Biomedical subjects

I C Ennker

Publications and source records attributed to I C Ennker.

At least 19 recordsLinked to original sources

PubMed2006

[Experiences collected in more than 2,300 diabetics undergoing coronary artery bypass grafting: patients with a specific risk profile].

BACKGROUND: The objective of this paper was to analyze demographic and clinical characteristics of diabetic patients undergoing coronary artery bypass grafting on the basis of a significant number of cases. METHODS: The data of 8,195 patients who have undergone coronary bypass operations between 1996 and 2003 were analyzed. Non-diabetic patients (no DM), oral treated diabetics (DM oral) and insulin-treated diabetics (DM insulin) were compared in terms of their pre-operative, intra-operative and post-operative characteristics. The statistical analyses were performed with the support of SPSS 11.5 under application of chi-square and student-t tests. RESULTS: In cardiosurgery, diabetics differ in various ways from non-diabetic patients. They show a significantly higher prevalence of the known cardiovascular risk factors such as raised body mass index, age and hypertension. Furthermore they present a higher prevalence of vascular comorbidity such as peripheral vascular disease and carotid disease. At the postoperative stage, cerebral dysfunction occurred more often among the diabetic patients (no DM 5.2% vs. DM oral 7.3% vs. DM insulin 10.5%; p < 0.05), they suffered from apoplexies more frequently (no DM 1.9% vs. DM oral 2.1% vs. DM insulin 3.2%; p < 0.05), and they required re-intubation more frequently (no DM 2.6% vs. DM oral 3.1% vs. DM insulin 5.6%; p < 0.05). Peri-operative mortality was highest in the group of insulin-treated diabetics (no DM 1.1% vs. DM oral 1.6% vs. DM insulin 1.8%; p < 0.05). CONCLUSION: In coronary surgery, diabetic patients represent an especially challenging patient group with an independent risk profile, who require specific consideration as far as the selection of the operative approach, on, one hand, and the post-operative follow-up, on the other hand, are concerned.

Age Factors↗

PubMed2005

Intraoperative bypass flow measurement reduces the incidence of postoperative ventricular fibrillation and myocardial markers after coronary revascularisation.

OBJECTIVE: Sudden ventricular fibrillation (VF) and myocardial infarction (MI) are life-threatening complications after coronary artery bypass grafting (CABG). We prospectively analysed the impact of intraoperative bypass flow measurement with the transit time flow Doppler method (TTFD) on the incidence and outcome of postoperative VF and MI. METHODS: In 1995 a standardized algorithm for the treatment of postoperative VF was introduced in our institution. The rate of postoperative VF was therefore exactly registered. In 1998 the TTFD method was implemented as a standard in all CABG cases. Whenever insufficient bypass graft flow was detected, anastomoses were redone and technical problems affecting the grafts were excluded. The incidence of postoperative VF and CK/CK-MB fraction was observed prospectively and the new data was compared to the data from 1995 to 1998. RESULTS: From 1/95 to 7/98 a total of 4321 patients (group A) were operated on with isolated CABG procedures using extracorporeal circulation. In the period from 8/98 to 10/02 a total of 3421 patients (group B) was operated on with isolated CABG procedures under the same conditions, except that the TTFD method was used in every case. The treatment of VF was standardised in both groups according to the algorithm. The most striking effect was the significant reduction of VF from 0.66% to 0.44% when TTFD was introduced and the steep decrease in mortality from 30% to 12.2% in patients with VF when the algorithm and TTFD were routinely applied. Furthermore the rate of insufficient bypass flow detected by angiography was reduced by 66%. CONCLUSION: Routinely the use of TTFD significantly reduced the incidence of postoperative VF, postoperative CK/CK-MB fraction, and angiographically detected bypass malfunction. A simultaneously implemented algorithm reduced the mortality with VF after CABG. The consequent use of TTFD intraoperatively reduced the incidence of postoperative anastomosis and technically related complications of bypass surgery and led to a significant reduction of postoperative mortality in CABG procedures.

Algorithms↗

PubMed2005

Mid term outcome and quality of life after aortic valve replacement in elderly people: mechanical versus stentless biological valves.

OBJECTIVE: To assess the benefit for patients older than 65 years of aortic valve replacement with stentless biological heart valves in comparison with mechanical valves. DESIGN: Multiple regression analysis of a retrospective follow up study. SETTING: Single cardiothoracic centre. PATIENTS: Between 1996 and 2001, 392 patients with a mean age of 74 years underwent aortic valve replacement with stentless Freestyle bioprostheses or mechanical St Jude Medical prostheses. MAIN OUTCOME MEASURE: Operative mortality and morbidity, postoperative morbid events, mid term survival, and New York Heart Association (NYHA) class improvement, and quality of life. RESULTS: No significant differences were found between patients receiving stentless biological valves and patients receiving mechanical prostheses. However, analysis of subgroups showed that patients older than 75 years with mechanical valves had an increased risk of major bleeding events (p = 0.007). Patients requiring anticoagulation by means of coumarin had a twofold increased risk of an impaired emotional reaction (p = 0.052). However, for patients who received a mechanical valve for severe combined aortic valve disease a survival advantage (p = 0.045) and a decreased risk of prolonged ventilation (p = 0.001) was observed. On the other hand, patients receiving a stentless bioprosthesis had an increased risk of a prolonged stay in intensive care (p = 0.04) and stroke (p = 0.01) if they had severely reduced cardiac function (NYHA class IV). CONCLUSIONS: Elderly people receiving stentless bioprostheses benefit emotionally because of the avoidance of coumarin. However, in patients with severe hypertrophied ventricles and extraordinary calcifications, stentless bioprostheses should be chosen with caution.

Aged↗

PubMed2001

[The impact of morbid obesity on the peri- and postoperative course after aortocoronary bypass surgery].

BACKGROUND AND OBJECTIVE: Excessive obesity is considered to be a risk factor in coronary bypass grafting. The aim of the current study was to examine if grossly overweight patients with a body mass index (BMI) > 35 suffer from higher morbidity and mortality when compared with patients with normal body weight (BMI = 20-25). PATIENTS AND METHODS: 206 extremely obese patients (group A) and 206 patients with normal body weight (group B) originating from a total of 5614 patients undergoing coronary bypass grafting in the time span between 1.4.1996-1.10.2000 were studied retrospectively and consecutively. The data were obtained from case histories, questionnaires and interviews. Statistical analysis was performed by the chi 2 test after Pearson, the t test and the Kaplan-Meier method depending on the statistical problem analysed using the SPSS software v. 8.0. RESULTS: The comparison of group A with group B revealed a significantly higher incidence of diabetes mellitus (p < 0.001), hypertension (p < 0.001) and hyperlipidaemia (p < 0.01) in group A. The only significant differences regarding the surgical procedure were the longer operation time (212.3 +/- 44.6 min, mean +/- SD) and aortic cross-clamp time (53.8 +/- 17.4 min, mean +/- SD) in group A (p < 0.05). The duration of mechanical ventilation, the incidence of respiratory insufficiency and the stay in the intensive care unit were not significantly different. The disorders of wound healing both in the sternal and the graft removal regions occurred significantly more frequently in group A (p < 0.001). The 30 days mortality rate in group A (1.5%) was not significantly different from group B (p < 0.001). The 30 days mortality rate in group A (1.5%) was not significantly different from group B (2.9%). The follow-up analysis of the 30 days mortality rate in different age groups revealed no significant differences in patients aged between 60 and 75 years. The mean survival rate after 4 years was 87.2% in group A and 86.4% in group B. CONCLUSION: In spite of higher morbidity our results did not reveal significantly higher mortality in extremely obese patients. After operation the patients considered their state improved, therefore elective coronary surgery in grossly overweight patients seems to be indicated also without previous weight reduction.

Adult↗

PubMed2001

[Short and long term results of aortic valve replacement in patients 80 years of age and older].

BACKGROUND: Due to demographic changes in average life expectancy the age of patients undergoing cardiac surgery is increasing as well. We have reviewed the short- and long-term outcome in patients over 80 years of age after aortic valve replacement with or without concomitant coronary grafting. PATIENTS AND METHOD: From 1.1.1995 until 31.12.1999, 126 patients (93 women, 33 men between 80 and 89 years, 82.8 +/- 2.4) underwent aortic valve replacement. 64 patients (group A) received isolated valve replacement, 62 (group B) underwent myocardial revascularization as well. RESULTS: The 30-day hospital mortality rate was 6.3% for group A and 14.5% for group B. The follow-up time ranged between 3 and 63 months (32 +/- 16). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulation therapy were observed by one patient from group A 3 years after the operation. Of the 15 deaths during the follow-up period seven (47%) were cardiac in nature and two (13%) related to stroke. Acturial survival rates for group A were 89%, 85% and 77% at 1, 2 and 3 years, and for group B 76%, 72% and 70%. Permanent nursing care was not required 1 year after the operation by 100% of patients in group A (2 years: 98%, 3 years 95%) and by 100% of patients in group B (2 years: 93%, 3 years: 90%). At an interval of 1 year after the operation 96% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years: 96%, 3 years: 94%). The rates for group B were 88%, 81% and 75%. CONCLUSION: Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, functional status as well as life expectancy in this age group seem to be positively influenced by aortic valve replacement.

Actuarial Analysis↗

PubMed2001

Aortic valve replacement with or without concomitant coronary artery bypass grafting in the ninth decade of life.

Due to demographic changes in average life expectancy, the age of patients undergoing cardiac surgery is increasing. We have reviewed the short- and long-term outcome after aortic valve replacement with or without concomitant coronary artery bypass grafting in patients over 80 years of age. From 1 January 1995 until 30 June 1999, 114 patients (83 women and 31 men, 80-89 years of age, 82.8+/-2.4 years) with symptomatic aortic valve disease underwent aortic valve replacement. Of these patients, 54% (group A) received isolated valve replacement and 46% (group B) underwent myocardial revascularization as well. The perioperative mortality rate was 4.8% for group A and 7.7% for group B. The 30-day hospital mortality rate was 4.8% for group A and 15.4% for group B. The follow-up time ranged between 3 months and 63 months (32+/-15 months). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulation therapy were not observed. Of the 15 deaths during the follow-up period, seven (47%) were cardiac in nature and two (13%) were related to stroke. Actuarial survival rates for group A were 90%, 84%, and 76% at 1, 2, and 3 years, respectively, and for group B were 75%, 71%, and 68%. One year after the operation, permanent nursing care was not required by 100% of patients in group A (2 years, 98%; 3 years, 95%) and by 100% of patients in group B (2 years, 95%; 3 years, 91%). At a 1-year interval after the operation, 98% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years, 98%; 3 years, 95%). The rates for group B were 90%, 85%, and 85%. Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that, considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, functional status as well as life expectancy in this age group seem to be positively influenced by aortic valve replacement.

Actuarial Analysis↗

PubMed2001

Postoperative evaluation of radial artery grafts for coronary artery bypass grafting by transit-time Doppler flow measurements.

UNLABELLED: Due to the histological configuration of the vessel wall, the radial artery is prone to spasm as a result of handling or harvesting. Therefore, certain degrees of arterial wall spasm are unpreventable, even with appropriate pharmacologic treatment, while using the radial artery as a bypass graft in CABG. Consequently, the radial artery is only reluctantly used compared to saphenous vein grafts in CABG. In our clinical experience, the radial artery, if harvested carefully, has proved to be an excellent bypass graft. This investigation was undertaken to study the differences in blood flow measured directly after extracorporeal circulation in radial artery grafts and venous grafts. Both grafts were compared to the left internal mammarian artery anastomosed to the LAD. METHODS: Between January 1998 and December 1999, 198 patients who were undergoing coronary artery revascularization with two grafts were retrospectively investigated. In all patients, the left internal mammarian artery (LIMA) was anastomosed to the left anterior descending branch (LAD). For the second graft, either the saphenous vein or the radial artery was used. Proximal anstomoses were performed as end-to-side into the ascending aorta. Patients were divided into four groups: Group 1: n = 79 IMA-LAD, vein to the circumflex artery; Group 2: n = 56 IMA-LAD, vein to the right coronary artery; Group 3: n = 34; IMA-LAD, radial artery to the circumflex artery; Group 4: n = 29 IMA-LAD, radial artery to the right coronary artery. Graft-flow measurements were performed using the transit-time method after extracorporeal circulation was terminated. The mean systolic, diastolic, and mean blood flow were measured, and the pulsatility index was calculated. Statistical analysis was performed using the of t-test analysis between the variables mean blood flow and pulsatility index. A p-value of < 0.05 was defined as statistically significant. RESULTS: There were no statistically significant differences in mean blood flow or pulsatility index between radial artery and saphenous vein grafts to the right coronary artery and the circumflex artery, respectively. Also, there were no differences regarding vein grafts to the right coronary artery and to the circumflex artery, or regarding radial artery grafts to the two coronaries, respectively. In group 4, significantly lower blood flow to the LAD was found compared to group 1, and a significantly higher pulsatility index compared to groups 2 and 3. CONCLUSIONS: Radial artery grafts compared to saphenous vein grafts do not show significant differences early after operation in mean blood flow or pulsatility index. Further studies are needed to evaluate long-term performance of radial arteries as coronary bypass grafts and to compare the radial artery to the right mammarian artery and the standard saphenous vein graft.

Blood Flow Velocity↗

PubMed2001

[Risk of perioperative mortality and complications following biological aortic valve replacement in elderly patients: stented vs. unstented prostheses].

Recently published studies suggest that the hemodynamic advantage of stentless bioprostheses in comparison to stented bioprostheses positively influence the long-term survival after aortic valve replacement. However, the more complex and time consuming implantation technique may increase the risk of operative death. Between April 1996 and September 2000, 201 patients with the mean age of 75 +/- 5 years underwent aortic valve replacement (AVR) with a stentless Medtronic Freestyle Bioprosthesis (FP) and 166 patients with a mean age of 77 +/- 5 years received a stented Medtronic Mosaic Bioprosthesis (MP). Patients requiring concomitant procedures other than coronary artery bypass grafting (CABG) were excluded. The operative mortality was 3.5% after AVR with the FP and 6% after AVR with the MP. Multiple logistic regression analysis considering the different patient populations revealed no increased risk of operative death after AVR with FB (p = 0.46). Previously heart operations (p = 0.046) and emergency operation (p = 0.022) were risk factors for operative death after AVR with the biological bioprostheses. The risk for postoperatively neurological impairment (p = 0.15) and other complications (p = 0.46) was furthermore not increased after implantation of a Freestyle stentless valve. The risk of delayed mobilization (p < 0.001) was 2.4-fold increased for patients after AVR with the Freestyle valve. A positive influence on survival due to the implantation of a stentless Freestyle valve could not be shown within the observed period. However, in spite of the more complex and time-consuming operation technique, the risk of operative death and postoperative complications is not increased after aortic valve replacement with the stentless FB.

Age Factors↗

PubMed2001

[Perioperative complications after heart valve replacement].

These days, the majority of perioperative complications resulting from operations on heart valves are more a consequence of the increasing age and morbidity of the patients and, despite all cardiac surgical and intensive care innovations, are still more the effect of the procedure on the other organ systems of the patient than being purely of a surgical nature. The surgical short- and long-term results after heart valve operations are significantly influenced by the early detection and adequate management of these manifold complications.

Adult↗

PubMed2000

[Aortic valve replacement in 80- and over 80-year-old patients. Short-term and long-term results].

Due to demographic changes in average life expectancy, the age of patients undergoing cardiac surgery is increasing as well. We have reviewed the short- and long-term outcome in patients over 80 years of age after aortic valve replacement. From 01 Jan 1995 until 31 Dec 1998, 105 patients (76 women, 29 men between 80 and 89 years, median: 83) underwent aortic valve replacement. 42% presented with aortic stenosis, 58% with combined valve disease with leading stenosis. 53% (group A) received isolated valve replacement, 47% (group B) underwent myocardial revascularization as well. The in-hospital mortality rate was 8.9% for group A and 14.3% for group B. The follow-up time ranged between 10 and 243 weeks (median: 112 weeks). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulant therapy were not observed. Of the 11 deaths during the follow-up period, 5 (45%) were cardiac in nature and 2 (18%) related to stroke. Actuarial survival rates for group A were 98, 95 and 88% at 1, 2 and 3 years, and for group B 92, 84 and 84%, respectively. Permanent nursing care was not required 1 year after the operation by 98% of patients in group A (2 years: 95%, 3 years: 88%) and by 100% of patients in group B (2 years: 95%, 3 years: 88%). At an interval of 1 year after the operation 98% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years: 98%, 3 years: 94%). The rates for group B were 90, 82 and 82%. Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, the functional status as well as life expectancy in this age group seems to be positively influenced by aortic valve replacement.

Aged↗

PubMed2000

[Isolated coronary bypass operation in the 9th decade of life].

The average age of patients undergoing cardiac surgery has increased continuously during the last three decades due to a progressively increasing number of older people in the population and the advances in operative and perioperative treatment in open heart surgery. Consequently we have investigated the short- and long-term results of isolated myocardial revascularization in patients who are in their ninth decade of life. Between 1 January 1995 and 31 December 1998, 121 patients (51 women, 70 men, age 80 to 88 years, median: 82 years) underwent isolated coronary artery bypass grafting. As part of the revascularization, a unilateral internal mammary artery graft (IMA) was used in 87% of cases. The in-hospital mortality was 6.6%. Analysis of predictors of mortality unveiled the following factors: ejection fraction less than 50%; history of recent left ventricular failure; extent of coronary artery disease; perioperative use of an intraaortic balloon pump (IABP) and symptomatic pericardial effusion. Use of the IMA revealed no influence on in-hospital mortality. The median follow-up time was 20 months (range: 2-48 months). Survival rates after 1, 2, and 3 years were 93.1%, 87.3% and 73.7% for women and 86.9%, 82.5% and 65.1% for men. These survival rates were comparable with those of the entire 82 year old population. Predictors for late death were male gender, history of stroke, history of arterial embolism, and postoperative pulmonary failure resulting in mechanical ventilation. During the follow-up period myocardial infarcts were subsequently not observed. Freedom from angina after 1, 2 and 3 years was 90.1%, 82.6% and 78.1%, respectively. At an interval of 1 year after the operation 87.6% of patients had not been hospitalized as a result of cardiac disorders (2 years: 80.1%, 3 years: 73.2%). Permanent nursing care was not required 1 year after the operation by 94.3% of patients (2 years: 91.5%, 3 years: 91.5%). Four percent of the survivors suffered from permanent delirium, 3% from depression, 5% from lack of concentration, and 6% from vertigo. In summary this study has revealed that, in patients over eighty years of age suffering from ischemic heart disease, coronary artery bypass grafting has acceptable short- and long-term results. Yearly mortality rates during the first 3 years after the operation are comparable with the expected mortality rate in an age-matched population.

Aged↗

PubMed1999

[Arterial myocardial revascularization in the 9th decade of life. Personal results and review of the literature].

The rate of the population being 80 years of age and even older, has an increasing tendency in the Federal Republic of Germany. In 1996, a total of 87,372 patients received surgery supported by the heart-lung-machine, 2,383 patients out of these (2.7%) were 80 years of age and older. In view of the limited life expectance, the arterial revascularization in this age category is faced with controverse discussions. We analysed our patients in relation to this aspect. Between January 1, 1995 and June 30, 1997, 4,338 patients underwent surgery supported by the heart-lung-machine. Hundred and fifty-five out of these (3.6%) were in the 9th decade of life. Seventy-seven patients out of the 155 (49.7%, 34 women, 43 men, 80 to 88 years old, mean: 82 years of age) underwent an isolated myocardial revascularization. We performed 55 (71%) elective, 16 (21%) urgent and 6 (8%) emergency surgeries. Twelve patients (15.6%) solely received venous bypasses (Group I), 65 (84.4%) additionally also received unilateral bypasses of the internal mammaria artery (IMA) (Group II). Three patients died at our facility (3.9%), 3 further patients died during the follow-up treatment in outlying hospitals, the in-patient mortality rate in Group I therefore presented a rate of 8.3%, in Group II 7.7% and in total, a rate of 7.8%. In 1996, the in-patient mortality rate could be reduced to 3.6%. The follow-up observation time ranged between 7 and 138 weeks (median 44 weeks). The survival rate for patients with an IMA-bypass after 1 year was 86.3%, after 2 years 77%, and for the entire collective 85.3% and 75%. Whereas 96% of the patients could pre-operatively be related to Class III or IV of the NYHA-classification, 55 of the 63 survivors (87%) belonged to Class I (6%) or II (81%). Two Group I patients (22.2%), 3 Group II patients (5.6%) and 7.9% of the total collective complained about repeated angina symptoms. The myocardial revascularization with the internal mammaria artery performed on patients in the 9th decade of life, achieves an acceptable morbidity and mortality compared to solely venous coronary bypasses. The more prolonged follow-up observation period will clarify, whether the arterial myocardial revascularization also proves to be the superior method in this age category.

Aged↗

PubMed1999

The disproportion of female and male surgeons in cardiothoracic surgery.

In ancient times, female medical practitioners and female surgeons were well known. With the introduction of medicine as an academic course and the ban on women studying, the medical career became virtually impossible for women. This condition changed with the general admission for women to colleges, in Germany in 1908. The current situation of women in surgery is presented here, with cardiovascular surgery as an example. Of 302 active cardiothoracic and cardiac surgeons 4.6% are female. According to an inquiry of all German heart institutes, there are 20 female senior registrars and 27 female surgeons as well as 162 female assistants. Most of the medical directors do have a positive opinion about female surgeons, but criticize that only a few women who apply for actually finish surgical training. One reason for this may be the greater difficulties for women to take care of a family and become a surgeon simultaneously. In this regard, an improvement in the position of female doctors is desirable.

Cardiology↗

PubMed1999

Simultaneous myocardial revascularization and aortic valve replacement: stentless versus stented bioprostheses.

Implantation of stentless aortic valve prostheses is more time-consuming than implantation of conventional stented bioprostheses. Simultaneous myocardial revascularization can result in a considerably prolonged operation time. We reviewed our patients with regard to surgical aspects in the specific patient cohorts. From April 1996 to April 1999, 303 patients were operated for aortic valve disease with or without concomitant coronary artery revascularization. Mean age was 75 years, ranging between 36 and 90 years. Using the Medtronic Freestyle valve, the following techniques of implantation were used: subcoronary technique, 163 patients, 61.5%; root inclusion technique, 7 patients, 3.5%; total root replacement, 30 patients, 15%. Total hospital mortality rate was 5.6%, reflecting age and concomitant disease of these patients. For isolated aortic valve replacement, the mortality rate was 4.7% and 6.7% for combined procedures. Coronary artery patients who are not suitable for stentless valve implantation owing to extensive aortic root calcification have a higher perioperative mortality rate. Compared with the isolated valve replacement and despite more extensive surgery and prolonged operative time, simultaneous myocardial revascularization in patients with stentless prostheses implantation can be performed without an increased risk.

Adult↗

PubMed1994

Formaldehyde-free collagen glue in experimental lung gluing.

Because of the well-known limitations of the adhesive strength of fibrin glue, it is imperative to develop a stronger glue with acceptable biocompatibility. This was accomplished by removing the formaldehyde component from gelatin-resorcinol-formaldehyde glue and replacing it by two less toxic aldehydes--pentanedial and ethanedial. To evaluate the adhesive strength of this new glue, GR-DIAL, lung incisions in rabbit hybrids were glued together. Each group (n = 5) was examined histologically after 2 days and 1, 2, and 4 weeks. The glue disintegrated gradually with good bioresorption when the incision was closed with a thin layer of glue. The healing process was favorable, indicating good biocompatibility. Therefore, GR-DIAL glue is capable of enhancing the use of surgical glues in the field of thoracic surgery by enabling surgeons to close larger parenchymal lesions than with fibrin glue.

Animals↗

PubMed1994

The impact of gelatin-resorcinol glue on aortic tissue: a histomorphologic evaluation.

PURPOSE: Although gelatin-resorcinol-formaldehyde glue has been used to treat acute aortic dissections for some time, concerns about formaldehyde's mutagenicity and carcinogenicity made it imperative to develop a new glue compound. Gelatin-dialdehyde glue was produced by omitting the formaldehyde component and replacing it with two less toxic aldehydes, glutaraldehyde and glyoxal. This study evaluated the histomorphologic effects of the new glue through in vivo use on the aortic tissue of domestic pigs. METHODS: Each animal's infrarenal aorta was glued around an implanted prosthesis. Histomorphologic evaluation was performed after operation after 1 and 4 weeks. RESULTS: The results demonstrated that the clinically observed tanning effect can be attributed primarily to the disintegration of the fiber texture, specifically collagenous, as well as smooth muscle fibers, and to the reciprocal alterations of the proteoglycan interstitial substance in the aortic wall. Macroscopic, microscopic, and electron microscopic analysis of the gluing process revealed an adequate healing process without any morphologically significant difference between formaldehyde and formaldehyde-free gelatin-resorcinol glue. CONCLUSIONS: Gelatin-dialdehyde glue is able to produce the same effects in the area of the aortic wall as the substantially more toxic gelatin-resorcinol-formaldehyde glue and thus could be recommended for clinical trials for treating acute aortic dissections thus far yielding excellent initial results.

Animals↗

PubMed1993

Video-assisted thoracoscopic surgery--indications, results, complications, and contraindications.

In recent times minimally invasive surgery has secured a firm place among the therapeutic options in thoracic surgery. The experience and results gained from video-assisted surgery on 109 patients between January 1, 1992 and July 31, 1993 are critically discussed. The procedure could be completed thoracoscopically on 94 of them. A change of method was necessary nine times for technical reasons and six times for oncological reasons (two times due to metastasis, four times due to bronchial carcinoma). A total of 154 individual operations were conducted. Sixty-three patients with recurrent spontaneous pneumothorax were successfully treated. The relapse rate was 1.5%. With the exception of three rethoracotomies (one due to postoperative hemorrhaging and two to persistent fistula) no significant complications occurred. Further indications included capsulated pleural empyema (n = 1), persistent hematothorax (n = 2), pleurectomy for malignant pleural effusion (n = 2), pleural tumors (n = 3), pulmonary parenchyma (n = 2), interstitial lung diseases (n = 3), bullous emphysema (n = 2), peripheral lung nodules (n = 18), mediastinal tumors (n = 8), and sympathectomy (n = 2). The advantages of video-assisted thoracoscopic surgery for patients include cosmetic considerations, low pain, earlier postoperative mobilization, and for some indications, a shorter operation period. The significant disadvantages for the surgeon are the loss of binocular vision as well as the impossibility of intraoperative palpation.

Bronchial Neoplasms↗

PubMed1992

[Changes in liver function and morphology after various portocaval bypass operations].

Using an experimental animal model consequences of operatively changed modes of liver perfusion on hepatic function could be demonstrated. Three groups of 5 animals each (swine) had the following operations: Group I received a portocaval shunt. In group II in addition to the portocaval shunt a vein graft was interposed between the vena cava and the portal vein. In group III an arterialization of this graft was performed in addition to the two operations mentioned above. Follow-up at defined time intervals included clinical, laboratory and histological data. It could be demonstrated that animals in group II and III showed normal parameters as far as behavior and controlled lab data are concerned. Animals of group I had significantly poorer results in all tests. In this study we found that direct portal perfusion was not necessary for a normal liver function and could be fully compensated both by caval venous blood and by arterialized caval venous blood.

Animals↗