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Biomedical subjects

M Heise

Publications and source records attributed to M Heise.

At least 37 records · Page 2Linked to original sources
PubMed2001

The influence of intraarterial prostaglandin E(1) on vascular hydraulic impedance and infrainguinal graft patency.

OBJECTIVES: To evaluate the influence of intraoperative arterial prostaglandin E(1)(alprostadil) infusion on hydraulic impedance in relation to graft patency. METHODS: Hydraulic impedance was measured in 115 infrainguinal bypasses by means of the extracorporeal-bypass-flow method (EBF). Fifty-eight femoro-popliteal and 57 femoro-crural polytetrafluoroethylene (PTFE) grafts were included. 10 microg of alprostadil were administered into a temporary bypass and the haemodynamic changes were recorded. The reactions of input (Z(x)) and characteristic (Z(0)) impedances as well as phase relations were derived and related to graft outcome after three years. RESULTS: Significant changes after administration of prostaglandin were observed for overall pressure (74 vs. 84 mmHg, p<0.01), flow rate (194 vs 160 ml/min, p<0.01), input impedance (0.55 vs. 0.75 PRU, p<0.01) and the phase angle of the first harmonic (-18 degrees vs -26 degrees, p<0.01). An increase of at least one degree of the first harmonic phase angle following alprostadil injection in the crural bypass group was associated with a significant better graft prognosis of crural (p<0.01) but not popliteal grafts. Primary and secondary patency rates after three years for crural grafts with an increase of at least one degree were 62% and 63% (n=45) and for non-responders 18% and 0% (n=12, p(prim)<0.01, p(sec)<0.001). All crural bypasses with poor prostaglandin reaction occluded within 9 months (n=12) after the operation. CONCLUSIONS: The EBF method allows a combined assessment of peripheral resistance and impedance parameters. The response of the first harmonic phase angle provides important predictive information regarding femoro-crural grafts.

Adult↗
PubMed2001

[Femoro-distal ePTFE bypass grafting using femoro-crural patch prosthesis (FCPP). Results of a prospective clinical study].

Femorodistal bypass using exclusively PTFE is known to have a poor prognosis, mostly because of the development of myointimal hyperplasia (MIH). Several vein patch techniques are established but the role of hemodynamics within the anastomotic site has only been explained insufficiently and is hardly considered clinically. In a prospective study, between 6/1992 and 7/1998 129 patients (89 m/40 f, mean age 65.2 +/- 10.0 years) with critical limb ischemia and no usable saphenous vein were included to undergo femorodistal ePTFE bypass grafting with a new, hemodynamically optimized distal end-to-side anastomosis. Patients were followed at 6-month intervals with clinical investigation and color-coded Doppler sonography. Primary and secondary graft patency (PPR, SPR), limb salvage, and patient survival were calculated according to Kaplan-Meier. With a median follow-up of 45 (range 6 to 72) months, PPR and SPR at 1, 3 and 5 years were 63.0, 35.7 and 27.6% and 74.5, 44.8%, and 37.6%, respectively. Limb salvage at 1, 3 and 5 years was 86.4%, 78.7% und 73.2%. There was no perioperative mortality. Graft infection occurred in 7 patients (5.2%). ePTFE bypass grafting represents a valuable option for infragenicular and crural reconstruction in the absence of autologous vein. The new anastomotic design was feasible and represents another adjunct to possibly improve patency of femorodistal bypass allografts.

Aged↗
PubMed2000

Arterial complications after liver transplantation.

From September 1988 through April 1998, 1,000 liver transplantations were performed on 911 patients. During the postoperative control examinations of 837 patients, we found 23 (2.74 %) with hepatic artery thromboses, 27 stenoses of the hepatic artery (3.22 %), and 6 aneurysms of the graft artery. Seventeen patients underwent retransplantation because of arterial complications. Depending on the clinical symptoms, we treated both the local situation as well as the resulting complications of inadequate arterial graft flow. The aneurysms were primarily treated surgically. The first choice of treatment of stenoses was balloon angioplasty. Early postoperative artery thromboses were also treated surgically by thrombectomy in selected cases. For the resulting biliary and local septic complications we preferred endoscopic and drainage procedures. Our clinical experiences have led us to find pretransplantation angiography recommendable, especially in the case of splanchnic artery stenoses, for bypassing from the aorta for arterial perfusion of the graft.

Adult↗
PubMed2000

Venous complications after orthotopic liver transplantation.

Complications involving the portal vein or the vena cava, are rare after orthotopic liver transplantation. We report on the incidence and treatment of venous complications following 1000 orthotopic liver transplantations in 911 patients. Twenty-six of the adult patients (2.7%) suffered from portal complications after transplantation, whereas complications of the vena cava were observed in only 17 patients (1.8%). Technical problems or recurrence of the underlying disease (e.g. Budd-Chiari syndrome) accounted for the majority of complications of the vena cava, whereas alteration of the vessel wall or splenectomy during transplantation could be identified as important risk factors for portal vein complications. In patients undergoing modification of the standard end-to-end veno-venous anastomosis of the portal vein due to pathological changes of the vessel wall, complications occurred in 8.3%, whereas only 2.4% of patients who received a standard anastomosis of the portal vein experienced complications of the portal vein. Furthermore, splenectomy during transplantation was also associated with an increased incidence of portal vein complications (10.5 vs. 2.2% in patients without splenectomy). Treatment was dependent on the signs and symptoms of the patients, and varied considerably between patients with portal vein complications and patients suffering from complications of the vena cava. Complications of the vena cava led to retransplantation in about one-third of the patients, whereas in patients with occlusion of the portal vein, retransplantation was necessary in only 15%, and more than half of the patients suffering from portal vein complications did not require any treatment at all. Usually, treatment of patients with portal vein complications only became necessary when additional complications such as arterial occlusion or bile duct injuries occurred.

Adult↗
PubMed2000

[Management of simple midfacial fractures, particularly in professional soccer players].

Uncomplicated midfacial fractures represent a frequent and typical injury of soccer-players in oral and maxillofacial surgery. The treatment of these fractures in professional players requires special treatment modalities, especially concerning quick rehabilitation. The examples of a nasal bone fracture, a malar bone fracture and a zygomatic arch fracture in 3 professional soccer players demonstrate the therapeutic principles of these most common uncomplicated midfacial fractures. In this context the fabrication of individual facial masks is presented, which allow an improved postoperative protection and therefore an earlier participation of the player in training and matches.

Adult↗
PubMed2000

Effect of intravenous iloprost and alprostadil (PGE1) on peripheral resistance during femoro-distal reconstructions.

BACKGROUND: A prospective, randomised study was undertaken to investigate the effect of intravenous infusion of either iloprost, the stable prostacyclin (PGI2) analogue, or alprostadil (prostaglandin E1) on peripheral resistance (PR) during femoro-distal reconstruction. METHODS: A prospective randomised study was performed with 35 patients. The PR Measurement of peripheral resistance involved a silicon tube temporarily inserted between the donor and recipient vessel. A flowmeter probe and a pressure transducer were inserted into the tube. The peripheral resistance was calculated as a quotient of pressure and flow under approximate physiological conditions. Patients received either alprostadil (4.4 ng/min/kg) or iloprost (2 ng/min/kg) intravenously over ten minutes. After the end of the infusion, the measurements were taken for five minutes. RESULTS: Baseline peripheral resistance was similar for both groups (iloprost 0.76+/-0.54 mmHg/ml/min, alprostadil 0.72+/-0.35 mmHg/ml/min, p>0.05). Following the measurement procedure, the final peripheral resistance in the iloprost group was reduced (0.57+/-0.33 mmHg/ml/min), but the difference to the alprostadil group (0.70+/-0.36 mmHg/ml/min) was not significant (p>0.05). The different decrease of ratio peripheral resistance (quotient between final and baseline resistance times one hundred) was highly significant (iloprost: 79.4+/-13.4% vs alprostadil: 97.0+/-15.6%, p<0.01). CONCLUSIONS: Intravenous application of prostanoids, infused with usual doses over ten minutes during femoro-distal reconstructions, produces significant differences in decrease of peripheral resistance. Alprostadil only causes a slight drop of resistance, whereas iloprost causes a significant higher reduction of peripheral resistance.

Adult↗
PubMed1999

Strategic control of gastrointestinal nematode and lungworm infections with eprinomectin at turnout and eight weeks later.

Two groups of 10 first-year grazing cattle were either left untreated as controls (group 1) or treated with eprinomectin as a pour-on application at turnout and eight weeks later (group 2). The control group developed a mild infection with gastrointestinal nematodes and lungworms during the season, whereas the treated animals remained healthy. The interval between the treatments allowed the establishment of adult worms, but the egg counts remained negligible. The total number of eggs shed by the treated cattle during the grazing season was significantly smaller than by the controls.

Animal Husbandry↗
PubMed1999

Variations of surgical reconstruction in liver transplantation depending on vasculature.

BACKGROUND: From September 1988 through April 1998, 1000 liver transplantations were performed on 911 patients. The standard technique for liver re-vascularization to guarantee an optimal blood inflow during transplantation was modified in 19% of the cases on the arterial side and in 5.6% of the cases on the portal side as a result of unusual anatomical features and pathological changes in the vasculature of the organ recipient. In 113 transplantations, successful reconstruction of accessory vessels of the graft (12 left and 101 right hepatic arteries) was performed without complications. It is our opinion that preoperative diagnosis of the vasculature (stenoses of the celiac trunk etc.) of the organ recipient by duplexsonography and angiography is necessary. Even with the help of these tests, it is extremely difficult to diagnose a "steal" syndrome in the splenic artery: for example, 31 of 40 patients with poor liver function received postoperative therapy for newly diagnosed "steals". RESULTS AND CONCLUSIONS: There is no increase in complications (stenosis and thrombosis) with modifications of arterial reconstruction (4.9 vs 6.3%); however, with modification of portal reconstruction the increase is from 2.4% to 8.3%.

Adult↗
PubMed1999

Genus-specific PCR for the differentiation of eggs or larvae from gastrointestinal nematodes of ruminants.

Using sequences of the ribosomal second internal transcribed spacer (ITS2), PCR primers were designed for the differentiation of the gastrointestinal nematode genera Ostertagia, Cooperia, Nematodirus, Haemonchus and Trichostrongylus. Single eggs or larvae from faeces could be differentiated without previous DNA extraction. Quantification of the PCR result proved to be difficult because the DNA content between eggs from fresh or 24-h-old faeces varied considerably.

Animals↗
PubMed1999

A new method of intraoperative hydraulic impedance measurement provides valuable prognostic information about infrainguinal graft patency.

PURPOSE: Prognostic information about graft outcome, obtained by using a new method for intraoperative measurement of vascular impedance, was evaluated. METHODS: Hydraulic impedance was measured in 136 infrainguinal bypass grafts that were entered into a multicenter trial. Seventy femoropopliteal and 66 femorocrural polytetrafluoroethylene (PTFE) grafts were used. The arterial impedance measurement involved a silicon bypass graft temporarily inserted between the proximal and distal anastomoses sites. A flowmeter probe and a pressure transducer were incorporated into the tube. The digitally stored waveforms were subjected to a fast Fourier transformation and both input (Z(x)) and characteristic (Z(0)) impedances, as well as phase relations, were computed and related to graft outcome after 3 years. RESULTS: Significant prognostic information for both popliteal and crural grafts was provided by means of the phase angle of the first harmonic. Primary and secondary patency rates for popliteal bypasses were 45% +/- 1% and 65% +/- 2% for phase angles greater than -40 degrees (n = 57) and 37% +/- 1% and 40% +/- 1% for phase angles less than -40 degrees (n = 13, p(prim ) = not significant, p(sec) < 0.01). For crural grafts, the secondary patency rates were 49% +/- 1% and 61% +/- 2% for phase angles greater than -40 degrees (n = 53) and 15% +/- 1% and 0% for phase angles less than -40 degrees (n = 13, P <.01). All crural bypass grafts with phase angles less than -40 degrees occluded within 16 months. Steady flow resistance, as well as Z(x) and Z(0), failed to indicate a significant relation to graft prognosis. CONCLUSION: This method provides reliable prognostic information regarding graft patency and opens hydraulic impedance measurement to clinical surgery. The phase lag between flow and pressure curves, as expressed by the phase angle of the first harmonic, provides significant prognostic information.

Adult↗
PubMed1999

Differences in the second internal transcribed spacer (ITS-2) of eight species of gastrointestinal nematodes of ruminants.

Genetic differences in the nucleotide sequence of the second internal transcribed spacers (ITS-2) among Trichostrongylus axei, Trichostrongylus colubriformis, Ostertagia ostertagi, Cooperia oncophora, Cooperia punctata, Nematodirus helvetianus, Nematodirus filicollis, and Haemonchus contortus are described. The ITS-2 sequences of the 8 species ranged between 230 and 241 base pairs in length. Sequence similarities between the different genera varied between 60% and 80%. Identities between the different species within a genus varied between 99% for C. oncophora and C. punctata, 95% for T. axei and T. colubriformis, and 89% for N. helvetianus and N. filicollis. The ITS-2 sequences proved to be useful for species differentiation. Except for the species of Cooperia (2.07% intraspecific variations for C. oncophora and 0.83% for C. punctata) the degree of intraspecific variations (N. filicollis 0.85%, T. colubriformis 1.26%, T. axei 1.27%, H. contortus 2.60%, O. ostertagi, and N. helvetianus no variation) was markedly lower than the interspecific variations allowing a reliable differentiation within the ITS-2 region between single species.

Animals↗
PubMed1997

[Primary malignant intraluminal tumor of the aorta].

Primary malignant tumors of the aorta are only rarely reported. We describe here our findings in a 55-year-old patient who was referred to us with progressive renal insufficiency. At angiography, right renal artery occlusion and high-grade stenosis of the left renal artery was found in this patient, who had undergone aortobiliacal reconstruction for acute Leriche syndrome 5 months previously. Histological evaluation of thrombotic material revealed an intraluminal malignant tumor to be the underlying cause. This diagnosis was then confirmed in samples harvested during angiography. CT scan showed an extension beginning 2 cm proximal to the celiac trunk. The patient was treated by thoracoabdominal resection of the aorta, including the paraaortal tissue, left side nephrectomy, and adrenalectomy. A thoracoabdominal aortic prosthesis was inserted up to the iliacal bifurcations and the celiac and superior mesenteric arteries reimplanted. Right nephrectomy followed 3 weeks later. The postoperative course was uneventful.

Aorta, Abdominal↗
PubMed1993

Interaction between T cells and murine acquired immunodeficiency virus superantigen: effect of second signal on T cell reactivity to the MAIDS virus superantigen.

A murine acquired immunodeficiency (MAIDS) virus transformed B cell line, B6-1710, was shown to express superantigen activity and stimulate T cell hybridomas to produce IL-2. However, T cell clones and lines from which B6-1710 reactive hybridomas were established failed to proliferate upon stimulation with B6-1710, while B6-1710 cells were capable of presenting bacterial superantigen to stimulate both T cell hybridomas and clones. Proliferative response of T cells to MAIDS virus superantigen could be detected by the addition of the pharmacological agent phorbol myristate acetate (PMA). Thus, B6-1710 seems to lack a stimulatory activity necessary for the proliferative response of T cells to the MAIDS viral superantigen. In the analysis of the response of naive splenic T cells to the MAIDS superantigen, T cells recovered from a culture stimulated with B6-1710 cells in the presence of PMA showed no dominant TCR V beta chain usage, while cells recovered from a culture stimulated with B6-1710 alone were dominated by T cells expressing V beta 5, 11, and 12 TCR chains. These results suggest that T cells bearing a majority of TCR V beta chains are capable of responding to B6-1710 superantigen. The avidity of interaction between T cells and viral superantigen may differ significantly among T cells and those T cells exhibiting weak interaction with MAIDS virus superantigen may require additional signals, such as PMA, for an in vitro proliferative response to B6-1710 cells.

Animals↗