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Biomedical subjects

C Huth

Publications and source records attributed to C Huth.

At least 55 records · Page 3Linked to original sources
PubMed1987

[Penetrating chest injuries--an indication for early thoracotomy].

Indication for thoracotomy is undisputed in cases of gaping wounds with massive haemorrhage. However, discrete stab and gunshot wounds may quite often conceal imminent pericardial tamponade. Three quarters of all penetrating thorax injuries are located in or close to the cardiac silhouette. When it comes to patients with circulatory conditions of good stability, management of superficial wounds may cost valuable time and cause delay to thorough revision of the cardiac injury which usually would be possible without extracorporeal circulation. Success of that revision may then be limited due to tamponade-related impairment of cerebral perfusion and subsequent ischaemic brain damage. The risk implied in early exploratory thoracotomy was found to be low, as compared to the risk emanating from pericardial tamponade in cases of stab wounds in the cardiac region. Hence, early thoracotomy is generally indicated and should be generously decided to handle penetrating wounds of the chest. Superiority of early thoracotomy in handling penetrating thorax injuries is demonstrated in this paper by six of the authors' own patients. While relief of cardiac tamponade is possible by pericardiocentesis, immediate and safe restoration of blood volume through a central vein or the right atrium, control of haemorrhage, and definite repair of the cardiac defect can be achieved only by thoracotomy.

Adult↗
PubMed1986

[Acute mitral valve insufficiency caused by a broken mitral valve prosthesis].

Breaks in a mechanical heart valve prosthesis with resulting acute valvar insufficiency are extremely rare. The case is reported of a 49-year-old man who, two-and-a-half years after implantation of a mitral valve prosthesis, suddenly went into acute cardiogenic shock, after having been in good health since the valve replacement. Although the symptoms were unequivocal, the correct diagnosis was not made for more than 40 hours. Emergency re-operation could not prevent death from severe interstitial pulmonary oedema with hyaline membranes. Within the last 20 years 25 similar cases have been reported.

Acute Disease↗
PubMed1986

[Biatrial myxomas--a diagnostic challenge].

Like isolated cardiac myxoma, biatrial myxoma may manifest itself only by extracardiac symptoms over a prolonged period. A 24-year-old patient presented over seven years a history of repeated arthalgia with concomitant anaemia, elevated blood sedimentation rate, positive antistreptolysin test and electrophoretic signs of inflammation. A discrete systolic sound on auscultation gave rise to an echocardiographic examination which revealed a biatrial myxoma.

Adult↗
PubMed1986

[Stab injuries of the heart--an indication for thoracotomy].

The indication for thoracotomy is undisputed with gaping wounds and massive hemorrhage. Pericardial tamponade, however, can develop with discrete stab wounds. Since valuable time is lost during management of superficial wounds, the success of cardiac wound revision, which is usually possible without a pump-oxygenator, is limited due to the tamponade-related reduction of cerebral perfusion and subsequent ischemic brain damage. Exploratory thoracotomy, the risks from which are small compared to those from pericardial tamponade, is generally indicated for stab wounds of the heart.

Adult↗
PubMed1986

[Clinical course following thymoma extirpation].

The authors report on 48 thymomas operated on between 1968 and 1985. The survival curve of the 37 (77.1%) totally resected patients showed a marked decrease during the first year postoperatively to 85.8%. The 5-year-survival-rate was 78.5%. Predominantly epithelial thymomas had a significantly worse prognosis than those with lymphocytic predominance. Associated myasthenia gravis (21 of the totally resected patients) as well as invasion beyond the capsule proved to be of negative prognostic significance. Even in cases of gross invasion into neighbouring organs a curative resection was followed by a markedly better prognosis than a mere biopsy or partial resection plus radiotherapy.

Follow-Up Studies↗
PubMed1985

[Unusual rhythm disorders with a DDD pacemaker].

A tachycardia caused by an inadvertent change of the lead connections in a patient with a DDD pacemaker is reported. This was demonstrated by operating in different modes (i.e. AOO, VOO) by displaying the marker channel graphically and by X-ray examination revealing unchanged lead positions.

Electrocardiography↗
PubMed1983

Local hemostasis with fibrin glue after intracardiac repair of tetralogy of Fallot and transposition of the great arteries.

In the last year fibrin glue Tissucol was used for local hemostasis in 21 patients subjected to correction of tetralogy of Fallot (ToF) and in 10 patients subjected to Senning-procedure in transposition of the great arteries (TGA). The postoperative blood loss was compared with the blood loss of 20 ToF-patients and 10 TGA-patients who had undergone correction one year ago without fibrin glue. Between the 2 groups were no differences in age, sex, bodyweight (BW), coagulation state or operative management. Two hours postoperatively the blood loss with fibrin glue was 2.2 ml/hr/kg BW in ToF-patients and 2.4 ml/hr/kg BW in TGA-patients, whereas without fibrin glue it was 4.2 ml/hr/kg BW in ToF (p less than 0.01) and 4.5 ml/hr/kg BW in TGA (p less than 0.01). The same significant difference (p less than 0.01) was found 6 hours postoperatively with 1.4 versus 2.2 ml/hr/kg BW in ToF and 1.9 versus 2.5 ml/hr/kg BW in TGA. Over the following 18 hours the secretion from the chest tubes was identical in both groups. Six patients with ToF and one patient with TGA required reoperation for bleeding. The blood loss per kg BW per hour at reoperation was 6.9 ml with and 8.2 ml without fibrin glue (N.S.). The blood loss of patients who did not require reoperation at the same time was 4.6 times lower with fibrin glue and only 3.7 times lower without fibrin glue. Fibrin glue reduces blood loss after intracardiac repair of ToF and TGA by local hemostasis at patches and suture lines. The application of fibrin glue can facilitate differentiation of surgical bleedings and the indication for reoperations.

Child↗
PubMed1980

[Influence of left atrial pressure on left ventricular function after extracorporeal circulation (author's transl)].

In 10 patients with coronary heart disease, in 9 with advanced mitral and in 11 with aortic valve disease left ventricular function curves were constructed by volume loading immediately after cardiopulmonary bypass. After aortocoronary bypass surgery an approximately linear correlation between both cardiac index and stroke volume index and left ventricular filling pressure was demonstrated. After aortic and mitral valve replacement increase in left ventricular filling pressure above 15 mm Hg failed to result in significant increase in CI and SVI. Apparently, volume loading has limited effects in regulating left ventricular function in advanced aortic and mitral valve disease.

Atrial Function↗
PubMed1979

Ultrastructural and biochemical changes of human papillary heart muscle during different methods of induced cardiac arrest.

To determine the protective effects of different methods of cardioplegia, studies on ATP/lactate levels and ultrastructure were performed in human papillary muscles obtained during mitral valve replacement. In group I (n = 5), plain ischemic arrest in hypothermia (systemic venous temperature = 24 degrees C) was accomplished. In group II (n =12), the heart was arrested by injection cardioplegia using magnesium-aspartate-procaine at systemic venous and myocardial temperatures of 24 degrees C. In group III (n = 12) Bretschneider infusion cardioplegia at systemic venous and myocardial temperatures of 26 degrees C and 19 degrees C respectively was applied. With regard to ultrastructural changes there were no clearcut differences in the three methods of hypothermic cardiac arrest after 60 minutes of ischemia. Ischemic changes tended to be slightest in group III (infusion cardioplegia). ATP decay and lactate increase were significant in group I and moderate to minimal in groups II and III after the same period of time. It is concluded that for aortic cross-clamp times up to 60 minutes, body hypothermia and injection cardioplegia using magnesium-aspartate-procaine at a myocardial temperature of 24 degrees C provide adequate protection of the myocardium. For ischemia times beyond 70 minutes, profound myocardial hypothermia below 20 degrees C is preferred.

Adenosine Triphosphate↗
PubMed1978

[The protective effect of magnesium-aspartate-procaine cardioplegia on the hypertrophied left ventricle of the mini-pig (author's transl)].

After induction of left ventricular hypertrophy by supravalvar constriction of the ascending aorta in mini pigs (ATP and lactate) were measured under different cardioplegic conditions. In normothermia and plain anoxic arrest ATP decrease and lactate increase were significantly slower in hypertrophied myocardium compared to normal myocardium. Injection cardioplegia using magnesium-aspartate-procaine at 37 degrees C did not influence the ATP decrease and lactate increase in the hypertrophied ventricle, whereas in the normal heart it showed some protection according to these parameters. Optimal ATP preservation and the lowest lactate increase rate were achieved in left ventricular hypertrophy by combined application of magnesium-aspartate-procaine and hypothermia of 25 degrees C. We conclude that normothermic injection cardioplegia has no protective effect on the hypertrophied left ventricle, whereas additional hypothermia can improve magnesium-aspartate-procaine cardioplegia significantly.

Adenosine Triphosphate↗
PubMed1978

[Behaviour of ATP and lactate in human papillary muscle during profound hypothermia and injection cardioplegia with magnesium-asparatate-procaine (author's transl)].

In 53 patients with mitral- or aortic-mitral valve disease, the content of ATP and lactate of the papillary muscles resected at the time of valve replacement was investigated at the beginning of ischemic arrest and at the time of reperfusion. Profound body hypothermia (25 degrees C) and injection cardioplegia using magnesium-aspartate-procaine were applied for myocardial protection. In hypertrophic papillary muscles the myocardial ATP content decreased at a slower rate (ATP decay 12% of the initial value after 60 minutes of ischemia) than in normal papillary muscles obtained from patients with isolated mitral stenosis (ATP decay 33% of the initial value after 40 minutes of ischemia). 20% of the patients required temporary inotropic circulatory support postoperatively for 12 to 88 hours. The ATP content of the papillary muscles of these patients differed only little from those, in who no myocardial failure occurred. However the myocardial lactate levels were higher in patients in whom a low cardiac output state evolved.

Adenosine Triphosphate↗
PubMedDate not supplied

Load independence of radionuclide diastolic filling measurements in acute coronary occlusion.

BACKGROUND: An accurate noninvasive method for measuring the effects of pharmacologic agents on active relaxation of the left ventricle would provide a valuable tool for monitoring the treatment of diastolic heart failure related to coronary artery disease. METHODS AND RESULTS: The time constant of isovolumic relaxation (T) and the left atrioventricular gradient were measured with micromanometer catheters and diastolic left ventricular filling variables were measured with radionuclide ventriculography in nine anesthetized, open-chest dogs with an acute coronary artery occlusion. Infusion of the positive inotropic drug dobutamine hydrochloride (5 to 10 micrograms/kg/min) resulted in a 35% shortening of T and a 37% increase in the radionuclide first-half filling fraction (both p < 0.05), but no change in the left atrioventricular gradient. Conversely, infusion of the alpha-adrenergic vasoconstrictor phenylephrine hydrochloride (20 to 40 micrograms/min) augmented left ventricular load, increasing the atrioventricular gradient by 45%, but had no significant effect on T or the first-half filling fraction. Infusion of the direct-acting vasodilator, sodium nitroprusside (80 to 120 micrograms/min), was accompanied by a 14% lengthening of T with a corresponding 28% decrease in the first-half filling fraction (both p < 0.05). CONCLUSION: In an anesthetized, open-chest canine model of acute myocardial ischemia, the radionuclide first-half filling fraction reflects pharmacologically induced changes in the lusitropic state of the left ventricle with relative independence of loading conditions.

Acute Disease↗
PubMedDate not supplied

[Pacemaker therapy in children].

Between 1975 and June 1987 55 children underwent first permanent pacemaker (PM) implantation. The patients' age at time of implantation ranged between 1 month and 17 1/2 years (mean 5 5/12 years). In all cases - except a 17 years old girl who received a transvenous endocardial lead - only epicardial screw-in electrodes were used. Only VVI-PM have been implanted. In 84% the indication for implantation was post-surgical brady-arrhythmia, in 16% it was an inborn or acquired disturbance of the conducting system. With our patients we have a survey of 2603 months of PM implantation. During this period 14 children underwent totally 20 revisions, in 50% the electrode was the cause of failure. The interval between two revisions calculated as a quotient from months of PM implantation and number of revisions has increased significantly during the last years and amounts now to 130 months. The relative low incidence of revisions is in our opinion mostly related to the nearly exclusive use of epicardial leads.

Adolescent↗