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G Rettig

Publications and source records attributed to G Rettig.

At least 19 recordsLinked to original sources
PubMed2002

Iatrogenic ruptures of the tracheobronchial tree.

OBJECTIVE: Iatrogenic tracheobronchial ruptures are seldom but severe complications after intubation or bronchoscopy. Therefore, we evaluated the reasons, the subsequent therapy and the outcome of patients with tracheal rupture, who were admitted to our hospital. METHODS: In a retrospective study we examined 19 patients (15 women, four men; 43-87 years) treated for acute tracheobronchial lesions. Eleven (58%) patients had a tracheobronchial rupture by single-lumen tube, four (21%) by double-lumen tube and two patients (10%) by tracheal cannula. A total of 47% of whom were carried out under emergency conditions. Two patients had a rupture due to a stiff bronchoscopy. Mean symptoms were mediastinal and subcutaneous emphysema. Two emergency collar incisions had been done. RESULTS: The localization of ruptures was in all cases in the paries membranaceus, length: 1-7 cm (mean: 4.8 cm). The interval between the onset of symptoms and the diagnose differed widely (up to 72 h), nine (47%) diagnoses were made during intubation/bronchoscopy. One patient, with a small tear (1 cm) was treated conservatively with fibrin-glue. The other 18 patients had surgical repair through a thoracotomy. The postoperative mortality was determined with 42%, which was not dependent on the rupture but basically by the underlying diseases requiring intubation. CONCLUSIONS: Iatrogenic tracheal rupture is a dangerous complication with potentially high postoperative mortality, mostly influenced by the underlying disease. Early surgical repair must be the preferred treatment.

Adult↗
PubMed1992

Cardiodynamic effects of dopamine and dobutamine.

On 11 patients undergoing coronary surgery, at the end of the surgical intervention, the inotropic responses to 0.4 and 0.8 microgram x kg-1 x min-1 dopamine and dobutamine given via the aorto-coronary bypass directly into the coronary artery were compared. These dosages correspond to ones 10 times greater applied intravenously. The measurements were made using needle force probes which were implanted into the myocardial offstream area in the left ventricular wall. Bypass flow was measured simultaneously by an electromagnetic flow probe. There is a significant increase in coronary bypass flow induced by both rates of 0.4 and 0.8 microgram x kg-1 x min-1 dobutamine, but there was no significant effect on bypass flow induced by dopamine. Developed myocardial force is raised more by dobutamine medication than by dopamine. However, the rate of contraction increases significantly and relaxation is significantly accelerated by dopamine at both dosages. A significant increase in rate of contraction and relaxation was only induced by the higher dosage of 0.8 microgram x kg-1 x min-1 dobutamine.

Aged↗
PubMed1991

Quantitative assessment of the effects of 'inodilators' on the myocardium in patients without primary cardiac insufficiency after coronary surgery: Part I--Amrinone.

The positive inotropic and peripheral vasodilating effect of amrinone has been measured in 20 patients without manifest cardiac insufficiency during the early (8-18 h postoperative) and late (18-48 h postoperative) recovery phase after coronary surgery. On conclusion of the surgical intervention first the aortocoronary bypass flow was compared during dobutamine and amrinone administration. It increased by 88% with amrinone and by 19% with dobutamine. Then a needle force probe was implanted in the myocardium. Directly measured local myocardial force increased not significantly by 3.5% after the first and by 5.1% after the second bolus injection of 2 mg/kg amrinone. The rate of myocardial contraction increased by 18.7% and 12%. The rate of relaxation decreased by 5.3% after the first and increased by 15% after the second injection. Mean pulmonary arterial pressure fell from 18.5 to 15.5 mmHg and from 19.7 to 17 mmHg. Cardiac output increased by 23% after the first and by 20% after the second injection. Heart rate rose from 88 to 99 bpm and from 86 to 94 bpm. Total peripheral resistance fell from 1,035 to 706 dyn*s*cm-5 and from 1,036 to 819 dyn*s*cm-5. The systolic arterial pressure fell from 132 to 116 mmHg after the first injection and did not change after the second injection. Amrinone was found to be a powerful peripheral vasodilator with a mild positive inotropic action. The variations in the effects between the early and late recovery phases mainly reflect a progressive haemodynamic stabilization with a decreasing tendency toward hypotensive disregulation. Careful consideration has to be paid to a properly balanced filling of the vascular system before administering amrinone.

Adult↗
PubMed1991

Quantitative assessment of the effects of 'inodilators' on the myocardium in patients without primary cardiac insufficiency after coronary surgery: Part II--Enoximone.

Twelve patients undergoing routine coronary artery surgery received a bolus injection of 1.5 mg/kg enoximone between 8 and 18 hours and again between 18 and 48 hours after operation. No patient showed clinically manifest myocardial heart failure. The haemodynamic and cardiodynamic response to enoximone was quantified over a 30 minutes period following injection. Local myocardial developed force increased by 24 +/- 7% after the first and by 12 +/- 6% after the second injection. The rate of myocardial contraction increased by 50 +/- 14% and 15 +/- 10%, respectively, and relaxation increased by 35 +/- 14% and 22 +/- 19%. There was a decrease in total peripheral resistance of 38.8 and 42.9%, and an increase in heart rate of 11 and 15%. The mean arterial pressure showed small reductions from 73 (+/- 3.7) to 67 (+/- 2.6) mmHg for the first dose and from 83 (+/- 3.1) to 78.4 (+/- 2.8) mmHg for the second. Central venous and pulmonary artery pressures were essentially unaltered. The substantial positive inotropic effect of enoximone has been shown to match its peripheral vasodilatory activity, so that in the normovolaemic patient there is a clinically insignificant small fall in mean arterial pressure.

Aged↗
PubMed1991

[Comparison of new cardiac agents using differential therapeutic criteria].

Positive inotropism, reduction in preload, and reduction in afterload induced by any cardiacum are not exactly quantified in humans, nor are the patients classified as to their respective requirements. Also, any of these drug activities change with the patient's instantaneous cardiac and hemodynamic functional state. One reason for incomplete knowledge is a shortage of methods which allow to assess the inotropic state of the myocardium. In 17 patients, age range 56-76 years (two females, 15 male), undergoing routine coronary surgery, informed consent was obtained for implantation of a needle transducer for measurement of wall force. At the end of coronary surgery, developed myocardial force and aorto-coronary bypass flow were measured electromagnetically. After control measurements, 0.03, 0.06 and 0.1 mg/kg enoximone were injected slowly (3 min per dose) into the aorto-coronary bypass. Eight to 18 h after surgery, and again 18-48 h after surgery, the following measurements were made, first as a control, and then after 1.5 mg/kg enoximone i.v.: aortic pressure (AoP), central venous pressure (CVP) and pulmonary artery pressure (PAP), cardiac output (CO), and heart rate (HR). Peripheral vascular resistance (TPR) was calculated. Developed force and its derivatives were recorded continuously. Immediately after recovery from cardioplegia a 0.19 mg/kg dose of enoximone injected over 9 min into the aorto-coronary bypass induced an increase in bypass flow of 64 +/- 30%. Mean arterial pressure (MAP) showed a fall 5 min after enoximon injection on both occasions. The values were 73 (+/- 3.7) to 67 (+/- 2.6) mmHg, and 83 (+/- 3.1) to 78 (+/- 2.8) mmHg, respectively. The increase obtained in cardiac output (CO) 6.0 (+/- 0.4) to 7.4 (+/- 0.7) l.min-1, and 6.2 (+/- 0.7) to 8.5 (+/- 1.3) l.min-1 was significant at 5 min and remained so at 30 min on both occasions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Electrophysiological effects of nicainoprol in patients with paroxysmal supraventricular tachycardias.

The electrophysiological effects of nicainoprol, a new class I antiarrhythmic drug, were evaluated in 29 patients with supraventricular reentrant tachycardias, due to accessory pathways in 15 and dual atrioventricular nodal pathways in 14 patients. Nicainoprol was administered intravenously as a bolus followed by continuous infusion of 1.5 mg/kg in two and of 2 mg/kg in 27 patients over one hour. Nicainoprol was given as a bolus of 1.5-2 mg/kg during sinus rhythm in 11 patients or during induced supraventricular tachycardia in 18. The drug successfully terminated the tachycardia in 17 patients due to block in the retrograde tachycardia limb in 15 and the antegrade limb in 2 patients. Prolongation of the cycle length preceded the termination in each case. In one case, the termination could not be achieved despite the administration of 3 mg/kg. The sinus cycle length, heart rate corrected QT interval as well as right atrial and right ventricular effective refractory periods remained unchanged. In contrast, the intranodal and infranodal conduction times, as well as QRS duration, were prolonged significantly. In patients with dual atrioventricular nodal pathways, there was a significant (P less than 0.05) increase of the effective refractory periods of the anterograde slow pathways. The changes of the anterograde fast pathways, however, did not reach significance level. More pronounced effects were found on effective refractory periods of the retrograde pathways, which were blocked in 4 patients and significantly (P less than 0.05) prolonged in the remainder. Similarly, in patients with accessory pathways the effect on the retrograde conduction was more marked with complete block in 5 patients and significant prolongation of effective refractory periods and shortest paced cycle lengths in the remainder.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Development of retinofugal neuropil areas in the brain of the alpine newt, Triturus alpestris. II. Topographic organization and formation of projections.

The development of retinal projections and the formation of their retinotopic organization were studied by means of anterograde transport of horseradish peroxidase in the newt, Triturus alpestris. All tracts found in the adult on the contralateral brain side are established during embryonic stages. At this stage a few uncrossed fibers are also detectable. Retinal fibers project first to the contralateral optic tectum. These are followed by contralateral projections to the thalamic recipient areas. Beginning at embryonic stages, the projections from the retinal quadrants into the optic tectum are topographically organized. The other terminal areas innervated by the marginal optic tract (MaOT) show a topographic order from midlarval stages. The terminal areas innervated by the medial optic tract (MeOT) show no clear topographic organization at any stage. The contralateral projection of the MeOT originates from the central area of the retina, whereas the uncrossed projection originates from the temporal peripheral retina. Ipsilateral (uncrossed) retinal projections develop during metamorphic climax. The MeOT is more distinct than the MaOT. The latter shows a clear retinotopic organization. The topography of the ipsilateral MaOT and its corresponding terminal areas are mirror-symmetric to the contralateral tract and terminal areas.

Animals↗
PubMed1988

Antianginal efficacy of gallopamil in comparison to nifedipine.

In a randomized double-blind crossover trial 30 patients with chronic stable angina were studied to compare the antianginal actions of gallopamil (150 mg/day) and nifedipine. With the initial nifedipine dose of 60 mg/day, the trial had to be stopped because of severe exacerbation of angina in 3 patients of the nifedipine group. Twenty-one patients were entered into a second protocol with the nifedipine dose reduced to 30 mg/day. Compared to the preceding placebo period, the exercise time to onset of angina (+ 30%, P less than 0.01) and the total exercise time (+ 18%, P less than 0.01) were prolonged by gallopamil but not by nifedipine (+ 20 and 13%, respectively, not significant) with no significant difference between the test drugs. Four patients became free of angina during exercise testing with gallopamil therapy and one patient with nifedipine. Both agents significantly reduced ST depression at maximal comparable workload by 77% (gallopamil) and 52% (nifedipine) compared with placebo; the difference between the drugs reached borderline significance (P = 0.055). The increase in heart rate and the rate-pressure product at maximal comparable workload was less with gallopamil than with nifedipine (P less than 0.01). In contrast to nifedipine, very few side effects were reported with gallopamil. Thus, gallopamil is an effective antianginal agent whose therapeutic to toxic ratio appears to be superior to that of nifedipine.

Adult↗
PubMed1988

[Dose-related effect of nicainoprol (CAS 924) on basic electrophysiologic parameters in patients with and without diseases of the heart conduction system].

The dose-dependent effects of nicainoprol (1 and 2 mg/kg/h), a new antiarrhythmic drug, on invasive electrophysiological parameters were evaluated in 28 patients during diagnostic electrophysiologic studies. The most pronounced effects by nicainoprol were observed on the specialized AV conduction system. The intranodal (1 mg/kg/h: A-H interval: 92 +/- 19 ms to 107 +/- 25 ms, p less than 0.002, n = 13; 2 mg/kg/h: 92 +/- 18 ms to 114 +/- 27 ms, p less than 0.001, n = 16) and, in particular, the infranodal conduction time (1 mg/kg/h: H-V interval: 45 +/- 5 ms to 52 +/- 9 ms, p less than 0.001, n = 15; 2 mg/kg/h: 45 +/- 6 ms to 58 +/- 10 ms, p less than 0.0001, n = 18) were delayed in a dose-dependent fashion. With the higher dose, there was a highly significant prolongation of the AV nodal Wenckebach cycle length (380 +/- 69 ms to 440 +/- 79 ms, p less than 0.0001, n = 13) as well as of the effective (368 +/- 112 ms to 428 +/- 108 ms, p less than 0.001, n = 12) and functional refractory periods (470 +/- 102 ms to 521 +/- 135 ms, p less than 0.001, n = 15). The intraatrial conduction time was slightly prolonged for both doses, the intraventricular conduction time increased significantly with the higher dose (89 +/- 12 ms to 102 +/- 19 ms, p less than 0.001, n = 19). In contrast, there were only small changes of right atrial and right ventricular refractorion.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Arrhythmia Agents↗
PubMed1988

Connections of the tectum opticum in two urodeles, Salamandra salamandra and Bolitoglossa subpalmata, with special reference to the nucleus isthmi.

Tectal connections were studied in two urodele species following horseradish peroxidase injections into the tectum opticum. In both species retrogradely labelled cells were observed: ipsilaterally in the corpus striatum, lateral amygdala, ventral and dorsal thalamus and nucleus of DARKSCHEWITSCH--bilaterally in the pretectal nucleus, dorsal tegmentum and nucleus reticularis medius--contralaterally in the tectum opticum and area octavo lateralis. Besides these nuclei the nucleus isthmi was bilaterally labelled. Rostral efferent projections of the tectum opticum terminated in the ipsilateral pretectal area and the ipsilateral dorsal and ventral thalamus ipsilaterally coursing to the contralateral tectum via the commissura postoptica. Caudal efferents formed the bilaterally organized tecto-bulbar tracts innervating the rhombencephalon. Comparison of the results of a series of tectal horseradish peroxidase injections differing in depth, tangential extension and location, indicated that tectal afferents from the telencephalon, the contralateral tectum opticum and the medulla were sparse and widely branching. Projections of the telencephalon and all diencephalic nuclei terminated deep in the rostral tectum opticum. Projections of the medulla terminated preferentially deep in the caudal tectum opticum. The tecto-isthmic projection was highly topographic forming a layered terminal field lateral to the nucleus isthmi. The isthmo-tectal projection innervated the whole tectum opticum on the ipsilateral side and was highly topographic. On the contralateral side the caudal part of the tectum opticum was not innervated. The isthmo-tectal fibers terminated superficially in the tectum opticum on both sides of the brain. The nucleus isthmi identified here is proposed to be homologe to that of other vertebrates.

Animals↗
PubMed1986

Withdrawal of long-term amrinone therapy in patients with congestive heart failure: a placebo controlled trial.

To verify favourable long-term effects, 14 patients with chronic congestive heart failure, NYHA class II-IV, who had been treated with oral amrinone for 8-15 months with apparent clinical benefit, had the drug withdrawn according to a 12 week placebo controlled double-blind crossover protocol. Evaluation was performed noninvasively by means of exercise stress test, echocardiogram, radionuclide angiography and systolic time intervals. None of these variables were significantly changed after discontinuation of amrinone, regardless of whether placebo was introduced during the first (group B, N = 7) or the second 6 week period (group A, N = 5), nor when the medication was finally openly withheld for another 6 weeks. In 2 further group A patients, premature termination of the trial was due to deterioration of symptoms on blinded amrinone. Hence, no sustained drug related effects could be proven by controlled withdrawal of long-term amrinone in this trial.

Adult↗
PubMed1986

[Diseases of the central nervous system and cardiac arrhythmias].

Diseases of the central nervous system can result in various cardiac arrhythmias. In some neuromuscular disorders, a distinctive morphologic correlate of such arrhythmias can be found as a secondary cardiomyopathy. In other intracranial diseases, in particular subarachnoid and intracerebral hemorrhages, the lack of gross alterations of cardiac morphology suggests some "functional" nature of rhythm disturbances. Lesions of the autonomic regulatory centres frequently cause (unilateral) autonomic imbalance that is projected to the heart according to its asymmetric peripheral sympathetic innervation. The resultant propensity for sympathetically mediated arrhythmias is frequently reflected in prolongation of the QT interval and can be accentuated by simultaneous vagal discharge as well as catecholamine-mediated disseminated myocardial necroses. It is, however, unlikely that such neurogenic arrhythmias bear any independent prognostic significance; on the contrary, prognosis is usually determined by the severity of the underlying neurologic disease and its complications.

Arrhythmias, Cardiac↗
PubMed1985

[Atrial flutter and atrial fibrillation by DDD stimulation].

136 patients were followed after implantation a DDD pacemaker (PM) for a total of 1,919 patient-months (m = 14.1 months/patient). 22/136 patients had one or more episodes of atrial flutter or fibrillation (AF) postoperatively. In 121/136 patients (group A) AF had not been documented before, in 4 it was unknown at the time of implantation, but was verified retrospectively (group B). 11 patients (group C) had a positive history of previous AF. Post implantation 7.4% in group A and 81.8% in group C developed AF. In patients with sick sinus syndrome (SSS) the incidence was 10/37 (27%), in those with AV block (AV) 6/77 (7.8%) and in cases with both SSS and AV 6/22 (27.3%). The first AF episode occurred during the implantation itself (n = 2) or during the hospital course in 9/22 patients (A: 11%, B/C: 64% early attacks), and later on in 13 with a time delay of 1-24 months (m = 8.5, 8 patients) in group A and 2-15 months (m = 6.6, 4 patients) in groups B/C. 2 patients of group C had no AF episodes post implantation. In the individual patient the number of attacks ranged from 1 to 3 (10.4/100 patient-months) in group A and from 1 to 6 (20.1/100 patient-months) in groups B/C. During AF 16/22 patients had a ventricular rate of 110-185, m = 132 bpm. In 6 patients the tachycardia was mediated by the PM and in 10 by fast intrinsic AV conduction. 1 patient with SSS, 2 with SSS + AV (spontaneous ventricular rate less than 45 bpm) and 3 with AV needed ventricular backup-pacing during AF. In 7 patients a total of 15 attacks of atrial flutter could be terminated by atrial overdrive pacing, in 5 of these episodes by temporary high rate A00 stimulation via the implanted pacemaker lead system. Otherwise AF was converted to sinus rhythm by antiarrhythmic drugs. After termination AF often recurred, but only 3 patients developed chronic atrial fibrillation. In 2 patients a ventricular rate greater than 180 bpm during AF reverted the PM to asynchronous mode, a possible cause of ventricular fibrillation in one. No other complications due to the PM itself have been encountered. AF, therefore, common during DDD pacing, even in patients without any AF history before implant. Both the incidence and the recurrence of AF depend on the presence or absence of previous atrial arrhythmias.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1984

[Incidence of ventricular arrhythmia relative to the QT interval in spontaneous intracranial hemorrhages].

A prospective study was done in 54 patients with acute spontaneous intracranial haemorrhage, 27 of them with subarachnoid bleeding and 27 with primary intracerebral haemorrhage. The frequency of ventricular arrhythmias was registered by continuous long-term ECG and the incidence of QT prolongation by daily standard ECG registration. Prolongation of frequency-corrected QT-interval (QTc) developed in 9 patients with subarachnoid haemorrhage and in 10 with intracerebral haemorrhage. For assessment of time-relation between QT-interval and ventricular arrhythmias the results of corresponding long-term ECG and standard ECG were used and two groups were defined: group A (149 tapes) = QTc less than or equal to 450 ms, group B (43 tapes) = QTc greater than 450 ms. In group B singular frequent ventricular extrasystoles, couplets and non-persistent ventricular tachycardias occurred more frequently though not significantly so. Persistent ventricular tachycardias occurred significantly more frequently in group B (14% vs. 1%, P less than 0.01). In three tapes of group B, all of them with QTc prolongation of more than 550 ms persistent ventricular tachycardias with typical "torsade de pointes " morphology were seen. The results show that QTc prolongation of more than 450 ms occurs in a third and significant ventricular arrhythmia in nearly half of patients with spontaneous intracranial haemorrhage. Persistent ventricular tachycardias occur almost only in cases of QTc-prolongation. Pronounced QTc prolongation of more than 550 ms is rare. However, it can give rise to torsade de pointes and ventricular fibrillation.

Adult↗
PubMed1984

Distribution of accessory and hypoglossal nerves in the hindbrain and spinal cord of lungless salamanders, family Plethodontidae.

Study of the innervation of the musculature related to feeding behavior in plethodontid salamanders by means of the horseradish peroxidase (HRP) technique has demonstrated the existence of a true spinal accessory nerve which innervates neck musculature, enters the brain via the ganglion of IX/X cranial nerves and has its motor neurons within the nucleus of the second spinal nerve. Further, it has been shown that the first spinal nerve, being strictly motor, alone constitutes the ramus hypoglossus and is, therefore, homologous to the hypoglossus of amniotes.

Animals↗
PubMed1984

Recurrent torsade de pointes type ventricular tachycardia in intracranial hemorrhage.

Two out of 72 cases of intracranial hemorrhage-induced polymorphous ventricular tachycardia with typical Torsade de Pointes morphology are presented. Both patients had marked QTc prolongation more than 550 ms. In one patient (QTc: 669 ms) Torsade de Pointes degenerated into fatal ventricular fibrillation. Even though polymorphous Torsade de Pointes type ventricular tachycardia is rare during the clinical course of intracranial hemorrhage, attention should be given to the QT interval. QTc prolongation more than 550 ms may carry a high risk of Torsade de Pointes type ventricular tachycardia and ventricular fibrillation.

Adult↗
PubMed1984

Sustained atrial flutter after cardiac surgery: successful termination by rapid atrial pacing.

For termination of sustained atrial flutter, 28 rapid atrial stimulations were performed in 26 patients undergoing cardiac surgery, including coronary bypass surgery, and valvular heart surgery as well as surgery for primum and secundum atrial septal defect and anomalous connection of the pulmonary veins. In 18 patients rapid atrial pacing was successful in directly converting a flutter to a sinus rhythm, in 5 patients after a short period of transient atrial fibrillation. Atrial flutter could be changed to atrial fibrillation in a further 3 patients who remained in permanent atrial fibrillation and subsequently underwent DC cardioversion. Our results demonstrate that rapid atrial pacing is very effective in the treatment of sustained atrial flutter in patients following cardiac surgery and may be used alternatively to DC countershock.

Adolescent↗