A retrospective investigation was undertaken of the mediastinal infections in patients submitted ... more A retrospective investigation was undertaken of the mediastinal infections in patients submitted to cardiac surgery. A total of 1,763 patients participated in a period of 11 years from 1978 to 1988. All of the case records were reviewed for the occurrence of infections in the mediastinum and 24 patients (1.4%) were found to have had mediastinitis. Predisposing factors to mediastinal infections are reviewed. In all of the cases, treatment consisted re-thoracotomy with removal of all necrotic and infectious material. This was followed by primary closure over a retrosternal irrigation system which supplied an antibiotic solution for six days. In addition, oral antibiotics were administered on the basis of the findings on culture. The incidence of infection was found to be increased when the left internal mammary artery (LIMA) had been employed and in cases of combined cusp and coronary surgery. In 20 patients (83%), relevant culture findings were found from the mediastinal drain on an average of 2.5 days after the primary operation. These were reencountered in the mediastinum at rethoracotomy which was performed on an average of 15 days after the primary operation. This raises the question of the possibility of earlier intervention. The commonest microorganisms were micrococci and Staphylococcus aureus which together comprized approximately 83%. The antibiotic treatment routinely employed was 1 g meticillin four times daily. Five patients died (21%) and 19 patients were discharged. On follow-up examination, the sternum was stable and the scar healed. When infection in the mediastinum is suspected after cardiac surgery, early diagnosis and active surgical treatment are important. The closed method of irrigation drainage is recommended by the authors.
Coronary complications caused by percutaneous transluminal coronary angioplasty (PTCA) may necess... more Coronary complications caused by percutaneous transluminal coronary angioplasty (PTCA) may necessitate emergency coronary artery bypass grafting (CABG). In 1994-1998, 132 patients (1.5% of the patients registered in the Danish PTCA registry) underwent CABG within 24 h because of angioplasty complications. We reviewed the files of 86 patients who had emergency operations within 6 h and found that 35% suffered from 1-vessel disease. Fifty-eight percent were taken directly to the operating room from the cardiovascular laboratory, and 13% were given preoperative cardiovascular resuscitation. The vessels most frequently injured were the right coronary artery and the left anterior descending branch (LAD). The patients received a mean of 2.4 coronary bypasses each. Forty-three percent of the patients with lesions of the left main coronary artery and/or the LAD received a vein graft to the LAD. A perioperative Q-wave myocardial infarction developed in 51% of the patients. The in-hospital mortality rate was 12%. These results are inferior to those obtained after elective surgery. Local cardiothoracic backup is vital when PTCA is performed in an unselected patient group.
During 1993-95 1000 consecutive patients were admitted for coronary bypass surgery. The total 30-... more During 1993-95 1000 consecutive patients were admitted for coronary bypass surgery. The total 30-day mortality of 1.9% was 0.9% for elective cases, 0.8% for reoperations and 0.2% for urgent cases. Perioperative myocardial infarction occurred in 44 patients of whom 25% had infarction at the start of the operation. Respiratory insufficiency occurred in 1.4% of the patients, 3.6% developed renal insufficiency and 1.8% had neurological defects postoperatively. Reoperation for bleeding occurred in 6%, and 0.2% developed sternal or mediastinal infection. This study demonstrates that the results of coronary bypass surgery at Rigshospitalet, Copenhagen are fully comparable to similar results in our neighbouring countries. The results can probably be further improved by more intensive treatment of perioperative ischaemia, especially in reoperations and urgent cases.
Platelets, which have been isolated from the blood and labelled with a radioactive isotope, most ... more Platelets, which have been isolated from the blood and labelled with a radioactive isotope, most frequently 51Cr or 111In, are normally used for in vivo platelet kinetic studies and it is essential that the labelled platelets represent a cross-section of the blood’s platelets. This means that during isolation of the platelets from the blood, platelets having another age composition than those later injected into the recipient must not be lost.
A retrospective investigation was undertaken of the mediastinal infections in patients submitted ... more A retrospective investigation was undertaken of the mediastinal infections in patients submitted to cardiac surgery. A total of 1,763 patients participated in a period of 11 years from 1978 to 1988. All of the case records were reviewed for the occurrence of infections in the mediastinum and 24 patients (1.4%) were found to have had mediastinitis. Predisposing factors to mediastinal infections are reviewed. In all of the cases, treatment consisted re-thoracotomy with removal of all necrotic and infectious material. This was followed by primary closure over a retrosternal irrigation system which supplied an antibiotic solution for six days. In addition, oral antibiotics were administered on the basis of the findings on culture. The incidence of infection was found to be increased when the left internal mammary artery (LIMA) had been employed and in cases of combined cusp and coronary surgery. In 20 patients (83%), relevant culture findings were found from the mediastinal drain on an average of 2.5 days after the primary operation. These were reencountered in the mediastinum at rethoracotomy which was performed on an average of 15 days after the primary operation. This raises the question of the possibility of earlier intervention. The commonest microorganisms were micrococci and Staphylococcus aureus which together comprized approximately 83%. The antibiotic treatment routinely employed was 1 g meticillin four times daily. Five patients died (21%) and 19 patients were discharged. On follow-up examination, the sternum was stable and the scar healed. When infection in the mediastinum is suspected after cardiac surgery, early diagnosis and active surgical treatment are important. The closed method of irrigation drainage is recommended by the authors.
Coronary complications caused by percutaneous transluminal coronary angioplasty (PTCA) may necess... more Coronary complications caused by percutaneous transluminal coronary angioplasty (PTCA) may necessitate emergency coronary artery bypass grafting (CABG). In 1994-1998, 132 patients (1.5% of the patients registered in the Danish PTCA registry) underwent CABG within 24 h because of angioplasty complications. We reviewed the files of 86 patients who had emergency operations within 6 h and found that 35% suffered from 1-vessel disease. Fifty-eight percent were taken directly to the operating room from the cardiovascular laboratory, and 13% were given preoperative cardiovascular resuscitation. The vessels most frequently injured were the right coronary artery and the left anterior descending branch (LAD). The patients received a mean of 2.4 coronary bypasses each. Forty-three percent of the patients with lesions of the left main coronary artery and/or the LAD received a vein graft to the LAD. A perioperative Q-wave myocardial infarction developed in 51% of the patients. The in-hospital mortality rate was 12%. These results are inferior to those obtained after elective surgery. Local cardiothoracic backup is vital when PTCA is performed in an unselected patient group.
During 1993-95 1000 consecutive patients were admitted for coronary bypass surgery. The total 30-... more During 1993-95 1000 consecutive patients were admitted for coronary bypass surgery. The total 30-day mortality of 1.9% was 0.9% for elective cases, 0.8% for reoperations and 0.2% for urgent cases. Perioperative myocardial infarction occurred in 44 patients of whom 25% had infarction at the start of the operation. Respiratory insufficiency occurred in 1.4% of the patients, 3.6% developed renal insufficiency and 1.8% had neurological defects postoperatively. Reoperation for bleeding occurred in 6%, and 0.2% developed sternal or mediastinal infection. This study demonstrates that the results of coronary bypass surgery at Rigshospitalet, Copenhagen are fully comparable to similar results in our neighbouring countries. The results can probably be further improved by more intensive treatment of perioperative ischaemia, especially in reoperations and urgent cases.
Platelets, which have been isolated from the blood and labelled with a radioactive isotope, most ... more Platelets, which have been isolated from the blood and labelled with a radioactive isotope, most frequently 51Cr or 111In, are normally used for in vivo platelet kinetic studies and it is essential that the labelled platelets represent a cross-section of the blood’s platelets. This means that during isolation of the platelets from the blood, platelets having another age composition than those later injected into the recipient must not be lost.
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Papers by Henrik Arendrup