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Biomedical subjects

C Huth

Publications and source records attributed to C Huth.

At least 37 records · Page 2Linked to original sources
PubMed2000

Neurobehavioral outcome prediction after cardiac surgery: role of neurobiochemical markers of damage to neuronal and glial brain tissue.

BACKGROUND AND PURPOSE: The goal of the present study was to investigate the predictive value of neurobiochemical markers of brain damage (protein S-100B and neuron-specific enolase [NSE]) with respect to the short- and long-term neuropsychological outcomes after cardiac surgery with cardiopulmonary bypass (CPB). METHODS: We investigated 74 patients who underwent elective CABG or valve replacement surgery and who showed no severe neurological deficits after surgery. Patients were investigated with a standardized neurological examination and a comprehensive neuropsychological and neuropsychiatric assessment 1 to 2 days before surgery, 3 and 8 days after surgery, and 6 months later. Serial venous blood samples were taken preoperatively and 1, 6, 20, and 30 hours after skin closure. Protein S-100B and NSE were analyzed with immunoluminometric assays. RESULTS: Patients with severe postoperative neuropsychological disorders showed a significantly higher and longer release of neurobiochemical markers of brain damage. Patients who presented with a delirium according to DSM-III-R criteria 3 days after surgery had significantly higher postoperative S-100B serum concentrations. Multivariate analysis (based on postoperative NSE and S-100B concentrations and age of patients, type of operation, length of cross-clamp and perfusion time, and intraoperative and postoperative oxygenation) identified NSE and S-100B concentrations 6 to 30 hours after skin closure as the only variables that contributed significantly to a predictive model of the neuropsychological outcome. NSE, but not S-100B, release was significantly higher in patients undergoing valve replacement surgery. CONCLUSIONS: Postoperative serum concentrations and kinetics of S-100B and NSE have a high predictive value with respect to the early neuropsychological and neuropsychiatric outcome after cardiac surgery. The analysis of NSE and S-100B release might allow insight into the underlying pathophysiology of brain dysfunction, thus providing a valuable tool to monitor and evaluate measures to improve cardiac surgery with CPB.

Biomarkers↗
PubMed1999

A contrastive analysis of release patterns of biochemical markers of brain damage after coronary artery bypass grafting and valve replacement and their association with the neurobehavioral outcome after cardiac surgery.

OBJECTIVE: The present study aimed at a comparative analysis of neurobiochemical markers of brain damage and the neurobehavioral outcome in patients undergoing either valve replacement (VR) or isolated coronary artery bypass surgery (CABG). In order to control for well known risk factors both samples were strictly matched according to age, sex and preoperative neuropsychological performance. METHODS: We analysed neurone-specific enolase (NSE) and protein S-100B (S-100B) concentrations in serial venous blood samples taken preoperatively and 1, 6, 20 and 30 h postoperatively in 36 patients undergoing VR (N = 18) or isolated CABG surgery (N = 18). Mini Mental State Examination (MMS) was performed preoperatively, 3 and 7 days after surgery and 0.5 years later. Neuropsychiatric assessments were based on the diagnosis of postoperative delirium according to DMS-IIIR criteria and the Brief Psychiatric and the Delirium Rating Scale. RESULTS: VR and CABG patients, respectively, showed an increase of both S-100B (exact two-tailed Wilcoxon signed ranks test: P = 0.0001) and NSE (P = 0.0001) concentrations followed by a decrease during the next 30 h. Whereas S-100B values did not differ between patients groups subjects undergoing VR surgery exhibited higher NSE values during the postoperative course. Furthermore, VR patients showed a higher decline in cognitive performance which was also detectable 0.5 years after surgery. We found a weak association between the degree of individual postoperative decline of cognitive performance and S-100B area under curve values. CONCLUSIONS: Our data indicate that--apart from patients' age and preoperative neuropsychological performance--type of surgery remains a risk factor for postoperative neurobehavioral disorders. The different vulnerability of neurobehavioral disorders might be mirrored in different postoperative release patterns of NSE. We assume that both, NSE release and neurobehavioral disorders might be caused by a higher amount of intraoperative cerebral embolic events in VR patients.

Biomarkers↗
PubMed1999

Myocardial kinetics of 99m technetium-Q agents: studies in isolated cardiac myocyte, isolated perfused rat heart, and canine regional myocardial ischemia models.

OBJECTIVE: Based on reports of high cellular uptake and low plasma binding of nonreducible mixed ligand Tc(III) cations (Q complexes) and high linear uptake versus blood flow of 99mTc-Q3 in canine hearts, the authors hypothesized that the two Q complexes, 99mTc-Q63 and 99mTc-Q64, would have high cell uptake and better differentiation between ischemic and nonischemic myocardium compared with other 99mTc-based compounds. METHODS: Uptake and retention kinetics of 99mTc-Q63 and 99mTc-Q64 were measured in isolated rat cardiac myocytes, isolated perfused rat hearts, and intact canines and compared with previously reported Q-based compounds, a clinically available 99mTc perfusion agent (sestamibi), and 201Tl. RESULTS: Uptake of Q63, Q64, and sestamibi by isolated cardiac myocytes was similar. Maximum extraction (Emax) of Q64 by isolated perfused rat hearts was greatest among the 99mTc agents (P < 0.02), but net extraction (Enet) of Q64 was not different from Q63 or sestamibi 3 minutes after tracer injection. By 15 minutes, 201Tl Enet was lower than Q63, Q64, and sestamibi (P < 0.05). Among 99mTc agents, the uptake versus flow of Q3, Q63, and Q64 by canine heart was superior to Q12 and sestamibi (P < 0.05). CONCLUSIONS: The activity of Q63 and Q64 in the myocardium is related to actual myocardial blood flow over a broad, clinically relevant range of flows. The ischemic-to-normal zone activity distributions of Q63 and Q64 approximate actual flow in a manner more like that of 201Tl than sestamibi or Q12. These results provide a rational foundation in support of further evaluation of Q63 and Q64 in humans.

Acute Disease↗
PubMed1995

[Treatment of ventricular tachycardia with bypass surgery. A case report].

We report on a 45-year-old man with a 4-year-old myocardial infarction and a history of recurrent syncopes. A monomorphic ventricular tachycardia was inducible during electrophysiologic study. After coronary bypass-grafting ventricular tachycardia was no longer inducible. The patient is now, 6 months after surgery, and without antiarrhythmic drugs, free from recurrence of syncope and has had no spontaneous tachycardia event. Treatment with antiarrhythmic drugs, endocardial resection, and the implantable cardioverter-defibrillator are well established approaches to fight sudden cardiac death. The role of coronary artery bypass-grafting alone in the prevention or suppression of malignant ventricular arrhythmias is debatable, especially in cases of monomorphic ventricular tachycardia. Some of these high-risk patients may well be protected by coronary artery bypass grafting alone.

Cardiac Pacing, Artificial↗
PubMed1994

Effect of biphasic waveform pulse on endocardial defibrillation efficacy in humans.

Several clinical studies have proved increased defibrillation efficacy for implantable cardioverter defibrillators with biphasic pulse waveforms compared to monophasic pulse waveforms. This difference in defibrillation efficacy depends on the type of defibrillation lead system used. The influence of biphasic defibrillation pulse waveforms on the defibrillation efficacy of purely endocardial defibrillation lead systems has not yet been sufficiently examined, we, therefore studied 30 consecutive patients with drug refractory ventricular tachyarrhythmias during the implantation of a cardioverter defibrillator. After implanting an endocardial "integrated" sensing/defibrillation lead we performed a prospective randomized comparison of the defibrillation efficacy of monophasic and biphasic defibrillation waveform pulses. For endocardial defibrillation with the biphasic waveform the mean defibrillation threshold was 12.5 +/- 4.9 joules and for the monophasic waveform 22.2 +/- 5.6 joules (P < 0.0001). There was a decrease in the required defibrillation energy of biphasic defibrillation in 29/30 patients. Thus considering purely endocardial defibrillation a statistically significant and clinically relevant increase in defibrillation efficacy can be demonstrated for biphasic defibrillation waveform pulses.

Defibrillators, Implantable↗
PubMed1994

[Doppler and echocardiography parameters in detection of acute graft rejection after heart transplantation].

Due to the invasive nature of myocardial biopsies, a complication rate of up to 2.5%, and the limitations, e.g., at focal distribution of rejection, there is a continuous need for reliable, non-invasive parameters in recognizing moderate (grade 2) and severe (grade 3) acute cardiac allograft rejections in patients treated with cyclosporine A. 64 biopsies of 20 patients with previous heart transplantations in the past 3 weeks to 36 months (mean 11 months) were compared prospectively to Doppler and echocardiographic results. Parameters of systolic function such as percent fractional shortening (FS) and systolic wall thickness of the posterior wall (SWT) remained without significant changes at grade 2 and grade 3 rejections. The same is valid for relaxation parameters such as maximum velocity of posterior wall reduction (PTR), the time interval of endsystole to maximum velocity of posterior wall reduction (tES-PTR), and the isovolumic relaxation time (IVRT). Left-ventricular filling parameters such as maximum early diastolic flow velocity (VEmax) increased significantly from 73.3 +/- 15.2 cm/s in the rejection-free interval (grade 0) to 103.9 +/- 15.0 cm/s at grade 2 rejection and 101.1 +/- 9.2 cm/s at grade 3 rejection (both p < 0.001). A sensitivity of 50% and a negative predictive value of 77% are, however, too low to diagnose or exclude a moderate or severe acute rejection in the individual case.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1993

[Cardioverter-defibrillator implantations without thoracotomy: clinical experience with various electrode configurations and defibrillation wave forms of an endocardial/subcutaneous defibrillator system].

Twenty-seven consecutive patients with refractory ventricular arrhythmias were investigated for implantation of an nonthoracotomy cardioverter-defibrillator lead system. Supply with a nonthoracotomy lead system could be achieved in 25 of 27 patients (92.5%), while implantation proved impossible in two patients due to elevated defibrillation thresholds. After implantation of an endocardial defibrillation electrode no differences were found compared to the implantation of an endocardial defibrillation electrode with a subcutaneous chest wall defibrillation patch with regard to the defibrillation thresholds obtained for monophasic defibrillation waveform. Supply with an endocardial defibrillation lead system was successful in 18 of 25 patients (72%). Ten consecutive patients with implantation of an endocardial defibrillation lead system alone were compared for defibrillation efficacy following monophasic and biphasic defibrillation waveforms. Defibrillation with biphasic waveforms led to a decrease in the necessary defibrillation energy from 19 J (4.6 J) to 10 J (4.0 J). There was occurrence of refractory ventricular fibrillation that could not be controlled by endocardial and transthoracic defibrillation in two patients during the intraoperative testing of defibrillation thresholds. In both cases these arrhythmias could be terminated by the described method of endocardial/extrathoracic defibrillation (200 J). Further perioperative complications were not observed. Over a mean follow-up of 6.8 (1-17) months all patients demonstrated regular functioning of the cardioverter-defibrillator. Dislocation of defibrillation electrodes did not occur. Implantation of a cardioverter-defibrillator can be performed without thoracotomy in the majority of cases. The use of defibrillator systems with biphasic waveform widens the scope for implantation of nonthoracotomy defibrillating lead systems.

Adult↗
PubMed1989

[Asymptomatic carotid stenosis: is surgical prevention of infarct still justified?].

The present retrospective study compared the incidence of TIA, stroke, and death in patients with asymptomatic carotid stenosis (greater than 50%) during a follow-up period of 24 to 30 months. 65 patients were operated and 193 treated medically. The incidence of death was comparable in both groups. Death in most patients was due to cardiac disease or cancer. The annual incidence of TIA and stroke was not different between the two populations. Despite the low incidence of perioperative complications (%) surgery of asymptomatic carotid stenosis cannot be recommended at the present time.

Aged↗
PubMed1989

Pulmonary hypertensive vasculopathy--no indication for corrective operation of isolated ventricular septum defect in babyhood.

The frequency of surgical closure of a ventricular septum defect (VSD) in the first year of life has risen from 10% to 30% in the last seven years in West Germany. Whereas there was a decrease of mortality in older children, mortality has stagnated at 8% for correction at age 12 months or less (early correction). Development of an irreversible pulmonary hypertensive vasculopathy (PHVP) and recurrent heart failure with growth disorders are given as reasons for operation in the first year of life. In the last six years, we have operated on 31 infants for isolated VSD with pulmonary hypertension (PH) and closed the VSD. In approximately equal preoperative pressure in the two ventricles with a pressure ratio of 0.88 +/- 0.16, there was an immediate fall in pressure in the right ventricle with pressure ratios of 0.43 +/- 0.24. Three patients (9.7%) died perioperatively. In the same period, a primary VSD closure was carried out in 120 children even after over 12 months with three deaths (2.5%). Pulmonary tissue removed in this operation did not show any PHVP in four patients (13%), grades 0 to I and I to II in 10 patients each (total 33%) and a PHVP grade II to III in six patients (20%). This PHVP is capable of full regression. An irreversible PHVP does not develop up to the end of the first year of life in isolated VSD with PH, so that the correction can be safely postponed to the beginning of the second year of life provided that recurrent heart failure with growth disorders does not compel earlier correction.(ABSTRACT TRUNCATED AT 250 WORDS)

Aging↗
PubMed1989

[Lung inflation or mechanical ventilation in extracorporeal circulation?].

Extracorporeal circulation (ECC), with its shock-like pulmonary perfusion, leads to pathomorphologic and functional pulmonary changes, the postperfusion syndrome. This study investigated the effects of different types of ventilation during ECC on postoperative pulmonary function and the resulting pulmonary blood gas changes. METHOD. Thirty patients scheduled for aortocoronary bypass surgery were studied. Patients with pre-operative left ventricular end-diastolic pressures exceeding 15 mmHg or signs of right ventricular failure, pulmonary hypertension, or pre-existing pulmonary disease were excluded. The patients were randomly assigned to one of the following three groups: Group 1 (n = 10): static pulmonary inflation during ECC, PEEP 5-10 cm H2O, F1O2 1.0; Group 2 (n = 10): low-frequency ventilation during ECC, rate 10/min, PEEP 5 cm 5H2O, F1O2 1.0; Group 3 (n = 10): medium-frequency ventilation during ECC, rate 120/min, PEEP 5 cm 5H2O, F1O2 1.0. The measurements were made under relative steady-state conditions before the start of surgery and postoperatively after an equilibrium phase of at least 15 min. During ECC using a bubble oxygenator (Bentley BOS 10 S) in moderate hypothermia, blood was aspirated from the pulmonary artery during inflation of the wedge balloon and blood gases were analyzed. Postoperative changes in pulmonary function were evaluated by venous admixture (QVA/Qt); changes in pulmonary vascular resistance after ECC were determined using the pulmonary pressure-flow relationship. RESULTS. In group 1, QVA/Qt rose significantly from 9.6 +/- 2.9% preoperatively to 13.6 +/- 3.5% postoperatively (P less than 0.05, t-test for paired samples). In groups 2 and 3, postoperative QVA/Qt was significantly lower than preoperative QVA/Qt (P less than 0.05; group 2: preoperative 11.9 +/- 3.5%, postoperative 8.1 +/- 2.6%; group 3: preoperative 11.9 +/- 3.0%, postoperative 7.8 +/- 3.2%; Fig. 1). The postoperative pulmonary pressure-flow relationship changed similarly in all three groups (Fig. 2). During ECC, blood aspirated from the pulmonary artery during inflation of the wedge balloon was fully oxygenated with a hematocrit approximating that of arterial blood. In ventilated patients, pO2 during ECC was higher in pulmonary arterial blood than in arterial blood. Pulmonary ventilation during ECC did not lead to pulmonary arterial alkalosis. CONCLUSIONS. Pulmonary ventilation during ECC can prevent a post-operative increase in venous admixture. ECC-related pulmonary vascular changes were not affected by ventilation. Middle-frequency ventilation offers no advantage over low-frequency ventilation during ECC, except that the operating field is more quiet.

Acid-Base Equilibrium↗
PubMed1988

Ultrasonographic follow-up of subclavian stenosis and occlusion: natural history and surgical treatment.

Continuous-wave Doppler ultrasonography and clinical examination were used over a 2-year period to monitor the natural history of subclavian stenoses and occlusions in 67 patients. Thirty-nine presented with subclavian steal and 28 without. We also studied an additional group of 29 patients who had undergone surgery for subclavian steal syndrome and vertebrobasilar transient ischemic attacks. The results, in terms of both ultrasonographic and clinical criteria, demonstrate the benign nature of the subclavian steal syndrome: all neurologic signs and symptoms were of a transient character. Spontaneous remission of vertebrobasilar transient ischemic attacks occurred in approximately 50% of the initially symptomatic patients, and only 15% of the initially asymptomatic patients experienced vertebrobasilar transient ischemic attacks during follow-up. Doppler ultrasonography revealed progression during follow-up in only 17% of the subclavian stenoses, and in 13% a stenosis was no longer detectable. Still-ongoing brainstem transient ischemic attacks were reported in 24% of the operated patients. The most important factor for the lack of improvement was the occlusion of the bypass. Continuation of transient neurologic symptoms could be observed in only 14% of the patients with intact carotid-subclavian bypass. In conclusion, indications for surgical treatment of the subclavian steal syndrome should be restricted to cases in whom vertebrobasilar transient ischemic attacks occur frequently and are either debilitating or greatly frighten the patient.

Arterial Occlusive Diseases↗
PubMed1987

[Percutaneous transluminal coronary angioplasty and aortocoronary bypass surgery in unstable angina pectoris and coronary multivessel disease].

In 113 patients demonstrating the clinical syndrome of unstable angina, acute-stage coronary angiography revealed multivessel disease. Acute PTCA of the ischaemia-related coronary artery or bypass grafting was performed depending on angiographic criteria. Of the total of 68 patients in whom PTCA was performed, 45 had two-vessel disease (2 vd) and 23 three-vessel disease (3 vd). 12 of the 45 patients with bypass operation had a left main stem stenosis, whereas 33 had three-vessel disease. The primary success rate of PTCA was 81%, 89% in patients with 2 vd and 70% in patients with 3 vd. Acute post-PTCA bypass grafting was necessary in 2 patients having 2 vd and in 5 patients suffering from 3 vd. 5 of the 68 patients treated with PTCA developed a transmural myocardial infarct and one patient died after PTCA and emergency bypass surgery. 8 of the 45 operated patients had a perioperative or postoperative myocardial infarct and 5 patients died intraoperatively or postoperatively. The overall morbidity was 11.5%, and the mortality of hospitalised patients was 5.3% (6/113). Combination of PTCA with emergency bypass grafting offers a new and effective treatment with an acceptable risk even in multivessel disease patients and in those having unstable angina pectoris. The additional use of PTCA definitely improves therapeutic management in this high-risk population.

Angina Pectoris↗
PubMed1987

[Bilateral obstruction of the ureters as a complication of iliac aneurysms].

A case of bilateral obstruction of the ureters secondary to iliac aneurysms is reported. While perianeurysmal fibrosis in so-called "inflammatory" aneurysms causes the obstruction in most cases, this is a report on a case of compression of both ureters by huge aneurysms without inflammatory reaction. Recurrent back pain of urinary type is the first symptom in 75% of the cases. Ultrasonography shows hydronephrosis and deviation of the ureters as well as the aneurysms. Intravenous pyelography, angiography and CT-scan are necessary to show the real size of the ureters and the aneurysm. Treatment of choice is resection of the aneurysm and replacement by a prosthesis. Ureterolysis may be necessary if the ureters are enveloped by perianeurysmal fibrosis.

Aneurysm↗
PubMed1987

[Cardiovascular manifestations of pseudoxanthoma elasticum (Grönblad-Strandberg syndrome)].

Pseudoxanthoma Elasticum (PXE) is a rare inherited disease with generalized degeneration of the elastic fibers. Typical changes occur in the skin and the eyes, but 25% of all cases present an involvement of the peripheral arteries. A typical case of familiar PXE is presented. Changes can occur in nearly all arteries, but involvement of the arteries of the leg, arm, foot and hand are most common. Usually, the symptoms are the same as in the peripheral arterial occlusive disease, but 70% of the patients are less than 35 years old. Angiography shows calcifications of the arteries with multiple stenoses and occlusions but also a very well developed system of collateral arteries. Involvement of abdominal arteries causes recurrent hemorrhage. Changes in the coronary artery system cause myocardial infarction and sudden death in children and young adults. Changes of the mitral, aortic and tricuspid valve and the endocard have been described. As the evolution of the disease is very slow and the system of collateral arteries is usually well developed, operation (i.e. femoro-popliteal bypass, aorto-coronary bypass) is in most cases not necessary.

Arterial Occlusive Diseases↗
PubMed1987

Complications and efficacy of transsternal thymectomy in myasthenia gravis.

Between January 1977 and September 1985, 75 patients in our department underwent elective surgery for myasthenia gravis through a median sternotomy. The main prerequisite was optimal stabilization by medical treatment with the best possible vital capacity. The Osseman types were as follows: type I (22), type IIa (19), type IIb (26), type III (7), and type IV (1). All patients, except for 3 who were mechanically ventilated for a few hours after surgery, were immediately extubated at the end of the operation. The most frequent histologic finding was thymic hyperplasia (36%); 21.3% of the patients had thymomas. No surgery-related deaths occurred. Wound healing was impaired in 6.7% of the patients, including one patient with complete sternal instability, while 5.3% developed pneumonia. The most serious complications were myasthenic (9.3%) and cholinergic (2.7%) crises. Paresis of the phrenic (2.7%) and recurrent laryngeal (1.3%) nerves occurred only in the thymoma patients, who also had a higher frequency of all other complications. The effect on the myasthenic symptoms 3 months after surgery was as follows: 7.5% of the patients were in complete remission, 61.2% had improved, 9% had deteriorated. In a logistic regression model, the parameters age, sex, duration of disease, Osserman type, histology, pre-operative antibody titer to acetylcholine receptors, and post-operative change in titer were examined with respect to their influence on the effect of surgery. Only thymic histology had an appreciable influence (p = 0.057). The effect of these parameters on the success of surgery as well as the type and frequency of complications in relation to perioperative procedure are discussed in detail.

Adolescent↗
PubMed1987

[Thymoma--a retrospective study of 48 cases].

Of the 48 thymomas operated on between 1968 and 1985 50% were associated with myasthenia gravis, in 25% diagnosis was made due to accidental X-ray findings. In the staging according to Masaoka et al. [10] the following distribution was noted: I:22, II:5, III:18, IV:3. The 5-year survival rate of the 37 curatively resected patients was 78.5% (stage I: 88.6%, stage III: 55.6%). No stage III patient with residual tumor survived more than 2 years. Predominantly epithelial tumors had a significantly worse prognosis as compared to those with lymphocytic predominance. None of the 4 patients with category II thymoma survived more than 15 months. Association with myasthenia proved to have a negative prognostic influence in stage I and II patients. Frequency of local recurrences and metastases is documented. The value of irradiation and chemotherapy is discussed.

Adolescent↗