From Hgrmd at aol.com Sun Apr 1 00:42:29 2007 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sat Mar 31 23:46:55 2007 Subject: [HSF] Ao Wraping Message-ID: Ani, Again, the main question is whether a Ross is clearly superior to the Magna so as to justify the increased complexity and longer clamp time. I see from your post that you are planning to start implanting On-X aortic valve. I've looked at it, but have heard that the high subannular profile can make it difficult to implant. I also predict that the results of the aspiring/Plavix only study will be quite slow to surface. Who wants to take the risk for their patients even if this study is approved by the FCA? Hal ************************************** See what's free at http://www.aol.com. From tdmartin2000 at aol.com Sun Apr 1 01:19:33 2007 From: tdmartin2000 at aol.com (Tdmartin2000) Date: Sun Apr 1 00:20:26 2007 Subject: [HSF] Ao Wraping In-Reply-To: <001601c7728b$9f94faf0$0201a8c0@yourg8he5gjrox> References: <001601c7728b$9f94faf0$0201a8c0@yourg8he5gjrox> Message-ID: <33424e8f.ee6b.49be.a652.6323ca1ac73a@aol.com> Personally I would have just replaced his aorta. If it was just a hemiarch your arrest time for something like this should be under 10 minutes and with such a young patient we would have even tried to have him extubated in the room. However, what you did is not unheard of or unreasonable. Tom Martin U of Florida Gator Land National Champions In a message dated 03/30/07 01:32:52 Eastern Daylight Time, damle@cableone.net writes: I operated on a 19 year old last week to replace his aortic valve. (What a treat! A change from my usual 84 yr old dialysis dependent valves and CABGs!) He was known to have a bicuspid valve. In the past few months, he started to become symptomatic (with LV dilatation) so this was a good time to replace his valve. He looked Marphanoid, so I had a pre-op CT. That showed, a smooth fusiform aneurysm starting in the distal ascending aorta, from 1cm below the brachiocephalic takeoff to proximal arch. The diameter was 3.8cms. For comparison, the proximal ascending aorta was 2..6 cms and the descending Aorta was 2.3 cms. The patient is 6' tall and a BSA of 2.3. I was prepared to replace his arch. I am very confident and comfortable replacing aortic arches, and touch wood, very lucky. But I had some nagging doubts regarding the risk/reward ratio in this man. At surgery, to I found that his aortic tissue strength was quite good. I did cannulate the undersurface of aortic arch, instead the femoral cannulation I had planned (I had the fem artery exposed). I replaced the bi-cuspid valve with a 27 Carbomedics. I used a 28 Hemashield graft to externally wrap the aorta and sutured it to to the aortic adventitia meticulously, with substantial dissection, from just above the coronary ostia to the take-off of brachio-cephalic laterally and well past it medially, past my aortic input site. Before I did the wrapping, I may point out that the aortotomy suture line, the cardioplegia and aortic cannula input site, none required any additional sutures, indicating that the aortic tissue quality was good. Did I do the right thing? I will have this man under CT surveillance for ever, but still................. Ajit Damle Fargo ND _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From toruasai at belle.shiga-med.ac.jp Sun Apr 1 14:42:57 2007 From: toruasai at belle.shiga-med.ac.jp (Tohru Asai) Date: Sun Apr 1 00:43:27 2007 Subject: [HSF] cannula for selective cerebral perfusion In-Reply-To: Message-ID: Dear Mark Thank you for your inquiry. Our system has a separate roller pump for cerebral perfusion, it is not a branch of main arterial perfusion line. In the operative field, the line (size is the same to blood cardioplegia line) is devided into three lines, with two "Y"s. Antegrade catheters are set up for all three brachiocephalic vessels, with total flow rate 500 ml/min at 25 degree C. Left subclavian artery is always cannulated. Because of following reasons. 1. The vertebro-basilar system is occasionally left dominant, or there may be stenotic lesion in right vertebral artery. 2. Three slip-stopper ballooned catheters create surprisingly clean bloodless field compared with DHCA and/or RCP. Even small venous injury near the distal aortic stump.At least for me, the operative field look better than the subclavian artery clamping. 3. The subclavian anastomosis is easy to construct with gentle traction of the slip-stopper cath. IMHO. Many forum members are American. They are more or less influenced strongly by prominent surgeons like Dr.Griep, That is why they have been a little hesitating to challenge other modalities (RCP, SCP).I understand Ani's position for example. I was trained in US, and learned a lot of benefits and techniques of DHCA.Then I started up my practice here and adopted selective cerebral perfusion from other Japanese surgeons.Compared to God fathers like Kazui, Ohkita,, I am still like a baby, but developing surgeon. I like Dr. Bachet's words, I also want to be an ordinary simple cardiac surgeon! Best regards -- Tohru Asai > Do you have a manifold or splitter on your arterial line? > How do you connect these cannula to your arterial circuit? From alsadd at ksu.edu.sa Sun Apr 1 11:09:37 2007 From: alsadd at ksu.edu.sa (A) Date: Sun Apr 1 02:06:32 2007 Subject: [HSF] hyperkalemia In-Reply-To: <20070331081013.12166.qmail@webmail46.rediffmail.com> Message-ID: <20070401060414.A9BBCD5FF0@smtp.ksu.edu.sa> Manoj: I deliberately waited for a whole day before I responded hoping that other forum members will tell us their experience. I had a similar situation in few cases spread over years and I did request the forum for opinion but no one enthusiastically responded. In my opinion Hyperkalemia in spite of adequate dialysis is an enigma that received little attention because it is rare???.. I would look for other sources for this like an abdominal catastrophe like gangrenous bowel or a compartment syndrome. Did you use femoral cannulation? In my cases none of that was the case and yet I had fatal Hyperkalemia. One thing did you have periods of hypotension? How was the acid base status? was there unexplained acidosis? That would tell you about an acute abdomen situation? The unusual thing in your case is the initial hyperglycemia and the subsequent hypoglycemia! Did the patient make it? If He did not did you do an autopsy? Ahmed -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Manoj Pradhan Sent: Saturday, March 31, 2007 12:10 AM To: openheart-l@lists.hsforum.com Subject: [HSF] hyperkalemia ?Dear forum members, I would invite your opinions on this rather interesting case I had 3 days ago. A 49 yr old insulin dependent diabetic ( since 15 years ) who had undergone a CABG with 4 grafts 11 years ago, presented with unstable angina. Angio revealed 3/4 grafts to be blocked with an LVEF - 30%. He was taken up for a Redo CABG. During the entire surgery, he had extreemly high sugars ( 300-400), very low K ( 2.4-2.8) and a low SVR < 700 with pressures around 120 with very hi cardiac outputs. Assuming him to be septic , he was given meropenum and vanco with adequate doses of insulin and K supplements( rather large amounts on pump in view of the persistently low K ). He came off CPB after the grafts with moderate ionotropes and remained well and stable for the 1st 24 hours.Thereafter the K started rising ( shift ) with hypoglycemic episodes, and despite dialysis, a urine output of around 50 ml /hr and glucose insulin , rapidly climbed to 8.5 followed by a diastolic arrest. I would welcome the members thoughts on this patient Manoj Pradhan Pune _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From DukeB60 at aol.com Sun Apr 1 03:15:16 2007 From: DukeB60 at aol.com (DukeB60@aol.com) Date: Sun Apr 1 02:15:53 2007 Subject: [HSF] Ao Wraping Message-ID: Ani, Point well taken. If I ever published these results a statistical analysis would obviously be required but thus far I am only sharing the raw data in an ongoing series. I have no idea how many I did in each respective year since the first one ten years ago. In fact, perhaps the numbers are so raw they aren't worth even bringing up. Unfortunately, analyzing the actual durability and other characteristics of various valve substitutes is a difficult process and there are a multitude of statistical means to report (and sell) the data. I am always curious as to why different surgeons select their valve of choice as clearly there are many differing opinions and preferences - some well founded and some not so well founded. You asked what people thought of the Ross so I simply intended to relate that in my somewhat limited experience the initial mortality of the Ross is no different than other aortic valve procedures in a low risk population and there is a body of literature to suggest that longer term results are at least potentially as good or better than porcine or bovine pericardial replacements - hence I offer the option but only after a very thorough discussion. Thus far few have presented a problem - statistically relevant or not. There are, additionally, some probable hemodynamic advantages, especially in younger patients who are physically very active, that are potentially appealing as well to make the Ross a worthwhile alternative. I am also well aware that this is all, undoubtedly, a decidedly minority opinion. None of the valve replacement options we have to select from are perfect so I leave it to the individual patient to select their poison. Interestingly, the cardiologists here seem to like the Ross for some reason and often it is they who have planted the seed for the Ross as an option before I am even consulted for a surgical evaluation. Ed Edward P. Raines, M.D., J.D. BryanLGH Cardiothoracic Surgery BryanLGH Medical Center East 1600 South 48th Str. Lincoln, Nebraska 68506 Office: 402-481-8430 Cell: 402-730-9242 Fax: 402-481-8429 ************************************** See what's free at http://www.aol.com. From anianyanwu at hotmail.com Sun Apr 1 05:03:38 2007 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun Apr 1 04:04:56 2007 Subject: [HSF] Ao Wraping References: Message-ID: I share similar concerns regarding feasibility of aspirin plavix mechanical valve study. Recruitment thus far has been rather slow and both surgeons, cardiologists and patients seem apprehensive about it. ----- Original Message ----- From: Hgrmd@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Saturday, March 31, 2007 11:42 PM Subject: Re: [HSF] Ao Wraping Ani, Again, the main question is whether a Ross is clearly superior to the Magna so as to justify the increased complexity and longer clamp time. I see from your post that you are planning to start implanting On-X aortic valve. I've looked at it, but have heard that the high subannular profile can make it difficult to implant. I also predict that the results of the aspiring/Plavix only study will be quite slow to surface. Who wants to take the risk for their patients even if this study is approved by the FCA? Hal ************************************** See what's free at http://www.aol.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From smmalik at brain.net.pk Sun Apr 1 16:56:43 2007 From: smmalik at brain.net.pk (Shahid Mahmud Malik) Date: Sun Apr 1 07:00:42 2007 Subject: [HSF] Hyperkalemia Message-ID: <052d01c7744c$701a0b40$aec151cb@shahid> Manoj, The insulin dependent diabetics in my experience always require a lot of extra management issues.Exactly why the sequence of events happened in your case, I cannot comment with any certaininty.However following are my general obsevations, 1) They over years of regular Insulin use,have a very high total body potassium. 2) Most IDDM patients usuallly have an abnormal serum creatinine and low GFRs.The GFRs may not be calculated in every patient and giving them drugs like Vancomycin may further knock off their excretory reserve. 3) Many IDDM patients have compromized LV functions (low EFs) and may not have adequate cardiac output in the immediate post op period which may further complicate renal output. 4) Use of pressor agents in higher doses, further add to the renal insult. 5) Generally some patients would go through a period of severe oliguria or anuria before recovering to some extent.Some would require dialysis.(Your patient was on dialysis) 6) To over come the generally low output in these patients we are now liberally using hemofilteration during surgery on these paients. 7) I have also started to use IABP on any IDDM with abnormal serum creatinine and low EFs(even 35%-that I would not consider in a non-diabetic pt) for a post op period of 24-36hrs. 8) Using IABP reduces the need for pressor agents that is helpful and in our very limited experience provided adequate urine output. 9) I maintain the blood sugar in the initial periods to around 200 and avoid large K supplements if possible. !0) Sometimes,even Heparin in the post operative period used in the flushes causes inappropriate rise in serum K.Not too long ago Dr Prassana provided a no.of referances for it. Like I said these are obsevations and not necessarily an explantion to your patients demise. Shahid Malik From alsadd at ksu.edu.sa Sun Apr 1 16:12:40 2007 From: alsadd at ksu.edu.sa (A) Date: Sun Apr 1 07:09:42 2007 Subject: [HSF] Hyperkalemia In-Reply-To: <052d01c7744c$701a0b40$aec151cb@shahid> Message-ID: <20070401110716.72787D5FF0@smtp.ksu.edu.sa> Shahid Malik: What do you think the cause of Hyperkalemia in spite of the adequate dialysis? Your input please Ahmed -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Shahid Mahmud Malik Sent: Sunday, April 01, 2007 3:57 AM To: OpenHeart-L@lists.hsforum.com Subject: [HSF] Hyperkalemia Manoj, The insulin dependent diabetics in my experience always require a lot of extra management issues.Exactly why the sequence of events happened in your case, I cannot comment with any certaininty.However following are my general obsevations, 1) They over years of regular Insulin use,have a very high total body potassium. 2) Most IDDM patients usuallly have an abnormal serum creatinine and low GFRs.The GFRs may not be calculated in every patient and giving them drugs like Vancomycin may further knock off their excretory reserve. 3) Many IDDM patients have compromized LV functions (low EFs) and may not have adequate cardiac output in the immediate post op period which may further complicate renal output. 4) Use of pressor agents in higher doses, further add to the renal insult. 5) Generally some patients would go through a period of severe oliguria or anuria before recovering to some extent.Some would require dialysis.(Your patient was on dialysis) 6) To over come the generally low output in these patients we are now liberally using hemofilteration during surgery on these paients. 7) I have also started to use IABP on any IDDM with abnormal serum creatinine and low EFs(even 35%-that I would not consider in a non-diabetic pt) for a post op period of 24-36hrs. 8) Using IABP reduces the need for pressor agents that is helpful and in our very limited experience provided adequate urine output. 9) I maintain the blood sugar in the initial periods to around 200 and avoid large K supplements if possible. !0) Sometimes,even Heparin in the post operative period used in the flushes causes inappropriate rise in serum K.Not too long ago Dr Prassana provided a no.of referances for it. Like I said these are obsevations and not necessarily an explantion to your patients demise. Shahid Malik _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From smmalik at brain.net.pk Sun Apr 1 17:32:45 2007 From: smmalik at brain.net.pk (Shahid Mahmud Malik) Date: Sun Apr 1 07:33:17 2007 Subject: [HSF] Hyperkalemia References: <20070401110716.72787D5FF0@smtp.ksu.edu.sa> Message-ID: <000401c77451$7a852e70$aec151cb@shahid> Ahmed, Like I said,I am not sure why the hyerkalemia did not respond despite adequate dialysis and urine output around 50mls per hour.Dialysis usually bails us out in these situations,unless there was some sort of filter problem providing inadequate filteration or such related technical problems?We should also keep in mind the rare serum K rise secondary to the use of Heparin in flushes and for dialysis. Shahid Malik ----- Original Message ----- From: "A" To: Sent: Monday, April 02, 2007 3:12 AM Subject: RE: [HSF] Hyperkalemia > Shahid Malik: > > What do you think the cause of Hyperkalemia in spite of the adequate > dialysis? Your input please > > Ahmed > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Shahid Mahmud > Malik > Sent: Sunday, April 01, 2007 3:57 AM > To: OpenHeart-L@lists.hsforum.com > Subject: [HSF] Hyperkalemia > > > > Manoj, > The insulin dependent diabetics in my experience always require a lot of > extra management issues.Exactly why the sequence of events happened in > your > case, I cannot comment with any certaininty.However following are my > general > obsevations, > 1) They over years of regular Insulin use,have a very high total body > potassium. > 2) Most IDDM patients usuallly have an abnormal serum creatinine and low > GFRs.The GFRs may not be calculated in every patient and giving them drugs > like Vancomycin may further knock off their excretory reserve. > 3) Many IDDM patients have compromized LV functions (low EFs) and may not > have adequate cardiac output in the immediate post op period which may > further complicate renal output. > 4) Use of pressor agents in higher doses, further add to the renal insult. > 5) Generally some patients would go through a period of severe oliguria or > anuria before recovering to some extent.Some would require dialysis.(Your > patient was on dialysis) > 6) To over come the generally low output in these patients we are now > liberally using hemofilteration during surgery on these paients. > 7) I have also started to use IABP on any IDDM with abnormal serum > creatinine and low EFs(even 35%-that I would not consider in a > non-diabetic > pt) for a post op period of 24-36hrs. > 8) Using IABP reduces the need for pressor agents that is helpful and in > our > very limited experience provided adequate urine output. > 9) I maintain the blood sugar in the initial periods to around 200 and > avoid > large K supplements if possible. > !0) Sometimes,even Heparin in the post operative period used in the > flushes > causes inappropriate rise in serum K.Not too long ago Dr Prassana provided > a > no.of referances for it. > Like I said these are obsevations and not necessarily an explantion to > your patients demise. > Shahid Malik > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- From prasannasimha at gmail.com Sun Apr 1 20:13:20 2007 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Apr 1 13:14:16 2007 Subject: [HSF] Hyperkalemia In-Reply-To: <000401c77451$7a852e70$aec151cb@shahid> References: <20070401110716.72787D5FF0@smtp.ksu.edu.sa> <000401c77451$7a852e70$aec151cb@shahid> Message-ID: <89c4ed2d0704011013u6d119b85vc586a42b825ac09e@mail.gmail.com> I had presented such a case some time back which was also PD nonresponsive till we stopped Heparin Prasanna from Zagreb. On 4/1/07, Shahid Mahmud Malik wrote: > > Ahmed, > Like I said,I am not sure why the hyerkalemia did not respond despite > adequate dialysis and urine output around 50mls per hour.Dialysis usually > bails us out in these situations,unless there was some sort of filter > problem providing inadequate filteration or such related technical > problems?We should also keep in mind the rare serum K rise secondary to > the > use of Heparin in flushes and for dialysis. > Shahid Malik > ----- Original Message ----- > From: "A" > To: > Sent: Monday, April 02, 2007 3:12 AM > Subject: RE: [HSF] Hyperkalemia > > > > Shahid Malik: > > > > What do you think the cause of Hyperkalemia in spite of the adequate > > dialysis? Your input please > > > > Ahmed > > -----Original Message----- > > From: openheart-l-bounces@lists.hsforum.com > > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Shahid > Mahmud > > Malik > > Sent: Sunday, April 01, 2007 3:57 AM > > To: OpenHeart-L@lists.hsforum.com > > Subject: [HSF] Hyperkalemia > > > > > > > > Manoj, > > The insulin dependent diabetics in my experience always require a lot of > > extra management issues.Exactly why the sequence of events happened in > > your > > case, I cannot comment with any certaininty.However following are my > > general > > obsevations, > > 1) They over years of regular Insulin use,have a very high total body > > potassium. > > 2) Most IDDM patients usuallly have an abnormal serum creatinine and low > > GFRs.The GFRs may not be calculated in every patient and giving them > drugs > > like Vancomycin may further knock off their excretory reserve. > > 3) Many IDDM patients have compromized LV functions (low EFs) and may > not > > have adequate cardiac output in the immediate post op period which may > > further complicate renal output. > > 4) Use of pressor agents in higher doses, further add to the renal > insult. > > 5) Generally some patients would go through a period of severe oliguria > or > > anuria before recovering to some extent.Some would require > dialysis.(Your > > patient was on dialysis) > > 6) To over come the generally low output in these patients we are now > > liberally using hemofilteration during surgery on these paients. > > 7) I have also started to use IABP on any IDDM with abnormal serum > > creatinine and low EFs(even 35%-that I would not consider in a > > non-diabetic > > pt) for a post op period of 24-36hrs. > > 8) Using IABP reduces the need for pressor agents that is helpful and in > > our > > very limited experience provided adequate urine output. > > 9) I maintain the blood sugar in the initial periods to around 200 and > > avoid > > large K supplements if possible. > > !0) Sometimes,even Heparin in the post operative period used in the > > flushes > > causes inappropriate rise in serum K.Not too long ago Dr Prassana > provided > > a > > no.of referances for it. > > Like I said these are obsevations and not necessarily an explantion to > > your patients demise. > > Shahid Malik > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Apr 1 20:19:43 2007 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Apr 1 13:20:37 2007 Subject: [HSF] blood product in open heart surgery In-Reply-To: References: <4329c7e70703261311w170ecffaoe9a61f3ed104d518@mail.gmail.com> Message-ID: <89c4ed2d0704011019j2730ce7fw36818d0d44ca6ba1@mail.gmail.com> Miranda !! sge is Claudia !! to us. Prasanna On 3/31/07, erdin? naseri wrote: > > Dear Miranda, > Thank you for clarification. It releaved me to know that at > least inBrazil > there are some centers with the facilities close to us..Any way at least > in > the next 10 years I will be working as my own bare foot hematologist( > reference to chinese medical system during the great famine days). > erdinc > PS:hematologists are not very interesred in this type of job.( at least > those whom I know) > > > >From: "claudia miranda" > >Reply-To: OpenHeart-L@lists.hsforum.com > >To: OpenHeart-L@lists.hsforum.com > >Subject: Re: [HSF] blood product in open heart surgery > >Date: Mon, 26 Mar 2007 17:11:23 -0300 > > > >Prasanna, > > > >You are so kind, as always. > >I would like very much to see you operating. It must be showtime! :-) > >In Brazil it is common for a physician to have many jobs. I spend my > >wednesday nights inside a local small hospital ICU, where I keep my hands > >skilled with the procedural part of my intensive care nature - and every > >other week I spend 12 hours during the weekend in a prehospital setting > >emergency system gathering the pieces of some trauma victims - this is > only > >to keep my epinephrine circulating. :-) > >I still work in that government hospital, but not in the post surgical > ICU > >- recently I was invited to be the responsible for the anticoagulation > and > >hemostasis clinic there, and also to work as a clinical research > physician. > >I do this during the morning. In my private practice, I take care of the > >hemostasis lab of one of the best hospitals in my town, during the > >afternoon.Right now, I am writing to you from this private hospital?s ICU > >- > >which is right beside the lab, and where I spend a lot of time, attending > >rounds, discussing lab results, etc. > >Now, of course I was pulling his leg. > >We did not have an hematologist at our hospital until recently. > >Ten years ago, the blood bank coordinator in the poor government hospital > >where I developed my practice was a paediatrician. The blood bank was a > >small cubicle with a fridge, and a microscope. She decided to take care > of > >that because no hematologist was available in the state government health > >care department that would voluntarily apply for the job. > >This nice and caring doctor - who became by practice a true commited > >hemotherapist and hematologist, has enrolled a specialization course and > >was kept on charge during all these years - but she?s had a lot of hard > >work, many times performing selfteaching and lonely research to discover > >how > >to deal with some problems. She now counts with two hematologists and > >several technicians with her, both of the docs did medical residence > >training in hematology/hemotherapy like me, but since I am the > >only hematologist in the hospital who also has critical care and > >cardiovascular background, and who is deeply interested in coagulation > and > >hemostasis, I pilot the rotational thromboelastometer at the OR > together > >with the anaesthesiology team, and also take care of the anticoagulation > >clinic - which is fastly becoming an independent department at our > >hospital. > >We only achieved this number of professionals after many years of > constant > >complaints to our health system administrators who, most of times simply > >ignore the need for a specialized professional for running the blood > bank. > > > >Erdinc, I believe you have a hospital, and I understand your point of > view, > >of course, but your institution will improve a lot in quality if you > demand > >from the ones who set the rules that they bring you an hemotherapist and > >hematologist who really enjoys the job. Find an hematologist who enjoys > >molecules, cells and coag cascades to help you. Molecules are important > for > >surgeons and anaesthesiologists. > > > >My 0,00000000000000000000002 brazilian cents. > > > >Claudia Teles, MD > >Hematologist and Intensivist > >Hemostasis Lab Medical Coordinator - Pro Cardiaco Hospital > >Anticoagulation Clinic - Instituto Estadual de Cardiologia Aloysio de > >Castro. > > > > > > > > > > > > > >2007/3/23, prasannasimha : > >> > >>Erdinc, > >>She is pulling your leg . She has also worked in a government hospital > >>before going to a plush job in private practice. She has gone through > >>the same trials and tribulations as us . She has struggled to become a > >>top notch hematologist now and I always wait for her opinions on > >>hematological problems. > >>Prasanna > >>erdin? naseri wrote: > >> > Claudia, > >> > Although I completely agree with you that a medical school hospital > >> > must have a well developed blood bank and at least a hematologist, I > >> > am sure that not all the hospitals in the world have a hematologist( > >> > even USA) and still they are considered as hospitals . > >> > Erdinc Naseri > >> > Tokat medical school-Turkey > >> > > >> >> From: "claudia miranda" > >> >> Reply-To: OpenHeart-L@lists.hsforum.com > >> >> To: OpenHeart-L@lists.hsforum.com > >> >> Subject: Re: [HSF] blood product in open heart surgery > >> >> Date: Fri, 23 Mar 2007 14:04:33 -0300 > >> >> > >> >> WHAAAT? > >> >> No hematologist in the hospital?????? > >> >> Then you don?t have an hospital at all. > >> >> :o) > >> >> > >> >> Claudia Teles, MD > >> >> Hematologist- Intensivist > >> >> Lamina Laboratories - Pro Cardiaco Unit > >> >> Anticoagulation and Hemostasis Clinic > >> >> Instituto Estadual de Cardiologia Aloysio de Castro > >> >> Rio de Janeiro, Brazil. > >> >> > >> >> > >> >> > >> >>> No hematologist in the hospital > >> >> _______________________________________________ > >> >> OpenHeart-L mailing list > >> >> > >> >> Send postings to: > >> >> OpenHeart-L@lists.hsforum.com > >> >> > >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> >> http://mmp.cjp.com/mailman/listinfo/openheart-l > >> >> > >> >> All messages transmitted by the OpenHeart-L are subject to the > >> >> policies and > >> >> disclaimers posted at: > >> >> http://www.hsforum.com/listdisclaim > >> >> ----------------------------------------- > >> > > >> > > >> > _______________________________________________ > >> > OpenHeart-L mailing list > >> > > >> > Send postings to: > >> > OpenHeart-L@lists.hsforum.com > >> > > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >> > http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > > >> > All messages transmitted by the OpenHeart-L are subject to the > >> > policies and disclaimers posted at: > >> > http://www.hsforum.com/listdisclaim > >> > ----------------------------------------- > >> > > >> > > >> > >> > >>_______________________________________________ > >>OpenHeart-L mailing list > >> > >>Send postings to: > >>OpenHeart-L@lists.hsforum.com > >> > >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >>All messages transmitted by the OpenHeart-L are subject to the policies > >>and > >>disclaimers posted at: > >>http://www.hsforum.com/listdisclaim > >>----------------------------------------- > >> > >_______________________________________________ > >OpenHeart-L mailing list > > > >Send postings to: > >OpenHeart-L@lists.hsforum.com > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >All messages transmitted by the OpenHeart-L are subject to the policies > and > >disclaimers posted at: > >http://www.hsforum.com/listdisclaim > >----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Sun Apr 1 20:27:39 2007 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Sun Apr 1 13:28:23 2007 Subject: [HSF] MS In-Reply-To: <93F431B4ABF11C43BDB776B643B691BC0B34DF@EX04.ad.tulane.edu> References: <93F431B4ABF11C43BDB776B643B691BC0B34DF@EX04.ad.tulane.edu> Message-ID: <89c4ed2d0704011027n376dd636w7fbef6241c032773@mail.gmail.com> Beware of Uithoffs syndrome in patients with MS changes in temperature causes flaccidity. Prasanna On 3/30/07, Pigott, John D III wrote: > > > Anybody with any significant experience in patients with Multiple > Sclerosis with aortic stenosis...or with any CPB procedure? Any > recommendations? > > John > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From rwmfglycar at aol.com Sun Apr 1 15:20:04 2007 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Sun Apr 1 14:21:14 2007 Subject: [HSF] Ao Wraping In-Reply-To: References: Message-ID: <8C942A18154E11F-34C-61E0@FWM-D25.sysops.aol.com> Just so you know there is another aspirin/plavix trial going on with a -----Original Message----- From: anianyanwu@hotmail.com To: OpenHeart-L@lists.hsforum.com Sent: Sun, 1 Apr 2007 4:03 AM Subject: Re: [HSF] Ao Wraping I share similar concerns regarding feasibility of aspirin plavix mechanical valve study. Recruitment thus far has been rather slow and both surgeons, cardiologists and patients seem apprehensive about it. ----- Original Message ----- From: Hgrmd@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Saturday, March 31, 2007 11:42 PM Subject: Re: [HSF] Ao Wraping Ani, Again, the main question is whether a Ross is clearly superior to the Magna so as to justify the increased complexity and longer clamp time. I see from your post that you are planning to start implanting On-X aortic valve. I've looked at it, but have heard that the high subannular profile can make it difficult to implant. I also predict that the results of the aspiring/Plavix only study will be quite slow to surface. Who wants to take the risk for their patients even if this study is approved by the FCA? Hal ************************************** See what's free at http://www.aol.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- ________________________________________________________________________ AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. From enaseri at hotmail.com.tr Sun Apr 1 19:27:17 2007 From: enaseri at hotmail.com.tr (=?iso-8859-9?B?ZXJkaW7nIG5hc2VyaQ==?=) Date: Sun Apr 1 14:28:16 2007 Subject: [HSF] MS In-Reply-To: <89c4ed2d0704011027n376dd636w7fbef6241c032773@mail.gmail.com> Message-ID: Prasanna , What is Uitoffs syndrome? erdinc >From: "Prasanna Simha M" >Reply-To: OpenHeart-L@lists.hsforum.com >To: OpenHeart-L@lists.hsforum.com >Subject: Re: [HSF] MS >Date: Sun, 1 Apr 2007 19:27:39 +0200 > >Beware of Uithoffs syndrome in patients with MS changes in temperature >causes flaccidity. >Prasanna > > >On 3/30/07, Pigott, John D III wrote: >> >> >>Anybody with any significant experience in patients with Multiple >>Sclerosis with aortic stenosis...or with any CPB procedure? Any >>recommendations? >> >>John >>_______________________________________________ >>OpenHeart-L mailing list >> >>Send postings to: >>OpenHeart-L@lists.hsforum.com >> >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: >>http://mmp.cjp.com/mailman/listinfo/openheart-l >> >>All messages transmitted by the OpenHeart-L are subject to the policies >>and >>disclaimers posted at: >>http://www.hsforum.com/listdisclaim >>----------------------------------------- >> > > > >-- >Prasanna Simha M >_______________________________________________ >OpenHeart-L mailing list > >Send postings to: >OpenHeart-L@lists.hsforum.com > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: >http://mmp.cjp.com/mailman/listinfo/openheart-l > >All messages transmitted by the OpenHeart-L are subject to the policies and >disclaimers posted at: >http://www.hsforum.com/listdisclaim >----------------------------------------- From tacuff at swbell.net Sun Apr 1 12:37:02 2007 From: tacuff at swbell.net (Tea Acuff) Date: Sun Apr 1 14:37:56 2007 Subject: [HSF] Ao Wraping Message-ID: <886733.92345.qm@web81604.mail.mud.yahoo.com> Just to be fair to Ed I think that not knowing whether the reop rate is 2% or 50% is pretty much not knowing anything. What do you know about your results, Ani? Assuming that a series of 100 over ten years for a technically challenging operation particularly if the two failures were in the first year gives one the power to use complex actuarial analysis, while common seems savant (the idiot variety). Maybe we should rename the AATS the Savant Society. Nothing personal here for either Ani or Ed. This numbers thing is a circle. Perhaps there is, for example, no difference in stent and meds at 7 years. If this is not just diagonal and PDAs for which the result would be expected, what about at one year? Perhaps we should do what my father would always remark when I would draw lines in the sand, "What is the difference in a hundred years?" What would the best designed study prove then? tea ----- Original Message ---- From: Ani Anyanwu To: OpenHeart-L@lists.hsforum.com Sent: Saturday, March 31, 2007 8:23:59 PM Subject: Re: [HSF] Ao Wraping Ed Just a small correction - quoting your freedom from reoperation as 98% is somewhat inaccurate. You should present an actuarial figure and with two reoperations, the reoperation rate could be higher than you think. For example, assuming these two patients were one of four patients you did in your first year (I.e. one of only four to have survived 10 years) then your actuarial reoperation rate at 10 years would be 50% and not 2%! There is no doubt that the Ross can be done with as low a mortality as a stented AVR by those who do the procedure often - several series have demonstrated this, so on safety basis there is no reason to discontinue the use of the procedure. The question really is its efficacy, and that is unanswered and it is uncertain as to whether the durability in adults is better than a pericardial valve. Data from Yacoub's randoized trial shows the Ross better than allograft, but unfortunately that may have been the wrong question and maybe the Ross should have been randomized to the pericardial valve. Actually Takkenberg has a paper in press (electronic version available through pubmed) and the results, although painted as excellent are not really that fantastic. Most series show that the reoperation rate at 15 years is about 25% when one adds autograft and pulmonary reoperations. Percutaneous valves could however change that as will modifications to the autograft procedure as you describe so it might well be that current patients will have a much lower reoperation rate (though will have a percutaneous reintervention rate). Ani ----- Original Message ----- From: DukeB60@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Saturday, March 31, 2007 4:21 PM Subject: Re: [HSF] Ao Wraping The controversy unquestionably exists with the Ross and the concerns are well founded. Usually the decision for my patients comes down to a minimally invasive partial upper sternotomy Magna vs. a Ross. Very few patients choose the mechanical valve and life long coumadin with the one to one and a half percent per year risk of bleeding or thrombotic complications which are cumulative over the life of the patient or the valve. In my personal series the operative mortality is under one percent with the only death being in a 23 yo male redo who had an infected mechanical prosthesis with destruction of the annulus who died from MOF due to sepsis. He could have had an allograft root replacement or the Ross but I don't think it was the decision to do the Ross in his particular case that resulted in the unfortunate outcome. So far two have been reoperated for autograft dilation and in those two one had his ascending aorta only replaced with preservation of the neo-aortic valve and the other had a root including valve replacement after a failed attempt to repair the autograft valve. Both are doing fine. Although my follow up is admittedly not complete and the number of years out varies from ten years to days the operative mortality is less than one percent and the freedom from reop is 98 percent. A few of the Ross's have involved redo's to remove mechanical valves as the patients had failed valves either due to infection or pannnus and wanted to get off of coumadin. One case involved the removal of a Starr-Edward's ball-cage valve with the dacron covering which had frayed that was causing TIAs and he elected to have a Ross for his replacement The Ross reops I have done were quite easy and both were prior to buttressing the autograft with the Hemashield. There have been no instances of allograft stenosis or injury to the first septal perforator, although one must be very aware of the latter to avoid it. Our aortic root conference next October with Sir M. Yacoub focuses a fair amount of attention to the Ross and Dr. Takkenburg will look at the long term data for the Ross. I'm not sure it is a dead option at all but it is without question a much more demanding and controversial procedure than a simple prosthetic replacement. Edward P. Raines, M.D., J.D. BryanLGH Cardiothoracic Surgery BryanLGH Medical Center East 1600 South 48th Str. Lincoln, Nebraska 68506 Office: 402-481-8430 Cell: 402-730-9242 Fax: 402-481-8429 ************************************** See what's free at http://www.aol.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From Hgrmd at aol.com Sun Apr 1 15:49:12 2007 From: Hgrmd at aol.com (Hgrmd@aol.com) Date: Sun Apr 1 14:53:55 2007 Subject: [HSF] Ao Wraping Message-ID: Tea, Huh? Hal ************************************** See what's free at http://www.aol.com. From rwmfglycar at aol.com Sun Apr 1 15:53:13 2007 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Sun Apr 1 14:54:09 2007 Subject: Fwd: [HSF] Ao WrapingAspirin plavix mechanical valves In-Reply-To: <8C942A18154E11F-34C-61E0@FWM-D25.sysops.aol.com> References: <8C942A18154E11F-34C-61E0@FWM-D25.sysops.aol.com> Message-ID: <8C942A622C0F799-34C-6280@FWM-D25.sysops.aol.com> Something funny is going on with my computer. It sends messages off willy-nilly while I am typing and I get notices of failure to deliver messagres which I have never sent. There is another trial going on using aspirin and plavix with another mechanical valve. It is progressing well, Bob -----Original Message----- From: rwmfglycar@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Sun, 1 Apr 2007 2:20 PM Subject: Re: [HSF] Ao Wraping Just so you know there is another aspirin/plavix trial going on with a -----Original Message----- From: anianyanwu@hotmail.com To: OpenHeart-L@lists.hsforum.com Sent: Sun, 1 Apr 2007 4:03 AM Subject: Re: [HSF] Ao Wraping I share similar concerns regarding feasibility of aspirin plavix mechanical valve study. Recruitment thus far has been rather slow and both surgeons, cardiologists and patients seem apprehensive about it. ----- Original Message ----- From: Hgrmd@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Saturday, March 31, 2007 11:42 PM Subject: Re: [HSF] Ao Wraping Ani, Again, the main question is whether a Ross is clearly superior to the Magna so as to justify the increased complexity and longer clamp time. I see from your post that you are planning to start implanting On-X aortic valve. I've looked at it, but have heard that the high subannular profile can make it difficult to implant. I also predict that the results of the aspiring/Plavix only study will be quite slow to surface. Who wants to take the risk for their patients even if this study is approved by the FCA? Hal ************************************** See what's free at http://www.aol.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- ________________________________________________________________________ AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- ________________________________________________________________________ AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. From tacuff at swbell.net Sun Apr 1 13:02:43 2007 From: tacuff at swbell.net (Tea Acuff) Date: Sun Apr 1 15:04:39 2007 Subject: Fwd: [HSF] Ao WrapingAspirin plavix mechanical valves Message-ID: <695323.41460.qm@web81615.mail.mud.yahoo.com> Which "computer", Bob? tea ----- Original Message ---- From: "rwmfglycar@aol.com" To: Openheart-L@lists.hsforum.com Sent: Sunday, April 1, 2007 1:53:13 PM Subject: Fwd: [HSF] Ao WrapingAspirin plavix mechanical valves Something funny is going on with my computer. It sends messages off willy-nilly while I am typing and I get notices of failure to deliver messagres which I have never sent. There is another trial going on using aspirin and plavix with another mechanical valve. It is progressing well, Bob -----Original Message----- From: rwmfglycar@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Sun, 1 Apr 2007 2:20 PM Subject: Re: [HSF] Ao Wraping Just so you know there is another aspirin/plavix trial going on with a -----Original Message----- From: anianyanwu@hotmail.com To: OpenHeart-L@lists.hsforum.com Sent: Sun, 1 Apr 2007 4:03 AM Subject: Re: [HSF] Ao Wraping I share similar concerns regarding feasibility of aspirin plavix mechanical valve study. Recruitment thus far has been rather slow and both surgeons, cardiologists and patients seem apprehensive about it. ----- Original Message ----- From: Hgrmd@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Saturday, March 31, 2007 11:42 PM Subject: Re: [HSF] Ao Wraping Ani, Again, the main question is whether a Ross is clearly superior to the Magna so as to justify the increased complexity and longer clamp time. I see from your post that you are planning to start implanting On-X aortic valve. I've looked at it, but have heard that the high subannular profile can make it difficult to implant. I also predict that the results of the aspiring/Plavix only study will be quite slow to surface. Who wants to take the risk for their patients even if this study is approved by the FCA? Hal ************************************** See what's free at http://www.aol.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- ________________________________________________________________________ AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- ________________________________________________________________________ AOL now offers free email to everyone. Find out more about what's free from AOL at AOL.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From tacuff at swbell.net Sun Apr 1 13:08:22 2007 From: tacuff at swbell.net (Tea Acuff) Date: Sun Apr 1 15:10:15 2007 Subject: [HSF] Ao Wraping Message-ID: <188265.64255.qm@web81614.mail.mud.yahoo.com> Hal, Yes. tea ----- Original Message ---- From: "Hgrmd@aol.com" To: OpenHeart-L@lists.hsforum.com Sent: Sunday, April 1, 2007 1:49:12 PM Subject: Re: [HSF] Ao Wraping Tea, Huh? Hal ************************************** See what's free at http://www.aol.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From wftjrtyler at aol.com Sun Apr 1 20:46:17 2007 From: wftjrtyler at aol.com (wftjrtyler@aol.com) Date: Sun Apr 1 19:50:37 2007 Subject: [HSF] Ao Wraping Message-ID: In a message dated 3/30/2007 9:54:39 P.M. Central Daylight Time, tacuff@swbell.net writes: Remember when i said that structure is function and you thought I was nuts or at least waxing philosophic? The aortic wall when structure/function relationship is an incontrovertible universal truth.....keep rantin' Tea....bill ************************************** See what's free at http://www.aol.com. From cvteles at gmail.com Sun Apr 1 23:52:51 2007 From: cvteles at gmail.com (claudia miranda) Date: Sun Apr 1 21:59:58 2007 Subject: [HSF] blood product in open heart surgery In-Reply-To: <89c4ed2d0704011019j2730ce7fw36818d0d44ca6ba1@mail.gmail.com> References: <4329c7e70703261311w170ecffaoe9a61f3ed104d518@mail.gmail.com> <89c4ed2d0704011019j2730ce7fw36818d0d44ca6ba1@mail.gmail.com> Message-ID: <4329c7e70704011852y51505ab4y45f1df1978f9758@mail.gmail.com> Prasanna & all, Full name Claudia Miranda Teles. Claudia for the friends - like in CCM-L or HSF. Dr Miranda or Dr Teles professionally. Best, Claudia 2007/4/1, Prasanna Simha M : > > Miranda !! sge is Claudia !! to us. > Prasanna > > > On 3/31/07, erdin? naseri wrote: > > > > Dear Miranda, > > Thank you for clarification. It releaved me to know that at > > least inBrazil > > there are some centers with the facilities close to us..Any way at least > > in > > the next 10 years I will be working as my own bare foot hematologist( > > reference to chinese medical system during the great famine days). > > erdinc > > PS:hematologists are not very interesred in this type of job.( at least > > those whom I know) > > > > > > >From: "claudia miranda" > > >Reply-To: OpenHeart-L@lists.hsforum.com > > >To: OpenHeart-L@lists.hsforum.com > > >Subject: Re: [HSF] blood product in open heart surgery > > >Date: Mon, 26 Mar 2007 17:11:23 -0300 > > > > > >Prasanna, > > > > > >You are so kind, as always. > > >I would like very much to see you operating. It must be showtime! :-) > > >In Brazil it is common for a physician to have many jobs. I spend my > > >wednesday nights inside a local small hospital ICU, where I keep my > hands > > >skilled with the procedural part of my intensive care nature - and > every > > >other week I spend 12 hours during the weekend in a prehospital > setting > > >emergency system gathering the pieces of some trauma victims - this is > > only > > >to keep my epinephrine circulating. :-) > > >I still work in that government hospital, but not in the post surgical > > ICU > > >- recently I was invited to be the responsible for the anticoagulation > > and > > >hemostasis clinic there, and also to work as a clinical research > > physician. > > >I do this during the morning. In my private practice, I take care of > the > > >hemostasis lab of one of the best hospitals in my town, during the > > >afternoon.Right now, I am writing to you from this private hospital?s > ICU > > >- > > >which is right beside the lab, and where I spend a lot of time, > attending > > >rounds, discussing lab results, etc. > > >Now, of course I was pulling his leg. > > >We did not have an hematologist at our hospital until recently. > > >Ten years ago, the blood bank coordinator in the poor government > hospital > > >where I developed my practice was a paediatrician. The blood bank was a > > >small cubicle with a fridge, and a microscope. She decided to take care > > of > > >that because no hematologist was available in the state government > health > > >care department that would voluntarily apply for the job. > > >This nice and caring doctor - who became by practice a true commited > > >hemotherapist and hematologist, has enrolled a specialization course > and > > >was kept on charge during all these years - but she?s had a lot of > hard > > >work, many times performing selfteaching and lonely research to > discover > > >how > > >to deal with some problems. She now counts with two hematologists and > > >several technicians with her, both of the docs did medical residence > > >training in hematology/hemotherapy like me, but since I am the > > >only hematologist in the hospital who also has critical care and > > >cardiovascular background, and who is deeply interested in coagulation > > and > > >hemostasis, I pilot the rotational thromboelastometer at the OR > > together > > >with the anaesthesiology team, and also take care of the > anticoagulation > > >clinic - which is fastly becoming an independent department at our > > >hospital. > > >We only achieved this number of professionals after many years of > > constant > > >complaints to our health system administrators who, most of times > simply > > >ignore the need for a specialized professional for running the blood > > bank. > > > > > >Erdinc, I believe you have a hospital, and I understand your point of > > view, > > >of course, but your institution will improve a lot in quality if you > > demand > > >from the ones who set the rules that they bring you an hemotherapist > and > > >hematologist who really enjoys the job. Find an hematologist who enjoys > > >molecules, cells and coag cascades to help you. Molecules are important > > for > > >surgeons and anaesthesiologists. > > > > > >My 0,00000000000000000000002 brazilian cents. > > > > > >Claudia Teles, MD > > >Hematologist and Intensivist > > >Hemostasis Lab Medical Coordinator - Pro Cardiaco Hospital > > >Anticoagulation Clinic - Instituto Estadual de Cardiologia Aloysio de > > >Castro. > > > > > > > > > > > > > > > > > > > > >2007/3/23, prasannasimha : > > >> > > >>Erdinc, > > >>She is pulling your leg . She has also worked in a government hospital > > >>before going to a plush job in private practice. She has gone through > > >>the same trials and tribulations as us . She has struggled to become a > > >>top notch hematologist now and I always wait for her opinions on > > >>hematological problems. > > >>Prasanna > > >>erdin? naseri wrote: > > >> > Claudia, > > >> > Although I completely agree with you that a medical school hospital > > >> > must have a well developed blood bank and at least a hematologist, > I > > >> > am sure that not all the hospitals in the world have a > hematologist( > > >> > even USA) and still they are considered as hospitals . > > >> > Erdinc Naseri > > >> > Tokat medical school-Turkey > > >> > > > >> >> From: "claudia miranda" > > >> >> Reply-To: OpenHeart-L@lists.hsforum.com > > >> >> To: OpenHeart-L@lists.hsforum.com > > >> >> Subject: Re: [HSF] blood product in open heart surgery > > >> >> Date: Fri, 23 Mar 2007 14:04:33 -0300 > > >> >> > > >> >> WHAAAT? > > >> >> No hematologist in the hospital?????? > > >> >> Then you don?t have an hospital at all. > > >> >> :o) > > >> >> > > >> >> Claudia Teles, MD > > >> >> Hematologist- Intensivist > > >> >> Lamina Laboratories - Pro Cardiaco Unit > > >> >> Anticoagulation and Hemostasis Clinic > > >> >> Instituto Estadual de Cardiologia Aloysio de Castro > > >> >> Rio de Janeiro, Brazil. > > >> >> > > >> >> > > >> >> > > >> >>> No hematologist in the hospital > > >> >> _______________________________________________ > > >> >> OpenHeart-L mailing list > > >> >> > > >> >> Send postings to: > > >> >> OpenHeart-L@lists.hsforum.com > > >> >> > > >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > >> >> http://mmp.cjp.com/mailman/listinfo/openheart-l > > >> >> > > >> >> All messages transmitted by the OpenHeart-L are subject to the > > >> >> policies and > > >> >> disclaimers posted at: > > >> >> http://www.hsforum.com/listdisclaim > > >> >> ----------------------------------------- > > >> > > > >> > > > >> > _______________________________________________ > > >> > OpenHeart-L mailing list > > >> > > > >> > Send postings to: > > >> > OpenHeart-L@lists.hsforum.com > > >> > > > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > >> > http://mmp.cjp.com/mailman/listinfo/openheart-l > > >> > > > >> > All messages transmitted by the OpenHeart-L are subject to the > > >> > policies and disclaimers posted at: > > >> > http://www.hsforum.com/listdisclaim > > >> > ----------------------------------------- > > >> > > > >> > > > >> > > >> > > >>_______________________________________________ > > >>OpenHeart-L mailing list > > >> > > >>Send postings to: > > >>OpenHeart-L@lists.hsforum.com > > >> > > >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > >>http://mmp.cjp.com/mailman/listinfo/openheart-l > > >> > > >>All messages transmitted by the OpenHeart-L are subject to the > policies > > >>and > > >>disclaimers posted at: > > >>http://www.hsforum.com/listdisclaim > > >>----------------------------------------- > > >> > > >_______________________________________________ > > >OpenHeart-L mailing list > > > > > >Send postings to: > > >OpenHeart-L@lists.hsforum.com > > > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > >All messages transmitted by the OpenHeart-L are subject to the policies > > and > > >disclaimers posted at: > > >http://www.hsforum.com/listdisclaim > > >----------------------------------------- > > > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > From anianyanwu at hotmail.com Sun Apr 1 18:41:03 2007 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun Apr 1 23:24:33 2007 Subject: [HSF] Lima to LAD References: <6764E7F21669F64C81BBE14C902CDEDD042BB7A2@TLH-MAIL.ad.mlhs.org> Message-ID: What exactly is a small lateral thoracotomy? Where and how small? Ani ----- Original Message ----- From: Goldman, Scott To: OpenHeart-L@lists.hsforum.com ; OpenHeart-L@lists.hsforum.com Sent: Saturday, March 31, 2007 12:25 PM Subject: RE: [HSF] Lima to LAD I use a small lateral thoracotomy via 5th space and use descending aorta for proximal. Scott -----Original Message----- From: openheart-l-bounces@lists.hsforum.com on behalf of wftjrtyler@aol.com Sent: Thu 3/29/2007 5:08 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Lima to LAD In a message dated 3/26/2007 7:50:44 A.M. Central Daylight Time, drdharris@yahoo.co.uk writes: I have also done circumflex grafting via a larger anterior thoracotomy in the 4th space, with minimal discomfort to the patients. Proximals work well on the subclavian, which Dave,How do you expose Cx system? How do you reach subclavian for proximals and how long is incision? thanks,bill turner ************************************** See what's free at http://www.aol.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From anianyanwu at hotmail.com Sun Apr 1 20:24:38 2007 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun Apr 1 23:24:36 2007 Subject: [HSF] Stent-vs-surgery debate heats up again References: <8C93EC696AB2F0E-A78-A2AA@MBLK-M22.sysops.aol.com> Message-ID: Michael When you say your current operation is not same as Cleveland's 1970s CABG, on what basis do you say this? Certainly you were not around in the 1970s so either you just believe so, were told so or read so. I suspect it is not the latter because if you read some of the original descriptions of the procedures we do now, you will be surprised how little has changed. For example, I was last week reading a paper of Dr Starr from 1961 on his first 8 MVRs in humans and really there has been not much change in the technique of MV replacement in the ensuing four decades. Similarly if you read Barnard's 'the operation', or indeed Dr Lower's paper a decade earlier, you will see that aside from modifications in right atrial anastomosis, heart transplantation technique has not changed much. At the beginning of my training I used to read an out of print book from 1981 written by Hank Edmunds called I think atlas of cardiothoracic surgery. I have never come across a better written book on operative technique and I was amazed to find that the book was more than adequate for operative learning of majority of cardiothoracic techniques and procedures I was exposed to as a junior trainee in late 1990s. We believe things do change because we can't know all of history and we can't read all the literature, but if we could, we would realize that most of what we think is new in surgical technique, has been done or thought of before. For example in the field of mitral repair, the groundbreaking alfieri stitch was described over 60 years ago, external splinting (ala coapsys) was tried experimentally (I believe by Harken but sure Dr Frater will know correct reference) in the 1950s, suture rather than resection of the mitral leaflet was described by McGoon in the 1950s etc. Whatever you consider state of the art CABG was done 30 years ago. Koselov was doing off-pump LIMA-LAD via thoracotomy (which we now give the sexy name MIDCAB) in 1960s even before Favalaro popularized his operation. We just go round in circles - there are few real original ideas, often just a recirculation of old ones. I sent an report of a novel operative technique to a journal two months ago and one of the reviewers said I need to be clear if this a a new technique and add a statement to the effect that " we report the first xxxyyy..." I refused replying that there are thousands of cardiac surgeons round the world and there is no way I can know that someone else has not come up with or used the same technique independently; indeed it would be extremely unlikely that one is the only surgeon past or present to ever have thought up the idea - others either just have not published it or have done but I have not read it (there is literature beyond pubmed) . I often laugh when surgeons describe their 'own' technical innovations and tricks - if you go around the block often enough you will often find other surgeons who have independently come up with the same 'original' ideas you have. Whilst there have been some true innovations in the last decade, the essence of what we do has not changed that much. The more things change the more they are the same. Maybe the future is in those catheters after all ...now that is progress. Or is it? Ani PS - As is generally the case, I expect to be crucified by the usual suspects but to spare me some bombardment please note I am referring to surgical technique and not to peri-operative management which I agree has changed much! ----- Original Message ----- From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Wednesday, March 28, 2007 7:29 AM Subject: Re: [HSF] Stent-vs-surgery debate heats up again Hal, I agree that we must continue to advance, define, redefine, develop, and innovate. However my question is how many referring Docs (or patients) come to you, ask for, want, insist on a specific operation? I dont deny that a subset of people "must have a mini-mitral to beach season" but what is the data? How many patients show up in your office with an internet page and say "I want a MIDCAB"? Interesting how we have spent the past week, in honor of ACC, slamming stents and proclaiming CABG as the greatest thing since sliced bread and yet we criticise a 40 year/old operation. Having spent time in Cleveland where CABG was first mass-produced (not discussing "invented") - I can clearly attest it is not the same operation. But, gee - it works and from the data, it works well - the concept and the basic application are sound and proven. Thinks like incisions, sternal approaches, retractors, oxygenators, shunts, wigets, and so on may change - but the basics will be around. No one is doing the same operation that they did 40 years ago (well except that surgeon who does not use retrograde). Hal - do you still drive a car? Fly an airplane? Watch TV - all old technology using current logic. Besides, you sound pretty busy (although you have time to contibute frequently to this forum) - you went out and got new business, perfected new operations, expanded your product line so to speak. That is what we need to do. I think the dying surgeons are the open who only want to 3 graft CABG on healthy people with normal EFs - those days are gone. Yes, we still see those patients - did 2 last week in fact - but the difference is the comorbidities that come with them. 1 had a huge SAH from a ruptured aneurysm a few years ago and the other has awful diabetes. Between the 2 they had a working pair of eyes and kidneys. Surgeons who dont take on those problems are the ones who dont or wont find work. Got to go round, and see the 79 year/old who I took a LVAD out of last night.......... -michael On 3/27/07, hgrmd@aol.com > wrote: > > Michael, > The "best, busiest, and most respected surgeons who don't do anything > fancy" are a dying breed. You have to stay cutting edge if you are to > remain relevant. I highly doubt a 40 yo operation (CABG) is going to be the > mainstay for the rest of your career. Don't believe me? Stay tuned. > > Hal > > -----Original Message----- > From: msfirst@gmail.com > To: OpenHeart-L@lists.hsforum.com > Sent: Tue, 27 Mar 2007 7:50 AM > Subject: Re: [HSF] Stent-vs-surgery debate heats up again > > > Hal, > I think the key is polishing skills - while some patients and referring > docs > want specific operations or approaches (particularly if offerred) - from > what I have seen over the years (granted not too many), is beyond a safe > operation and getting discharged alive the approach is a distant second. > Although, I have (as we have discussed time and time again), patients, > referring docs, and surgeons play too much emphasis on cosmetic results or > macho approaches. Patients want someone who cares. > > Many of the best, busiest and most respected surgeons that I have known > dont > do anything fancy - they just provide good patient care and safe > operations > with good outcomes. > > -michael > > On 3/26/07, Hgrmd@aol.com > wrote: > > > > MIchael, > > I understand a provincial view when you are polishing your basic skills. > > However, if you think no catheters and full sternotomies are the way you > > will > > practice for the foreseeable future, I predict you'll one day regret > that > > policy. > > Hal > > > > > > > > ************************************** AOL now offers free email to > > everyone. > > Find out more about what's free from AOL at http://www.aol.com. > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > ________________________________________________________________________ > AOL now offers free email to everyone. Find out more about what's free > from AOL at AOL.com. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From anianyanwu at hotmail.com Mon Apr 2 00:23:49 2007 From: anianyanwu at hotmail.com (Ani Anyanwu) Date: Sun Apr 1 23:24:41 2007 Subject: [HSF] Stent-vs-surgery debate heats up again References: <8C93EC696AB2F0E-A78-A2AA@MBLK-M22.sysops.aol.com> Message-ID: Michael When you say your current operation is not same as Cleveland's 1970s CABG, on what basis do you say this? Certainly you were not around in the 1970s so either you just believe so, were told so or read so. I suspect it is not the latter because if you read some of the original descriptions of the procedures we do now, you will be surprised how little has changed. For example, I was last week reading a paper of Dr Starr from 1961 on his first 8 MVRs in humans and really there has been not much change in the technique of MV replacement in the ensuing four decades. Similarly if you read Barnard's 'the operation', or indeed Dr Lower's paper a decade earlier, you will see that aside from modifications in right atrial anastomosis, heart transplantation technique has not changed much. At the beginning of my training I used to read an out of print book from 1981 written by Hank Edmunds called I think atlas of cardiothoracic surgery. I have never come across a better written book on operative technique and I was amazed to find that the book was more than adequate for operative learning of majority of cardiothoracic techniques and procedures I was exposed to as a junior trainee in late 1990s. We believe things do change because we can't know all of history and we can't read all the literature, but if we could, we would realize that most of what we think is new in surgical technique, has been done or thought of before. For example in the field of mitral repair, the groundbreaking alfieri stitch was described over 60 years ago, external splinting (ala coapsys) was tried experimentally (I believe by Harken but sure Dr Frater will know correct reference) in the 1950s, suture rather than resection of the mitral leaflet was described by McGoon in the 1950s etc. Whatever you consider state of the art CABG was done 30 years ago. Koselov was doing off-pump LIMA-LAD via thoracotomy (which we now give the sexy name MIDCAB) in 1960s even before Favalaro popularized his operation. We just go round in circles - there are few real original ideas, often just a recirculation of old ones. I sent an report of a novel operative technique to a journal two months ago and one of the reviewers said I need to be clear if this a a new technique and add a statement to the effect that " we report the first xxxyyy..." I refused replying that there are thousands of cardiac surgeons round the world and there is no way I can know that someone else has not come up with or used the same technique independently; indeed it would be extremely unlikely that one is the only surgeon past or present to ever have thought up the idea - others either just have not published it or have done but I have not read it (there is literature beyond pubmed) . I often laugh when surgeons describe their 'own' technical innovations and tricks - if you go around the block often enough you will often find other surgeons who have independently come up with the same 'original' ideas you have. Whilst there have been some true innovations in the last decade, the essence of what we do has not changed that much. The more things change the more they are the same. Maybe the future is in those catheters after all ...now that is progress. Or is it? Ani PS - I am referring to surgical technique and not to peri-operative management which I agree has changed much... ----- Original Message ----- From: Michael Firstenberg To: OpenHeart-L@lists.hsforum.com Sent: Wednesday, March 28, 2007 7:29 AM Subject: Re: [HSF] Stent-vs-surgery debate heats up again Hal, I agree that we must continue to advance, define, redefine, develop, and innovate. However my question is how many referring Docs (or patients) come to you, ask for, want, insist on a specific operation? I dont deny that a subset of people "must have a mini-mitral to beach season" but what is the data? How many patients show up in your office with an internet page and say "I want a MIDCAB"? Interesting how we have spent the past week, in honor of ACC, slamming stents and proclaiming CABG as the greatest thing since sliced bread and yet we criticise a 40 year/old operation. Having spent time in Cleveland where CABG was first mass-produced (not discussing "invented") - I can clearly attest it is not the same operation. But, gee - it works and from the data, it works well - the concept and the basic application are sound and proven. Thinks like incisions, sternal approaches, retractors, oxygenators, shunts, wigets, and so on may change - but the basics will be around. No one is doing the same operation that they did 40 years ago (well except that surgeon who does not use retrograde). Hal - do you still drive a car? Fly an airplane? Watch TV - all old technology using current logic. Besides, you sound pretty busy (although you have time to contibute frequently to this forum) - you went out and got new business, perfected new operations, expanded your product line so to speak. That is what we need to do. I think the dying surgeons are the open who only want to 3 graft CABG on healthy people with normal EFs - those days are gone. Yes, we still see those patients - did 2 last week in fact - but the difference is the comorbidities that come with them. 1 had a huge SAH from a ruptured aneurysm a few years ago and the other has awful diabetes. Between the 2 they had a working pair of eyes and kidneys. Surgeons who dont take on those problems are the ones who dont or wont find work. Got to go round, and see the 79 year/old who I took a LVAD out of last night.......... -michael On 3/27/07, hgrmd@aol.com > wrote: > > Michael, > The "best, busiest, and most respected surgeons who don't do anything > fancy" are a dying breed. You have to stay cutting edge if you are to > remain relevant. I highly doubt a 40 yo operation (CABG) is going to be the > mainstay for the rest of your career. Don't believe me? Stay tuned. > > Hal > > -----Original Message----- > From: msfirst@gmail.com > To: OpenHeart-L@lists.hsforum.com > Sent: Tue, 27 Mar 2007 7:50 AM > Subject: Re: [HSF] Stent-vs-surgery debate heats up again > > > Hal, > I think the key is polishing skills - while some patients and referring > docs > want specific operations or approaches (particularly if offerred) - from > what I have seen over the years (granted not too many), is beyond a safe > operation and getting discharged alive the approach is a distant second. > Although, I have (as we have discussed time and time again), patients, > referring docs, and surgeons play too much emphasis on cosmetic results or > macho approaches. Patients want someone who cares. > > Many of the best, busiest and most respected surgeons that I have known > dont > do anything fancy - they just provide good patient care and safe > operations > with good outcomes. > > -michael > > On 3/26/07, Hgrmd@aol.com > wrote: > > > > MIchael, > > I understand a provincial view when you are polishing your basic skills. > > However, if you think no catheters and full sternotomies are the way you > > will > > practice for the foreseeable future, I predict you'll one day regret > that > > policy. > > Hal > > > > > > > > ************************************** AOL now offers free email to > > everyone. > > Find out more about what's free from AOL at http://www.aol.com. > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > ________________________________________________________________________ > AOL now offers free email to everyone. Find out more about what's free > from AOL at AOL.com. > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From alsadd at ksu.edu.sa Mon Apr 2 10:22:06 2007 From: alsadd at ksu.edu.sa (A) Date: Mon Apr 2 01:18:31 2007 Subject: [HSF] Hyperkalemia In-Reply-To: <89c4ed2d0704011013u6d119b85vc586a42b825ac09e@mail.gmail.com> Message-ID: <20070402051639.ED118D5FF0@smtp.ksu.edu.sa> Prasanna: You are still out of your base but keeping up with HSF; this is great. I wish you a save return. I was waiting for your input on this issue. Did you publish your case report? How high did the serum K get to? Did the patient made it? A lot of questions sorry about that but because I had three such cases over a period of years I would like to collect data for I may just write it up. Thanks -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Sunday, April 01, 2007 10:13 AM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Hyperkalemia I had presented such a case some time back which was also PD nonresponsive till we stopped Heparin Prasanna from Zagreb. On 4/1/07, Shahid Mahmud Malik wrote: > > Ahmed, > Like I said,I am not sure why the hyerkalemia did not respond despite > adequate dialysis and urine output around 50mls per hour.Dialysis usually > bails us out in these situations,unless there was some sort of filter > problem providing inadequate filteration or such related technical > problems?We should also keep in mind the rare serum K rise secondary to > the > use of Heparin in flushes and for dialysis. > Shahid Malik > ----- Original Message ----- > From: "A" > To: > Sent: Monday, April 02, 2007 3:12 AM > Subject: RE: [HSF] Hyperkalemia > > > > Shahid Malik: > > > > What do you think the cause of Hyperkalemia in spite of the adequate > > dialysis? Your input please > > > > Ahmed > > -----Original Message----- > > From: openheart-l-bounces@lists.hsforum.com > > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Shahid > Mahmud > > Malik > > Sent: Sunday, April 01, 2007 3:57 AM > > To: OpenHeart-L@lists.hsforum.com > > Subject: [HSF] Hyperkalemia > > > > > > > > Manoj, > > The insulin dependent diabetics in my experience always require a lot of > > extra management issues.Exactly why the sequence of events happened in > > your > > case, I cannot comment with any certaininty.However following are my > > general > > obsevations, > > 1) They over years of regular Insulin use,have a very high total body > > potassium. > > 2) Most IDDM patients usuallly have an abnormal serum creatinine and low > > GFRs.The GFRs may not be calculated in every patient and giving them > drugs > > like Vancomycin may further knock off their excretory reserve. > > 3) Many IDDM patients have compromized LV functions (low EFs) and may > not > > have adequate cardiac output in the immediate post op period which may > > further complicate renal output. > > 4) Use of pressor agents in higher doses, further add to the renal > insult. > > 5) Generally some patients would go through a period of severe oliguria > or > > anuria before recovering to some extent.Some would require > dialysis.(Your > > patient was on dialysis) > > 6) To over come the generally low output in these patients we are now > > liberally using hemofilteration during surgery on these paients. > > 7) I have also started to use IABP on any IDDM with abnormal serum > > creatinine and low EFs(even 35%-that I would not consider in a > > non-diabetic > > pt) for a post op period of 24-36hrs. > > 8) Using IABP reduces the need for pressor agents that is helpful and in > > our > > very limited experience provided adequate urine output. > > 9) I maintain the blood sugar in the initial periods to around 200 and > > avoid > > large K supplements if possible. > > !0) Sometimes,even Heparin in the post operative period used in the > > flushes > > causes inappropriate rise in serum K.Not too long ago Dr Prassana > provided > > a > > no.of referances for it. > > Like I said these are obsevations and not necessarily an explantion to > > your patients demise. > > Shahid Malik > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From prasannasimha at gmail.com Mon Apr 2 09:21:04 2007 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Apr 2 02:21:36 2007 Subject: [HSF] blood product in open heart surgery In-Reply-To: <4329c7e70704011852y51505ab4y45f1df1978f9758@mail.gmail.com> References: <4329c7e70703261311w170ecffaoe9a61f3ed104d518@mail.gmail.com> <89c4ed2d0704011019j2730ce7fw36818d0d44ca6ba1@mail.gmail.com> <4329c7e70704011852y51505ab4y45f1df1978f9758@mail.gmail.com> Message-ID: <89c4ed2d0704012321g6e13e098sffbefe1b850b5ce2@mail.gmail.com> Thanks Claudia and the Croatian typewriter has different alphabets so my spelling is disastrous !! On 4/2/07, claudia miranda wrote: > > Prasanna & all, > > Full name Claudia Miranda Teles. > Claudia for the friends - like in CCM-L or HSF. > Dr Miranda or Dr Teles professionally. > > Best, > > Claudia > > > 2007/4/1, Prasanna Simha M : > > > > Miranda !! sge is Claudia !! to us. > > Prasanna > > > > > > On 3/31/07, erdin? naseri wrote: > > > > > > Dear Miranda, > > > Thank you for clarification. It releaved me to know that at > > > least inBrazil > > > there are some centers with the facilities close to us..Any way at > least > > > in > > > the next 10 years I will be working as my own bare foot hematologist( > > > reference to chinese medical system during the great famine days). > > > erdinc > > > PS:hematologists are not very interesred in this type of job.( at > least > > > those whom I know) > > > > > > > > > >From: "claudia miranda" > > > >Reply-To: OpenHeart-L@lists.hsforum.com > > > >To: OpenHeart-L@lists.hsforum.com > > > >Subject: Re: [HSF] blood product in open heart surgery > > > >Date: Mon, 26 Mar 2007 17:11:23 -0300 > > > > > > > >Prasanna, > > > > > > > >You are so kind, as always. > > > >I would like very much to see you operating. It must be showtime! > :-) > > > >In Brazil it is common for a physician to have many jobs. I spend my > > > >wednesday nights inside a local small hospital ICU, where I keep my > > hands > > > >skilled with the procedural part of my intensive care nature - and > > every > > > >other week I spend 12 hours during the weekend in a prehospital > > setting > > > >emergency system gathering the pieces of some trauma victims - this > is > > > only > > > >to keep my epinephrine circulating. :-) > > > >I still work in that government hospital, but not in the post > surgical > > > ICU > > > >- recently I was invited to be the responsible for the > anticoagulation > > > and > > > >hemostasis clinic there, and also to work as a clinical research > > > physician. > > > >I do this during the morning. In my private practice, I take care of > > the > > > >hemostasis lab of one of the best hospitals in my town, during the > > > >afternoon.Right now, I am writing to you from this private hospital?s > > ICU > > > >- > > > >which is right beside the lab, and where I spend a lot of time, > > attending > > > >rounds, discussing lab results, etc. > > > >Now, of course I was pulling his leg. > > > >We did not have an hematologist at our hospital until recently. > > > >Ten years ago, the blood bank coordinator in the poor government > > hospital > > > >where I developed my practice was a paediatrician. The blood bank was > a > > > >small cubicle with a fridge, and a microscope. She decided to take > care > > > of > > > >that because no hematologist was available in the state government > > health > > > >care department that would voluntarily apply for the job. > > > >This nice and caring doctor - who became by practice a true commited > > > >hemotherapist and hematologist, has enrolled a specialization course > > and > > > >was kept on charge during all these years - but she?s had a lot of > > hard > > > >work, many times performing selfteaching and lonely research to > > discover > > > >how > > > >to deal with some problems. She now counts with two hematologists and > > > >several technicians with her, both of the docs did medical residence > > > >training in hematology/hemotherapy like me, but since I am the > > > >only hematologist in the hospital who also has critical care and > > > >cardiovascular background, and who is deeply interested in > coagulation > > > and > > > >hemostasis, I pilot the rotational thromboelastometer at the OR > > > together > > > >with the anaesthesiology team, and also take care of the > > anticoagulation > > > >clinic - which is fastly becoming an independent department at our > > > >hospital. > > > >We only achieved this number of professionals after many years of > > > constant > > > >complaints to our health system administrators who, most of times > > simply > > > >ignore the need for a specialized professional for running the blood > > > bank. > > > > > > > >Erdinc, I believe you have a hospital, and I understand your point of > > > view, > > > >of course, but your institution will improve a lot in quality if you > > > demand > > > >from the ones who set the rules that they bring you an hemotherapist > > and > > > >hematologist who really enjoys the job. Find an hematologist who > enjoys > > > >molecules, cells and coag cascades to help you. Molecules are > important > > > for > > > >surgeons and anaesthesiologists. > > > > > > > >My 0,00000000000000000000002 brazilian cents. > > > > > > > >Claudia Teles, MD > > > >Hematologist and Intensivist > > > >Hemostasis Lab Medical Coordinator - Pro Cardiaco Hospital > > > >Anticoagulation Clinic - Instituto Estadual de Cardiologia Aloysio de > > > >Castro. > > > > > > > > > > > > > > > > > > > > > > > > > > > >2007/3/23, prasannasimha : > > > >> > > > >>Erdinc, > > > >>She is pulling your leg . She has also worked in a government > hospital > > > >>before going to a plush job in private practice. She has gone > through > > > >>the same trials and tribulations as us . She has struggled to become > a > > > >>top notch hematologist now and I always wait for her opinions on > > > >>hematological problems. > > > >>Prasanna > > > >>erdin? naseri wrote: > > > >> > Claudia, > > > >> > Although I completely agree with you that a medical school > hospital > > > >> > must have a well developed blood bank and at least a > hematologist, > > I > > > >> > am sure that not all the hospitals in the world have a > > hematologist( > > > >> > even USA) and still they are considered as hospitals . > > > >> > Erdinc Naseri > > > >> > Tokat medical school-Turkey > > > >> > > > > >> >> From: "claudia miranda" > > > >> >> Reply-To: OpenHeart-L@lists.hsforum.com > > > >> >> To: OpenHeart-L@lists.hsforum.com > > > >> >> Subject: Re: [HSF] blood product in open heart surgery > > > >> >> Date: Fri, 23 Mar 2007 14:04:33 -0300 > > > >> >> > > > >> >> WHAAAT? > > > >> >> No hematologist in the hospital?????? > > > >> >> Then you don?t have an hospital at all. > > > >> >> :o) > > > >> >> > > > >> >> Claudia Teles, MD > > > >> >> Hematologist- Intensivist > > > >> >> Lamina Laboratories - Pro Cardiaco Unit > > > >> >> Anticoagulation and Hemostasis Clinic > > > >> >> Instituto Estadual de Cardiologia Aloysio de Castro > > > >> >> Rio de Janeiro, Brazil. > > > >> >> > > > >> >> > > > >> >> > > > >> >>> No hematologist in the hospital > > > >> >> _______________________________________________ > > > >> >> OpenHeart-L mailing list > > > >> >> > > > >> >> Send postings to: > > > >> >> OpenHeart-L@lists.hsforum.com > > > >> >> > > > >> >> To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > >> >> http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >> >> > > > >> >> All messages transmitted by the OpenHeart-L are subject to the > > > >> >> policies and > > > >> >> disclaimers posted at: > > > >> >> http://www.hsforum.com/listdisclaim > > > >> >> ----------------------------------------- > > > >> > > > > >> > > > > >> > _______________________________________________ > > > >> > OpenHeart-L mailing list > > > >> > > > > >> > Send postings to: > > > >> > OpenHeart-L@lists.hsforum.com > > > >> > > > > >> > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > >> > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >> > > > > >> > All messages transmitted by the OpenHeart-L are subject to the > > > >> > policies and disclaimers posted at: > > > >> > http://www.hsforum.com/listdisclaim > > > >> > ----------------------------------------- > > > >> > > > > >> > > > > >> > > > >> > > > >>_______________________________________________ > > > >>OpenHeart-L mailing list > > > >> > > > >>Send postings to: > > > >>OpenHeart-L@lists.hsforum.com > > > >> > > > >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > >>http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >> > > > >>All messages transmitted by the OpenHeart-L are subject to the > > policies > > > >>and > > > >>disclaimers posted at: > > > >>http://www.hsforum.com/listdisclaim > > > >>----------------------------------------- > > > >> > > > >_______________________________________________ > > > >OpenHeart-L mailing list > > > > > > > >Send postings to: > > > >OpenHeart-L@lists.hsforum.com > > > > > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > > >All messages transmitted by the OpenHeart-L are subject to the > policies > > > and > > > >disclaimers posted at: > > > >http://www.hsforum.com/listdisclaim > > > >----------------------------------------- > > > > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the > policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > > > > > > -- > > Prasanna Simha M > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Mon Apr 2 09:17:52 2007 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Apr 2 02:25:09 2007 Subject: [HSF] MS In-Reply-To: References: <89c4ed2d0704011027n376dd636w7fbef6241c032773@mail.gmail.com> Message-ID: <89c4ed2d0704012317s50ca5894n8fe2b65912e4fd51@mail.gmail.com> Uithoff's syndrome is flaccidity due to temperature lateration in multiple sclerosis. A history of weakness accelerated by a warm bath is classical and should warn the surgeon of possible problems of weaning the ventilator postoperaively if inadvertent temperature mismanagement occurs. Prasanna On 4/1/07, erdin? naseri wrote: > > Prasanna , > What is Uitoffs syndrome? > erdinc > > > > >From: "Prasanna Simha M" > >Reply-To: OpenHeart-L@lists.hsforum.com > >To: OpenHeart-L@lists.hsforum.com > >Subject: Re: [HSF] MS > >Date: Sun, 1 Apr 2007 19:27:39 +0200 > > > >Beware of Uithoffs syndrome in patients with MS changes in temperature > >causes flaccidity. > >Prasanna > > > > > >On 3/30/07, Pigott, John D III wrote: > >> > >> > >>Anybody with any significant experience in patients with Multiple > >>Sclerosis with aortic stenosis...or with any CPB procedure? Any > >>recommendations? > >> > >>John > >>_______________________________________________ > >>OpenHeart-L mailing list > >> > >>Send postings to: > >>OpenHeart-L@lists.hsforum.com > >> > >>To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >>http://mmp.cjp.com/mailman/listinfo/openheart-l > >> > >>All messages transmitted by the OpenHeart-L are subject to the policies > >>and > >>disclaimers posted at: > >>http://www.hsforum.com/listdisclaim > >>----------------------------------------- > >> > > > > > > > >-- > >Prasanna Simha M > >_______________________________________________ > >OpenHeart-L mailing list > > > >Send postings to: > >OpenHeart-L@lists.hsforum.com > > > >To UNSUBSCRIBE, to CHANGE email address, or to view archives: > >http://mmp.cjp.com/mailman/listinfo/openheart-l > > > >All messages transmitted by the OpenHeart-L are subject to the policies > and > >disclaimers posted at: > >http://www.hsforum.com/listdisclaim > >----------------------------------------- > > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From prasannasimha at gmail.com Mon Apr 2 09:15:37 2007 From: prasannasimha at gmail.com (Prasanna Simha M) Date: Mon Apr 2 02:45:00 2007 Subject: [HSF] Hyperkalemia In-Reply-To: <20070402051639.ED118D5FF0@smtp.ksu.edu.sa> References: <89c4ed2d0704011013u6d119b85vc586a42b825ac09e@mail.gmail.com> <20070402051639.ED118D5FF0@smtp.ksu.edu.sa> Message-ID: <89c4ed2d0704012315p7262eb6do9c07bd8935456837@mail.gmail.com> The patient surived. The K went up to 6.8 despite dialysis and came down within 4 hours after stopping all Heparin. After one day we gave a test odse of heparin which produced hyperkalemia again. Prasanna On 4/2/07, A wrote: > > Prasanna: > You are still out of your base but keeping up with HSF; this is great. I > wish you a save return. I was waiting for your input on this issue. Did > you > publish your case report? How high did the serum K get to? Did the patient > made it? A lot of questions sorry about that but because I had three such > cases over a period of years I would like to collect data for I may just > write it up. > Thanks > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha > M > Sent: Sunday, April 01, 2007 10:13 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Hyperkalemia > > I had presented such a case some time back which was also PD nonresponsive > till we stopped Heparin > Prasanna from Zagreb. > > > On 4/1/07, Shahid Mahmud Malik wrote: > > > > Ahmed, > > Like I said,I am not sure why the hyerkalemia did not respond despite > > adequate dialysis and urine output around 50mls per hour.Dialysisusually > > bails us out in these situations,unless there was some sort of filter > > problem providing inadequate filteration or such related technical > > problems?We should also keep in mind the rare serum K rise secondary to > > the > > use of Heparin in flushes and for dialysis. > > Shahid Malik > > ----- Original Message ----- > > From: "A" > > To: > > Sent: Monday, April 02, 2007 3:12 AM > > Subject: RE: [HSF] Hyperkalemia > > > > > > > Shahid Malik: > > > > > > What do you think the cause of Hyperkalemia in spite of the adequate > > > dialysis? Your input please > > > > > > Ahmed > > > -----Original Message----- > > > From: openheart-l-bounces@lists.hsforum.com > > > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Shahid > > Mahmud > > > Malik > > > Sent: Sunday, April 01, 2007 3:57 AM > > > To: OpenHeart-L@lists.hsforum.com > > > Subject: [HSF] Hyperkalemia > > > > > > > > > > > > Manoj, > > > The insulin dependent diabetics in my experience always require a lot > of > > > extra management issues.Exactly why the sequence of events happened in > > > your > > > case, I cannot comment with any certaininty.However following are my > > > general > > > obsevations, > > > 1) They over years of regular Insulin use,have a very high total body > > > potassium. > > > 2) Most IDDM patients usuallly have an abnormal serum creatinine and > low > > > GFRs.The GFRs may not be calculated in every patient and giving them > > drugs > > > like Vancomycin may further knock off their excretory reserve. > > > 3) Many IDDM patients have compromized LV functions (low EFs) and may > > not > > > have adequate cardiac output in the immediate post op period which may > > > further complicate renal output. > > > 4) Use of pressor agents in higher doses, further add to the renal > > insult. > > > 5) Generally some patients would go through a period of severe > oliguria > > or > > > anuria before recovering to some extent.Some would require > > dialysis.(Your > > > patient was on dialysis) > > > 6) To over come the generally low output in these patients we are now > > > liberally using hemofilteration during surgery on these paients. > > > 7) I have also started to use IABP on any IDDM with abnormal serum > > > creatinine and low EFs(even 35%-that I would not consider in a > > > non-diabetic > > > pt) for a post op period of 24-36hrs. > > > 8) Using IABP reduces the need for pressor agents that is helpful and > in > > > our > > > very limited experience provided adequate urine output. > > > 9) I maintain the blood sugar in the initial periods to around 200 and > > > avoid > > > large K supplements if possible. > > > !0) Sometimes,even Heparin in the post operative period used in the > > > flushes > > > causes inappropriate rise in serum K.Not too long ago Dr Prassana > > provided > > > a > > > no.of referances for it. > > > Like I said these are obsevations and not necessarily an explantion > to > > > your patients demise. > > > Shahid Malik > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the > policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the > policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M From alsadd at ksu.edu.sa Mon Apr 2 12:20:19 2007 From: alsadd at ksu.edu.sa (A) Date: Mon Apr 2 03:16:26 2007 Subject: [HSF] Hyperkalemia In-Reply-To: <89c4ed2d0704012315p7262eb6do9c07bd8935456837@mail.gmail.com> Message-ID: <20070402071451.AA832D5FF0@smtp.ksu.edu.sa> In my cases it went to more than 7 even to 8 in one of them. It was fatal. Can you think of another mechanism other than the heparin? Thanks -----Original Message----- From: openheart-l-bounces@lists.hsforum.com [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha M Sent: Sunday, April 01, 2007 11:16 PM To: OpenHeart-L@lists.hsforum.com Subject: Re: [HSF] Hyperkalemia The patient surived. The K went up to 6.8 despite dialysis and came down within 4 hours after stopping all Heparin. After one day we gave a test odse of heparin which produced hyperkalemia again. Prasanna On 4/2/07, A wrote: > > Prasanna: > You are still out of your base but keeping up with HSF; this is great. I > wish you a save return. I was waiting for your input on this issue. Did > you > publish your case report? How high did the serum K get to? Did the patient > made it? A lot of questions sorry about that but because I had three such > cases over a period of years I would like to collect data for I may just > write it up. > Thanks > > -----Original Message----- > From: openheart-l-bounces@lists.hsforum.com > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Prasanna Simha > M > Sent: Sunday, April 01, 2007 10:13 AM > To: OpenHeart-L@lists.hsforum.com > Subject: Re: [HSF] Hyperkalemia > > I had presented such a case some time back which was also PD nonresponsive > till we stopped Heparin > Prasanna from Zagreb. > > > On 4/1/07, Shahid Mahmud Malik wrote: > > > > Ahmed, > > Like I said,I am not sure why the hyerkalemia did not respond despite > > adequate dialysis and urine output around 50mls per hour.Dialysisusually > > bails us out in these situations,unless there was some sort of filter > > problem providing inadequate filteration or such related technical > > problems?We should also keep in mind the rare serum K rise secondary to > > the > > use of Heparin in flushes and for dialysis. > > Shahid Malik > > ----- Original Message ----- > > From: "A" > > To: > > Sent: Monday, April 02, 2007 3:12 AM > > Subject: RE: [HSF] Hyperkalemia > > > > > > > Shahid Malik: > > > > > > What do you think the cause of Hyperkalemia in spite of the adequate > > > dialysis? Your input please > > > > > > Ahmed > > > -----Original Message----- > > > From: openheart-l-bounces@lists.hsforum.com > > > [mailto:openheart-l-bounces@lists.hsforum.com] On Behalf Of Shahid > > Mahmud > > > Malik > > > Sent: Sunday, April 01, 2007 3:57 AM > > > To: OpenHeart-L@lists.hsforum.com > > > Subject: [HSF] Hyperkalemia > > > > > > > > > > > > Manoj, > > > The insulin dependent diabetics in my experience always require a lot > of > > > extra management issues.Exactly why the sequence of events happened in > > > your > > > case, I cannot comment with any certaininty.However following are my > > > general > > > obsevations, > > > 1) They over years of regular Insulin use,have a very high total body > > > potassium. > > > 2) Most IDDM patients usuallly have an abnormal serum creatinine and > low > > > GFRs.The GFRs may not be calculated in every patient and giving them > > drugs > > > like Vancomycin may further knock off their excretory reserve. > > > 3) Many IDDM patients have compromized LV functions (low EFs) and may > > not > > > have adequate cardiac output in the immediate post op period which may > > > further complicate renal output. > > > 4) Use of pressor agents in higher doses, further add to the renal > > insult. > > > 5) Generally some patients would go through a period of severe > oliguria > > or > > > anuria before recovering to some extent.Some would require > > dialysis.(Your > > > patient was on dialysis) > > > 6) To over come the generally low output in these patients we are now > > > liberally using hemofilteration during surgery on these paients. > > > 7) I have also started to use IABP on any IDDM with abnormal serum > > > creatinine and low EFs(even 35%-that I would not consider in a > > > non-diabetic > > > pt) for a post op period of 24-36hrs. > > > 8) Using IABP reduces the need for pressor agents that is helpful and > in > > > our > > > very limited experience provided adequate urine output. > > > 9) I maintain the blood sugar in the initial periods to around 200 and > > > avoid > > > large K supplements if possible. > > > !0) Sometimes,even Heparin in the post operative period used in the > > > flushes > > > causes inappropriate rise in serum K.Not too long ago Dr Prassana > > provided > > > a > > > no.of referances for it. > > > Like I said these are obsevations and not necessarily an explantion > to > > > your patients demise. > > > Shahid Malik > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the > policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > > > _______________________________________________ > > > OpenHeart-L mailing list > > > > > > Send postings to: > > > OpenHeart-L@lists.hsforum.com > > > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > > > All messages transmitted by the OpenHeart-L are subject to the > policies > > > and > > > disclaimers posted at: > > > http://www.hsforum.com/listdisclaim > > > ----------------------------------------- > > > > _______________________________________________ > > OpenHeart-L mailing list > > > > Send postings to: > > OpenHeart-L@lists.hsforum.com > > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > > http://mmp.cjp.com/mailman/listinfo/openheart-l > > > > All messages transmitted by the OpenHeart-L are subject to the policies > > and > > disclaimers posted at: > > http://www.hsforum.com/listdisclaim > > ----------------------------------------- > > > > > > -- > Prasanna Simha M > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > > _______________________________________________ > OpenHeart-L mailing list > > Send postings to: > OpenHeart-L@lists.hsforum.com > > To UNSUBSCRIBE, to CHANGE email address, or to view archives: > http://mmp.cjp.com/mailman/listinfo/openheart-l > > All messages transmitted by the OpenHeart-L are subject to the policies > and > disclaimers posted at: > http://www.hsforum.com/listdisclaim > ----------------------------------------- > -- Prasanna Simha M _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim ----------------------------------------- From rwmfglycar at aol.com Mon Apr 2 05:22:33 2007 From: rwmfglycar at aol.com (rwmfglycar@aol.com) Date: Mon Apr 2 04:23:08 2007 Subject: [HSF] Ao WrapingAspirin plavix mechanical valvesOT In-Reply-To: <695323.41460.qm@web81615.mail.mud.yahoo.com> References: <695323.41460.qm@web81615.mail.mud.yahoo.com> Message-ID: <8C9431732DE0FDD-1498-6C67@webmail-de16.sysops.aol.com> My very own but this could be a wider problem than me and my toy. I hear complaints from others about internet malfunction Bob -----Original Message----- From: tacuff@swbell.net To: OpenHeart-L@lists.hsforum.com Sent: Sun, 1 Apr 2007 3:02 PM Subject: Re: Fwd: [HSF] Ao WrapingAspirin plavix mechanical valves Which "computer", Bob? tea ----- Original Message ---- From: "rwmfglycar@aol.com" To: Openheart-L@lists.hsforum.com Sent: Sunday, April 1, 2007 1:53:13 PM Subject: Fwd: [HSF] Ao WrapingAspirin plavix mechanical valves Something funny is going on with my computer. It sends messages off willy-nilly while I am typing and I get notices of failure to deliver messagres which I have never sent. There is another trial going on using aspirin and plavix with another mechanical valve. It is progressing well, Bob -----Original Message----- From: rwmfglycar@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Sun, 1 Apr 2007 2:20 PM Subject: Re: [HSF] Ao Wraping Just so you know there is another aspirin/plavix trial going on with a -----Original Message----- From: anianyanwu@hotmail.com To: OpenHeart-L@lists.hsforum.com Sent: Sun, 1 Apr 2007 4:03 AM Subject: Re: [HSF] Ao Wraping I share similar concerns regarding feasibility of aspirin plavix mechanical valve study. Recruitment thus far has been rather slow and both surgeons, cardiologists and patients seem apprehensive about it. ----- Original Message ----- From: Hgrmd@aol.com To: OpenHeart-L@lists.hsforum.com Sent: Saturday, March 31, 2007 11:42 PM Subject: Re: [HSF] Ao Wraping Ani, Again, the main question is whether a Ross is clearly superior to the Magna so as to justify the increased complexity and longer clamp time. I see from your post that you are planning to start implanting On-X aortic valve. I've looked at it, but have heard that the high subannular profile can make it difficult to implant. I also predict that the results of the aspiring/Plavix only study will be quite slow to surface. Who wants to take the risk for their patients even if this study is approved by the FCA? Hal ************************************** See what's free at http://www.aol.com. _______________________________________________ OpenHeart-L mailing list Send postings to: OpenHeart-L@lists.hsforum.com To UNSUBSCRIBE, to CHANGE email address, or to view archives: http://mmp.cjp.com/mailman/listinfo/openheart-l All messages transmitted by the OpenHeart-L are subject to the policies and disclaimers posted at: http://www.hsforum.com/listdisclaim