PubMed Health⌕ Search

Biomedical subjects

G Rodewald

Publications and source records attributed to G Rodewald.

At least 37 records · Page 2Linked to original sources
PubMed1982

[Wound infection and its treatment. In thoracic and cardiovascular surgery].

Wound infections following aseptic operations are considered to be hospital infections. Among 4,166 patients operated on between 1973 and 1980 for cardiovascular diseases, there have been wound infections in 58 cases (1.4%) and associated sternal or mediastinal infection in 11 cases (0.26%). One-third of the infections were caused by staphylococci. In superficial infections therapy consisted in healing by second intention. In deep infections surgical intervention with débridement and irrigation was the method of choice.

Anti-Bacterial Agents↗
PubMed1981

Intracoronary streptokinase thrombolytic recanalization and subsequent surgical bypass of remaining atherosclerotic stenosis in acute myocardial infarction: complementary combined approach effecting reduced infarct size, preventing reinfarction, and improving left ventricular function.

In 48 patients with acute myocardial infarction (AMI) the acutely thrombus-occluded coronary artery was successfully recanalized nonsurgically via catheter with intracoronary streptokinase (SK) infusion after a mean occlusion time of 3.1 +/- 1.6 hours. In all cases residual high-grade fixed atherosclerotic stenosis remained after percutaneous transluminal coronary recanalization (PTCR). Subsequent aortocoronary bypass surgery (ACBS) circumventing the stenotic coronary artery was performed during the acute stage of myocardial infarction (within 10 days of AMI onset) in 34 patients and electively (longer than 10 days after AMI onset) in 14 patients. No patient died from early PTCR or from ACBS intervention. There were two late post-ACBS arrhythmogenic deaths, two patients suffered nonfatal reinfarction post ACBS several months after hospital discharge, only two had occasional post-ACBS angina pectoris, and one patient had post-ACBS mild heart failure. The remaining 41 post-ACBS patients were completely asymptomatic throughout long-term follow-up evaluation. In the left ventricular (LV) segment supplied by the initially occluded coronary artery, which was recanalized early by means of SK therapy and subsequently grafted, wall motion improved significantly from the acute to the postoperative stage in patients who underwent early surgery (from 13.6% +/- 1.9% to 40.3% +/- 2.7%, p less than 0.001) and in the electively operated group (from 18.0% +/- 7.1% to 48.2% +/- 6.3%, p less than 0.001). Ischemic wall motion was improved irrespective of whether or not the bypass graft circumventing the residual stenosis of the infarct vessel remained patent. Wall motion of nonischemic segments remained essentially unchanged. In the patients who underwent surgery in the early stage, the closure rate of the bypass graft to the infarct-related vessel was 17%, and in the electively operated group no graft was found to be occluded. In conclusion, coronary artery recanalization, achieved by means of early SK-PTCR therapy with subsequent ACBS, can be performed safely in patients with AMI, and the result will be marked improvement in LV segmental wall motion and global function, diminished reinfarction rate, and reduced incidence of angina pectoris, all benefits that are consistently maintained during long-term evaluation.

Angioplasty, Balloon↗
PubMed1981

[Perioperative complete right bundle branch block after aorto-coronary bypass surgery (author's transl)].

In 322 patients undergoing isolated coronary artery bypass grafting, the possible factors responsible for the development of intraventricular conduction disturbances were investigated. In 18 patients (5.6%), complete right bundle branch was observed perioperatively, 2 of whom also demonstrated left anterior hemiblock. Left bundle branch block, either complete or incomplete, was not observed. Patients demonstrating perioperative complete right bundle branch block were further characterized by the finding that 14 of 18 (77.7%) had preoperative inferior wall infarction as opposed to only 34% in the remaining 304 patients. Fifteen of the 18 patients (83.3%) had prolonged aortic cross-clamp times in contrast to only 37.5% of the remaining patients. Three-vessel disease, present in 16 of the 18 (88.9%) patients, was less frequently present (56.2%) in those in whom complete right bundle branch block did not develop perioperatively. Application of the chi 2-test showed significant differences in all of the latter variables. The perioperative onset of complete right bundle branch block may be due to several factors. The results of this study indicate that the extent of scar tissue and arteriosclerotic changes as well as the ischemic time during surgery may play a decisive role. In ten of the patients, the perioperatively-incurred complete right bundle branch block was irreversible. Postoperative angiographic studies revealed no relationship between block development and graft occlusion.

Adult↗
PubMed1980

Cardiac surgery in the Federal Republic of Germany during 1978 and 1979. A report by the German Society for Thoracic and Cardiovascular Surgery.

This is a report of the first 2 annual summaries of cardiac surgery performed in 21 units throughout the Federal Republic of Germany during 1978 and 1979. Including hospital mortality rates of the more conventional cardiac procedures, this register demonstrates development in and emphasis on cardiac surgery throughout the country over the years as well as it enables each cardiac surgeon to compare the work of his unit with that of other by giving a nationwide standard.

Cardiac Surgical Procedures↗
PubMed1980

[Urea and ammonia metabolism as partial aspects of nitrogen metabolism after surgery using the heart-lung machine].

22 patients undergoing open heart surgery for mitral valve dysfunction using extracorporeal circulation were studied pre- and postoperatively. Our study revealed a hypercatabolic situation with increased excretion of total nitrogen, urea and less significant excretion of ammonia on the day of surgery and during the 1-4th postoperative days. The portion of urea in percent of the total nitrogen excretion rose up to 95%. Ammonia excretion, however, did not exceed 4% during the whole period of investigation (7 days preoperatively, the day of surgery and 13 days postoperatively). Obviously the combined enteral and parenteral nutrition containing an average of 59.5 g protein, 207.0 g carbohydrate and 47.8 g fat per day which gave a total caloric intake of 1,536 kcal/day was not sufficient to compensate for the postoperative catabolism, but excessive situations could be avoided. The values of urea and nitrogen excretion in relation to the nitrogen intake indicate that a sudden shift of enteral and parenteral nutrition is associated with a considerable loss of body nitrogen. Therefore we suggest simultaneous enteral and parenteral nutrition which should be shifted only gradually over a period of 10-12 days to complete enteral nutrition for the postoperative treatment of patients undergoing open heart surgery with the use of extracorporeal circulation.

Adult↗
PubMed1979

Open-heart surgery: somatic predictors of postoperative psychopathology.

This study reports on some relationships between somatic conditions and postoperative psychopathological disturbances in 102 subjects from 20 to 65 years of age, undergoing open heart surgery. The overall incidence of postoperative psychiatric complications was 40%. Only two variables showed a significant correlation with the psychiatric criteria we used, independent of the different diagnoses: body weight and preoperative urea-N levels in serum. Some of the somatic predictors reported in the literature could be found to be specific for mitral or aortic valve disease. Predictors for psychiatric complications in patients with aortic valve replacement were: age, preoperative protein and urea-N levels in serum, and daytime sedation. The predictor in mitral valve replacement was the decrease in venous oxygenation (pulmonary artery) under physical strain.

Adult↗
PubMed1979

Hemodynamic changes following ventricular aneurysmectomy during the first three postoperative days.

One hundred twenty-eight patients underwent left ventricular aneurysmectomy; in 78 cases the procedure was combined with either aortocoronary bypass or valve replacement. In 7 patients undergoing isolated aneurysmectomy the influence of atrial pacing on various hemodynamic parameters was studied immediately postoperatively and on the first, second and third postoperative days. Until a certain point, increase in heart rate resulted in decrease of left ventricular filling pressure and increase of cardiac output, while systemic pressure changed only slightly. For each patient and each day the optimal heart rate as well as the optimal point of the Starling curve in these patients was found at extremely low filling pressures Kirklin's scheme of therapy may be limited in these patients. Therefore, in low cardiac output syndrome, left ventricular filling pressure should only be increased after the optimal heart rate is selected by atrial stimulation.

Heart Aneurysm↗
PubMed1979

Clinical application of cardioplegia in aortic cross-clamping periods longer than 150 minutes.

Out of more than 1000 patients operated upon by means of cardioplegia in profound myocardial hypothermia (15 degrees - 20 degrees C) aortic crossclamping time exceeded 150 min in 26 cases. The average clamping time in this group of patients was 169 +/- 22 min (150 to 227 min). The average duration of the cardioplegic coronary perfusion was 35 +/- 21 min (14 to 99 min). The following procedures were performed. Aneurysmectomy of the ascending thoracic aorta combined with valve replacement (n = 7); valve replacement combined with aorto-coronary bypass procedures (n = 9); multiple valve replacement (n = 3); multiple coronary grafting (n = 6) and one complicated reoperation. Three patients (11.5%) died, none intraoperatively and none as the result of a heart failure connected with the operation.

Adenosine Triphosphate↗
PubMed1979

Open-heart surgery from the psychological point of view and resulting therapeutic considerations.

A total of 168 patients underwent thorough psychological investigation before and after open-heart surgery. The pre-operative psychological status and the psychosocial situation of the patients were studied by means of questionnaires and semi-standardized interviews. The post-operative psychic status was documented daily on the first four post-operative days and once after discharge from the intensive care unit, by means of a slightly modified version of the AMP rating scale. We found significant correlations between psychosocial problems, the patients' ability to cope with their illness, the surgical stress and the environmental stress of the intense care unit, and post-operative psychic disturbances. The results lead to deliberations on therapeutic consequences.

Cardiac Surgical Procedures↗
PubMed1979

[Problems in the classification of psychopathological disorders following cardiac surgery with extracorporeal circulation].

Classifications of postoperative psychopathological disorders after heart surgery according to the literature are very different as the results are dependent upon the accuracy of the observation. The accuracy and choice of classification are important as the base for identifying causal factors. We studied 214 patients using three alternative methods of classification and discuss problems of classification of the postoperative psychopathological dysfunctions.

Cardiac Surgical Procedures↗