[Miniaturized extracorporeal circulation for infants]

By using the smallest commercially available oxygenator and our own modification of an apparatus for extracorporeal circulation we achieved minimal filling. By placing the apparatus close to the operating table the set can be miniaturized and the length of the tubes can be maximally reduced, while a satisfactory overview is ensured. The authors compared a group of 10 children operated by using this miniature apparatus with a control group of 20 children where the standard set up was used. The filling of the apparatus incl. added solutions was significantly smaller in the group with the mini-apparatus--on average 420 ml, as compared with the control group (671 ml). Despite the substantially larger amount of transfused blood in the control group with the greater volume (500 ml/patient), the resulting packed cell volume was the same in both groups. The other common postoperative parameters did not differ significantly in the two groups. The minimal filling of the apparatus for extracorporeal circulation in the described set up makes possible in the majority of children and infants with an elevated packed cell volume perfusion without the use of donor blood which is consistent with contemporary trends.

[Possible use of the autotransfusion technic in pediatric heart surgery]

Consequential miniaturization of the apparatus for extracorporeal circulation and its simple connection, by introduction of haemodilution into perfusion technique along with careful surgical technique and the introduction of the principle of autotransfusion made it possible to reduce the consumption of donor blood in our department during the last six years to 25%. Autotransfusion proved to be in children weighing more than 15 kg a safe method. In the first half of 1989 we made 194 operations of the open heart. 167 patients (i.e. 86%) of this number did not require preserved blood in the primary filling of the apparatus for extracorporeal circulation. In a group of 100 patients weighing more than 15 kg in 65% the method of autotransfusion was applied; 55% of the patients did not need donor blood in the course of hospitalization.

[The effect of heart surgery during extracorporeal circulation and deep hypothermia on glucose metabolism in infants and young children]

Authors examined levels of glucose, insulin, and C-peptide in the plasma of 6 infants and small children with the isolated transposition of the great arteries (3 pts) and ventricular septal defect (3 pts) in the course of open-heart surgery in deep hypothermia. The mean age of the patients was 7.2 months (6 to 15) and weight 5.6 kg (5.2-7.5). Exogenous intake of glucose during the operation was excluded. Methods of anaesthesia, operation technique, and conduction of extracorporeal circulation (ECC) were constant in all patients. Fresh ACD blood diluted with Hartman solution approximately 1:1 was used for the prime of ECC circuit (content 800 ml) to get the hematocrit 0.27 +/- 0.2 after mixing the prime with the patient's blood volume. Glycemia was determined by Beckman ERA 2001 analyzor, and levels of insulin and C-peptide by radioimmunoassay kits MJ-96 (Poland) and Novo (Denmark). Significant hyperglycemia was found in all patients during the period of hypothermia, and was overlasting to the rewarming period until the end of the operation and 1 hour postoperatively. Then level of glycemia was decreasing to the normal values which were found in the last sample (17 hours post-op). The raise of glycemia was not a stimulus to the proportional increase of insulin and C-peptide levels in plasma. It proved transitional suppress of insulin secretion in the beta cells of the pancreas in the cooling period. Levels of insulin and C-peptide significantly and concordantly increased after 20 min. of rewarming (r = 0.83). However, hyperglycemia overlasted during the course of rewarming, too.(ABSTRACT TRUNCATED AT 250 WORDS)

Erdheim-Chester disease

A new case of Erdheim-Chester lipoid granulomatosis is described in a 40-year-old man. In this lipid storage disease, characteristic symmetrical osteosclerotic areas are observed mainly in metadiaphyses of long tubular bones. Bone biopsy is mandatory for definite diagnosis, although characteristic radiographic pictures often provide an important clue to the correct diagnosis.

Unilateral absence of pulmonary artery: a report on 19 selected clinical cases

Nineteen cases of unilateral absence of the pulmonary artery (UAPA) were found in a group of 2,960 patients investigated consecutively by cardiac catheterization, angiocardiography, and pulmonary perfusion scintigraphy. The incidence of UAPA was 0,6%. In 8 cases (40%) UAPA was found in isolation, and in 11 cases (60%) it was combined with other congenital heart defects (CHD). In 30% of our patients the diagnosis of UAPA was suggested by clinical symptoms and plain chest X-ray. Pulmonary perfusion scan was made in 2,600 children before catheterization. Though it can provide strong evidence of the diagnosis, this should be confirmed by cardiac catheterization and selective angiography. Eight patients were operated upon. Systemic-pulmonary shunt operations were performed in 6, and ligation of PDA in 2 patients. In one of the latter severe hemoptysis occurred following ligation of the PDA. The pathophysiological and diagnostic aspects of UAPA are discussed.

DOPA stability in plasma and plasma extracts

Unextracted heparinized plasma samples containing L-DOPA can be refrigerated or frozen with negligible losses in drug for at least two weeks. This stability of L-DOPA in the sample obviates difficulties in collection and processing of plasma samples within clinical settings which may be remote from the analytical laboratory facilities.

Some aspects of sodium nitroprusside reaction with human erythrocytes

Sodium nitroprusside is an excellent agent for lowering blood pressure in hypertensive emergencies, for producing controlled hypotension during anesthesia, and for treating acute myocardial infarction and chronic heart failure. Toxic effects of this drug have been reported and above-normal cyanide and thiocyanate concentrations have been observed in the blood of a small proportion of subjects receiving nitroprusside. Nitrite, syanide, and thiocyanate are major decomposition products of nitroprusside, resulting from an in vitro reaction with human blood. On the basis of the conversion mechanism, we suggest that, in the cyanide/thiocyanate cycle, only cyanide is directly responsible for any acute toxicity attributed to sodium nitroprusside. In this work, the extent of cyanide production by erythrocytes in vitro was studied. The rate of detoxification of cyanide by human liver in vitro was experimentally determined and data from a search for a possible inhibitor of the nitroprusside/hemoglobin reaction are presented. Also, the possible mechanism of the nitroprusside/hemoglobin reaction is discussed.