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Biomedical subjects

C Hubscher

Publications and source records attributed to C Hubscher.

At least 19 recordsLinked to original sources
PubMed1986

Valve replacement in acute native valve endocarditis.

From 1974 to 1984, 46 patients underwent emergency surgery for acute native valve endocarditis. Urgent valve replacement was necessary because of rapid hemodynamic deterioration in 34 (73%), uncontrolled sepsis plus heart failure in 9 (19%), and life-threatening emboli in 3 (7%) patients. At the time of surgery 23 patients (50%) were in NYHA functional class IV, 20 in Class III, and 3 in class II. Streptococcus was the most common organism encountered, followed by staphylococcus. Thirty-four cases presented severe aortic regurgitation, 3 mitral incompetence, 8 mitral plus aortic insufficiency, and one aortic plus tricuspid insufficiency. Operative mortality rate was 17% (8/46). Most deaths were due to preoperative multiple system deterioration, especially in cases with lesions of both the aortic and mitral valves, and were unrelated to the duration of preoperative antibiotic therapy. The postoperative observation period of long-term survival is from 6 to 102 months (= 44 months). There were 7 late deaths. The actuarial survival, including operative mortality, is 67%. Twenty-two patients are now in NYHA class II, 6 in class III. The duration of postoperative antibiotic treatment (6 weeks in our series) seems to be important for the prevention of reinfection, early surgery is of great benefit; our 31 survivors showed an excellent clinical improvement.

Adult↗
PubMed1986

[Results of surgical treatment in acute native endocarditis. Apropos of 41 patients].

This study was based on the analysis of 41 cases of infectious endocarditis of native valves operated during the acute phase. Patients with bacteriological cures, prosthetic valve endocarditis and endocarditis on congenital non-valvular lesions were excluded. There were 32 men and 9 women with an average age of 49 years. The valve lesions were aortic incompetence, mitral incompetence, mitro-aortic disease and mitro-tricuspid disease. Fourteen patients had preexisting valvular disease (rhumatic in 12 and congenital in 2 cases). These patients were in an advanced clinical state at the time of operation: 23 Class IV, 16 Class III and 2 Class II operated for systemic embolism. The surgical indications were severe cardiac failure in 30 cases, systemic embolism in 2 cases and persistance of septicaemia with worsening cardiac function in 9 cases. The causal organism was isolated from blood cultures in 34 cases (83%) and from the excised valve in 13 cases. The early postoperative mortality during the first month was 5 patients (3 cases of aortic incompetence associated with mitral incompetence and 2 cases of aortic incompetence alone). Death was caused in most cases by irreversible cardiac failure related to the advanced preoperative cardiac failure. All the other patients were followed up for 1 to 102 months (average 44 months). There were 7 late postoperative deaths. The mortality rate was 3.4% per patient year including patients undergoing chronic haemodialysis. The actuarial survival was 79% at 78 months excluding the operative mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1982

Follow-up of surgically treated patients with massive pulmonary embolism--with reference to 12 operated patients.

Since 1978, 17 patients have undergone surgery for massive pulmonary embolism in our department. Twelve patients survived and have been followed up for between 2 and 31 months postoperatively (mean 16 months). Reassessment of these patients included exercise tolerance test, pulmonary function test, perfusion scan, right heart catheterization and coagulation screening. Two survivors present major sequelae, namely vascular pruning and definite signs of pulmonary hypertension. The other 10 patients have minimal or no residual vascular occlusion, but show a high incidence of minor abnormalities: slight rise in pulmonary arterial pressure during exercise (3 cases), small angiographic and scintigraphic defects (5 cases), arterial hypoxemia (5 cases) and disturbances of pulmonary function (10 cases). Systemic venous problems were found to be frequent and to be a handicap in 5 cases, and an abnormal pattern of response to exercise was observed in 4 patients. These disturbances may be related to ligation of the vena cava. Various derangements of coagulation were found in all but one of the patients.

Adolescent↗
PubMed1979

[Prevention of post-operative infection in heart surgery with extracorporeal circulation (apropos of 295 cases)].

From April 1977 to November 1978, 295 patients were operated on using artificial circulation. 31 p. 100 of these developed a post-operative infectious complication, 7.3 p. 100 being of a serious nature (3.3 p. 100 suffered from mediastinitis, and 4 p. 100 from septicaemia). The organisms responsible are, in the case of the mediastinal infections the staphylococcus Citreus, and Gram negative bacilli in the case of the septicaemias. A retrospective analysis shows that there are two successive periods and that in the course of the second there is a decrease in the occurence of all of the infections and particularly in the cases of mediastinitis. This improvment would seem on superficial analysis to correspond with a change in the preventive antibiotic treatment, the cephradine--gentamicin combination having replaced penicillin G. However, the statistical study shows that other factors were altered between the two periods (type of antiseptic, duration of treatments, time of postoperative intubation) and that these equally contributed to the fall in the incidence of infection. In the light of this study, it would seem that if prophylactic antibiotic treatment essentially directed against staphylococci has a place in cardiac surgery with artificial circulation, it can only be regarded as one of several preventive factors. The statistical data gathered so far is not sufficient to prove the efficacy of this treatment.

Adolescent↗