 patients who underwent aortocoronary bypass grafting and 11 patients who underwent valvular or other thoracic surgery, as methods of diagnosing perioperative myocardial infarction. Of the 26 patients who had aorto coronary bypass grafting, 7 (group 1) had myocardial infarction perioperatively; of these, only 2 had positive results from all four diagnostic tests. The other 19 patients (group 2) had no perioperative myocardial infarction and the only diagnostic method yielding positive results was the LD1 to LD2 ratio, in 7 of the 19. In the 11 patients who did not undergo aortocoronary bypass grafting (group 3), only 1 patient had myocardial infarction perioperatively; results from the measurement of CK2 isoenzyme activity and LD1 to LD2 ratio were positive while electrocardiography and 99mTc pyrophosphate scintigraphy yielded negative results. The respective sensitivity (%) and specificity (%) of the four diagnostic methods were as follows: electrocardiography: 38, 100; 99mTc pyrophosphate scintigraphy: 88, 100; LD1 to LD2 ratio: 100, 68; CK2: 38, 100. When the CK2 criterion was redefined, using patients in group 2 as controls, the sensitivity and specificity of this method became 100 and 90 respectively. The authors conclude that 99MTc pyrophosphate scintigraphy and measurement of myocardial creatine kinase isoenzyme are of comparable value and are the most reliable indicators of perioperative myocardial infarction.

Topics: Coronary Artery Bypass; Creatine Kinase; Diphosphates; Electrocardiography; Female; Humans; Isoenzymes; L-Lactate Dehydrogenase; Male; Middle Aged; Myocardial Infarction; Myocardium; Postoperative Complications; Postoperative Period; Prospective Studies; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

Topics: Aspartate Aminotransferases; Cardiac Surgical Procedures; Creatine Kinase; Diagnosis, Differential; Diphosphates; Electrocardiography; Humans; Isoenzymes; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

In 40 patients with angiographically-documented coronary artery disease, technetium 99m pyrophosphate (99mTc-PYP) myocardial scintigrams were obtained prior to and four to six weeks after aorto-coronary bypass surgery. In the majority of patients, preoperative and postoperative exercise testing with simultaneous pulmonary artery pressure recordings was performed. In 22 of 30 patients with preoperatively increased 99mTc-PYP myocardial activity, no tracer accumulation could be found postoperatively. In the latter patients, there was also a significant increase in exercise capacity and lessening of ischemic ST-segment depression in the exercise ECG. In the remaining eight patients in whom increased tracer accumulation was found to persist postoperatively, there was no improvement in exercise capacity. In ten patients with no myocardial tracer accumulation preoperatively, unchanged myocardial scintigrams and a significant decrease of the ischemic ST-segment depression in the exercise ECG were seen postoperatively except in one patient with perioperative myocardial infarction. These results were also partially confirmed by repeated coronary angiography and ventriculography. Patent bypass grafts were associated with regional improvement in left ventricular function. The results indicate that postoperative absence of myocardial tracer accumulation appears due to amelioration of preexisting myocardial ischemia at rest. Thus, in the assessment of the results of aorto-coronary bypass surgery, the 99mTc-PYP scintigram offers an important diagnostic potential.

Topics: Coronary Artery Bypass; Coronary Disease; Diphosphates; Electrocardiography; Hemodynamics; Humans; Myocardial Contraction; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate

The incidence of operative myocardial infarction was assessed by electrocardiogram (ECG) and technetium-99m pyrophosphate (99mTc-PyP) myocardial scintigrams in 89 consecutive patients undergoing coronary artery bypass grafting (CABG). Myocardial scintigrams were performed on the day before operation and repeated 2 to 3 days postoperatively. All patients survived operation, with three in-hospital deaths not related to myocardial infarction (mortality rate 3 percent). Operative infarction was assessed to have occurred in four of 89 patients (4 percent). Two had new Q waves and positive scintigrams; one, major ST-T wave changes and a positive scintigram; and the fourth, new Q waves without a positive scintigram. Three further patients (3 percent) had Q waves and positive scintigrams postoperatively, but myocardial infarction was evolving before anesthesia and operation. Twenty-seven of 89 patients (30 percent) were found to have abnormal scintigrams preoperatively. In two patients, both operated upon with evolving myocardial infarction, the scintigram was worse postoperatively. In 13 patients the scintigram was improved after operation. In 12 patients (13 percent) the abnormal preoperative scintigram was unchanged after operation. Preoperative and postoperative myocardial scintigrams and ECG's must be compared to assess the incidence of operative myocardial infarction in patients undergoing CABG.

Topics: Adult; Aged; Angina Pectoris; Coronary Artery Bypass; Diphosphates; Electrocardiography; Female; Heart; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Technetium

The authors have performed radioisotope examinations in 271 patients with various non-neoplastic bone diseases. According to their opinion, early diagnosis and follow-up of therapeutic results are the main characteristics which allow radioisotopes to play an important and irreplaceable role. They particularly emphasize the usefulness of radioisotope methods in femoral aseptic necrosis and Paget's disease.

Topics: Adolescent; Bone Diseases; Diphosphates; Epiphyses, Slipped; Female; Femur Head Necrosis; Follow-Up Studies; Hip Prosthesis; Humans; Inflammation; Osteitis Deformans; Postoperative Complications; Radionuclide Imaging; Technetium

In 44 consecutive patients undergoing elective open heart surgery (OHS), serial electrocardiograms (ECG), vectorcardiograms (VCG), serum CPK, cardiac isoenzymes (CPKMB), and myocardial images using Tc-99m pyrophosphate were obtained, before and after the operation, for the detection of acute myocardial infarction (AMI). Twenty-nine patients developed one or more positive tests postoperatively. Two patients had positive myocardial scintiscans; both had other evidence of infarction. Conversely, the appearance of CPKMB, or new ECG and VCG changes, occurred frequently without evidence of infarction, and were not associated with the development of a positive scintiscan. The results show that false-negative results are infrequent in patients imaged early after OHS, and that cardiac surgical procedures do not cause a high incidence of false-positive scintigrams. Consequently, radionuclide imaging for AMI offers an important adjunct for excluding acute infarction following open heart surgery.

Topics: Cardiac Surgical Procedures; Clinical Enzyme Tests; Creatine Kinase; Diphosphates; Electrocardiography; Female; Humans; Isoenzymes; L-Lactate Dehydrogenase; Male; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Technetium; Vectorcardiography

Myocardial imaging using technetium 99m stannous pyrophosphate (99mTc-PYP) has been utilized preoperatively and three to five days postoperatively to detect myocardial infarction in 48 patients undergoing aortocoronary bypass grafting, including 7 having valve replacement (5 aortic, 2 mitral) in addition to revascularization. In the total group of patients operated on there were 3 deaths (6%). Preoperatively, 26 patients had unstable angina and 10 had severe left main coronary artery disease. Eleven of the 48 (23%) were women. ECG and enzyme-proved infarctions occurred in 6 of the 48 patients (12%), but the addition of 99mTc-PYP myocardial imaging demonstrated scintigraphic evidence of infarction in 15 patients (31%), including 2 who died in the operating room. The 99mTc-PYP myocardial imaging technique, which has proved safe, simple, and relatively inexpensive in these patients, suggests that the incidence of infarction after coronary bypass operations is somewhat higher than has been previously recognized from just ECG and enzyme changes. This technique also has been of value in helping to exclude myocardial infarction in difficult clinical situations such as postoperative arrhythmias and the postpericardiotomy syndrome.

Topics: Adult; Angina Pectoris; Coronary Artery Bypass; Coronary Disease; Diphosphates; Electrocardiography; Female; Heart Valve Prosthesis; Humans; Male; Middle Aged; Myocardial Infarction; Postoperative Complications; Radionuclide Imaging; Technetium; Tin

Topics: Acute Disease; Age Factors; Aged; Calcium; Chondrocalcinosis; Diagnosis, Differential; Diphosphates; Female; Hospitals; Humans; Knee Joint; Male; Middle Aged; Postoperative Care; Postoperative Complications; Sex Factors; Syndrome; Synovitis

Topics: Adult; Aged; Chondrocalcinosis; Diphosphates; Female; Humans; Knee; Male; Middle Aged; Postoperative Complications; Surgical Procedures, Operative; Synovial Fluid