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Biomedical subjects

J Harrer

Publications and source records attributed to J Harrer.

At least 19 recordsLinked to original sources
PubMed2006

[Penetrating aortic ulcers--case report on endovascular therapy].

We report our experience with two cases of endovascular treatment of penetrating aortic ulcers (PAU). The first patient was a 71-year-old woman with 30 mm width aortic ulcer accompanied by intramural hematoma of the descending thoracic aorta. The second patient was an 80-year-old obese woman with 50 mm pseudoaneurysma of the abdominal aorta, which was result of PAU. Both patients were successfully treated by means of tubular stentgraft, implanted from surgical cut down of the right femoral artery. Penetrating aortic ulcer represents localized, potentially lethal pathology of the aorta. Together with dissection and intramural hematoma belongs among the acute aortic syndromes. During nature course PAU can progress to the acute classic dissection, pseudoaneurysma or rupture of the aorta. It is principally disease of elderly hypertensive patients. Early diagnosis and appropriate therapy improves prognosis of patients with PAU. Open surgical repair with synthetic graft has been the gold standard of treatment but endovascular therapy is an attractive option in risk elderly patients. It seems to be a safe, effective treatment but stability of results of this method should be proved.

Aged↗
PubMed2005

[The endovascular treatment of the aortic trauma].

BACKGROUND: Traumatic injuries of the thoracic aorta are very frequent during motor vehicle accidents with sudden deceleration. Spiral CT has become the modality of choice for evaluating significant blunt trauma and grading system for aortic injury has been developed. Immediate diagnosis, introduction of antihypertensive therapy and endovascular treatment by means of stentgraft give a better chance for patients with blunt aortic injury. AIM: Prospective evaluation of results of endovascularly treated patients with blunt aortic injury. MATERIALS AND METHODS: We prospectively followed patients after endovascular treatment of acute aortic injury. Diagnosis was based on chest x-ray and CT examination. Stentgrafts were placed under fluoroscopic guidance and patients were routinely followed by CT and clinical visit. RESULTS: Between December 1999 and September 2004 we endovascularly treated seven patients (6 men, 1 woman, mean age 41.7 years) for blunt aortic injury of the thoracic aorta. Stentgraft was implanted between 5 hours and 6 days (mean 3.2 days) after injury. Seven stentgrafts were implanted in 7 patients in total. One patient died due to failure of endovascular technique for collapsed stentgraft. A new onset of lower legs paraparesis was detected in one patient. Other five patients are regularly followed (3-55 months, mean 30.7 months) without any complications. CONCLUSION: Endoluminal technique can be used successfully in the immediate repair of aortic trauma. At present time in our center, treatment by means of the stentgraft placement is the first line therapy in injured patients. It allows rapid stabilization of aortic trauma and further treatment of other injuries.

Absorptiometry, Photon↗
PubMed2001

Extensive spinal epidural hematoma: a rare complication of aortic coarctation.

Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported.

Adult↗
PubMed2001

Paraplegia as an unusual manifestation of aortic coarctation.

In this report, we present an unusual case of a 20-year-old man whose first symptom of aortic coarctation was sudden paraplegia due to spinal epidural hemorrhage caused by rupture of an aneurysmal collateral vessel. Now, one year after surgical correction of coarctation, the patient has had no cardiac or neurological problems. To our knowledge, this is the only clearly documented case of such an aortic coarctation complication.

Adult↗
PubMed2001

Lipoblastoma and lipoblastomatosis: a report of two cases and review of the literature.

Lipoblastoma and lipoblastomatosis are rare benign neoplasms of foetal white fat tissue that occur almost exclusively in infants and children. Two cases are reported and a review of the literature is given. An almost one-year-old girl and a full-term male infant were brought to our hospital with a solid mass in the right thigh. Nine months after total excision of the lipoblastoma, the little girl developed tumour recurrence, with unexpected histopathological maturation. In the case of the little boy, lipoblastomatosis with infiltration of the surrounding muscles, together with involvement of the sciatic and posterior femoral cutaneous nerves was found. Histologically, the tumour showed an unusual inflammatory reaction. The diagnosis of this tumour was made by the pathologist, but the histopathological picture bears a striking similarity to myxoid liposarcoma, and may be indistinguishable. Recent studies describe rearrangements of chromosome 8 q11-q13 region as a new discriminative marker that distinguishes lipoblastoma and lipoblastomatosis from myxoid liposarcoma.

Biopsy↗
PubMed2001

Recovery and neurological examination after remifentanil-desflurane or fentanyl-desflurane anaesthesia for carotid artery surgery.

We studied 44 patients undergoing carotid endarterectomy (CEA) to compare recovery after general anaesthesia with desflurane supplemented with either remifentanil or fentanyl. Remifentanil was infused at 0.1 microg kg(-1) min(-1) and desflurane was adjusted at 2 vol% end-tidal. Fentanyl was given as a bolus dose of 2 microg kg(-1) before induction and repeated at skin incision; desflurane was adjusted as needed. Times for early recovery and response to simple neurological tests (digit symbol substitution test (DSST) and Trieger dot test (TDT)) were measured 30, 60 and 90 min after operation. Emergence from remifentanil-desflurane anaesthesia was significantly quicker than that from fentanyl-desflurane anaesthesia: mean times to extubation were 4.1 (SD 1.7) and 8.2 (4.9) min, respectively; mean times for patients to state their name correctly were 6.0 (2.8) and 13.8 (9.0) min, respectively. Patients in the remifentanil-desflurane group successfully performed neurological tests significantly earlier than those in the fentanyl-desflurane group; for example, patients in the former group completed the arm holding test at 7.9 (3.0) min, while those in the latter group did this at 20.6 (19.7) min (P < or = 0.01). Intermediate recovery was less impaired at 30 min (DSST, TDT) and at 60 min (DSST). More rapid awakening and an earlier opportunity for neurological examination suggest that remifentanil-desflurane is a suitable alternative to a standard fentanyl-based general anaesthetic technique in patients undergoing CEA.

Adult↗
PubMed2001

Morbidity and mortality in patients 70 years of age and over undergoing isolated coronary artery bypass surgery.

BACKGROUND AND AIM: Due to the constantly improving results of surgical revascularization for coronary heart disease even the elderly patients are offered more frequently this type of treatment. Since older age is a harbinger of reduced vital capacity and increased morbidity the results of coronary artery bypass grafting (CABG) in elderly as well as long-term benefit deserve a careful examination. MATERIALS AND METHODS: 1475 isolated CABG procedures performed between 1995 and 1997 in a university hospital cardiac surgery unit, divided in group I (age below 70, n = 1324) and group II (age 70 and over, n = 151). A retrospective analysis of pre-operative, peri-operative and post-operative data. RESULTS: Significant differences (lower BMI and BSA, advanced NYHA and CCS stage, higher prevalence of diabetes, renal dysfunction and extracardial atherosclerotic lesions) were found in elderly. CABG was performed in both groups with no differences in technique of procedure (only slightly longer duration of CPB in group II). However, there was markedly higher mortality (2.3 vs. 7.3%, p < 0.005), incidence of NearMiss+ (18.4 vs. 36.4%, p < 0.005) and post-operative morbidity (34.6 vs. 56.3%, p < 0.005) in the older group, which was also expressed in a longer ICU stay and postoperative hospitalization. CONCLUSION: Coronary revascularization can be performed in elderly with higher but still acceptable risk. Higher mortality and associated morbidity is caused by higher preoperative prevalence of known risk factors as well as generally reduced vital capacity. Surgical procedure should not be denied to elderly population because of the age alone but a careful evaluation of an individual patient is required.

Age Factors↗
PubMed2000

Axillary-coronary artery bypass reconstruction as an alternative in coronary artery reoperations.

BACKGROUND AND AIMS: The increasing incidence of reoperations in coronary surgery associated with higher perioperative risks is a challenge for refinement of the surgical methods. The aim of the work is to prove the feasibility and satisfactory intermediate results of minimally invasive axillary-coronary artery bypass reconstruction in redo coronary surgery in case the left internal mammary artery had already been harvested. MATERIAL AND METHODS: Three patients (six months, two and six years after primary coronary artery bypass grafting) admitted for redo coronary surgery because of a recurrence of angina and proven malfunction of the left internal mammary artery-left anterior descending coronary artery anastomosis. An axillary-coronary venous graft was performed via left anterior small thoracotomy (LAST) on a beating heart in all three cases. RESULTS: Excellent patency of the graft was noted on control angiography within 9 days after the procedure together with good clinical improvement in midterm follow-up. CONCLUSION: Minimally invasive axillary-coronary artery bypass via LAST access in redo coronary surgery is a good alternative in cases where the left internal mammary artery cannot be used.

Aged↗
PubMed1998

Medium-term results of coronary artery bypass surgery in patients with severe left ventricular dysfunction and preoperatively documented hibernating myocardium.

In patients with multivessel coronary artery disease (CAD), severe left ventricular dysfunction (LVD) and hibernating myocardium (HM) demonstrated on preoperative assessment, coronary artery bypass grafting (CABG) surgery can be performed safely with low operative morbidity and mortality rates. Surgical revascularization of reversibly dysfunctional myocardium improves significantly both patient's clinical status and left ventricular ejection fraction (LVEF). Diagnosis of HM prior to CABG surgery seems to be crucial because it does not leave the patient with multivessel CAD and LVD a candidate only for heart transplantation (HTX). In the presence of HM, more aggressive surgical approach could be recommended to salvage chronically jeopardized but viable myocardium using not only routine CABG procedures in extracorporeal circulation (ECC) but also alternative approach of coronary endarterectomy (EAE) or minimally invasive direct coronary artery bypass grafting (MIDCAB) procedures on beating heart, without any adverse impact on operative mortality.

Coronary Artery Bypass↗
PubMed1997

[The hibernating myocardium--its use in clinical practice].

Hibernated myocardium is a term used to describe a state of myocardial hypocontractility which is due to chronic hypoperfusion of the heart muscle. The myocardium remains, however, viable and therefore revascularization can significantly improve the reduced mechanical function of the left ventricle. Differentiation between hibernated myocardium and a myocardium which was irreversibly damaged and replaced by scar tissue is particularly important in patients with ischemic dysfunction of the left ventricle. Information on the viability of dysfunctional areas of the myocardium helps in reflections on the indication and strategy of the revascularization operation.

Coronary Circulation↗
PubMed1997

Hemothorax--a complication of subclavian vein cannulation.

Massive bleeding into pleural cavity after subclavian vein cannulation is a rather rare but very serious complication. Usually laceration of the venous wall is the cause. In patients where conservative treatment, i.e. pleural drainage, maintaining the circulatory volume, treatment of possible coagulopathy, etc. is ineffective, surgery has to be performed. Bleeding can be surgically managed either from posterolateral thoracotomy or direct subclavian vessel revision is possible after partial resection of the clavicle. Brachiocephalic vein bleeding can be approached and managed through median sternotomy. We present a case report of 22-year old man with hemothorax after subclavian vein cannulation. In our patient only complex surgical procedure enabled proper management of bleeding complication.

Adult↗
PubMed1997

[Coronary revascularization in diffuse atherosclerosis of the anterior descending coronary artery].

The authors present surgical possibilities of treatment of diffuse atherosclerotic changes of the left anterior descending coronary artery. In such serious disease they choose the procedure of endarterectomy performed from long arteriotomy under direct eye control followed by reconstruction by long bypass anastomosis. Endarterectomy of the left anterior descending artery was performed in 32 patients during the period between 1988-1996. This represents 1.38% of patients operated for ischemic heart disease during that period (32/2324). Two patients died in consequence with the operation (6.25%), also there was one myocardial infarction as a perioperative complication (3.1%). Endarterectomy of the diffusely diseased left anterior descending coronary artery can, when carefully indicated and using proper technique, contribute to complete revascularization in patients with end-stage coronary artery disease.

Adult↗
PubMed1996

Hibernating myocardium--mechanisms and clinical implications.

Hibernating myocardium is defined as persistently impaired myocardial and left ventricular function at rest resulting from reduced myocardial blood flow. It is postulated that despite the reduced coronary blood flow, metabolic activity is sufficient to prevent tissue necrosis. Recovery of the hibernating myocardium has clearly been shown to occur with the establishment of successful revascularization either by coronary bypass surgery or by percutaneous transluminal coronary angioplasty. The differentiation of viable, hibernating myocardium from non-viable myocardium in patients with coronary artery disease and left ventricular dysfunction is a key issue in the current era of myocardial revascularization.

Humans↗
PubMed1996

Contribution to technique of endarterectomy of the right coronary artery.

We present our technique of performing endarterectomy of coronary arteries by means of injecting cardioplegic solution into the plane of dissection of the endarterium. This simple and gentle technique in combination with manual endarterectomy helps in separation of the core far into the periphery of the diseased vessel and thus helps to perform revascularization in patients with diffuse atherosclerotic changes. During the last 6 years (1991-1996) endarterectomy in coronary revascularization was used in 116 cases (it was 5.7 % (116/2031) of all myocardial revascularization procedures). On right coronary artery endarterectomy was used in 82 patients. Mortality rate in our group of patients was 4.88 % (4/82) and perioperative myocardial infarction developed in 4.88 % (4/82). According to our own experience with this technique of endarterectomy on right coronary artery we are convinced that in desperate patients with diffuse coronary artery disease our method can bring better and wider application of surgical treatment.

Adult↗
PubMed1994

Targeted ablation of the phospholamban gene is associated with markedly enhanced myocardial contractility and loss of beta-agonist stimulation.

Phospholamban is the regulator of the Ca(2+)-ATPase in cardiac sarcoplasmic reticulum (SR), and it has been suggested to be an important determinant in the inotropic responses of the heart to beta-adrenergic stimulation. To determine the role of phospholamban in vivo, the gene coding for this protein was targeted in murine embryonic stem cells, and mice deficient in phospholamban were generated. The phospholamban-deficient mice showed no gross developmental abnormalities but exhibited enhanced myocardial performance without changes in heart rate. The time to peak pressure and the time to half-relaxation were significantly shorter in phospholamban-deficient mice compared with their wild-type homozygous littermates as assessed in work-performing mouse heart preparations under identical venous returns, afterloads, and heart rates. The first derivatives of intraventricular pressure (+/- dP/dt) were also significantly elevated, and this was associated with an increase in the affinity of the SR Ca(2+)-ATPase for Ca2+ in the phospholamban-deficient hearts. Baseline levels of these parameters in the phospholamban-deficient hearts were equal to those observed in hearts of wild-type littermates maximally stimulated with the beta-agonist isoproterenol. These findings indicate that phospholamban acts as a critical repressor of basal myocardial contractility and may be the key phosphoprotein in mediating the heart's contractile responses to beta-adrenergic agonists.

Animals↗
PubMed1992

[Coronary endarterectomy in the surgical treatment of ischemic heart disease (review)].

The problems are overviewed with performing revascularization of the coronary bed when in diffuse affliction. The unique way how to revascularize a progressive atherosclerotic disorder of the coronary bed consists in elimination of a degenerated portion of the coronary vessel which is endarterectomy (EAE). This method is specially important in ischemic myocardium supplied with so disordered coronary. The EAE of the coronaries is of routine use with some extended working sites. However, they are not rare to take this method with some objections. These are due to a higher risk in performing surgery and scepticism upon the long term patency of the endarterectomized artery. Because of a polymorph character of atherosclerotic process, one should hardly mention some randomized studies able to prove both inconvenience and advantages of the method. Nevertheless, the large sets are known to exist at present which document the benefit of the EAE method from the scope of both immediate and long term results. This method is only efficient under the condition of a perfect technical skill as well as peculiar and total EAE completion. Besides the known "gas EAE" and "manual EAE" techniques, the authors present a new EAE approach developed by their own using the solution which is injected under tension into the separation layer. The EAE method appeared to be valuable on multiple cardio-surgical centres when correctly indicated and performed including the instantaneous recognition and correction of imminent complications. The authors' experience is in accord with the above conditions.

Coronary Artery Disease↗
PubMed1991

[Localized benign pleural mesothelioma].

The authors describe a case of benign mesothelioma of the pleura. This is a not very frequently encountered condition which as a rule is diagnosed only on the basis of histological examination of a preparation taken during operation. The surgical operation is most frequently indicated on account of the diagnosis of a lung tumour. If this diagnosis is taken into consideration and the patient's diagnosis is made in time and the patient is operated, the subsequent prognosis is very favourable.

Humans↗