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Biomedical subjects

E Grädel

Publications and source records attributed to E Grädel.

At least 19 recordsLinked to original sources
PubMed1992

[Heart valve substitution: the effect of preoperative findings on long-term outcome].

BACKGROUND: In a retrospective analysis of 653 consecutive patients who underwent heart valve replacement by one single type of mechanical prosthesis (St. Jude Medical) at three Swiss university medical centers (Basel, Bern, Lausanne), the outcome was judged on the basis of preoperative variables. These variables should facilitate the timing of heart valve replacement. METHODS: Preoperative evaluation includes NYHA classification of symptoms, chest X-ray, ECG, and LVEF on angiography. Postoperative outcome was assessed clinically at yearly intervals by NYHA classification, documentation of complications and mortality. RESULTS: Five-year-survival rates were 96 and 88%, and complication-free rates were 82 and 76% respectively in patients after isolated aortic and mitral valve replacement. An unsatisfactory outcome with death or persistent severe symptoms was more frequent when preoperative symptoms at rest and atrial fibrillation were present. CONCLUSION: Heart valve replacement should not be postponed until severe symptoms and functional impairment occur. Clinical criteria are at least as important for the timing of operation as the findings of more complex investigations.

Adolescent↗
PubMed1992

[Role of antibiotics in surgically treated active endocarditis].

In a retrospective study of 30 patients in whom a valve was replaced during active endocarditis, the role of the concomitant antimicrobial therapy was analyzed. In 75% of the patients with less than 1 week of adequate treatment before surgery, but only in 13% (p less than 0.001) with at least 1 week of therapy, could the microorganism be cultivated from the excised valve. Patients with bacteria on the valve had a 4-fold increased risk for prosthetic valve endocarditis and 2.7-fold more frequent paravalvular leakage. Therefore, in the absence of severe cardiac failure, the valve replacement should not be performed before the second week of therapy. Patients in whom microorganisms can be cultivated from the valve need a complete postoperative course of antimicrobial therapy.

Adult↗
PubMed1992

[Traumatic aortic rupture--an emergency indication?].

On the basis of a retrospective analysis that included 22 patients with traumatic rupture of the thoracic aorta, the appropriate time for surgical intervention will be evaluated. The patients were divided into two groups according to their clinical status at the time of surgery. Seven patients with unstable vital systems underwent immediate surgery; 5 out of 7 died intraoperatively. Because of either the surgeons decision or delayed diagnosis, 15 patients underwent surgical repair of the aorta after various time intervals; 3 of these expired late after the operation. These results indicate that the timing of surgical intervention in the stable covered aortic rupture with serious associated injuries should preferably be deferred until after the patients condition has stabilized.

Aorta, Thoracic↗
PubMed1991

[Plasma cell granuloma of the lung].

Isolated primary tumors of the lung are rarely seen in childhood and are benign in one third of the patients. Plasma cell granulomas represent the most common benign tumor of the lung in this age group. Histologically, the tumor is characterized by the various components of a chronic inflammation or granulation tissue. Frozen sections can pose difficulties in the differentiation between a malignant and benign process. In view of the case history of our patient we set out to demonstrate that a knowledge of the clinical picture and a correct interpretation of associated laboratory findings facilitate diagnosis. To our knowledge we describe for the first time the ultrastructural findings of so-called "microtubule-reticular structures" giving further evidence of the inflammatory origin of this lesion.

Child↗
PubMed1991

[Surgical treatment of coronary heart disease].

The goal of coronary surgery in stable angina pectoris is relief of symptoms and improvement of prognosis, whereas in unstable angina pectoris the main purpose is the prevention of infarction. In 'mechanical' complications of infarction, surgery is undertaken to treat severe congestive heart failure or cardiogenic shock. Prophylactic operations in asymptomatic patients are generally recommended in three-vessel disease, left main-stem stenosis and critical stenosis of the left anterior descending artery with the purpose to reduce the risk of myocardial infarction and to improve survival. Early surgically mortality was about 1% some years ago, but is actually slightly higher, mainly due to selection of high-risk patients since the introduction of PTCA. Late mortality is about 5% after one year and about 25% after ten years. The early patency rate of vein grafts is more than 90% and decreases about 5% per year, whereas results with arterial grafts are even better. Early surgical mortality in patients with mechanical complications is very high (40 to 50%) in the acute stage of infarction; results in the chronic stage are much better (5 to 10%).

Coronary Disease↗
PubMed1990

Heart valve replacement with the Björk-Shiley and St Jude Medical prostheses: a randomized comparison in 178 patients.

In 178 patients, a randomized prospective comparison between the 60 degrees spherical disc Björk-Shiley (BS) and the St Jude Medical (SJM) heart valve prostheses was performed. Four-week perioperative mortality was zero in the BS (n = 84) and 4.3% in the SJM group (n = 94). During a mean (+/- SD) follow-up of 52 +/- 20 months or 778 patient-years, late cardiac mortality per year was 2.4% in the BS and 2.2% in the SJM group. The yearly thromboembolic rates were 1.4% in the BS and 2.0% in the SJM group. There was no mechanical valve failure or haemolytic anaemia. Paravalvular leaks and major bleeding complications occurred at low rates in both groups (1.1% and 2.2% per year in BS; 0.7% and 1.7% per year in SJM). Functional results were similarly good with 96% of patients with BS valves and 95% of patients with SJM prostheses being in NYHA classes I and II, respectively. We conclude that heart valve replacement with mechanical prostheses can be performed with equally good results using either the Björk-Shiley spherical disc valve or the St Jude Medical bileaflet prosthesis.

Aged↗
PubMed1990

[Diagnostic value of CK-MB for the determination of perioperative infarct in coronary artery bypass operation].

To assess the diagnostic value of CK-MB determinations after CABG surgery to detect or exclude perioperative myocardial infarction, 228 consecutive patients were studied with serial ECGs, as well as pre- and postoperative left heart catheterization and thallium-201-scintigraphy. CK-MB values above or below 100 U/l had a sensitivity and specificity of 73% each. There was a linear correlation between CK-MB values and total ischemic time. Thus, an increasing amount of myocardium is lost with each additional minute of ischemia despite today's methods of myocardial protection. Due to its low diagnostic accuracy CK-MB seems not to be very helpful for the diagnosis of perioperative myocardial infarction.

Adult↗
PubMed1989

[How long should antithrombotic therapy be continued following aortocoronary bypass surgery?].

In a prospective randomized trial the effect of prolonged antithrombotic treatment with anticoagulants or antiplatelet drugs (50 mg aspirin + 400 mg dipyridamole daily) on late bypass-graft occlusion was studied. After 3 months active treatment was replaced by placebo in half of the patients. Between the angiographic checkups 2 weeks and 12 months postoperatively, 28/330 (8%) new graft occlusions had occurred on continued therapy, versus 44/319 (14%) on placebo (p = 0.03). This difference was most pronounced in individual grafts (6% vs 12%, p = 0.01), so that fewer patients with 12 months' active therapy had at least one occluded graft (22% versus 32%, p = 0.08). These findings suggest that antithrombotic treatment should not be halted 3 months after CABG surgery but should be continued for at least one year and possibly longer.

4-Hydroxycoumarins↗
PubMed1989

Sudden cardiac death after aortic valve surgery: incidence and concomitant factors.

A retrospective analysis of 599 consecutive patients after aortic valve surgery aged 7-82 years (mean 56) was performed. During a follow-up of 1-14 years (mean 4.7 years) a 4-week perioperative mortality of 6.9% and a late annual mortality of 3.6% were observed. Sudden cardiac death was the most frequent single cause of death, accounting for 24% of all deaths. Patients dying suddenly were younger than patients dying from other causes (51 +/- 17 vs. 59 +/- 14 years, p less than 0.05) and showed more left ventricular hypertrophy by electrocardiographic criteria when compared with matched survivors (mean Estes score 5.2 +/- 2.4 vs. 2.8 +/- 1.9; p less than 0.01) and with patients dying nonsuddenly (mean Estes score 5.2 +/- 2.4 vs. 1.8 +/- 1.8; p less than 0.01). Ventricular premature beats in the resting electrocardiogram were more prevalent in patients dying suddenly than in matched survivors (55 vs. 20%; p less than 0.025) as well as in patients dying from other causes (55 vs. 25%; p less than 0.05). In addition, there were more intracardiac conduction disturbances and more ungrafted coronary vessels with insignificant stenoses at the time of surgery in sudden death patients. Our findings suggest that after aortic valve replacement patients with left ventricular hypertrophy, bundle-branch block, and ventricular premature beats in the resting electrocardiogram are at increased risk for sudden cardiac death. A possible etiological role of concomitant coronary artery disease must be considered.

Adolescent↗
PubMed1988

Difference between endothelium-dependent relaxation in arterial and in venous coronary bypass grafts.

Both the internal mammary artery and the saphenous vein are used to construct coronary-artery bypass grafts. We hypothesized that the release or production of endothelium-derived relaxing factor, which regulates blood flow and inhibits platelet function, may differ in venous and arterial grafts. We therefore studied endothelium-dependent relaxation in internal mammary arteries, internal mammary veins, and saphenous veins obtained from 58 patients undergoing coronary bypass surgery. Vascular rings with and without endothelium were suspended in organ chambers, and isometric tension was recorded. Acetylcholine (10(-8) to 10(-4) M), thrombin (1 U per milliliter), and adenosine diphosphate (10(-7) to 10(-4) M) evoked potent endothelium-dependent relaxation in the mammary artery but weak response in the saphenous vein (P less than 0.005; n = 6 to 27). In the mammary artery, relaxation was greatest in response to acetylcholine (86 +/- 4 percent reduction in norepinephrine-induced tension), followed by thrombin (44 +/- 7 percent) and adenosine diphosphate (39 +/- 8 percent). In the saphenous and mammary veins, relaxation was less than 25 percent. Relaxation was unaffected by indomethacin but was inhibited by methylene blue and hemoglobin (P less than 0.005 and 0.01, respectively), which suggests that endothelium-derived relaxing factor was the mediator. Endothelium-independent relaxation in response to sodium nitroprusside was similar in arteries and veins. We conclude that endothelium-dependent relaxation is greater in the mammary artery than in the saphenous vein. The possibility that this contributes to the higher patency rate among arterial grafts than among venous grafts will require further study.

Acetylcholine↗
PubMed1987

[Coronary surgery in unstable angina pectoris].

Urgent surgical revascularisation for unstable angina is relatively frequent, though only where stabilization of angina with vigorous medical treatment is not successful. On the other hand, it has been shown that a large proportion of patients in whom unstable angina has been successfully stabilized subsequently suffer from severe chronic angina. Therefore it is recommended that coronarography be performed in all younger patients within a few days. If left main stem or three vessel disease is documented, aortocoronary bypass should be done during the same hospitalisation or, in suitable cases, percutaneous transluminal coronary angioplasty (PTCA) should be considered. Although some authors report an elevated risk for urgent revascularisation our own results do not confirm this. Operative mortality is not elevated and the functional results, including patency rate of grafts, do not differ from those in patients with chronic coronary heart disease.

Angina Pectoris↗
PubMed1987

[Dipyridamole and low-dose aspirin in patients with aortocoronary bypass--comparison with anticoagulation].

The effects of antiplatelet therapy (AP; dipyridamole 400 mg [beginning 2 days preoperatively] + aspirin 50 mg/day) and anticoagulation (AC) were compared prospectively in 251 patients with coronary artery bypass grafting (CABG). Two weeks postoperatively, 85.2% of AP and 81% of AC patients had all grafts patent with graft patency rates of 93.6% and 91.3% respectively (p = n.s.) Significant differences in favour of AP therapy were found in subgroups with multiple grafts and with low intraoperative graft flow. Up to 3 months postoperatively, severe complications occurred in 22 AC patients (11 bleedings) but only in 9 patients on AP therapy (p less than 0.01). Overall, AP therapy should therefore be preferred to AC in patients with CABG surgery.

Anticoagulants↗