Biomedical subjects

F Stocker

Publications and source records attributed to F Stocker.

At least 19 recordsLinked to original sources

PubMed2000

[Nonsurgical occlusion of an atrial septal defect in childhood: initial Swiss experiences].

The initial experience with catheter closure of an atrial septal defect (ASD) in children, performed at two Swiss centers is presented. The ASD closures were performed according to international multicenter study protocols. 14 children, aged 3.9-17.5 years underwent closure by catheter. The defect size varied between 12 and 22 mm (balloon sized), the ratio between pulmonary and systemic blood flow showed a mean of 2.2 (1.5-3.5). Catheter closure was done using three different occlusion devices. More recently only the Amplatzer occluder was used at both institutions. In 12 children (86%) defect closure was successful and after a follow-up of 3-32 months (mean 17) only one child had a trivial residual interatrial shunt. In all children, echocardiographic follow-up showed an unchanged and correct device position on both sides of the atrial septum. In two children, a floppy aortic segment of the atrial septal rim led to instable device position: both children underwent surgical defect closure later. The children with successful device closure showed no complications during the catheterization or during follow-up. There were no thrombotic complications on the surfaces of the devices. Catheter closure of an ASD during childhood is a safe and efficient alternative to standard surgical treatment.

Adolescent↗

PubMed1999

Troponin-I for prediction of early postoperative course after pediatric cardiac surgery.

OBJECTIVES: It was the aim of the study to test the prognostic value of cardiac troponin-I (cTnI) concerning the early postoperative course after pediatric cardiac surgery. BACKGROUND: Cardiac troponin-I is a very specific and sensitive marker of myocardial damage in adults and children. As perioperative myocardial damage may be a significant factor of postoperative cardiac performance, serial cTnI values were analyzed in children undergoing open heart surgery. METHODS: Seventy-three children undergoing elective correction of congenital heart disease including atrial and ventricular surgical manipulation were studied. Cardiac troponin-I levels were measured serially and correlated with intra- and postoperative parameters (such as doses and length of inotropic support, renal and hepatic function, duration of intubation). Patients with prolonged postoperative recovery were analyzed with special attention to the cTnI levels. RESULTS: The cutoff point for the definition of a high and a low risk group of cTnI values was set at 25 microg/liter, 4 h after admission to the intensive care unit (ICU) and at 35 microg/liter considering the maximal value of cTnI in the first 24 h in the ICU. The results showed a highly significant correlation between the need for inotropic support, the severity of renal dysfunction and the duration of intubation in relation to the serum levels of cTnI. CONCLUSIONS: Cardiac troponin-I serum levels after open heart surgery in children and infants 4 h after admission to the ICU allowed anticipation of the postoperative course and correlated with the incidence of significant postoperative complications.

Adult↗

PubMed1999

Surgery of the complete atrioventricular canal: relationship between age at operation, mitral regurgitation, size of the ventricular septum defect, additional malformations and early postoperative outcome.

The perioperative risk after repair of the complete atrioventricular canal is reported to be low provided there is a balanced relationship of both ventricles, and elevated pulmonary vascular resistance has been demonstrated to be reversible. However, some pre- and perioperative conditions may adversely affect early postoperative outcome. A consecutive series of 42 patients (mean age 8.5 months, 34/42, 81%, with trisomy 21) operated between 1994 and 1998 was analyzed prospectively for pre- and perioperative risk factors. Echocardiography alone was performed in 35 patients whereas cardiac catheterization was performed in 7 patients aged more than 18 months to confirm operability. Additional malformations were found in 20 patients. Early mortality was 2.3% (1/42), and postoperatively a low cardiac output was observed in 25 patients (59%); NO inhalation was used in 12 patients. Only the size of the ventricular septal defect (> than the diameter of the aortic annulus) could be identified as a predictor of adverse postoperative outcome in multivariate analysis. The presence of associated intracardiac malformations showed a trend to increased perioperative risk in multivariate analysis. Early results after repair of the complete atrioventricular canal are excellent. Survival, postoperative morbidity and normalization of pulmonary artery pressure can be related to the size of the ventricular septal defect. Continuous monitoring of the pulmonary artery pressure (with consequent NO application when indicated) is probably responsible for the low perioperative risk encountered in this series, despite the high incidence of postoperative pulmonary artery hypertension.

Administration, Inhalation↗

PubMed1998

[Status and after-care of young adults with congenital heart defects].

INTRODUCTION: We studied patients with congenital heart defects born in 1975 and followed by our institution. We were interested in the outcome of these patients at the age of 20 years with regard to professional status, physical activity and psychosocial aspects. Furthermore, we investigated the handover from the paediatric to the adult cardiologist as well as the information level concerning antibiotic prophylaxis against bacterial endocarditis. METHODS: From a previous follow-up study to the age of 16 years, we knew 224 patients with congenital heart disease born in 1975, 119 were considered to need further cardiological follow-up. In 112 (94%) we have a complete follow-up to the age of 20 years with a structured interview by phone. RESULTS: Mortality and medical care during the period between 16 and 20 years of age were at a lower level than in the previous periods. Except in patients suffering from complex or surgically treated cyanotic heart disease, the results, compared to the standard population at the age of 20 years, are better with regard to professional status, and equal for physical activity and psychosocial integration. Only 60% of the patients were followed by an adult cardiologist and only 45% of the patients needing antibiotic prophylaxis against bacterial endocarditis are aware of this. CONCLUSION: Except in patients with complex congenital or surgically treated cyanotic heart diseases, the outcome at the age of 20 years with regard to professional status, physical activity and psychosocial integration is very good compared with the standard population at the age of 20 years. The handover to the adult cardiologist is inadequate and knowledge and awareness of antibiotic prophylaxis against bacterial endocarditis is also insufficient-both aspects need improvement.

Adult↗

PubMed1997

Dilated cardiomyopathy and thrombo-embolism.

UNLABELLED: The purpose of this study was to investigate the incidence, outcome and prevention of thrombo-embolism in children with dilated cardiomyopathy. From 130 patients with dilated cardiomyopathy, 17 (14%) showed evidence of thrombo-embolism. Seven had initial cardiac thrombus, 7 exhibited initial embolus and in 3 thrombo-embolism was only diagnosed at autopsy. All 17 patients showed seriously impaired systolic function of the left ventricle with fractional shortening (FS) of 10 +/- 3%, range 5%-17%, as compared to those without thrombo-embolism with FS of 17% +/- 6%, range 5%-26% (P < 0.0001). Seven patients were treated with oral anticoagulants once thrombo-embolism had been diagnosed; one of them experienced a further embolic event as opposed to three out of four patients not treated with anticoagulants. CONCLUSION: All children with dilated cardiomyopathy and fractional shortening below 20% should be treated with prophylactic anticoagulative agents.

Adolescent↗

PubMed1997

Troponin-T: improved diagnostic assessment of myocardial damage in childhood.

Troponin-T (cTnT) as a marker of myocardial damage is well established in adults, but not yet in children. cTnT was measured in 85 children (aged 1 day-204 months, mean 46 months). Twenty-five children were non-surgical patients, with possible myocardial damage suspected on clinical grounds. The other 60 patients had cardiac surgery leading to a defined myocardial damage. In these children, troponin-T (cTnT), creatine kinase activity (CK), creatine kinase-MB activity (CK-MB), and creatine kinase-MB-Mass (CK-MB-Mass) were measured preoperatively and 3-4 times during the first 55 postoperative h. Except in four children with probable preoperative myocardial damage, all troponin-T values were in the normal range (< 0.1 microg/l). All children with intracardiac surgery showed a postoperative increase in troponin-T. Children with extracardiac surgery of the great vessels showed no postoperative increase of troponin-T. For the assessment of myocardial damage, troponin-T was more specific and more sensitive than the other markers tested, troponin-T might significantly improve the diagnostic assessment of myocardial damage in children.

Biomarkers↗

PubMed1994

[Congenital heart defects: prevalence and course during the school years (8 to 16 years)].

In continuation of former studies regarding the first year of life and the preschool period, the prevalence and course of congenital heart disease in children during compulsory schooling has been studied. Compared with the preschool period, few cardiac defects are discovered, the prevalence up to 16 years of age being 9.9/1000. The mortality rate (2.7%) and also the rate of spontaneous normalization (4%) is significantly lower (compared to 18.7% and 21% respectively in the preschool period). Medical measures are needed less frequently, with 10 times fewer operations and 15 times fewer heart catheterizations being performed. Apart from the decline of hospital stays, checkups in the outpatient clinic also declined 3-4 times in comparison with the period between birth and school entry. School performance is very good. Only 4% of the children are unable to attend a normal school for cardiac reasons, and the percentage of pupils attending secondary school is higher than normal. In 5% of the children exercise tolerance is decreased due to the cardiac condition. In 85%, the quality of life is normal during the compulsory school period. Impairment is most often caused by additional non-cardiac malformations or very severe heart disease.

Abnormalities, Multiple↗

PubMed1994

[Pediatric cardiological emergencies].

Emergencies in pediatric cardiology are heart failure, cyanosis and rhythm disturbances. The signs of heart failure are tachycardia, tachypnea and hepatomegaly. The therapy consists of oxygen, diuretics and digoxin. Occasionally, intubation with mechanical ventilation and intravenous catecholamines are needed. Cyanosis is often the only sign of a severe heart malformation, and prompt hospitalization is mandatory. Oxygen and warm environment is important during transport, correction of a possible metabolic acidosis and prostaglandin infusion are done in the hospital. Beyond the newborn period, so-called cyanotic spells are seen, particularly in tetralogy of Fallot. In supraventricular tachycardia, vagal manoeuvres can be tried first, if not successful, intravenous adenosine or electroconversion will restore sinus rhythm. In the older child, intravenous isoptin can be given. Slow heart rates from total AV block or sinus node affection are treated with atrophic, isuprel or electrical pacing.

Arrhythmias, Cardiac↗

PubMed1990

Primary lipid cardiomyopathy.

In this communication, we describe an isolated, apparently congenital cardiomyopathy (CMP) characterized by the accumulation of stainable lipid in mitochondria of cardiomyocytes. This lesion, which we term primary lipid cardiomyopathy, has not been reported so far. The structural alteration was associated with progressive heart failure, leading to death at the age of 3 years, and with massive hypertrophy of myocardium. Lipid storage in heart muscle cells resulted in an impressive yellow to orange color of the myocardium. We suggest that this type of primary CMP may represent a new member within the group of mitochondrial CMPs. Possible pathogenic mechanisms are discussed.

Cardiomyopathies↗

PubMed1986

[Exanthema during frequent use of antibiotics and antibacterial drugs (penicillin, especially aminopenicillin, cephalosporin and cotrimoxazole) as well as allopurinol. Results of The Berne Comprehensive Hospital Drug Monitoring Program].

Of 19,653 patients hospitalized in the medical divisions of two teaching hospitals, 3980 were treated with an aminopenicillin, 808 with other penicillins, 427 with a cephalosporin, 2619 with cotrimoxazole and 846 with allopurinol. The first part of the study deals only with the incidence of exanthemas definitely or probably due to a specific drug on the basis of clinical considerations. The exanthema incidence is 8.0% for aminopenicillins, 4.7% for other penicillins, 1.9% for cephalosporins and 2.8% for cotrimoxazole. The second part of the study employs a cross-tabulation to determine the incidence of exanthemas definitely and probably drug-induced, and the temporal relationship of these reactions to aminopenicillin and allopurinol exposure. The observed risks of developing an exanthema are as follows: aminopenicillin without allopurinol 10.1%, aminopenicillin combined with allopurinol 7.2%, allopurinol without aminopenicillin 3.0%, neither of the two drugs 1.5%. The increased incidence of exanthemas observed by the Boston Collaborative Drug Surveillance Program (BCDSP) in patients concomitantly treated with aminopenicillin and allopurinol was not confirmed by our results. Our hypothesis is that the time of exposure to aminopenicillins might have been shorter for patients of the BCDSP who were not treated in connection with neoplastic disease and did not receive allopurinol. The incidence of aminopenicillin induced exanthemas increases severalfold with the duration of exposure time during the first 2-3 weeks. In the CHDMB, on the other hand, exposure time does not differ between the patients treated with aminopenicillin alone or in combination with allopurinol.

Allopurinol↗

PubMed1986

[Results of digital subtraction angiography in children and adolescents].

In 43 children and adolescents, DSA was carried out, in 29 cases by the intravenous and in 17 cases by the intra-arterial route. IV-DSA was usually performed by putting a cannula (14 to 18 G) into the antecubital vein (bolus injection of 5 to 40 ml. of contrast and 5 to 20 ml. saline at 2 to 12 ml./sec.). The indication for IV-DSA is the investigation of congenital cardio-vascular abnormalities (stenosis or atresia of the pulmonary artery, anomalies of the pulmonary veins or the aortic arch and following vascular surgery). In these cases the more invasive heart catheter examinations can be avoided. IA-DSA is performed with a catheter with a fine lumen (4 to 5 F), diluting the contrast with an equal amount of saline. The advantage of IA-DSA is that it is less invasive, uses less contrast and provides better contrast and detail.

Adolescent↗

PubMed1986

Cerebral metabolic studies in situ by 31P-nuclear magnetic resonance after hypothermic circulatory arrest.

Cerebral high energy phosphates were studied in the intact rabbit brain using nuclear magnetic resonance spectroscopy. The effect of hypothermia on degradation kinetics in total ischemia due to circulatory arrest was examined, measuring phosphocreatine, adenosine triphosphate, and inorganic phosphate as a function of time at three different temperatures (35, 24, 21 degrees C). Phosphocreatine- and ATP-decays followed single exponential functions at all three temperatures. The half-life times increased by approximately a factor of three upon lowering the temperature from 35 to 21 degrees C with activation energies of 15-20 kcal/mol, which corresponds to values of Q10 between 2.4 and 3.2. In the temperature range studied, no critical temperature was found below which metabolism would stop completely. We conclude that nuclear magnetic resonance spectroscopy allows, in the intact animal, quantitative assessment of the influence of hypothermia on energy metabolism in the brain. This influence is a major concern in the field of cardiac surgery in infants and children who are often operated in total circulatory arrest under deep hypothermia.

Adenosine Triphosphate↗

PubMed1985

[Congenital heart defects, incidence and course up to the 8th year of life].

The incidence of congenital heart disease in children born alive in Switzerland in 1975 is estimated at 10%. Of these, 17% died within the first eight years of life (14% due to the cardiac lesion and 3% due to non-cardiac causes), with 2/3 dying within the first year of life. 33% of all these children become "normal", after successful operative correction or spontaneous closure of defects. Of the survivors, only 2% are prevented from attending normal school by the cardiac lesion, 2% are considered psycho-socially abnormal by parents or family doctor and 4% are regarded as having limited exercise tolerance due to the cardiac malformation. More problems may arise from additional non-cardiac malformations, such as chromosomal aberration. 62% of all these children need nothing more than out-patient follow-up, while 38% have had to be hospitalized due to heart disease. Of these, 31% underwent cardiac catheterization and 18% cardiac surgery within the first eight years of life. As is to be expected, there are significant differences in outcome and medical procedures depending on the nature of the cardiac lesion.

Cardiac Catheterization↗

PubMed1985

[Echocardiography detection of intracavitary ventricular tumors].

Intracavitary ventricular tumors were found in 3 male patients (newborn, and 18 and 23 years old) by 2-D echocardiography (metastasis of an osteogenic sarcoma in the right ventricle, teratoma embryonale growing from the retroperitoneum into the right ventricle, rhabdomyoma of the left ventricle). They all showed a uniform echo pattern and two of them were pedunculated. Wall motility, valves and cardiac dimensions were normal. In each case diagnosis was confirmed intraoperatively or at autopsy. Clinically the metastasis of the osteogenic sarcoma presented as obstruction of the superior vena cava, whereas the teratoma embryonale imitated tricuspid valve disease. The rhabdomyoma caused a systolic murmur and severe postpartal sinus bradycardia. It was successfully removed on the basis of echocardiography alone. 2-D echocardiography is a reliable, noninvasive diagnostic tool for evaluation of intracavitary, ventricular tumors.

Adolescent↗

PubMed1985

[Effect of two years of deferoxamine therapy on iron balance, ferritin, liver and heart in patients with thalassemia major].

The iron balance, the urinary excretion of iron between transfusions, the serum ferritin, the liver density, the size of the heart, the ECG and the echocardiogram of 14 children with thalassaemia major were assessed before and during or after 2 years of deferoxamine therapy (DF, 1 or 2 g/kg body weight/day according to age, by subcutaneous infusion on 5 days per week, 11 months per year). The mean iron balance decreased significantly (p less than 0.001) from 15.4 +/- 4 mg/kg body weight/month before DF to -7.1 +/- 9.4 mg/kg body weight/month in the first year of DF and increased to -2.5 +/- 6.5 mg/kg body weight/month during the second year of DF therapy. Despite administration of a constant dose of DF the urinary excretion of iron during the last days before transfusion was twice as high as during the first days after transfusion. The mean serum ferritin level fell from 6380 +/- 2600 ng/ml before DF to 5074 +/- 1600 ng/ml during the first and 4346 +/- 1900 ng/ml during the second year of DF therapy (p less than 0.05). There was no significant change in liver density or cardiac parameters.

Adolescent↗

PubMed1984

[Significance of age, sex, kidney function, atopy and number of prescriptions for the occurrence of adverse drug reactions, studied by multivariate statistical methods. Results from the Comprehensive Hospital Drug Monitoring Berne (CHDMB)].

UNLABELLED: The influence of five factors (age, sex, renal function, atopy and number of drugs) on the incidence of adverse drug reactions (ADRs) is analysed by multivariate statistical methods (loglinear models for contingency tables). The study is based on a total of 19,653 inpatients in the "Comprehensive Hospital Drug Monitoring Berne (CHDMB)". RESULTS: 1. The risk of ADRs mainly increases with the number of drugs. 2. Increasing age and female sex are also confirmed as risk factors by these statistical methods. Reduced renal function (increased serum creatinine) is strongly correlated with advancing age. Renal function, however, yields more pertinent information on ADR risk than does age. 3. In atopic and non-atopic patients, the ADR risk is identical. In both groups of patients the same number of drugs was given. If the pathogenetic mechanisms of the ADRs (allergic or pharmacologic in the broad sense) are considered, it is found that atopic patients show a ratio of about 2:1 pharmacologic to allergic reactions, compared to about 3:1 in non-atopic subjects. A reduction in the incidence of ADRs is best attained by even more restricted use of drugs and better and earlier adaptation of drug dosage to diminished renal function.

Adolescent↗

PubMed1983

[Psychosocial effects of heart disease in adolescents and adults with tetralogy of Fallot].

The progress of heart surgery has brought about an important improvement in the prognosis of many congenital heart diseases. More and more attention is now being paid to the psychosocial effects of heart disease in patients who have undergone cardiac surgery. The results are presented of a study designed to assess the psychosocial situation of patients aged 18 years or more with tetralogy of Fallot. Variables assessed in the study include school, work, insurance, marriage, children, sport and physical activity, and emotional wellbeing.

Adolescent↗

PubMed1982

[Drug side effects as the probable cause of death. Results of the Berne Comprehensive Hospital Drug Monitoring Program].

During the years 1974-1980, 19 of 17,285 inpatients of the divisions of internal medicine of two teaching hospitals showed a probable or definite adverse drug reaction (ADR) which was considered to be a major cause of death. In 7 patients the decisive ADR occurred during the hospital stay. The overall mortality from ADR is 0.040%. For each therapeutic group of drugs the following rate of drug-related death was calculated: for anticoagulants 0.047% (3/6378 inpatients), for cardiac glycosides 0.016% (1/6368), for analgesic/antirheumatic drugs 0.014% (1/7112) and for cytostatic drugs 0.38% (2/531). In 12 patients the ADR was already present on hospital admission.

Aged↗