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Biomedical subjects

J Schuler

Publications and source records attributed to J Schuler.

16 recordsLinked to original sources
PubMed1998

Randomised, double-blind, placebo-controlled trial of human recombinant growth hormone in patients with chronic heart failure due to dilated cardiomyopathy.

BACKGROUND: Some studies have suggested that treatment with recombinant human growth hormone (rhGH) increases left-ventricular mass and improves haemodynamic and functional status in patients with heart failure due to dilated cardiomyopathy. We did a double-blind, randomised, placebo-controlled study of rhGH in patients with chronic heart failure due to dilated cardiomyopathy. METHODS: 50 patients (43 men) were randomly allocated treatment with subcutaneous rhGH (2 IU daily) or placebo for a minimum of 12 weeks. The primary endpoints were the effects on left-ventricular mass and systolic wall stress. The secondary endpoints were the effects on left-ventricular size and function. Data were analysed by intention to treat. FINDINGS: Patients in the rhGH group had an increase in left-ventricular mass compared with those in the placebo group (27%, p=0.0001). There was no significant difference in left-ventricular systolic wall stress, mean blood pressure, or systemic vascular resistance between the two groups. New York Heart Association functional class, left-ventricular ejection fraction, and distance on the 6 min walking test were unchanged. The change in serum insulin-like growth factor (IGF)-I concentrations (rhGH 77 ng/mL; placebo -19 ng/mL, GH vs placebo p=0.0001) was significantly related to the change in left-ventricular mass (r=0.55, p=0.0001). One patient in the rhGH group was withdrawn at 6 weeks because of worsening heart failure. INTERPRETATION: There is a significant increase in left-ventricular mass in patients with dilated cardiomyopathy given rhGH but this is not accompanied by an improvement in clinical status. Changes in left-ventricular mass are related to changes in serum IGF-I concentrations. Whether a longer treatment period would provide clinical benefits and decrease mortality is unknown.

Adult↗
PubMed1997

Lower-limb salvage in a patient with recalcitrant venous ulcerations.

The authors report the salvage of a lower limb with recalcitrant venous stasis ulcers by "sequential" free flaps in a patient with co-existing chronic venous insufficiency and arterial occlusive disease. This presentation is interesting for inclusion of the following: (1) treatment of a recalcitrant venous ulcer by the combination of free-tissue transfer and valvular transplantation; (2) thrombosis of the free flap pedicle at an indeterminate time postoperatively without flap loss or leg ischemia; and (3) performance of a second free flap to the peroneal artery-only, to a one-vessel leg with an excellent clinical outcome at long-term follow-up.

Abdominal Muscles↗
PubMed1997

Free tissue transfer in treatment of the recalcitrant chronic venous ulcer.

We propose that a long-term cure for the recalcitrant chronic venous ulcer must involve a dual surgical approach including (1) wide excision of the ulcer and surrounding liposclerotic tissue bed, and (2) replacement by a free flap containing multiple, competent microvenous valves with a normal microcirculation. Advantages of free flaps over skin grafting include improvement of the underlying pathophysiology; increase in blood supply to the area; ability to cover exposed bone, joint, or tendon; and a lower incidence of recurrence. During the past 8 years, 20 consecutive muscle free flaps were performed in 18 patients for 19 recalcitrant venous ulcers (two "sequential" flaps to the ipsilateral leg in 1 patient and a repeat flap after initial failure in 1 patient). Twelve males and 6 females ranged in age from 17 to 76 years (mean, 44 years). Nontraumatic, nonosteomyelitic venous ulcers had been present for an average of 3.5 years (range, 1-10 years) and failed an average of 2.4 skin grafts (range, 0-6 grafts). Defects ranged from 100 to 600 cm2 (mean, 238 cm2). Donor tissues included rectus abdominis (N = 13), latissimus dorsi (N = 5), gracilis (N = 1), and serratus (N = 1) muscles. Recipient vessels included posterior tibial (N = 12), anterior tibial (N = 6), and peroneal (N = 2). In all instances except one, only one vein, usually one of the venae comitantes, was anastomosed in end-to-end fashion. Successful free tissue transfer was accomplished in 18 of 20 flaps (90%). Complications included infection with partial flap and/or skin graft loss (three flaps), and partial skin graft loss (two flaps). There were no recurrences within the flaps; however, breakdown occurred at the junction between the flap and residual adjacent liposclerotic skin in 1 patient. Follow-up average 32.7 months (range, 8-65 months); 3 patients were lost to follow-up. Free muscle transfer can provide a long-term cure for the recalcitrant venous ulcer by replacing the diseased tissue bed with healthy tissue containing multiple, competent microvenous valves and a normal microcirculation. This can be accomplished in one reconstructive procedure with excellent long-term results.

Adolescent↗
PubMed1997

Simultaneous reconstruction of extensive soft-tissue defects of both lower limbs with free hemiflaps harvested from the omentum.

Simultaneous resurfacing of extensive soft-tissue defects involving both lower extremities can be performed successfully with free hemiflaps harvested from the omentum. This avoids the need for staged operations or for separate donor sites with the concomitant morbidities, the possible need for intraoperative repositioning, and the significantly greater operative time. During the past 3 years, six omental free hemiflaps were performed in three patients for bilateral lower limb reconstruction. All patients had extensive ulcerations, averaging 207.5 cm2 in surface area. Ulcerations were secondary to either homozygous sickle cell anemia (two patients) or chronic venous insufficiency (one patient). Operative time averaged 11 hours for the bilateral procedures. Delayed skin grafting was performed in two patients. All six omental free hemiflaps were successful. Partial skin-graft loss due to infection occurred in both sickle cell anemia patients. Significant improvement in symptoms was noted in all patients. There were no donor-site complications. Free hemiflaps harvested from the omentum can provide sufficient well-vascularized tissue with large-caliber vessels for coverage of separate extensive soft-tissue defects in one operation with minimal donor-site morbidity, making this an ideal flap option when multiple sites are involved.

Adult↗
PubMed1995

Lower limb salvage by microvascular free-tissue transfer in patients with homozygous sickle cell disease.

Chronic, excruciatingly painful ulcerations of the lower extremities in patients with homozygous sickle cell anemia (HbSS) present a frustrating clinical problem for the reconstructive surgeon. Despite adequate wound care and skin grafting, there is a dismally high incidence of recurrence. Furthermore, there is a paucity of reliable locoregional fasciocutaneous, muscle, and myocutaneous flaps in the ankle region. Free-tissue transfer has become the procedure of choice for reconstruction of the lower third of the leg. However, in sickle cell anemia, does the obligate period of flap ischemia inherent in free-tissue transfer inevitably doom a flap to failure? We present our multidisciplinary experience over 55 months with five free flaps in four homozygous sickle cell anemia patients 21 to 38 years old who had chronic nonhealing leg ulcerations. Special perioperative measures included exchange transfusion to lower hemoglobin S to below 30 percent, maintaining the hematocrit at 31 to 35 percent, intraoperative flap washout and perfusion with warm heparinized saline-dextran solution, administration of dextran and aspirin intraoperatively and postoperatively, prophylactic topical and systemic anti-Pseudomonas antibiotics, supplemental oxygen, and warm ambient room temperature. Flaps included the latissimus dorsi muscle (two patients), the temporoparietal fascia (one patient), and "split" omentum for bilateral lower limb salvage (one patient). Successful free-tissue transfer was accomplished in all patients. One patient suffered gradual partial occlusion of the microcirculation by sickled erythrocytes following a transient hypothermic, hypotensive episode. Sufficient flap tissue survived to permit skin grafting with an excellent result. Pseudomonas infection occurred in two patients (three flaps).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Increased prevalence of fetal haemoglobin in type 1 (insulin-dependent) diabetes mellitus.

Fetal haemoglobin levels were measured in 106 patients with Type 1 (insulin-dependent) diabetes mellitus during a period of two to three years. In 15 patients (14.1%) increased fetal haemoglobin levels (greater than 0.5%), determined by high pressure liquid chromatography, were found in contrast to 3% in a healthy control group (n: 100) of equal age distribution. In children aged over 6 years, elevated fetal haemoglobin levels were measured in 13 diabetic patients (13.3%) in contrast to none of the control group. There was no correlation between fetal haemoglobin levels and duration of diabetes, diabetic control (glycated haemoglobin) and dosage of insulin (U.kg-1, day-1). The 15 patients had a younger mean age at onset of diabetes (5.6 years) than a sex and age matched control group of diabetic patients without increased fetal haemoglobin levels (7.4 years, p less than 0.05). Longitudinal assessment revealed a significant decline of fetal haemoglobin levels with age (p less than 0.005) but a further increase in fetal haemoglobin levels were found in adolescent patients (n: 2). These data indicate a possible effect of insulin-treatment on delaying transition from fetal to adult haemoglobin synthesis or on reactivation of fetal haemoglobin production.

Adolescent↗
PubMed1987

The early fate of venous repair after civilian vascular trauma. A clinical, hemodynamic, and venographic assessment.

Repair of major venous injuries of the extremities has been advocated to improve limb salvage rates and to prevent the early and late sequelae of venous interruption. The contribution of venous repair to the surgical outcome remains controversial, however, in part because the fate of venous reconstruction has previously not been well defined. The current study was done to determine the early patency rate of venous repair, to compare the accuracy of various methods used to assess venous patency, and to analyze the relationship between early venous patency and surgical outcome. During a recent 27-month period, 36 patients with major extremity venous injuries were treated by venous reconstruction; 34 patients (94%) had an associated major arterial injury that also required repair. Venous repair was performed in the upper extremity (22%) as well as the lower extremity (78%) using various reconstructive methods, including lateral repair (17%), end-to-end anastomosis (11%), autogenous vein patching (25%), interposition autogenous vein grafting (42%), and panelled autogenous vein grafting (6%). After operation, venous repair patency was evaluated by clinical examination, impedence plethysmography, and Doppler ultrasonography, and contrast venography. There were no perioperative deaths in these 36 patients. The limb salvage rate was 100% and all 34 major arterial repairs were patent at the time of hospital discharge. Venography performed on the seventh postoperative day demonstrated that 14 venous repairs had thrombosed (39%) and that 22 had remained patent (61%). Local venous repair had a significantly lower thrombosis rate (21%) than those requiring interposition vein grafting (59%) (p less than 0.03). Compared with venography, the clinical evaluation was 67% accurate in the assessment of venous repair patency, and the noninvasive examination was 53% accurate. In conclusion, a substantial percentage of venous repairs will thrombose in the postoperative period, especially if interposition vein grafting is used. However, in this series limb salvage was not adversely influenced by an unexpectedly high rate of venous repair thrombosis. In addition, clinical evaluation and noninvasive testing did not provide an accurate assessment of venous patency after venous repair.

Adolescent↗
PubMed1982

[Simple method for controlling anticoagulation with vitamin K antagonists during heparin therapy: rapid determination after heparin absorption by ECTEOLA cellulose].

ECTEOLA cellulose anion exchanger is known to remove heparin from citrated plasma without affecting the coagulation factors involved in the prothrombin time. For monitoring of simultaneous anticoagulation with oral anticoagulants and high dose heparin, Branson et al. have therefore proposed eliminating heparin from plasma by column chromatography prior to testing. To avoid this cumbersome procedure a simple test-tube absorption technique is presented which allows determination of prothrombin time in these patients with clinically sufficient accuracy.

Absorption↗
PubMed1975

Glucocorticoid and antibiotic effect on experimental gram-negative bacteremic shock.

This study was designed to answer the three following questions: (1) Are glucocorticoids as protective in Gram-negative bacteremic shock as they are in endotoxic shock? (2) Is there any difference in efficacy between a bacteriostatic and a bactericidal antibiotic in bacteremic shock? (3) Does the combination of glucocorticoid with antibiotic potentiate the individual protective effects of both? Bacteremia was induced in male Sprague-Dawley rats by a single intravenous injection of viable Escherichia coli. The results showed that dexamethasone sodium phosphate alone afforded significant protection against Gram-negative bacteremic shock up to eight hours after challenge. The choice of a bactericidal vs a bacteriostatic antibiotic did not influence the survival rates in this study. The survival rate was maximal when dexamethasone was used with both ampicillin sodium and gentamicin sulfate.

Ampicillin↗