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Biomedical subjects

A Laske

Publications and source records attributed to A Laske.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Simultaneous revascularization of the renal arteries in conjunction with reconstruction of aneurysms of the abdominal aorta].

Simultaneous revascularization of stenosed renal arteries during resection of aneurysms of the abdominal aorta was performed in a consecutive series of 30 patients (mean age: 65 +/- 7 years; men 27 [90%]; women 3 [10%]). Right renal artery was operated upon in 20/30 cases (66%) and left renal artery in 15/30 cases (50%) for a mean degree of stenosis of 79 +/- 19%. Suprarenal extension of the aneurysm of the abdominal aorta was observed in 7/30 cases (23%). Emergency operation because of rupture of the aneurysm was necessary in 7/30 cases (23%). The following procedures were performed upon the renal arteries, either isolated or combined, in addition to resection of the aneurysm of the abdominal aorta: reimplantation of the renal artery in 15 cases, thrombendarteriectomy of the renal artery in 11 cases, patchangioplasty in 8 cases, bypass in 4 cases, dilatation in 1 case, autotransplantation in 1 case. The 30-day mortality was 1/23 (4%) for elective procedures versus 3/7 (43%) for emergency procedures (ruptures). Systolic (diastolic) blood pressure dropped from a preoperative mean value of 181 +/- 139 (104 +/- 18) mm Hg to a postoperative mean value of 147 +/- 18 (80 +/- 18) mm Hg: p less than 0.05 (p less than 0.05). Hence, simultaneous revascularization of stenosed renal arteries during resection of aneurysms of the abdominal aorta helps not only to salvage renal parenchyma but also to control the risk factor hypertonia in a significant number of patients.

Adult↗
PubMed1991

[Blood transfusion and reducing the need for blood in heart transplantation].

Viral infections transmitted by the donor organ or by blood and blood products are severe complications in heart transplantation. The use of blood and blood saving management is evaluated in 57 consecutive orthotopic heart transplantations. Indication was cardiomyopathy in 63%, coronary artery disease in 30%, valve disease in 5%, congenital in 5%, arrhythmia in 5% and primary cardiac malignancy in 2%. Previous open heart surgery was performed in 32%, and 81% had anticoagulation, with a mean quick value of 0.28 +/- 0.13. The total use of blood and blood products was 1151 units and was distributed as follows: whole blood and packed cells 41%, platelets 17%, fresh frozen plasma (FFP) and coagulation factors 36%, albumine 7%. Anticoagulated recipients received more FFP and factors, 7.9 +/- 5.7 U vs. 4.4 +/- 4.8 U. In the reoperation group 78% vs. 22% (p less than 0.001) in the primary operation group received platelets. Hemodilution to hematocrit 0.24 instead of 0.30 lead to a decrease of red cell transfusions per patient from 12.3 +/- 6.7 U to 6.3 +/- 7.4 U (p less than 0.001) and the percentage of patients receiving red cells was reduced from 100% to 82%. Intraoperative hemofiltration was performed in 49% (mean filtration volume was 1652 +/- 910 ml). No differences in the amount of blood and blood products could be shown. Heart transplantation is an operation with a high need for blood and blood products. Reoperation and anticoagulation are predictors for a higher use of platelets, FFP and coagulation factors. Hemodilution reduces the use of red cells, whereas intraoperative hemofiltration has no influence on the use of blood.

Adolescent↗
PubMed1991

Fatal fungal pericarditis after cardiac surgery and immunosuppression.

The cases of two patients with fulminant pericarditis after cardiac surgery are reported. Both fungal infections developed after rethoracotomy for open-chest cardiac resuscitation and high-dose glucocorticoid treatment. Although the time course of both infections from the inoculation of fungi during rethoracotomy and immunosuppression with glucocorticoids to the lethal outcome was strikingly similar, histopathologic studies disclosed the disparate character of the two fungal pathogens responsible: the yeast Candida albicans and the angiotropic mold Aspergillus fumigatus.

Aged↗
PubMed1991

[Conservative surgery of congenital isolated mitral valve anomalies in children. Early and late results].

Conservative surgery for non-av-canal mitral valve anomalies was performed in 30 children under 15 years of age between 1965 and 1986 at our institution. In 14/30 (47%) children these anomalies were isolated (without other intra- or extracardiac defects). Mean age of the 14 children was 6.7 years (range 9 months to 15 years). Preoperatively mitral insufficiency was found in 12 cases, stenosis in one and combined insufficiency and stenosis in one case. The following morphological substrates of mitral valve were found: annular dilation 3, leaflet anomalies 20, chordal anomalies 4, papillary muscle anomaly 1. Surgical technique was as follows: annuloplasty 9, plication of leaflet 4, closure of cleft 10, commissurotomy 2, displacement of papillary muscle 1. Early mortality was 1/14 (7%) patients. There was no death during a mean follow-up interval of 14.8 years (range 30 days to 25 years). Actuarial survival was 93% after 10 and 15 years (95% confidence limits 78-100%). A total of 2 reoperations was necessary (delay 16 day and 46 months). In both cases valve replacement was performed (valve size 27 and 29 mm). Actuarial reoperation-free interval was 77% after 10 and 15 years (95% confidence limits 53-100%). In conclusion conservative surgery for isolated mitral valve disease gives good long-term results. When reoperation is necessary, adult-sized prosthesis can be implanted. Conservative surgery is the procedure of choice for congenital mitral valve disease.

Actuarial Analysis↗
PubMed1991

[Peritoneal dialysis in treatment of postoperative heart failure after correction of complex heart defects in young children and infants].

Low cardiac output can be encountered after corrective surgery for complex congenital malformation in children and infants and is often accompanied by an impairment of renal function, ascites, hyperosmolarity and hyperpyrexia. In most instances, combined afterload-reduction and inotropic stimulation will be effective. If low cardiac output persists, a peritonealdialysis (PD) may allow correction of fluid balance and consecutive improvement of hemodynamics. During a 18 month-period, PD was performed in 14 children in the postoperative period following major cardiac surgery (transposition 5, Fallot tetralogy 5, various complex anomalies 4). This represents 3.1% of all cardiac operations performed in children with congenital heart disease throughout the same period. There were 8 males and 6 females with a median age of 2.5 years (range 3 days to 4 years) and a median bodyweight of 5.5 kg (range 3.4 to 10 kg). Low cardiac output was defined when two or more of the following factors were met: mean arterial pressure (MAP) below 40 mm Hg despite inotropic stimulation, central venous pressure (CVP) over 15 mm Hg, urine production less than 1 ml/kg/hour and/or increasing transaminases. Before starting peritoneal dialysis all children received combined positive inotropic and vasodilative therapy. The PD-catheter was introduced 8 to 30 hours after operation. We used a PD-solution with 1.5% and/or 4.5% glucose. Fluid balance was monitored hourly. Just after introduction of the catheter a mean of 65 ml +/- 25 ml/kg ascites could be removed and the total quantity of removed fluid was 175 ml +/- 45 ml/kg bodyweight.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1991

[Surgery of ruptured aneurysms of the abdominal aorta and iliac arteries: mortality and early morbidity].

Two hundred patients with ruptured aneurysms of abdominal aorta and iliac artery were operated between 1979 and 1988. There were 179 males and 21 females with a mean age of 69 years (range 51 to 90 years). A total of 53/200 (27%) patients died in the hospital; of these 12/200 (6%) died intraoperatively. In following groups mortality was significantly higher: age greater than 70 years (37% vs 17%; p less than 0.01), preoperative shock (36% vs 14%; p less than 0.01), duration of symptoms greater than 12 hours (33% vs 17%; p less than 0.01), operative time greater than 240 min (53% vs 20%; p less than 0.01), intraoperative resuscitation (83% vs 21%; p less than 0.01), amount of volume greater than 4 liters (29% vs 12%; p less than 0.01) and intraperitoneal rupture (40% vs 24%; p less than 0.05). Location of rupture (suprarenal, infrarenal, iliac vessel), location of aortic clamping and the experience of the surgeon also influenced mortality but not significantly.

Aged↗
PubMed1990

[Long-term results of surgical coronary vessel intervention in patients with reduced left ventricular function].

From 1975 to 1980, 112 patients with an ejection fraction below 45% underwent coronary artery bypass grafting (CABG) in the Cardiovascular Surgery Unit, University Hospital Zürich. The mean age was 35 years and the mean ejection fraction 32% (21-44%). The vast majority of patients had severe symptoms (angina pectoris or congestive heart failure). Elective surgery was performed in 62 patients (55%) and emergent or urgent in 50 (45%). All were operated on in mild hypothermia (26-30 degrees C). An average of 2.9 bypasses per patient were performed; in 57, internal mammary artery bypass was carried out for revascularization of the left anterior descending branch. - Early postoperative mortality (within 30 days of operation) was 3.6%; all deaths were of cardiac origin. Perioperative myocardial infarction occurred in 7.5% of all patients. Cumulative survival was 83% at 5 years and 68% at 9 years. Mean mortality rate/year was 3.8% with a maximum of 6.5% in the first year after operation. The incidence of angina pectoris and congestive heart failure was significantly lower after revascularization. Cumulative survival was significantly enhanced in patients with complete revascularization (91% at 5 years vs 71% for incomplete revascularization). Early postoperative mortality was especially high in urgent and emergent cases, and was higher after revascularization with internal mammary artery bypass than with venous graft. Postoperative ejection fraction was assessed in 20 patients (12 with 2- or 3-vessel disease and 8 with left main coronary artery stenosis). Ejection fraction was significantly increased only in the patient group with left main coronary artery stenosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Long-term performance of mitral valve bioprosthesis].

Long-term clinical performance of mitral tissue valves was analyzed in a consecutive series of 250 patients (131 men, 118 women; mean age 51 years) over a 13-year period. Mean follow-up was 71 months (range 1-141 months). The total cumulative follow-up period was 1466 years. The late mortality was 2.0% per patient-year, whereas thromboembolism occurred in 1.4% per patient-year, prosthetic valve endocarditis in 1.0% per patient-year, periprosthetic leaks in 0.3% per patient-year and structural valve deterioration in 3.0% per patient-year. The rate of reoperation was 3.4% per patient-year. Actuarial analysis showed the following results (1 year/5 years/10 years): Survival rate: 97 +/- 1%/89 +/- 2%/82 +/- 5%; free of embolisms: 98 +/- 1%/96 +/- 1%/86 +/- 5%; free of endocarditis: 99 +/- 1%/95 +/- 2%/90 +/- 3%; free of valve deterioration: 99 +/- 1%/96 +/- 1%/60 +/- 8%; no reoperation: 98 +/- 1%/94 +/- 2%/57 +/- 8%; free of late complications: 92 +/- 2%/77 +/- 4%/41 +/- 10%. On the basis of our statistical evaluation the probabilities are that, 11 years after implantation of a mitral bioprosthesis: (a) only 35% of patients are free of late complications (including thromboembolisms, prosthetic valve endocarditis, structural valve deterioration and death); (b) and only 50% of patients have not needed reoperation.

Actuarial Analysis↗
PubMed1990

[Injuries of the large brain-feeding arteries].

Among 2923 severely injured patients in the period 1980-1988, 17 had injuries or large supraaortic arteries. The incidence was 0.58%, with an overall mortality of 53%. In 75% of survivors there was a persistent neurological deficit. We treated 5 penetrating (A. carotis 4, A. vertebralis 1) and 12 nonpenetrating (A. carotis 11, A. vertebralis 1) injuries. In all penetrating carotid injuries (4) repair was performed on admission and mortality was 50%; 1 of 2 survivors has postoperative hemiparesis. Localization of nonpenetrating carotid injuries (11) was intrathoracic (2), in the neck (7) and intracranial (2). Main complication of nonpenetrating extracranial carotid injuries is neurological deficit (7/9) due to thrombosis (3) or stenosis (4) with embolism (2). Surgery was performed in 3 cases comprising pseudoaneurysm in 2 and concomitant aortic rupture in 1. Mortality was 44%, and 80% of survivors had persistent neurological deficits. Extracranial carotid injuries (n = 13) carried a mortality rate of 83% in occluded and 29% in nonoccluded vessels (p less than 0.05). Location of carotid injury in the neck (n = 11) carried a mortality of 55%, and intracranial (n = 2) of 100% respectively. Duplex-Doppler scanning of carotid arteries is a safe, noninvasive method which is essential in blunt carotid artery trauma. Prognosis is dependent upon the size of cerebral infarction. Once neurologic deficit has been established for more than 24 hours, reconstruction of the artery should be postponed and performed only for complications (pseudoaneurysm or embolization). Clamping of arteries without hypothermic circulatory arrest or shunt should be avoided. The danger of rupture in dissection and pseudoaneurysm is slight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Liver transplantation with atrioatrial anastomosis for Budd-Chiari syndrome.

We report the case of a young woman with Budd-Chiari syndrome in whom mesentericoval shunt was first performed, followed by transcaval liver resection and hepatoatrial anatomosis 3 years later. Liver transplantation became necessary 5 years later because of deterioarating liver function with portal hypertension and bleeding. Successful transplantation was performed with atrioatrial anastomosis with help of cardiopulmonary bypass, simplifying considerably the technical procedure and reducing dramatically blood loss.

Adult↗
PubMed1990

Internal mammary artery anomalies.

The internal mammary arteries (IMA) are considered to be the superior conduit in coronary bypass grafting (CABG). Anomalies of an IMA can influence the surgical technique and results; their true incidence is not well known. The IMA's were visualised angiographically in 262 consecutive patients undergoing cardiac catheterisation prior to CABG. Satisfactory visualisation was possible of 459/524 IMA's studied (88%). A total of 118/459 (26%) surgically significant anomalies was observed in 79/262 patients (30%): common origin of another large artery in 48/459 (11%), large side branches in 41/459 (9%), tortuosity in 21/459 (5%), atypical course or origin in 5/459 (1%), atherosclerotic lesions in 2/459 (0.4%) and spasticity of an IMA in 1/459 (0.2%). Angiographic visualisation of the IMA's resulted in modification of surgical strategy in 11/262 patients (4%); meticulous preparation because of difficult or atypical IMA anatomy was necessary in 68/262 patients (26%). These results demonstrate that significant anomalies of the IMA which might--when unrecognized--jeopardize IMA-flow after CABG are relatively common; they might escape detection during IMA take-down but can be diagnosed by angiography during catheterisation.

Adult↗
PubMed1990

[Surgery of central lung embolism: indications, mortality and early morbidity].

Between 1979 and 1988 massive pulmonary embolism (PE) was treated surgically in 36 patients with extracorporeal circulation (ECC). Circulation was stable in 11 patients and unstable in 25; in this group 9 had previous resuscitation because of cardiac arrest. There were 7/36 early deaths (19%); 5 of those patients had to be resuscitated prior to surgery. Deaths were caused mainly by cerebral edema or hemorrhage. Significant complications occurred in 8 patients (28%). Diagnoses of PE was made clinically in most cases; confirmation by echocardiography was useful. Pulmonary angiography was made in patients with uncertain diagnosis and stable circulation. Operation is indicated in patients with unstable circulation and proved central PE; it is advisible in patients with embolism of the main pulmonary artery or its major branches. Hospital mortality is very high when the patient has to be resuscitated preoperatively; in this group surgery should be performed only in younger patients with a short period of resuscitation. Interruption of the inferior vena cava should be performed to prevent recurrent PE.

Adult↗
PubMed1990

[Cytomegalovirus (CMV) infection: a frequent and life-threatening complication in heart transplant patients].

We investigated the clinical relevance of cytomegalovirus infection in our heart transplant recipients (n = 48). There was a high incidence of CMV-infection in patients where IgG positive donor versus IgG negative recipient was present. A total of 5/8 patients (= 62.5%) showed severe clinical CMV-infection with pneumonitis, colitis or tonsillitis besides general malaise, requiring long hospital treatment (2 to 24 weeks). CMV-infection is a frequent and threatening complication in patients after heart transplant (HTPL). We discuss the various managements in diagnosis, prophylaxis and treatment.

Antibodies, Viral↗
PubMed1990

[Surgical and perioperative problems of heart transplantation].

Orthotopic heart transplantation is an established treatment for terminal cardiac diseases. Close cooperation and coordination with other clinics and laboratories is mandatory to transplant a good organ with minimal ischemic time. Accurate donor evaluation and treatment is essential for fast recovery after operation. Our series is 79 orthotopic heart transplantations form 9/85 to 10/89 in 78 patients. Average ischemic time is 38 minutes in organ procurement from table to table and rises distinctly in distal heart procurement (n = 33), but is usually under 120 minutes at organ procurement from any place in Switzerland. The transplantation is performed in the technique from Lower and Shumway. Immunosuppression with triple therapy (Cyclosporin A, Azathioprim, Prednisone) and initial cytolytic therapy is well tolerated. Consequent diagnosis and treatment for rejection and infections lead to good short and medium term survival. Prophylactic treatment is indicated in high risk constellation for cytomegalovirus and toxoplasmosis infection. Early mortality (less than 30 days) was two out of seven and caused by bacterial infections. Actuarial survival is 91% at one and two years and 85% at three years with good quality of life and NYHA class I.

Heart Diseases↗
PubMed1990

[Graft rejection reaction and immunosuppression following heart transplantation].

Acute rejection is the most important factor influencing mortality after heart transplant. Acute rejection occurs at least once in over 95% of the patients in the early phase after heart transplant. In the vast majority of episodes of acute rejection clinical symptoms are absent. The regular performance of endomyocardial biopsy after heart transplant allows histological diagnosis of rejection episodes as well as follow-up control of rejection treatment. This overview points to the major problems regarding acute rejection and immunosuppressive regimen in heart transplant recipients.

Graft Rejection↗
PubMed1990

[Toxoplasmosis in the heart transplant patient].

Toxoplasmosis is a well-known problem under immunosuppressive conditions in cardiac transplant patients. In our series 12% of the patients (8 of 65) had clinical and/or serological signs of active toxoplasmosis. Due to its serious prognosis once the clinical process has started we favor a generous diagnostic interpretation of the serological results and a broad indication to drug therapy.

Animals↗