khree-dimensional contrast-enhanced magnetic resonance angiography in a patient with chronic thromboembolic pulmonary hypertension before and after thromboendarterectomy.
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Aged↗
Biomedical subjects
E Mayer
Publications and source records attributed to E Mayer.
[In Process Citation]
Intimal sarcoma of the pulmonary artery is an extremely rare type of malignant tumor of the large vessels. Despite systematic diagnostics, distinguishing between pulmonary emboli and tumors is difficult. We report a patient who was referred because of suspected embolic occlusion of the pulmonary artery. The operation was started with the intention of performing a pulmonary artery thromboendarterectomy; however, intraoperative histology revealed a malignant mesenchymal tumor. Therefore, the left lung was resected with the use of extracorporeal circulation, and the pulmonary trunk and right pulmonary artery were reconstructed. A solitary right lung metastasis was resected 3 months later using stapling devices. Complete surgical resection is the treatment of choice for patients with sarcoma of the pulmonary arteries. Surgical therapy often includes extensive reconstructive measures. Since, thromboembolic obstruction cannot be excluded preoperatively, patients with this type of disease should be treated at centers experienced with the broad spectrum of pulmonary artery surgery.
Journal Article↗
To see better to the left when looking more to the right: effects of gaze direction and frames of spatial coordinates in unilateral neglect.
Unilateral spatial neglect entails a failure to detect or respond to stimuli in the space opposite to a brain lesion. However, the contralesional hemispace can be determined by different frames of spatial coordinates, such as eyes-, head-, body-, or environment-centered coordinates. We observed 2 patients with a right hemisphere stroke whose left spatial neglect was modulated by distinct coordinates systems depending on the task. Four tasks were given in different conditions of central gaze and either the eyes or the head rotated 30 degrees to the right or 30 degrees to the left. While the 2 patients had a retinotopic defect in 1 visual field quadrant that remained the same irrespective of gaze direction (upper or lower quadrant in 1 case each), the other quadranopic field defect improved with eyes rotation to the right but not with head rotation, suggesting a head-centered spatiotopic deficit. Performance on line bisection was influenced both by eyes and head rotation, as well as by the position of the lines with respect to the trunk midline, suggesting the involvement of both head-centered and body-centered coordinates. Visual imagery and auditory extinction were not modified by changing the eyes or head position. These findings suggest that distinct spatial coordinates are brought into play depending on the tasks demands.
Aged↗
[Sarcoma of the pulmonary artery--pre- and postoperative radiologic findings in initial tumor manifestation and recurrence].
PURPOSE: Primary pulmonary artery sarcomas are very rare tumors. Their diagnosis is difficult due to their unspecific symptoms. Still, an early preoperative diagnosis is the only possibility for a potential therapy. PATIENTS AND METHODS: 4 pre- and 5 postoperative CT- and three pre- and one postoperative MRT-examination(s) have been evaluated with respect to surgical and histological findings. RESULTS: The presence of a convex intraluminal bulging mass spreading mostly from the pulmonary trunc continuously into the peripheral pulmonary artery branches the filling and dilatation of the vessels, the tumor's inhomogeneity indicating hemorrhages and necrosis and the appearance of intrapulmonary nodules are found in both CT and MRI. Recurrent pulmonary artery sarcoma features an extravascular growth and is similar to lung cancer affecting the vessels. It shows contrast enhancement both in CT and MRI while the primary tumor shows a distinct contrast enhancement only of Gadopentetate dimeglumine but none or little enhancement in CT. CONCLUSION: The criteria presented in knowledge of CT and MRI serve to increase the probability for a correct preoperative diagnosis and thus allow adequate surgical planning.
Adult↗
Physiology of refractory chronic constipation.
OBJECTIVE: Investigators suggest three distinct pathophysiologies for patients with constipation symptoms: 1) slow colon transit, 2) irritable bowel syndrome (IBS), and 3) pelvic floor dysfunction (PFD). Our aim was to determine the prevalence of the three types of constipation pathophysiology, the degree of overlap, and what interactions exist between pathophysiologies. METHODS: Constipated patients refractory to fiber (n = 131) underwent regional colon transit studies, anorectal manometry/EMG, measurement of rectal compliance, and rectal sensory testing. Correlations were performed examining interactions between the above measures. RESULTS: Visceral hypersensitivity (typical of IBS) was found in 58%, slow colonic transit in 47%, PFD in 59%, and no physiological abnormalities were detected in 24%. Slow transit and visceral hypersensitivity overlapped in half of each group. PFD physiology was found in approximately half of each of the subgroups. There was no correlation between PFD physiology and rectosigmoid transit, total colon transit, or any other physiology. There were no correlations between slow transit and visceral hypersensitivity. Visceral hypersensitivity did correlate with increased rectal compliance, suggestive of increased accommodation reflexes in IBS. CONCLUSIONS: At a tertiary center, slow transit physiology and visceral hypersensitivity typical of IBS are equally common and overlap heavily in constipated patients. PFD physiology does not correlate with slower rectosigmoid colon transit, and is seen equally in all subgroups. No abnormalities were found in 24% of patients. We therefore identify four subgroups in constipation: IBS, slow transit, both, and neither.
Chronic Disease↗
The fate of cryopreserved sperm acquired during vasectomy reversals.
PURPOSE: Intraoperative sperm banking has been recommended during vasectomy reversal. These specimens are maintained as insurance for possible future intracytoplasmic sperm injection. We evaluated the fate of specimens collected intraoperatively from 48 vasectomy reversal patients. MATERIALS AND METHODS: Of 75 men 48 (64.0%) agreed to intraoperative sperm banking during vasectomy reversal. A total of 135 vials of epididymal sperm, 81 vials of testicular tissue and 13 vials of vasal sperm were cryopreserved. RESULTS: Among couples who stored sperm 10 (20.8%) voluntarily discarded the specimens within 4 months of vasectomy reversal. Specimens from 31 couples (64.5%) remain in storage. Seven couples (14.6%) have used frozen sperm for intracytoplasmic sperm injection. In 3 of these couples the men were azoospermic after surgery, 2 men had 10,000 to 15,000 sperm per ml. in the ejaculate with limited motility and 2 had 1 to 2 million sperm per ml. with limited motility. The 7 women who underwent intracytoplasmic sperm injection ranged between 37 and 39 years old, which was older than the mean age of the remaining study group (32.7 years). With intracytoplasmic sperm injection fertilization was achieved in all cases and 20 of 47 eggs (42.5%) developed into embryos. Of 7 women 4 achieved biochemical pregnancies (57.1%) and 2 (28.6%) delivered newborns with epididymal sperm. Natural pregnancy occurred in 7 of 16 vasectomy reversal couples (43.7%) who were followed at least 18 months postoperatively but the time to pregnancy averaged 1 year. CONCLUSIONS: Cryopreservation of sperm collected at vasectomy reversal is recommended for patients undergoing vasoepididymostomy or vasovasostomy. The couples who used the cryopreserved sperm for intracytoplasmic sperm injection included husbands whose postoperative ejaculate remained azoospermic or severely oligospermic and wives who were approaching 40 years old. Only a limited number of couples (14.6% of the study group) have used the cryopreserved sperm but the delivered newborn rate (28.6%) was comparable to other intracytoplasmic sperm injection data. The natural pregnancy rate after vasectomy reversal was 43.7% but the time to pregnancy after surgery was lengthy (average 1 year). These findings may be helpful for counseling couples who are planning vasectomy reversal surgery and may be considering intraoperative sperm banking.
Adult↗
Carbonic acid in the gas phase and its astrophysical relevance
In outer space, high-energy irradiation of cryogenic ice mixtures of abundant water and carbon dioxide is expected to form solid carbonic acid. Experiments and thermodynamic analyses show that crystalline carbonic acid sublimates without decomposition. Free-energy considerations based on highly accurate molecular quantum mechanics, in combination with vapor pressures resulting from experimental sublimation rates, suggest that in the gas phase, a monomer and dimer of carbonic acid are in equilibrium, comparable to that of formic acid. Gaseous carbonic acid could be present in comets, on Mars and outer solar system bodies, in interstellar icy grains, and in Earth's upper atmosphere.
Journal Article↗
Proximal colon distention increases Fos expression in the lumbosacral spinal cord and activates sacral parasympathetic NADPHd-positive neurons in rats.
Fos expression induced by nociceptive mechanical distention of the proximal colon was examined in the lumbosacral spinal cord in freely moving rats equipped with a chronic balloon in the proximal colon. Fos protein in lumbosacral neurons was detected immunocytochemically, and colocalization with nicotinamide adenine dinucleotide phosphate diaphorase (NADPHd) activity was determined histochemically at 1 hour after distention. Distention of the proximal colon (10 ml, 30 seconds on/off for 10 minutes, about 90 mm Hg) increased the number of Fos-positive cells in the lumbar 6 (L6) and sacral 1 and 2 (S1, S2) segments, whereas no change was observed in the L1-L5 and S3 segments compared with the sham distended group or with animals that received no treatment. In L6-S2 segments, Fos-positive neurons were increased by two-fold in laminae I-VII (mainly in laminae I and outer II) and area X (surrounding the central canal) and by nine-fold in the sacral parasympathetic nucleus. Results of time course studies indicate that the maximal increase in Fos expression observed at 1 hour after distention returns to basal levels within 4 hours. In the S1 segment, distention of the proximal colon increased the percentage of NADPHd/Fos-positive neurons selectively in the parasympathetic nucleus by 40% compared with less than 4% in the sham distention group; the number and pattern of NADPHd-stained cells were not modified. These results indicate that noxious distention of the proximal colon for a short duration in awake rats selectively activates neurons in the L6-S2 segments of the dorsal horn mainly in laminae involved in nociceptive and autonomic processing. The marked activation of NADPHd-positive neurons in the sacral parasympathetic nucleus suggests a possible role of nitric oxide in the visceroautonomic reflexes induced by distention of the proximal colon.
Animals↗
A novel dendritic cell population in human blood: one-step immunomagnetic isolation by a specific mAb (M-DC8) and in vitro priming of cytotoxic T lymphocytes.
Originating from a common progenitor cell, dendritic cells (DC) appear to develop along early branched pathways into various yet ill-defined subpopulations residing at various sites throughout the body where they capture and present antigen in the most professional fashion. Here we give evidence for a unique subpopulation of human DC circulating in blood that account for 0.5-1% of blood leukocytes only, their most specific characteristic being the expression of a cell surface protein recognized by a novel monoclonal antibody (M-DC8) which enables their isolation by a one-step immunomagnetic procedure. The isolated cells (> 97% pure) present morphologically as typical dendritic cells. They express the Fc(gamma)RIII (CD16), so far not found on DC, and avidly phagocytose latex beads as well as opsonized erythrocytes. These cells not only present antigens efficiently to naive T cells but also induce purified CD8+ T cells to become alloantigen-specific cytotoxic cells. Furthermore, when loaded with a tyrosinase-derived peptide they stimulate T cells from normal donors and melanoma patients to exhibit MHC-restricted specific cytotoxicity against melanoma cells.
Antibodies, Monoclonal↗
Near and far visual space in unilateral neglect.
A 24-year-old right-handed woman with a right temporal hematoma showed marked left visual neglect for far but not near space in a variety of tasks systematically given in near and far distance conditions. This case thus provides the dissociation opposite to Halligan and Marshall's patient, who had neglect for near but not far space after a right parietal stroke. Furthermore, although she made rightward errors in bisecting far-distant lines, our patient made smaller opposite leftward errors for near-distant lines. The evidence that unilateral neglect of far and near visual space may exist independently supports a division in the neural systems subserving attention to different compartments of the extrapersonal space in humans.
Adult↗
High-dose epsilon-aminocaproic acid versus aprotinin: antifibrinolytic efficacy in first-time coronary operations.
BACKGROUND: The antifibrinolytic efficacy of a high-dose regimen of epsilon-aminocaproic acid (epsilon-ACA) was compared with aprotinin in first-time coronary operations. METHODS: In a prospective, double-blinded, randomized study, 20 patients received high-dose epsilon-ACA (10 g both as a loading and cardiopulmonary bypass priming dose, 2.5 g/h until 4 hours after protamine), and another 20 patients received aprotinin (2 x 10(6) KIU [280 mg] for loading and priming, 0.5 x 10(6) KIU/h [70 mg/h]). Ten untreated patients served as controls. RESULTS: Both agents reduced postoperative levels of thrombin/antithrombin III complexes, D-dimers, fibrin degradation products, free plasma hemoglobin (epsilon-ACA versus aprotinin, p = not significant; p < 0.05 versus controls), and amount of retransfused autologous blood (p < 0.001). Epsilon-ACA increased, aprotinin suppressed antiplasmin-plasmin complex generation (epsilon-ACA versus controls, p < 0.02; epsilon-ACA versus AP, p < 0.0001). For 4 hours after discontinuation, more chest drainage occurred with epsilon-ACA than aprotinin (137 +/- 90 mL versus 62 +/- 29 mL; means +/- standard deviation; p < 0.02). Cumulative 12-hour drainage was similar for aprotinin (391 +/- 220 mL) and epsilon-ACA (582 +/- 274 mL), but higher without inhibitor (1,091 +/- 541 mL; p < 0.001 versus drugs). Postoperatively, aprotinin was associated with the lowest autologous retransfusion incidence and highest hematocrits (p < 0.01 versus epsilon-ACA). Homologous transfusion exposures did not differ. CONCLUSIONS: In first-time coronary operations, higher postoperative hematocrit and less shed blood retransfusion constitute only subtle advantages of aprotinin over high-dose epsilon-ACA.
Aminocaproic Acid↗
Pathophysiology of early failure of autologous aortic heart valves (ATCV).
BACKGROUND: Degeneration remains the major drawback of bioprostheses. Among various concepts to mitigate degeneration, the use of autologous pericardium for intraoperative construction of aortic valves (ATCV) was revived recently. Based on in-vivo studies the problem of tissue failure was claimed to be oversome by short immersion in glutaraldehyde. METHODS: Two often ATCV implanted 1994-1996 had to be replaced because of valvular insufficiency due to leaflet shrinkage or tearing. Pathophysiology of failure was evaluated by light microscopy and immune histology, scanning electron microscopy (SEM) and determination of tissue calcium content (AAS). RESULTS: AAS revealed high calcium levels in the shrunken and low levels in the torn leaflets. Histology demonstrated extensive fiber degeneration without inflammation in the destructed and moderate degeneration in the intact leaflets. SEM showed smooth surfaces in the 'normal' and exposure of collagen in the degenerated leaflet associated with calcification. Tears occurred close to the stents. CONCLUSIONS: Failure of ATCV is characterised by either shrinkage and calcification despite a short tanning or by tearing related to the stent design. Clinical use of ATCV cannot be recommended at present.
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[Effect of oxygen inhalation on hemodynamics in chronic thromboembolic pulmonary hypertension].
PURPOSE: This study evaluates the haemodynamic effects of oxygen inhalation on pulmonary artery pressure and pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension. METHOD: In 47 patients with chronic thromboembolic pulmonary hypertension haemodynamic parameters were measured before and after oxygen inhalation. RESULTS: In moderately severe and severe pulmonary hypertension oxygen inhalation significantly reduced mean pulmonary artery pressure by about 11.1% and 4.6%, respectively. However, pulmonary vascular resistance was not significantly affected. Oxygen saturation improved and heart rate was reduced. Cardiac index decreased in severe pulmonary hypertension. Systemic vascular resistance increased. CONCLUSION: We conclude that oxygen inhalation reduces pulmonary artery pressure and improves oxygen supply in patients with moderately severe and severe chronic thromboembolic pulmonary hypertension.
Blood Pressure↗
[Chronic thromboembolic pulmonary hypertension: hemodynamic effects of selective pulmonary artery DSA with nonionic contrast media].
PURPOSE: This study evaluates the effects of pulmonary bolus injection of nonionic contrast medium on pulmonary artery pressure and resistance in patients with chronic thromboembolic pulmonary hypertension. METHODS: In 39 patients (age 52 +/- 15) haemodynamic measurements were performed during bolus injection of nonionic contrast medium in a control group (I), in moderately severe (II) and severe pulmonary hypertension (III). RESULTS: Initial inspiratory arrest caused significant pressure increase in all groups prior to bolus injection (delta PAsyst: 7.1 +/- 6.7 [I], 6.8 +/- 3.9 [II] und 7.2 +/- 7.9 mmHg p < 0.05). However, contrast bolus injection (25.1 +/- 2.3 ml iopamidol, 13.0 ml/s) caused only minor additional pressure increase (delta PAsyst: 2.2 +/- 1.4 [I], 2.7 +/- 1.9 [II] und 4.9 +/- 5.4 mmHg [III] p < 0.05). After angiography pulmonary artery pressure and vascular resistance was increased only moderately, predominantly in group III. Systemic vascular resistance was slightly decreased. CONCLUSION: In patients with moderately severe and severe chronic thromboembolic pulmonary hypertension bolus injection of nonionic contrast medium causes no major haemodynamic effects.
Adult↗
Early failure of an autologous pericardium aortic heart valve (ATCV) prosthesis.
BACKGROUND AND AIMS OF THE STUDY: The risk of reoperation due to calcific degeneration is the most important drawback of biological heart valves compared with mechanical prostheses. Concepts to mitigate calcification have been tested experimentally and clinically, but none has proven completely to prevent degeneration. METHODS: Renewed interest has involved the use of autologous pericardium for intraoperative construction of autologous aortic valves (ATCV). RESULTS: Of 10 ATCV implanted between 1994 and 1996, one was removed from an 84-year-old female 27 months after implantation because of severe valvular insufficiency. Eight months earlier, a broken spring of the stent system was detected radiographically, with normal valvular competence at echocardiography. Valve dysfunction was due to shrinkage of one leaflet. Measurement of tissue calcium by atomic absorption spectroscopy showed high levels in the shrunken leaflet compared with two intact leaflets (42.82 versus 0.51 and 2.42 mg Ca2+/g). Histology and immunohistology demonstrated extensive fiber degeneration without inflammation or immune reactions in the destroyed leaflet, and moderate fiber degeneration in intact leaflets. Scanning electron microscopy showed smooth surfaces in the normal leaflet and exposure of collagen in the degenerated leaflet in association with calcium deposition. CONCLUSIONS: In contrast to the outcome in animal studies, intraoperative tanning did not prevent tissue shrinkage in this case. Leaflet malfunction was associated with calcification. At present, the clinical use of valves constructed from autologous pericardium can not be recommended.
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Long-term survivors: an overview on late effects, sequelae and second neoplasias.
A large number of haematological and oncological diseases as well as inborn errors can be cured today by stem cell transplantation. However, the chemotherapy and radiation used for the preparation of BMT can induce late effects which can be rather severe. Especially in malignant diseases the late toxicity of previous conventional therapy has an additional impact. The function of various organs can be impaired, such as the eyes, the central nervous system, the teeth, the legs, the heart, the kidneys, the liver, the endocrine functions and growth. Second neoplasias occur during various times after BMT: lymphoproliferative disease may occur during the first year, leukemias and myelodysplastic syndromes develop after several years, whereas solid tumours occur even later. The incidence of second neoplasias after BMT seems to be higher in children than in adults. Many late sequelae as well as psychological disturbances can impair the quality of life of the survivors of BMT. Paediatricians should take this fact into account when they think about stem cell transplantation in a child. This all means that a long-term observation in these persons is necessary and this is done best within a standardised follow-up programme. Meanwhile such programmes have been developed in some countries, and this should be promoted within the working party 'Paediatric Diseases' of EBMT.
Bone Marrow Transplantation↗
In vitro effects of anticalcification treatment on the calcium uptake of bioprosthetic materials.
BACKGROUND AND AIM OF THE STUDY: The frequent need for re-replacement of tissue valves due to calcification remains their major disadvantage compared with mechanical implants. A variety of anticalcification treatments has been proposed but none has proved to prevent calcific degeneration. The study aim was to evaluate, in vitro, the time course of calcium uptake of procine and bovine biomaterials and the efficacy of anticalcification treatments. METHODS: Samples of glutaraldehyde-tanned biomaterials with (Carpentier-Edwards, Medtronic Intact, Hancock II, MZGTB) or without anticalcification treatment (Mitroflow) were incubated with culture medium containing physiological calcium levels. Specimens were then analyzed at two, four or eight weeks for their calcium content (mg/g wet weight). RESULTS: All specimens calcified over time, though the time courses for each were significantly different. Mitroflow and Intact valves accumulated high calcium levels rapidly during the first two weeks, with small further increases thereafter. Anticalcification treatment reduced calcium uptake of Carpentier-Edwards material during the first two weeks of incubation, but the material gradually attained comparable calcium levels at eight weeks. Hancock valves and the self-customized MZGTB valve showed the lowest calcium levels over the test period. CONCLUSIONS: This in vitro study documented major differences in calcium uptake of different biomaterials. Some anticalcification treatments render the material temporarily less susceptible to calcium binding but none can prevent calcification. In vitro testing has proved to be a valuable instrument for evaluating anticalcification treatments, but should be combined with evaluation of bioprosthesis surface interaction with circulating blood.
Animals↗
Clinical performance of the native pulmonary valve in the systemic circulation.
BACKGROUND AND AIM OF THE STUDY: In a number of corrective and palliative procedures the autologous pulmonary valve is used as the systemic semilunar valve. This study reviews the surgical results and function of the native pulmonary valve in the systemic position after various surgical procedures. METHODS: Between January 1994 and December 1997, the autologous pulmonary valve was transferred functionally or anatomically into the systemic circulation in 89 patients. Follow up echocardiograms and cardiac angiograms were reviewed for 51 neonates with transposition of the great arteries after an arterial switch operation (ASO), in 21 patients after first-stage palliation of hypoplastic left heart syndrome (HLHS), in eight children and adults with pulmonary autograft aortic valve replacement (Ross procedure), and in nine patients with a pulmonary artery-to-aortic anastomosis (Damus-Kaye-Stansel (DKS) procedure) in complex heart defects with outflow obstruction. RESULTS: Nine patients (five with HLHS) died; thus, overall mortality rate was 10.2%. There was no evidence of valve-related mortality. Trivial insufficiency following ASO was noted in 11 patients, with no progression of incompetence over time. None of the HLHS patients had pulmonary insufficiency preoperatively, but all showed mild regurgitation on postoperative echocardiography. There was a moderate increase in insufficiency which was attenuated after an early second-stage palliation. Three of nine patients undergoing a DKS anastomosis demonstrated a hemodynamically insignificant insufficiency. Modification of the surgical technique avoided postoperative regurgitation. Four of seven patients having a Ross procedure showed trivial but non-progressive neoaortic regurgitation. CONCLUSIONS: Based on this experience, the autologous pulmonary valve performs adequately at intermediate term follow up. Postoperatively, trivial regurgitation was a frequent finding but was hemodynamically insignificant. Progression or late development of insufficiency as well as stenosis were rare problems.
Adolescent↗