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Biomedical subjects

C Seiler

Publications and source records attributed to C Seiler.

At least 109 records · Page 6Linked to original sources
PubMed1995

[Hypertrophic cardiomyopathy: spontaneous course].

Hypertrophic cardiomyopathy is a relatively rare (prevalence approximately 0.2%), primary myocardial disorder with an autosomal pattern of inheritance, characterized by mostly asymmetric left ventricular hypertrophy with myocyte and myofibrillar disarray. To date, about 34 mutations of the beta-cardiac myosin heavy chain gene have been described and shown to have prognostic implications. The disease has an annual mortality rate of 3%, related to both sudden cardiac death and progressive systolic dysfunction. Not only diastolic but also progressive systolic dysfunction with cavity dilatation occurs in a minority of patients with severe hypertrophy during the long-term course. Sudden death often occurs in young, asymptomatic or mildly symptomatic patients. The degree of hypertrophy and the presence of a pressure gradient are of little prognostic significance. Nonsustained ventricular tachycardia is associated with a poor prognosis in the presence of a history of syncope.

Adolescent↗
PubMed1995

[Severe, predominantly aortic stenosis without left ventricular hypertrophy (LVH): effect of LVH definition].

210 out of approximately 16,000 Doppler echocardiographic examinations between 1989 and 1992 at the University Hospital of Zurich, Switzerland, produced the diagnosis of severe, longstanding and predominant aortic stenosis with a mean transvalvular pressure gradient of > or = 50 mm Hg. These patients, who had no significant valvular heart disease other than aortic stenosis and no coronary artery disease, were investigated for the prevalence and for existing gender predominance of absent left ventricular hypertrophy (LVH) using eight different, clinically established and validated definitions for LVH. 4 to 44% of all study patients were found to have absent LVH depending on how LVH was defined. There was no gender predominance in patients without LVH if a gender-specific LVH definition was used. Defining absent LVH as LV mass index < 109 g/m2 body surface area (for women) and < 134 g/m2 body surface area (for men) combined with relative LV wall thickness < 0.45, the prevalence of absent LVH amounted to 4% (9/210 patients). The majority of patients had concentric LVH (132/210), 57/210 patients had excentric LVH, and 12/210 had concentric LV remodeling. There was a significant inverse association between the time elapsed since diagnosis of aortic stenosis and the finding of absent LVH. However, average duration since diagnosis of aortic stenosis in patients without LVH was quite long averaging 3.2 years. Therefore, factors other than duration of the disease and not investigated in this study seem to be more closely related to the absence of LVH.

Aged↗
PubMed1995

Injury to the diaphragm and its repair during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy has now become the "gold standard" for the treatment of gallstone disease. Parallel with the conversion from the open to laparoscopic technique, some complications peculiar to the laparoscopic approach have been experienced. Such a technique-related complication, resulting in an injury to the diaphragm and its repair during laparoscopic cholecystectomy is presented.

Acute Disease↗
PubMed1995

Exercise-induced vasomotion of angiographically normal and stenotic coronary arteries improves after cholesterol-lowering drug therapy with bezafibrate.

OBJECTIVES: We attempted to determine whether the coronary vasomotor response to exercise improves after cholesterol-lowering drug therapy with bezafibrate. BACKGROUND: Hypercholesterolemia and other coronary risk factors are associated with impaired endothelium-dependent coronary vasomotor response to physiologic or pharmacologic stimuli, even in the absence of overt coronary atherosclerosis. It is still unknown whether the coronary artery vasomotor response to dynamic exercise improves under cholesterol-lowering drug therapy. METHODS: Of 15 male patients (age 51 +/- 7 years [mean +/- SD]) included in the study, 7 had markedly elevated cholesterol levels (> or = 6.5 mmol/liter, therapy group), and 8 had normal or slightly elevated cholesterol levels (< 6.5 mmol/liter, control group). At baseline and after 7 months of cholesterol-lowering therapy with bezafibrate (400 mg/day) in the therapy group, coronary vasomotor response to dynamic exercise (percent change in cross-sectional vascular area at maximal exercise vs. rest [100%]) in normal and stenotic, previously dilated vessels was assessed by quantitative coronary angiography. RESULTS: During follow-up, total serum cholesterol levels in the therapy group decreased from 7.8 +/- 1.1 to 5.8 +/- 1.1 mmol/liter (p = 0.0001) and did not change significantly in the control group (from 5.4 +/- 0.9 to 6.0 +/- 1.2 mmol/liter, p = NS). Exercise-induced vasomotor response (at similar work loads in the therapy and control groups) in both normal and dilated stenotic coronary arteries improved significantly in the therapy group, from 100 +/- 9% to 109 +/- 7% (p = 0.0001, cross-sectional area at rest 100%) and from 80 +/- 11% to 106 +/- 7% (p = 0.0002), respectively, but did not improve during follow-up in the control group. CONCLUSIONS: The present study indicates that cholesterol-lowering drug therapy with bezafibrate for 7 months improves exercise-induced vasomotion of angiographically normal coronary arteries. Seven months after coronary angioplasty, the reduction in serum cholesterol levels is, at least in part, associated with a restoration of the initially disturbed vasomotor response of stenotic vessel segments to exercise.

Bezafibrate↗
PubMed1995

Gerstmann-Sträussler-Scheinker disease (PRNP P102L): amyloid deposits are best recognized by antibodies directed to epitopes in PrP region 90-165.

Gerstmann-Sträussler-Scheinker (GSS) disease is a familial neurological disorder pathologically characterized by accumulation of prion protein (PrP) in the form of fibrillary and non-fibrillary deposits within the cerebrum and cerebellum. We have studied two patients in whom the disease is caused by a leucine for proline amino acid substitution at residue 102 of PrP. In both patients, the neuropathologic findings are similar, consisting of spongiform changes, amyloid deposits, and gliosis. To investigate the antigenic profile of PrP deposits, we used antibodies raised against several peptides that correspond to segments of the N-terminus, repeat region, midregion, and C-terminus of PrP. By immunohistochemistry, PrP amyloid cores are best labeled by antibodies directed to epitopes spanning PrP residues 90-165. In GSS disease caused by a substitution of thymine to cytosine at PRNP codon 198 (Indiana kindred), the major amyloidogenic peptide spans residues 58-150; therefore, in these two genetic forms of GSS disease, amyloid may be composed of different peptides.

Adult↗
PubMed1995

Left ventricular chamber dilatation in hypertrophic cardiomyopathy: related variables and prognosis in patients with medical and surgical therapy.

BACKGROUND: To determine the incidence and prognosis of left ventricular dilatation and systolic dysfunction in 139 patients with hypertrophic cardiomyopathy during long term follow up. METHODS: Left ventricular chamber dilatation and systolic dysfunction (both together referred to as left ventricular chamber dilatation) were determined echocardiographically. Chamber dilatation was defined as an increase in the left ventricular end diastolic diameter of > 2% per year combined with a decrease in midventricular systolic fractional shortening of > 2% per year of follow up [10.3 (SD 6) years]. The predictive value for left ventricular chamber dilatation of clinical, invasive, and echocardiographic variables and its prognosis were assessed. RESULTS: In 119 of 139 individuals (86%), left ventricular chamber size and systolic function remained stable (group 1), and in 20/139 patients (14%) left ventricular chamber dilatation occurred during follow up (group 2). At baseline examination, symptoms such as dyspnoea and syncope occurred less often in group 1 than in group 2; New York Heart Association classification was lower in group 1 than in group 2 (P = 0.001). Left ventricular mass index relative to sex specific normal values was increased by 18% in group 1 and by 41% in group 2 (P = 0.04). Cumulative survival rates were slightly although not significantly higher in group 1 than in group 2. Event-free survival was significantly higher in group 1 than in group 2 (P < 0.05). CONCLUSIONS: (1) The development of left ventricular chamber dilatation and systolic dysfunction in hypertrophic cardiomyopathy occurs in approximately 1.5% of the patients per year. (2) Factors associated with left ventricular dilatation are dyspnoea, syncope, a higher functional classification, and a higher degree of left ventricular hypertrophy. (3) Patients with chamber dilatation have a worse prognosis than those without, particularly regarding quality of life.

Adolescent↗
PubMed1994

Recurrent laryngeal nerve palsy after thyroid gland surgery.

Risk factors for recurrent laryngeal nerve (RLN) lesions after thyroid gland surgery were evaluated retrospectively in 1026 patients. RLN palsy occurred in 5.9 per cent; the incidence of permanent palsy was 2.4 per cent as 59 per cent of paralyses were transient. For euthyroid nodular goitre, Graves' disease, chronic lymphocytic thyroiditis, recurrent goitre and thyroid carcinoma, permanent nerve damage occurred in 1.7, 4, 5, 3.8 and 8 per cent of patients respectively. In relation to the number of nerves at risk, the incidence of permanent RLN palsy was 1.1 per cent for subtotal lobectomy and 4.0 per cent for total lobectomy. The overall incidence of permanent RLN palsy was 1.8 per cent of nerves at risk. There was no statistically significant difference between the number of RLN paralyses occurring after nerve exposure and that occurring after non-exposure in subtotal lobectomy, but in total lobectomy the permanent palsy rate increased from 3.8 to 7 per cent when the nerve was not exposed or identified (P < 0.01). Underlying thyroid disease, the extent of resection and exposure of the nerve in total lobectomy are risk factors for both transient and permanent RLN palsy.

Adolescent↗
PubMed1994

[Second look laparoscopy after mesenteric infarct].

Second-look laparotomy is not always routinely performed after mesenteric infarction. Such operations are often not performed because of the high operative risk in aged patients and those with cardiovascular disease. We developed a minimally invasive technique for second-look laparoscopy with the aim of decreasing the operative morbidity. With the patient under general anaesthesia, the old incision is opened at the umbilicus. The running suture in the abdominal wall is lifted with a clamp and the incision line is gently reopened. A trocar with a blunt tip designed for open laparoscopy is then inserted and fixed. Following insufflation of CO2 through the trocar it is possible to explore the entire small bowel and colon. We operated on five patients after bowel resection performed for mesenteric infarction. Second-look laparoscopy was diagnostic in all but one, in whom laparoscopy failed due to massive small bowel dilatation. The technique described here is very promising and deserves further evaluation.

Aged↗
PubMed1994

Cholecystocholangiography vs cystic duct cholangiography during laparoscopic cholecystectomy. A prospective controlled trial.

Intraoperative cholangiography performed during laparoscopic cholecystectomy provides an exact picture of the biliary anatomy. It may prevent iatrogenic bile duct injury and detect unsuspected common duct stones. Laparoscopic cannulation of the cystic duct can be difficult and time-consuming. We therefore evaluated the simpler technique of cholecystocholangiography by direct puncture and filling of the gallbladder with contrast medium. This technique was compared with cystic duct cholangiography in a prospective controlled trial of 69 patients. Cystic duct cholangiography (n = 38) showed significantly better results than cholecystocholangiography (n = 31) with optimal visualization of the biliary tree in 29 cases (76%) and seven cases (22%), respectively. The failure rate was 8% and 52%, respectively. Delineation of the cystic duct junction is important in order to prevent bile duct injury. The anatomy in this region was clearly delineated in 34 cases (89.5%) using cystic duct cholangiography but only in 11 cases (35.5%) with cholecystocholangiography. Cystic duct cholangiography revealed unsuspected common duct stones in three cases; however, choledocholithiasis was missed by cholecystocholangiography in at least two patients. Cystic duct cholangiography is clearly the optimal technique. In situations of unclear anatomy in which safe dissection of the cystic duct is not possible, cholecystocholangiography remains a useful alternative.

Adult↗
PubMed1994

Risk stratification in hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy is a primary myocardial disorder with an autosomal pattern of inheritance, characterized by asymmetric left ventricular hypertrophy with myocyte and myofibrillar disarray. Approximately 30% to 50% of all cases are accounted for by mutations in the beta-cardiac myosin heavy chain gene on chromosome 14q1. Recent linkage analysis led to the association of the disease with additional loci on chromosomes 1q3, 11p13-q13, and 15q2, but the underlying gene defects are as yet unidentified. To date, about 34 mutations of the beta-cardiac myosin heavy chain gene have been described and shown to have important prognostic implications. Definite genotype-phenotype correlations have been described; however, wide diversity in cardiac morphology, pathophysiologic features, and clinical manifestations is still evident, even within the same family. The disease has an annual mortality of approximately 3%, related to both progressive heart failure and sudden cardiac death. Not only diastolic but also progressive systolic dysfunction with cavity dilatation occurs in a minority of patients with severe left ventricular hypertrophy. These patients usually have a poor prognosis, especially when atrial fibrillation ensues. Sudden death often occurs in young, asymptomatic or mildly symptomatic patients. The degree of hypertrophy and the presence of a pressure gradient are of little prognostic significance. Nonsustained ventricular tachycardia is associated with a poor prognosis in the presence of a history of syncope.

Arrhythmias, Cardiac↗
PubMed1994

[Formation of a neofascia after implantation of a composite patch in the inguinal region].

In this study, a novel patch material composed of polyglactin 910 and polydioxanon was tested in animal experiments for its use in the surgical repair of hernias. The material was implanted laparoscopically into the inner inguinal region of three hybrid running-pigs. No postoperative complications were observed. The animals were killed 14 and 48 days after surgery. Both the macroscopic and microscopic examination showed a de novo formation of connective tissue at the site of implantation, which may be regarded as a new fascia. Due to the cooperation of fibroblasts and free cells of the connective tissue, new intercellular matrix was formed after the resorption of the implanted material. A model of this cell cooperation is outlined in the study. The technical advantages of the implantation material are demonstrated and its benefits for minimally invasive surgery emphasized. Because of its special properties, the material may be recommended for later clinical traits in the surgery of fascia.

Animals↗
PubMed1994

[Candida infection in surgery].

Candida sepsis in surgical patients is rare, but accounting for a high lethality. The diagnosis of a candidemia is based by most authors upon two positive blood cultures in 24 h or on proof of fungi in an organ parenchyma or a normally sterile body cavity. The risk factors for the development of a candida sepsis are administration of broad spectrum antibiotics, invasive monitoring, underlying diseases affecting the immune response and surgery itself. We have checked the charts of 22,740 patients of our clinic from 1987-1992. We found 11 patients (6 male, 5 female) with a mean age of 53.2 (34-76) years with a candida sepsis. The known risk factors for the development of a candida sepsis could be confirmed: broad spectrum antibiotics 100%, invasive monitoring 100%, condition after operation 64%, nasogastric tube 54%, condition after endoscopy 45%, steroid medication 36%. Lethality was 27% (3/11); two out of three patients with a multiple organ system failure died. Recently, it has been shown that mortality was associated with older age and concomitant multiple organ system failure. The treatment of choice for fungal sepsis is intravenous amphotericin B. Finally therapeutic guidelines, the indication for a selective bowel decontamination and the question of prophylaxis with antifungal agents in all postoperative patients are discussed.

Adult↗
PubMed1994

[Postgastrectomy symptoms after partial stomach resection: Billroth I vs. Billroth II vs. reconstruction with roux-Y-loop].

We clinically followed 53 patients after a mean time of 3 years for postgastrectomy symptoms concerning 10 criteria including the Visick grading, dumping after Sigstad, efferent and afferent loop-syndrome, bile reflux, regurgitation and life-quality judged by the patient and the examiner. In our study we included 15 patients after a Billroth I, 15 after Billroth II, 15 patients after a Roux-en-Y reconstruction and 8 patients with a Roux-en-Y reconstruction because of severe disturbance of life quality after a primary Billroth II operation. The Roux-en-Y reconstruction showed significantly better results when compared to Billroth I and especially Billroth II reconstruction (p < 0.05). These results compare well with reports in the literature, where generally only one or two criteria are examined. We conclude that partial gastrectomy with Roux-en-Y reconstruction should be the preferred method provided that the procedure is adequate for the pathology found.

Adult↗
PubMed1993

Measurement from arteriograms of regional myocardial bed size distal to any point in the coronary vascular tree for assessing anatomic area at risk.

OBJECTIVES: To obtain the size of regional myocardial mass for individual coronary arteries in vivo. BACKGROUND: The anatomic site of occlusion in a coronary artery does not predict the size of the risk area because location of the occlusion does not account for the size of the artery or of its dependent myocardial bed. METHODS: Intracoronary radiolabeled microspheres were injected and coronary arteriograms were quantitatively analyzed by semiautomated methods. The coronary artery lumen areas and the sum of epicardial coronary artery branch lengths distal to the points where radiomicrospheres had been injected were determined from both in vivo and postmortem coronary arteriograms. Regional myocardial mass distal to the point of each microsphere injection was correlated with corresponding distal summed coronary branch lengths and with coronary artery lumen areas. RESULTS: 1) Regional myocardial mass was closely and linearly related to sum of coronary artery branch lengths distal to any point in the coronary artery tree and therefore could be determined for any location on a coronary arteriogram. 2) The fraction of total left ventricular mass at risk distal to a stenosis could be determined from the corresponding fraction of total coronary artery tree length independently of the scale or X-ray magnification used to measure absolute branch lengths. 3) Cross-sectional lumen area at any point in the left coronary artery tree was closely related to the size of the dependent vascular bed with a curvilinear relation similar to that observed in humans with normal coronary arteriograms. CONCLUSIONS: On coronary arteriograms, the anatomic area at risk for myocardial infarction distal to any point in the coronary artery tree can be determined from the sum of distal coronary artery branch lengths. There is a curvilinear relation between coronary artery lumen area and dependent regional myocardial mass comparable to that in humans, reflecting fundamental physical principles underlying the structure of the coronary vascular tree.

Animals↗
PubMed1993

Gastrointestinal hemorrhage due to splenic artery aneurysm pancreatic duct fistula in chronic pancreatitis. A case report and review of the literature.

Gastrointestinal hemorrhage due to splenic artery aneurysm pancreatic duct fistula in chronic pancreatitis is rare. It is, however, important to diagnose this condition particularly in patients having chronic pancreatitis, since it may result in a life-threatening situation. The diagnosis is usually difficult to establish and it may take repeated admissions for intermittent gastrointestinal bleeding until the real source is recognized. Clinical attacks of epigastric pain followed by GI-bleeding 30-40 minutes later are characteristic. Occasionally these attacks are followed by transient jaundice. The present case report describes this rare complication and reviews the current literature.

Aneurysm↗
PubMed1993

Influence of serum cholesterol and other coronary risk factors on vasomotion of angiographically normal coronary arteries.

BACKGROUND: It has been shown that there is impairment of the vasodilatory response to acetylcholine in patients with hypercholesterolemia and angiographically normal coronary arteries. Moreover, in patients with angiographically smooth coronary arteries, the number of coronary risk factors is associated with a loss of endothelium-dependent vasodilation. The purpose of the present analysis was to evaluate in patients with and without coronary artery disease coronary vasomotor response to dynamic exercise in angiographically normal and stenosed coronary arteries and to relate the response to serum cholesterol levels as well as to other coronary risk factors. METHODS AND RESULTS: Luminal area change during exercise (delta-ex, percent change compared with rest = 100%) was determined by biplane quantitative coronary arteriography in three groups: Group 1 consisted of 14 patients with normal total serum cholesterol of < 200 mg/100 mL; mean, 173 mg/100 mL (mean age, 51 years). Group 2 comprised 23 patients with a slightly elevated cholesterol of 200 to 250 mg/100 mL; mean, 223 mg/100 mL (mean age, 53 years). Group 3 had 24 patients with markedly elevated cholesterol of > 250 mg/100 mL; mean, 288 mg/100 mL (mean age, 54 years). Serum cholesterol levels and categorical risk factors such as positive family history, history of hypertension, smoking, obesity, and diabetes were related to exercise-induced vasomotor response. The three groups did not differ with regard to clinical characteristics, exercise work load, and hemodynamic data measured during exercise. However, delta-ex in normal vessels was significantly different between all three groups (ANOVA, P < .01): +31% (group 1), +18% (group 2), and +4% (group 3). Delta-ex in stenotic vessels did not differ between the groups: -5% (group 1), -13% (group 2), and -12% (group 3). Delta-ex of the nonstenosed vessel correlated significantly and inversely with total cholesterol, with low-density lipoprotein cholesterol, with the ratio of total to high-density lipoprotein cholesterol, and with the number of coronary risk factors present in a patient. High total cholesterol and a history of hypertension were independent risk factors for impaired coronary vasomotion. CONCLUSIONS: In patients with and without coronary artery disease, hypercholesterolemia and a history of hypertension independently impair exercise-induced coronary vasodilation in angiographically normal coronary arteries. In the stenotic vessel, vasomotion during exercise does not appear to be influenced by the actual serum cholesterol. The precise mechanism by which the impaired vasomotion of the angiographically normal coronary arteries is mediated is unknown, but a direct negative effect of hypercholesterolemia on endothelial function or early undetected atherosclerosis appears to be the most likely explanation.

Cholesterol↗
PubMed1993

[The value of conservative therapy, surgical treatment and interventional radiology in perforations and ruptures of the esophagus].

We have reviewed all the records of 23 patients hospitalized in our institution from January 1981 till December 1991 and presenting a confirmed diagnosis of esophageal perforation. We have studied the aetiology, the localization, morbidity and mortality and we discuss the therapeutic management. 9 patients presented a cervical perforation, 13 patients a thoracic perforation and 1 patient an abdominal perforation. Among the patients with cervical perforation 2 patients had a local revision with drainage, 3 patients a primary suture and 4 patients were treated conservatively. No complication was found in this group. The patients with thoracic perforation have been treated as follow: 3 conservatively, 8 with thoracotomy, primary suture +/- patch, drainage, 2 patients with thoracotomy and drainage alone. All complications happened in this group: 2 gastro-intestinal bleeding, 2 ARDS, 3 mediastinitis, 1 pneumonia. 2 patients in a very poor general condition died, one with a metastatic breast carcinoma, the other after a CVI with a massive gastro-intestinal bleeding. The cervical perforations have an excellent prognosis and can be treated conservatively if they are asymptomatic and do not display a pleural lesion. The thoracic perforations can be treated surgically if they are diagnosed early before septic complications. If not, they will be better treated conservatively with drainage. The intraabdominal perforations have to be treated as every intraabdominal perforation. In this case, we perform a primary suture completed with fundoplication.

Aged↗