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Biomedical subjects

C Feldmeier

Publications and source records attributed to C Feldmeier.

At least 19 recordsLinked to original sources
PubMed2001

Aortic valvotomy for congenital valvular aortic stenosis: a 37-year experience.

BACKGROUND: The purpose of the study was to analyze the long-term results of aortic valvotomy and the risk factors associated with reoperation and survival. METHODS: From 1960 to 1977, 116 patients with congenital valvular aortic stenosis underwent isolated aortic valvotomy at a mean age of 13.7 +/- 7.8 years with a mean aortic gradient of 78 +/- 33 mm Hg. Fifteen patients had additional aortic regurgitation, and leaflet calcification was present in another 15 patients. RESULTS: Postoperatively the mean aortic gradient decreased to 19.4 +/- 11.3 mm Hg (p < 0.0001). Early mortality was 2.6%. At a mean follow-up of 23.8 years, 26 late deaths (22.4%) occurred among the 113 early survivors. Actuarial 10-, 20-, 30-, and 37-year survival rates were 94.6%, 79.7%, 76.2%, and 72.5%, respectively. According to multivariate Cox regression analysis, survival was influenced by preoperative New York Heart Association class (p = 0.0418), leaflet calcification (p = 0.0339), date of operation (p = 0.0253), and postoperative endocarditis (p < 0.0001). At a mean interval of 18.3 years, 37 patients required reoperation (31.9%) mainly because of recurrent aortic stenosis. The reoperation rate increased significantly 15 years postoperatively from 0.73%/year to 2.31%/ year (p < 0.0001). In a multivariate risk model, reoperation was influenced by older patient age (p = 0.0032) and the presence of leaflet calcification (p = 0.0289). CONCLUSIONS: AORTIC valvotomy is a simple and effective procedure for congenital aortic stenosis with excellent long-term results. However, the rate of reoperation increases 15 years postoperatively, and clinical follow-up should be intensified. Our results suggest that early repair should be performed and that adequate patient selection is the most important determinant of the longterm results.

Actuarial Analysis↗
PubMed1999

Mitral commissurotomy, a technique outdated? Long-term follow-up over a period of 35 years.

BACKGROUND: The objective of this study was to evaluate long-term survival, valve-related complications as well as prognostic factors for early and late outcome after open and closed mitral commissurotomy covering a follow-up period of 35 years. METHODS: From 1955 to 1977, 183 patients with mitral stenosis underwent mitral commissurotomy at our institution. Closed valvotomy was performed on 143 patients (group A) and open valvotomy on 40 patients (group B). RESULTS: Survival rates after 10, 20, and 30 years were 89%, 67.8%, and 49.1% in group A and 91.7%, 66.7%, and 45.9% in group B (p = not significant). The risk of late death increased significantly with an advanced preoperative New York Heart Association functional class, atrial fibrillation, higher age at operation, pre- or postoperative mitral regurgitation, and leaflet calcification. Forty-four patients in group A and 5 patients in group B required reoperation (p < 0.05). Independent predictors for reoperation in a multivariate analysis were a remaining postoperative mitral stenosis or regurgitation. A total of 68 patients showed valve-related complications. The linearized rate of valve-related morbidity and mortality was 2.1% per patient-years in group A versus 1.1% per patient-years in B (p < 0.01). CONCLUSIONS: Long-term survival for open and closed commissurotomy are excellent, showing no difference between the groups. However, both the incidence of reoperation as well as valve-related morbidity and mortality were significantly lower after open commissurotomy. In well-selected patients with pure mitral stenosis and no leaflet calcification, open commissurotomy still remains a valid surgical option.

Adult↗
PubMed1998

Developing standards and quality measurements for case management practice.

Case management is a service offered in most health care and social service settings, but a universal definition and standards for practice, applicable to the various case management models, do not exist. Without nationally accepted standards and quality measures for community-based long-term-care case management, many agencies are scrambling to create them in order to justify their services to payers. This article describes the method followed by one county agency serving low-income elders and people with disabilities to create process standards and quality measures for case management practice. The project involved experienced case management staff who created measurement tools encompassing measures of 12 case management activities. Their goal was to justify the importance of the service being offered, to set minimum practice standards, and to raise the awareness and level of quality of case management practice.

Case Management↗
PubMed1986

[Winter sports injuries of the hand. 3 problem injuries].

Growing redistribution of injuries has been recordable from winter sport activities, in recent years, with the upper extremity being more often affected than in the past. This prompted the authors to undertake follow-up checks for the purpose of verifying therapeutic success of patients treated earlier for three frequent injuries which had quite often been underestimated or even overlooked, rupture of the ulnar ligament of the metacarpophalangeal joint of the thumb, fracture of the distal radius, and fracture of the scaphoid. Included in the follow-up check were 37 patients with rupture of the ulnar ligament, 34 with fracture of the distal radius, and 11 with scaphoid fracture. All of them had been treated by the authors, in 1982 and 1983. Periods between 4 and 26 months had passed from surgical treatment or beginning of conservative therapy at the time of the follow-up check.

Athletic Injuries↗
PubMed1985

[Treatment of fresh and aged cruciate ligament ruptures with combined autologous and alloplastic reinforced tendon transplant (polypropylene ligament)].

After discussing basic problems in repair and reconstruction of acute as well as secondary anterior cruciate ligament-lesions authors present a modified Kennedy-MacIntosh technique of acl-reconstruction. Temporary compensation of loss in tensile strength of the autograft (quadriceps-patellar-tendon) is achieved by an 8 mm Polypropylene band with excellent biocompatibility and mechanical characteristics. "Biological fixation" of the distal part of the tendon-graft avoids "stress shielding" and physiological applied stress may lead to remodeling and structuring in the sense of functional adaptation. Acute acl-ruptures are sutured or reinserted and treated with fibrine-tissue-glue. Furthermore a semitendinosus-autograft combined with a 6 mm Polypropylene band is added. Details of the operations-procedure are presented as well as steps in postoperative treatment. Early results and complications are finally discussed.

Biomechanical Phenomena↗
PubMed1984

[Pilous nevi of the hand].

Pilous nevi of the hand should be treated both to prevent cosmetic and functional disorders and because they can degenerate. In the first months of life a dermabrasio can be performed, later excision and skin-grafting is necessary. A case of pilous nevus involving nearly the whole right hand, which had been treated ten years previously, is reported.

Child, Preschool↗
PubMed1983

[Determination of cefoxitin serum and tissue levels. Perioperative antibiotic prevention in hand surgery in interventions in a bloodless field].

In 63 patients, who underwent handsurgery under tourniquet ischemia, 2 g of Cefoxitin were given i.v. The antibiotic levels in tissue and serum at different times were obtained using biological assay. The results area compared with cefoxitin-concentrations of samples from abdominal surgery. By means of regression-analysis the tissue-serumquotient is defined as the relation of function to the time. The model-character of the conditions unter tourniquet ischemia is described.

Adipose Tissue↗
PubMed1983

Comparative clinical studies with midazolam, oxazepam and placebo.

The efficacy and safety of midazolam compared with oxazepam and placebo were investigated in 50 hospital patients (19 males, 31 females; age range 21 to 74 years) in a double-blind parallel group study. On the first 2 nights (selection phase), patients received only placebo. On the next 5 nights, they received either 15 mg midazolam, 15 mg oxazepam or placebo. They received no medication on the last 2 nights and were kept under observation (withdrawal phase). Compared with placebo, both benzodiazepines shortened sleep onset latency, reduced the number of awakenings and improved sleep quality. All 3 compounds were well tolerated with only few, mild side-effects (headache, nausea) in the 2 verum groups. Psychometric performance was not impaired on the morning following drug administration. The overall patients' assessments showed 80% satisfaction with midazolam, 66% with oxazepam and 10% with placebo. Midazolam and oxazepam yielded similar results, although midazolam induced sleep more rapidly and was rated more favourably by the patients. Midazolam, in a dose of 15 mg, is thus an effective, fast-acting, well-tolerated hypnotic without residual effects and is suitable for the treatment of insomnia of mild to moderate degree. Oxazepam in a dose of 15 mg is also well suited for the treatment of sleep disorders, particularly if a rapid onset of action is not required.

Adult↗