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Biomedical subjects

H Aebert

Publications and source records attributed to H Aebert.

34 records · Page 2Linked to original sources
PubMed1996

Coronary artery bypass grafting after failed percutaneous angioplasty compared to direct coronary bypass grafting in patients with unstable angina.

With the increasing experience in percutaneous transluminal angioplasty (PTCA) for unstable angina surgical revascularization versus interventional angioplasty treatment has been controversial. From 1991 to 1993, 162 patients underwent coronary artery bypass grafting (CABG) for unstable angina. While 126 patients received primary surgery (group I), 36 had a PTCA first which was followed by emergency operation for complications (group II). In group II there were more cases of single-or double-vessel disease (p < 0.001) and none had left main stem stenosis (p < 0.0001), but there was no difference in ventricular function between the groups. The number of distal anastomoses, mean cross-clamp time, and usage of the internal mammary artery (IMA) were significantly lower in group II. The peri-operative mortality rate was comparable between groups (5.5% versus 8.3%; n.s.). Myocardial infarction occurred more frequently in patients after PTCA (8.3% versus 4.0%; p < 0.05) without increasing the rate of low output syndrome. In conclusion, emergency CABG after failed PTCA in patients with unstable angina carries an acceptable perioperative risk. Since the perioperative rate of myocardial infarction is higher and the IMA is used less frequently in this setting long-term results may be better with the direct surgical approach.

Aged↗
PubMed1996

Catheter-induced pulmonary artery perforation during cardiac surgery: intraoperative surgical management.

A case of pulmonary artery rupture due to Swan-Ganz catheterization is reported. A 73-year old women undergoing coronary artery bypass grafting developed massive endotracheal bleeding during weaning from the cardiopulmonary bypass and inflation of the balloon of the Swan-Ganz catheter. As bleeding could not be controlled by endobronchial Fogerty catheter blockade, resection of the lateral segment of the middle lobe was necessary before bypass could be terminated. The postoperative course was complicated by an abscess formation in the right middle lobe of the lung which required operative revision.

Aged↗
PubMed1996

[Heart operations in patients older than 75. Results and postoperative rehabilitation].

A total of 164 patients with a mean age of 78.6 +/- 2.7 years and often critical preoperative conditions [New York Heart Association (NYHA) class III + IV, 78.7%] underwent cardiac operations [coronary artery bypass grafting (CABG) 97; valve replacement, 33; CABG + valve replacement, 18; replacement of ascending aorta and others, 18] with an in-hospital mortality of 8.5% (n = 14). Follow-up was completed for 147 patients (98%) after 16.5 +/- 10.8 months. Most patients were in a good clinical condition (NYHA I + II, 79.6%; late deaths, 8 patients, 5.4%) and more than 95% of patients lived at home or with relatives. Charges for hospital treatment dropped to one third after the hospitalization period for surgery in the first postoperative year compared to the year immediately preceding the cardiac operation.

Aged↗
PubMed1995

The blood saving potential of vortex versus roller pump with and without aprotinin.

To evaluate the potential of centrifugal blood pumps for saving blood, 120 patients scheduled for elective coronary artery bypass grafting were entered into a prospective randomized trial. A standard roller pump (group I) was compared with a centrifugal blood pump (group II) and roller pump plus aprotinin (group III). There was no significant difference between groups I and II with respect to free haemoglobin, lactic dehydrogenase, serum bilirubin, platelet surface glycoprotein IIb-IIIa and granule membrane protein 140, chest-tube drainage, use of blood products, length of stay in intensive care, time on ventilator and postoperative mortality. Aprotinin reduced chest-tube drainage and use of blood products significantly. Three cases of graft occlusions were noted in group III. Centrifugal blood pumps offer no advantage in routine heart surgery over conventional roller pumps. Aprotinin reduces blood loss, but does not influence GP IIb-IIIa and GMP 140 expression on blood platelets.

Blood Component Transfusion↗
PubMed1994

Cerebral embolism due to left ventricular pacemaker lead: removal with cardiopulmonary bypass.

Malposition of a cardiac pacemaker lead within the left ventricle represents a source of early and late thromboembolic complications. We report a case of cerebral embolism, caused by an inadvertently misplaced left ventricular electrode, occurring 3 years after implantation. The lead was removed via a transaortic approach with extracorporeal circulation.

Echocardiography, Transesophageal↗
PubMed1994

Torsades de pointes arrhythmia in a patient with left ventricular myxoma.

A 38-year-old woman suffered from syncopes due to torsades de pointes arrhythmias. Echocardiography showed a left ventricular mass that was resected. By immunohistochemical investigations, an organized thrombus was excluded and the diagnosis of a rare ventricular myxoma was confirmed. Postoperatively the arrhythmias resolved without recurrence. We conclude that left ventricular myxoma may cause life-threatening arrhythmias, possibly by irritation of cardiac mechanoreceptors. To our knowledge, this is the first case of a left ventricular myxoma associated with a torsades de pointes arrhythmia.

Adult↗
PubMed1993

High incidence of aneurysm formation following patch plasty repair of coarctation.

Repair of aortic coarctation was performed in 152 adolescent and adult patients (mean age 28.5 years, range 14-67 years). Ninety patients were treated with patch plasty, 33 with end-to-end anastomosis, 18 with interposition of a tubular graft, 6 with prosthetic bypass and 5 with direct plasty. There were two (1.3%) early and ten (6.6%) late deaths after 2.9 to 11.8 (mean 6.6) years. Of the remaining 140 patients, 129 (92.1%) were reexamined with computed tomography and angiography after 1.5 to 17.2 (mean 9.1) years postoperatively. In 27 patients (35.1%) of the patch plasty group significant dilatation at the operative site was observed and reoperation for aneurysm formation was required in 15 patients (19.5%). Resection of the intimal crest did not increase the probability of aneurysm formation, whereas Dacron as patch material and late hypertension had a significant influence. Six of the ten late deaths occurred in the patch plasty group. Rupture of an aneurysm at the operative site was proved in two of these patients, and three patients died suddenly for unknown reasons. In the other groups significant dilatation was observed in 13 patients and 3 local aneurysms required reoperation (2 after end-to-end anastomosis and 1 after direct plasty). We conclude that patch plasty repair of coarctation should be abandoned in adults. End-to-end anastomosis is advisable only if possible without excessive tension. Reoperation with interposition of a tubular graft on left heart bypass proved to be a safe method.

Adolescent↗
PubMed1990

Bronchoscopy in severe blunt chest trauma.

Extended lesions of the lung parenchyma are often seen in association with blunt chest trauma. Blood aspiration, atelectasis and the formation of bronchopleural fistulae can lead to early respiratory deterioration and the development of severe post-traumatic complications (pneumonia, acute respiratory distress syndrome). Diagnostic and therapeutic bronchoscopy is essential on admission. This procedure helps to estimate the severity and extent of parenchymal lesions even before chest X-ray signs are noted. Bronchoalveolar lavage is needed for removal of aspirates. In our study bronchoalveolar lavage on admission reduced bacterial contamination and pneumonia in comparison to patients not lavaged. A new method for closure of bronchopleural fistulae is described. Fibrin instillation after balloon catheter occlusion leads to a significant reduction of tidal volume loss (greater than 50% in average).

Adult↗
PubMed1989

Emptying of the gastric substitute after total gastrectomy. Jejunal interposition versus Roux-y esophagojejunostomy.

Emptying of the gastric substitute and small bowel transit time of a 99mTc-labeled solid test meal were measured in 20 tumor-free patients 13 to 63 (median, 35) months after total gastrectomy with Roux-y (n = 11) and jejunal interposition (n = 9) reconstruction. The emptying half-times ranged from 2 minutes to greater than 20 minutes. Rapid emptying was associated with dumping symptoms (p less than 0.03) and shorter orocoecal transit-time (p less than 0.05). Serum glucose concentrations rose more quickly in jejunal interposition, but the areas under the curve were identical in both groups. The median insulin-to-glucose ratio (areas under the curve) during the 20 minutes after the meal was 11.4 in jejunal interposition and 7.1 in Roux-y esophagojejunostomy (NS). Interposition cases had regained a significantly higher percentage (89%) of their premorbid weight than patients with Roux-y (78%; p less than 0.05). The weight/height2 ratio was above the 50th centile in 45% of interpositions, but below the 50th centile in all patients after the Roux-y mode of reconstruction (p less than 0.05). It is concluded that the emptying velocity of the gastric substitute has no impact on postoperative weight gain. The authors contend that the concept of a gastric substitute pouch is not supported by the findings of this study.

Anastomosis, Roux-en-Y↗
PubMed1988

Paranasal sinusitis and sepsis in ICU patients with nasotracheal intubation.

During a 1-year period 4 out of 171 nasotracheally intubated patients (2.3%) developed sepsis due to purulent sinusitis. 98 (57%) of the patients received mechanical ventilation for more than 10 days. In all cases of sinusitis the diagnosis could be confirmed by conventional X-ray examination. Sepsis resolved 1 to 3 days after initiation of a therapy protocol consisting of tracheostomy, surgical drainage and lavage. Pseudomonas aeruginosa was involved as pathogenic organism in 3 of 4 patients. We conclude that purulent sinusitis represents a serious and often occult problem in already critically ill patients with multiple potential sources of sepsis. Most important for diagnosis is a high level of suspicion particularly in patients with risk factors for infection. Prompt and successful treatment can be achieved by an aggressive surgical approach.

Adult↗
PubMed1986

[Calculated initial chemotherapy in mechanically-ventilated postoperative patients with peritonitis, sepsis and pneumonia].

Calculated chemotherapy is based on the knowledge of the typical bacterial agents of a particular infection. From January 1983 to August 1985 bacteriological findings from surgical patients with peritonitis, septicemia or pneumonia treated in an intensive care unit were analysed. The study concentrated on those findings only which differed from previous bacteriological investigations. During the first three days 53 patients on assisted ventilation suffering from peritonitis exhibited mainly enterobacteria in their peritoneal secretions. At day 10 or later we also found bacteria from the pseudomonas group. At that time the bacterial spectrum of bronchial secretions was comparable to that of the peritoneal secretions of the same patient. After day 10, the bacterial spectrum was similar in 36 ventilated patients without peritonitis, in 56 patients suffering from post-operative pneumonia and in peritonitis patients. According to our findings, calculated chemotherapy may be based on the fact that patients with peritonitis who cannot be cured within a few days have a bacterial flora comparable to that of patients with septicemia or pneumonia. Patients with severe infections following surgery, such as potentially fatal pneumonia, generalised peritonitis or septicemia were treated with imipenem/cilastatin, according to the above definitions of calculated chemotherapy. 37 of 46 patients treated between May and December 1985, were clinically cured. Microorganisms persisted in five clinically cured patients. Development of resistance to imipenem was observed in one case. In one case treatment had to be stopped because of an allergic skin reaction. Monotherapy of peritonitis by imipenem/cilastatin appeared more satisfactory than treatment with combinations of other antibiotics.

Adult↗
PubMed1981

[Specificity control in the immunohistochemistry of enteral peptide hormones].

A great variety of peptide hormones have been demonstrated by immunocytochemical means in endocrine cells of the digestive system. Usually the specificity immunostaining in these cells is checked by antigen-adsorption of the antisera. This kind of specificity control, however, examines only antibody non-specificity but not staining non-specificity. Indeed staining non-specificities caused by ionic binding mechanisms are of considerable significance, at least for the immunostaining of some endocrine cell types (e.g. pancreatic glucagon- and PP-cells, pyloric gastrin-cells, intestinal GLI-cells). Therefore immunoreactivities of these cell types should be investigated under various experimental conditions. According to our present findings the following investigations should be performed to exclude staining non-specificities in immunostained endocrine cells of the digestive system: 1. Running of ascending dilutions of primary and secondary antisera. 2. Comparative investigations using crude antisera and purified antibodies against the peptide in question. 3. Use of phosphate buffered saline (PBS) with a relatively high salt content as a dilution agent for the antisera.

Animals↗
PubMedDate not supplied

Cytokine gene expression in monocytes of patients undergoing cardiopulmonary bypass surgery evaluated by real-time PCR.

Cardiopulmonary bypass (CPB) surgery induces systemic release of proinflammatory cytokines causing unspecific inflammatory reactions. This study deals with the development of a sensitive technique for detecting changes at the mRNA level in monocytes of patients undergoing CPB surgery, by using real-time PCR. Blood samples from patients undergoing elective coronary artery bypass grafting were obtained at six different time points. RNA was extracted from isolated monocytes and cDNA was synthesized by reverse transcriptase. CPB surgery induced gene expression of IL-1beta, IL-6, IL-8, and TNF-alpha, followed by a decrease below the preoperative expression values 6 h post CPB. High significant increases in gene expression for IL-8 at the end of surgery (p = 0.001) were detected. Real-time PCR is a powerful tool for getting simultaneously numerous sensitive, accurate, and reliable results from small amounts of biological material. This method avoids time-consuming and hazardous post-PCR manipulations and decreases the potential risk of PCR contamination.

Aged↗