Biomedical subjects

M Hummel

Publications and source records attributed to M Hummel.

292 records · Page 17Linked to original sources

PubMedDate not supplied

Aspergillosis with Aspergillus osteomyelitis and diskitis after heart transplantation: surgical and medical management.

This is the report of a 49-year-old man, who could be cured of aspergillosis with Aspergillus osteomyelitis and diskitis of the lumbar spine by medical and surgical therapy after heart retransplantation. Aspergillus osteomyelitis and diskitis is a rare complication of invasive aspergillosis. Lumbar involvement is the main manifestation, followed by rare locations in the tibia, ribs, wrist, sternum, pelvis, and knee. It is nearly always secondary to pulmonary aspergillosis, which occurs in about 6% to 14% of patients after heart transplantation. For treatment, a combined surgical and medical approach is recommended, which enables quick pain relief for the patient and histologic and microbiologic diagnosis and stabilization of the spine. Because of definitive cure of osteomyelitis cannot be guaranteed by removal of the abscess, medical therapy after surgery is necessary for years.

Amphotericin B↗

PubMedDate not supplied

Coronary artery disease in patients with hearts from older donors: morphologic features and therapeutic implications.

Of 558 heart transplant recipients, 234 long-term survivors (more than 12 months) were studied by annual catheterization to evaluate the risk of postoperative coronary artery disease in hearts from older donors. No significant difference was found in graft function between hearts from younger and older donors (group I: n = 157, mean donor age 23 +/- 5 years, mean follow-up 45 +/- 22 months; group II: n = 77, mean donor age 43 +/- 5 years, mean follow-up 42 +/- 22 months) as indicated by left and right ventricular ejection fraction, pulmonary artery pressure, and pulmonary capillary wedge pressure. Two morphologic patterns of coronary artery disease were observed: a diffuse type of concentric narrowing of the arteries (type 1) and a focal type with proximal single-vessel stenosis (type 2). Type 1 occurred in eight patients (5%) in group I and in four patients in group II (5%) (p = not significant). Type 1 coronary artery disease led to graft failure in seven patients in group I and two patients in group II. Type 2 coronary artery disease occurred in seven patients (4%) in group I and in 14 (18%) in group II (p < 0.001). No death was related to graft failure in patients with type 2 coronary artery disease. Eight patients with type 2 coronary artery disease were successfully treated by percutaneous transluminal coronary angioplasty; one patient underwent coronary artery bypass grafting. Hearts from older donors provide normal graft function. The risk of diffuse coronary artery disease is not elevated in comparison to hearts from younger donors. The higher incidence of focal coronary artery disease suggests donor-transmitted disease that can successfully be treated by conventional therapy.

Actuarial Analysis↗

PubMedDate not supplied

Reliable noninvasive rejection diagnosis after heart transplantation in childhood.

Rejection diagnosis was exclusively handled with noninvasive techniques in 16 children (mean age, 8.6 +/- 5.7 years; range, 0.9 to 15.2 years) over a total follow-up period of 18.3 patient years. No endomyocardial biopsies were performed. Intramyocardial electrogram recordings and echocardiographic investigations were used as two noninvasive techniques for rejection diagnosis. Daily noninvasive telemetric monitoring of the overnight intramyocardial electrogram was the major diagnostic guideline. The intramyocardial electrogram signal of the sleeping child was transmitted to a bedside receiver by an implanted telemetric pacemaker. The QRS amplitude was automatically analyzed and transferred to the in-hospital computer via a telephone modem connection. Rejection was diagnosed when QRS amplitude fell more than 8% below average baseline levels for 3 successive days, which was the indication for hospital admission. Medical antirejection treatment was instituted only if echocardiography showed impaired early diastolic left ventricular relaxation concomitant with a QRS-amplitude loss. The echocardiographic criterion was a prolongation of the parameter Te (Te is defined as the time span between onset of diastole and peak relaxation velocity of left ventricular wall) by more than 10 milliseconds compared to previous intraindividual values. Survival after a mean follow-up time of 13.7 months (range, 2 to 57 months) is 100%. A total of 22 rejection episodes were treated. During the first 6 postoperative months, the incidence of rejection requiring treatment was 1.4 episodes per patient. In patients at home, distant monitoring detected 13 episodes of a significant QRS-amplitude drop, which led to hospital readmission. In eight children, echocardiography was likewise positive, and rejection treatment was instituted. One child with positive intramyocardial electrography received antirejection treatment because of clinical evidence of rejection, although echocardiography was negative. In three instances, systemic infection was associated with the QRS-voltage loss. In one child a reason for QRS-complex reduction could not be identified. One rejection episode was treated on the grounds of clinical signs and positive echocardiography without a significant QRS-voltage drop. We conclude that distant noninvasive rejection monitoring based on meticulous application of the techniques described is a safe procedure. Daily monitoring of QRS amplitude in patients at home is an excellent safeguard against overlooking significant rejection episodes. This is of special importance in infants and children, in whom routine endomyocardial biopsy cannot be performed. Distant overnight monitoring minimizes psychosocial disturbance during follow-up after heart transplantation.

Adolescent↗

PubMedDate not supplied

Urodilatin, a new therapy to prevent kidney failure after heart transplantation.

Kidney failure after heart transplantation still remains a crucial problem, especially when cyclosporine is used for early postoperative immunosuppressive therapy. To preserve good renal function during immunosuppression with cyclosporine, urodilatin (CDD/ANP-95-126), the kidney-born analogue to the circulating cardiac peptide hANP (CDD/ANP-99-126), was given for the first time as a long-term, low-dose infusion in addition to the usual drug therapy immediately after heart transplantation. From November 1990 to January 1992, 47 patients (44 men and three women; mean age, 51 years) were treated by a 20 ng/kg body weight/min infusion for 96 hours after heart transplantation. Renal function and hemodynamic parameters of these patients were compared with a group of 40 patients (34 male and six female; mean age, 50 years) as controls, who underwent heart transplantation from May 1990 to November 1991. Both groups did not differ significantly with respect to age, sex, indication for heart transplantation, and preoperative renal function. With urodilatin treatment, renal function was significantly improved with lower peak plasma creatinine (1.83 +/- 0.1 versus 2.47 +/- 0.19 mg/dl; p = 0.003), lower peak serum urea (118 +/- 7 versus 178.3 +/- 10.3 mg/dl; p = 0.0036) and absence of hemodialysis (0% versus 10%; p = 0.026). Additionally, adequate diuresis was maintained although furosemide was reduced by more than 50% (p = 0.005) on each day of urodilatin treatment. Mean central venous pressure was significantly lower (-2 mm Hg; p = 0.02) during application of urodilatin, despite reduction of vasodilator therapy with nitroglycerin by about 50% (p = 0.02). Because of the significantly improved renal function and beneficial hemodynamic effects, the recommendation is therefore to introduce urodilatin in the postoperative treatment protocol after heart transplantation.

Adult↗