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F Oertel

Publications and source records attributed to F Oertel.

11 recordsLinked to original sources
PubMed2003

[Non-occlusive mesenteric ischemia].

The so-called non-occlusive disease (NOD) or non-occlusive mesenteric ischemia (NOMI) is a severe and life-threatening pathology. Even under optimal circumstances and standardised diagnostic and therapeutic procedures maximum survival rates do not exceed 50 %. The NOD is a pathology of the elder patient and its incidence rises with other comorbidities such as reduced cardiac output, diabetes and renal insufficiency. Induction of the disease with a severe vasoconstriction of the splanchnic vessels may be a simple cardiac decompensation, a frequent trigger however is a previous heart surgery with consecutive cardiac shock. Early diagnosis is difficult to conduct because of unspecific symptoms. Beside abdominal pain in awake patients, ileus or subileus is remaining the single acute symptom which could be also a consequence of a postoperative paralysis. Laboratory parameters such as leucocytosis and elevated lactat levels are often positive, but unspecific and the latter may be a delayed sign of progressive disease. The only sufficient method for diagnosis implicating a possible treatment option seems to be an immediate angiographic examination. Because of the disappointing results of a solitary surgical approach transarterial medication via catheter is indicated. Depending of the course of the disease only a combination of local mesenteric infusion of vasodilatory drugs and surgical resection of already necrotic bowel promises a successful therapeutic approach and better survival rates.

Abdominal Pain↗
PubMed1999

[Surgical treatment of atrial septal aneurysms with patent foramen ovale in patients with cerebral ischemia as an alternative to life-long anticoagulant therapy: surgical strategy and results in 5 patients].

There is a significantly higher incidence of cerebral ischemia among patients with an atrial septal aneurysm and/or a patent foramen ovale. According to the information provided by modern diagnostic procedures--and in particular by transesophageal echocardiography--two pathogenic mechanisms should be considered as possible causes of the cerebral ischemia. Thrombi may develop locally in the left atrium or atrial septal aneurysm and lead to embolization or, alternatively, thrombi from the inflow region of the inferior vena cava may become trapped in the atrial septal aneurysm and pass through the patent foramen ovale to bring about embolization in the arterial bloodstream. Current treatment consists of life-long anticoagulation with coumarin derivatives in order to prevent further neurological complications. With this treatment, however, the risk of producing hemorrhages cannot be regarded as trivial, especially in old people. Surgical intervention with the insertion of a button device has so far only been attempted in a few isolated cases, and it is in any case no use if there is only an atrial septal aneurysm without a patent foramen ovale. As an alternative to administering anticoagulants for the rest of the patient's life, we operated on five cases of atrial septal aneurysm with patent foramen ovale followed by the appearance of cerebral ischemia. As with the surgical treatment of atrial septal defects in general, the risk of the operation (or of subsequent complications) is very slight indeed. No such problems arose in any of our patients, no blood transfusions were necessary, and after short postoperative treatment they could all be discharged. For younger patients with little risk from the treatment itself, we regard surgical intervention in cases of atrial septal aneurysm with a patent foramen ovale and cerebral ischemia as an important therapeutic alternative.

Adult↗
PubMed1998

The effect of i.v. enalaprilat in chronically treated hypertensive patients during cardiac surgery.

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors are well established as long-term antihypertensives and have also been proved useful in hypertensive emergencies. Therefore, we investigated whether intraoperative i.v. enalaprilat may reduce the incidence of perioperative hypertensive reactions in coronary artery bypass grafting (CABG). METHODS: Thirty-eight male patients chronically treated for arterial hypertension and scheduled for CABG randomly and double-blindly received either enalaprilat 30 micrograms.kg-1 or NaCl 0.9% at the time of skin incision. Intraoperatively, increases of mean arterial pressure (MAP) > 85 mmHg or > 80 mmHg during cardiopulmonary bypass (CPB) were treated by an urapidil bolus. The total intraoperative amount of urapidil was documented for both groups. Systemic and pulmonary hemodynamics as well as the plasma levels of epinephrine, norepinephrine, arginine vasopressin and renin were measured intraoperatively and up to 2 h after admission to the intensive care unit. RESULTS: Mean arterial pressure, cardiac index and systemic vascular resistance did not differ between the enalaprilat and the control group. Renin plasma levels significantly increased after infusion of enalaprilat and did not change in the placebo group. Catecholamine and arginine vasopressin plasma levels increased significantly during CPB and remained high in the postoperative period without any intergroup difference. The same amount of urapidil had to be given in the two groups to maintain MAP below the defined limit. CONCLUSION: We conclude that infusing 30 micrograms.kg-1 enalaprilat in patients chronically treated for arterial hypertension does not prevent hypertensive reactions during CABG.

Adult↗
PubMed1996

[Initial clinical experiences with indirect myocardial revascularization--free skeletal muscle transplantation for induction of epimyocardial neovascularization].

Patients with multiple and peripherial coronary stenosis are not suitable for direct coronary artery surgery. For these patients a new surgical myocardial revascularization was developed. This new surgery was adopted on 5 patients from May 1993 through May 1995. The operation consisted in the grafting of a free skeletal muscle flap onto the anterior wall of the heart (musculus-latissimus-dorsi). The flap artery was implanted into the aorta, the venous flow was directed into the right atrium. All patients were about 3 weeks after the intervention free from angina. The postoperative bicycle ergometry showed no signs of ischemic ST-segment changes, meanwhile the preoperative ergometry evinced signs of ischemic ST-segment changes in almost all patients. Angiographically a patent anastomosis of the flap artery implanted into the aorta was found as well as a good contrast of the graft. Thus, "indirect myocardial revascularization" may be a surgical alternative treatment for patients suffering from therapy refractory ischemic heart disease.

Aged↗
PubMed1993

[Monitoring aortocoronary bypass. A new experimental approach].

Only few data are known concerning haemodynamic parameters and pathomechanisms of small vessels and bypass grafts. No easy-to-use bedside method exists for monitoring. We developed a miniaturised implantable Doppler probe linked to a 20 MHz pulsed Doppler system. In a circulation model and in animal studies we can show the accuracy of this method. We conclude that the implantable pulsed Doppler system is a sensitive method for monitoring the haemodynamics of small vessels.

Animals↗
PubMed1992

Experimental and first clinical experiences with implantable ultrasonic Doppler probes for postoperative bypass control after coronary surgery.

Concerning postoperative bypass hemodynamics after open heart surgery only few data are known. With this new implantable doppler probe we developed an easy-to-use bedside method for monitoring postoperative bypass function after coronary artery bypass grafting. The accuracy of our method is shown by using a circulation model and by animal studies. Furthermore first clinical data are shown which support our conclusion of having found a sensitive method for monitoring small vessels' hemodynamics.

Aged↗
PubMed1992

[The quality of life of the aged after heart surgery interventions. Analysis of a patient sample of very advanced age].

Due to the continual improvement of surgical and anaesthesiological techniques, the cardiac patients are now of a much higher age than was previously the case. Only pre- and postoperative comparison of life quality can show in what manner these old patients are improved by cardiac surgery. 71 patients with the mean age of 77.6 years were examined by standardized interviews at hospital admittance and one year after returning home. Although there was no statistical significance, there was a very clear trend towards improved quality of life. These very good long-term results concerning the quality of life justify an increased operative risk in this group of 70-80 years old patients. In our study we could show results which were as good as has been shown with younger patients in literature.

Activities of Daily Living↗
PubMed1992

[The elderly as heart surgery patients. Pre- and postoperative analysis of the quality of life].

UNLABELLED: The aim of the study was to measure pre- and postoperative quality of life of the old patient to find out his profit of open heart surgery. METHOD: 71 patients ranging from 75 to 86 years (mean 77.6 years) were examined by using a standard interview about their quality of life on the day of hospital admittance and one year after returning home (range 11-14 months). RESULTS: There was an improvement of postoperative quality of life. These results were similar to data reported in the literature after investigating younger patients. CONCLUSION: No one should be excluded from open heart surgery because of old age.

Activities of Daily Living↗