Biomedical subjects
Publications and source records attributed to M Lass.
We report on a case of papillary fibroelastoma of the aortic valve in a 55 year old female patient, who had thrombembolic complications and subsequent stroke. The tumor was resected without disturbing the structure and function of the aortic valve.
To investigate possible influence of aprotinin on graft patency, a randomized, double-blind group comparative study was carried out in male patients selected for primary bypass surgery. One hundred and ten patients received either placebo treatment or aprotinin according to the Hammersmith Hospital regimen(n = 55 per group). Graft patency was evaluated by angiography in 44 aprotinin and 35 placebo patients between the 18th and 35th day postoperatively. There was no difference in overall graft occlusion. Among the aprotinin patients, 73% (32/44) hsd grafts patent compared with 71% (25/35) of the placebo group. Graft occlusion was not accompanied by signs of myocardial infarction in any case. Blood loss within 6 h postoperatively was reduced by 58.5% in the aprotinin group (P < 0.001). of these patients 51% (26/51) did not need donor blood compared with 21% (10/47) of the placebo patients (P = 0.003). Mean transfusion requirements per patient were 1.1 and 2.7 units in the aprotinin and placebo groups, respectively.
The proteinase inhibitor aprotinin is used in open heart surgery to reduce intraoperative and postoperative blood loss and transfusion requirements. To investigate a possible influence on graft patency, a randomized double-blind group comparison study was carried out in male patients elected for primary bypass surgery. One hundred ten (55/55) patients received either placebo treatment or aprotinin according to the Hammersmith scheme (2 Mio KIU as loading dose before sternotomy, followed by an infusion of 0.5 Mio KIU/h until the end of surgery; 2 Mio KIU added to the priming volume additionally). Graft patency was evaluated by angiography in 44 aprotinin and 35 placebo patients between the 18th and 35th days postoperatively. There was no difference in the overall graft occlusion: in the aprotinin group 89.5% (111/124) grafts were found patent compared to 87.2% (89/102) in the placebo group. Of the aprotinin patients 72.7% (32/44) and 71.4% (25/35) of the placebo patients had all grafts patent. Venous grafts were occluded in 16% (7/44) of aprotinin patients and in 29% (10/35) of placebo patients. On the other hand 5/27 patients in the aprotinin group vs 0/27 in the placebo group had occluded internal mammary artery (IMA) grafts (P = 0.0511%). Graft occlusions were not accompanied by signs of myocardial infarction in any case. Fifty-one patients in the aprotinin group and 47 patients in the placebo group were valid for parameters of clinical efficacy: blood loss within 6 h postoperatively was reduced by 58.5% in the aprotinin group (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Little information is known concerning hemodynamic parameters of bypass grafts after open heart surgery during the postoperative period. As there is no easy to use bedside-method for monitoring, we developed a new implantable Doppler probe to measure blood flow velocity with a 20 MHz pulsed Doppler system. The accuracy of this method was proved in a circulatory model and in animal studies. Our conclusion is that the implantable pulsed Doppler system is a sensitive method for monitoring small vessel hemodynamics.
STUDY OBJECTIVE: To follow up endothelin (ET), adrenocorticotropic hormone (ACTH), and cortisol levels in patients undergoing aortocoronary bypass grafting (CABG) and to determine whether these are extracted from plasma by the pulmonary circulation. DESIGN: Convenience sample trial. SETTING: University hospital. PATIENTS: Eight male routine CABG patients without appreciable concomitant disease. INTERVENTIONS: Patients were given anaesthesia in a strictly standardised manner using etomidate, flunitrazepam, fentanyl, and pancuronium. Nitroglycerin was administered prior to cardiopulmonary bypass (CPB) at 2 mg/h and dopamine as the only catecholamine starting from CPB weaning until the end of sampling at 3.5-5 micrograms/kg.min. Samples were drawn in rapid sequence from cannulated radial and a distal pulmonary arteries (Swan-Ganz catheter) at eight sampling times starting after induction of anaesthesia and catheter placement and finishing 22 h after the end of operation. MEASUREMENTS AND RESULTS: ET levels were determined by an ET-1, 2, 3-sensitive radioimmunoassay (RIA), ACTH and cortisol by commercially available RIA kits. There was significant (P = 0.032, linear regression analysis) correlation between ET and cortisol from pulmonary arterial samples. ET was significantly (P = 0.042, two-tailed Wilcoxon test) extracted by the pulmonary circulation after induction of anaesthesia. This pulmonary-systemic arterial difference nearly disappeared intraoperatively, but tended to be restored 22 h after the end of operation at an approximately twofold increased level. CONCLUSIONS: No interrelation between ET and the hypothalamic-pituitary-adrenal axis could be established by the ET, ACTH, and cortisol plasma levels. However, the significant correlation between perioperative ET and cortisol lends further support to the hypothesis of ET release by cortisol from vascular smooth-muscle cells. There is a net pulmonary clearance of ET in patients prior to CABG that is lost intra- and early postoperatively, but tends to be restored on the 1st day thereafter at an increased level.
The effects of calcium gluconate on hemodynamics and saphenous vein graft flow in a group of patients undergoing elective coronary artery bypass grafting who developed ionized hypocalcemia at the end of the surgical procedure were examined. The patients received a central venous bolus of 15 mg/kg of calcium gluconate. Heart rate (HR), arterial pressure (AP), central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), and cardiac output were measured immediately before and 30, 60, 120, 180, and 240 seconds after injection of calcium gluconate. Systemic and pulmonary vascular resistance (SVR and PVR, respectively), cardiac index (CI), stroke volume index (SVI), and right and left ventricular stroke work index (RVSWI and LVSWI, respectively), were calculated. Venous bypass flow velocity (Vbypass-flow) was assessed using a Doppler probe that was attached to the left anterior descending artery (LAD) bypass intraoperatively. Calcium gluconate significantly increased MAP, SVR, and LVSWI from 67 +/- 3 mmHg (mean +/- SEM), 1,128 +/- 128 dyne.s.cm-5 and 25 +/- 3 g.m.beat/m to a maximum of 81 +/- 5 mmHg (P < 0.01), 1,401 +/- 196 dyne.s.cm-5 (P < 0.05), and 32 +/- 4 g.m/beat/m (P < 0.01), respectively. HR, CVP, PAP, PCWP, PVR, CI, SVI, and Vbypass-flow remained unaltered. It is concluded that calcium gluconate administered to moderately hypocalcemic patients increases arterial pressure mainly by peripheral vasoconstriction. Because the increase of arterial pressure, and, thereby, coronary perfusion pressure is not associated with an increase of LAD bypass flow, vasoconstriction in the coronary vascular bed distal to the venous graft cannot be ruled out, and deterioration of the myocardial oxygen supply/demand ratio is strongly suggested.
OBJECTIVE: This study aimed to investigate the influence of vasoactive drugs, including a calcium channel blocker, nitroglycerine, and a beta-blocker, often used after coronary artery bypass grafting (CABG). Measurements were taken using a new, completely implantable, mini-Doppler system. The probes were implanted during CABG, led outside through the thoracic wall, and removed 3 days after the operation by a simple pull. RESULTS: The mean Doppler flow increased dramatically in the calcium channel blocker and the nitroglycerine groups (P = 0.002) and decreased slightly in the beta-blocker group (P = 0.015). Mean arterial pressure decreased significantly in all three groups. Heart rate decreased in the beta-blocker group (P = 0.002). Changes in the other hemodynamic variables measured were not significant; there were no changes in the control group. Doppler sonographic monitoring of bypass diameters did not show any changes. CONCLUSION: This is the first study to measure the influence of vasoactive drugs directly and online after CABG. From our experience of more than 40 implantations, we conclude that our method is easy to use and reliable and will help improve the therapeutic regimen for patients after CABG.
Only few data are known concerning haemodynamic parameters and pathomechanisms of small vessels and bypass grafts. No easy-to-use bedside method exists for monitoring. We developed a miniaturised implantable Doppler probe linked to a 20 MHz pulsed Doppler system. In a circulation model and in animal studies we can show the accuracy of this method. We conclude that the implantable pulsed Doppler system is a sensitive method for monitoring the haemodynamics of small vessels.
Thoracic injuries can always involve cardiac structures. If the heart is affected, penetrating or blunt injuries need urgent treatment. An unstable cardiac situation with shock symptoms is life-threatening. The diagnostic method of choice is ultrasound examination. This can show pericardial effusion, enlargement of cardiac chambers, wall motion changes and intracardiac defects. Pathologic ultrasound and ECG findings or abnormal enzyme values arising after blunt traumas need intensive care monitoring. Surgical interventions should be done immediately by the first surgeon involved: time should not be wasted by sending patients to special units, as extracorporal circulation is seldom needed. If it is necessary treatment should be carried out by a cardiac surgeon. Between 1989 and 1990 seven patients with thoracic trauma and heart involvement were operated on at the University of Ulm. The indications applied and results achieved are discussed with reference to the literature.
We studied the effect of hematopoietic growth factors (granulocyte-macrophage colony-stimulating factor [GM-CSF], granulocyte [G]-CSF, interleukin (IL)-1, IL-3, IL-5, IL-6, and macrophage [M]-CSF) on differentiation and functional activity of human eosinophilic HL-60 cells (Eos-HL-60) and compared them with effects on parental HL-60 promyelocytic leukemia cells. Purified biosynthetic GM-CSF and IL-5 enhanced cell proliferation and induced eosinophilic differentiation in the eosinophilic subline in both liquid and agar cultures. IL-3 and IL-6 stimulated cell proliferation but had no effect on cell differentiation, whereas IL-1 and G-CSF affected neither differentiation nor proliferation of Eos-HL-60 cells under the conditions tested. GM-CSF-, IL-3-, and IL-5-treated Eos-HL-60 cells showed increased O2- production in response to phorbol esters (PMA), enhanced phagocytosis of Candida albicans, and release of the enzymes arylsulfatase, beta-glucuronidase and eosinophil peroxidase (EPO). The degranulation of eosinophils induced by GM-CSF, IL-5, and IL-3 may have relevance to the potential clinical toxicity of these hematopoietins, which also stimulate eosinophilopoiesis. G-CSF had no effect on enzyme release, oxidative metabolism, or phagocytic capacity of Eos-HL-60 cells. IL-5 did not affect proliferation, differentiation, or enzyme release in promyelocytic HL-60 cells. These results indicate the specificity of IL-5 for the eosinophil lineage, confirm the effects of GM-CSF and IL-3 on eosinophilopoiesis and mature eosinophil function in a model system, and indicate the absence of G-CSF and IL-1 stimulation of eosinophils. The Eos-HL-60 line is a useful model for studying human eosinophil responses to cytokines.
Concerning postoperative bypass hemodynamics after open heart surgery only few data are known. With this new implantable doppler probe we developed an easy-to-use bedside method for monitoring postoperative bypass function after coronary artery bypass grafting. The accuracy of our method is shown by using a circulation model and by animal studies. Furthermore first clinical data are shown which support our conclusion of having found a sensitive method for monitoring small vessels' hemodynamics.
Due to the continual improvement of surgical and anaesthesiological techniques, the cardiac patients are now of a much higher age than was previously the case. Only pre- and postoperative comparison of life quality can show in what manner these old patients are improved by cardiac surgery. 71 patients with the mean age of 77.6 years were examined by standardized interviews at hospital admittance and one year after returning home. Although there was no statistical significance, there was a very clear trend towards improved quality of life. These very good long-term results concerning the quality of life justify an increased operative risk in this group of 70-80 years old patients. In our study we could show results which were as good as has been shown with younger patients in literature.
UNLABELLED: The aim of the study was to measure pre- and postoperative quality of life of the old patient to find out his profit of open heart surgery. METHOD: 71 patients ranging from 75 to 86 years (mean 77.6 years) were examined by using a standard interview about their quality of life on the day of hospital admittance and one year after returning home (range 11-14 months). RESULTS: There was an improvement of postoperative quality of life. These results were similar to data reported in the literature after investigating younger patients. CONCLUSION: No one should be excluded from open heart surgery because of old age.
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