PubMed Health⌕ Search

Biomedical subjects

O Elert

Publications and source records attributed to O Elert.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Current intra- and early postoperative results of transvenous pacemaker implantation].

UNLABELLED: Between 1986 and 1989 295 pacemaker (PM)-implantations were performed (mean age: 69.9 +/- 14.5 years; 54.9% male, 45.1% female). INDICATIONS: AV-Block II+III (36.6%), sick-sinus-syndrome (26.4%), bradyarrhythmia (18.0%). Concomitant disease: hypertension (40.6%), diabetes mellitus (19.3%), coronary artery disease (11.5%), malignant tumors (10.8%), renal failure (7.5%). We implanted in 72.9% VVI-PM, in 23.7% DDD-PM and in 3.4% AAI-PM. The median fluoroscopy-time as a measure for time of surgery was 6.2 minutes (DDD: 6.7; VVI: 5.4; AAI: 9.9). In 6.5% there were intraoperative complications: arrhythmias (3.4%), skeletal muscular stimulation (M.pect.; 1.4%), lead dislodgment (0.7%), missed puncture (A.subcl.; 0.7%). The early postoperative (14 days) complications rate was 9.5% (lead dislodgment 3.7%, development of high threshold 1.7%, bleeding 1.4%, bacteriaemia 1.0%, skeletal muscular stimulation 0.7%). The complication rate of AAI-PM (70.0%) was significantly higher compared to DDD-PM (29.8%; p less than 0.01) and VVI-PM (12.1%; p = 0.00025). In 17 patients (5.8%) reoperation was necessary (lead dislodgment n = 11, development of high threshold n = 3, arrhythmias n = 2, postoperative bleeding n = 1). The highest dislodgment rate was seen in atrial leads with active fixation (5.0%). In 2.6% of active fixation leads there was a development of high thresholds (passive fixation leads 0.5%). The selection of the PM-system to be implanted has to be considered in respect to the increased complication rate of DDD- and AAI-PM, especially in elderly patients.

Adult↗
PubMed1991

Electron microscopic changes and edema after nine hours' perfusion of isolated canine hearts.

In a comparative study, we investigated whether or not removed and non-beating hearts could be preserved in vitro by continuous perfusion with oxygen-carrying solutions (blood, perfluoro-carbon emulsion) and simultaneous substitution with specific substrates. We used 18 mongrel dogs subdivided into 2 groups (1st group: perfluorocarbon emulsion; 2nd group: blood); the perfusion time was 9 h. In addition to parameters to control the medium of the perfusion solution, we measured parameters that would allow us to assess the success of the extended perfusion. These parameters were high-energy phosphates and, in particular, electron optical analysis. At the end of the perfusion period, electron optical analysis revealed a mild and reversible ischemic reaction by the myocardial cells in both groups. However, statistical analysis showed (1) a significant increase in the ischemic reaction for both groups over the perfusion period (P = 0.02), and (2) a significant, even more pronounced ischemic reaction in the subendocardial myocardium (P = 0.025). It should be noted that distinctly interstitial edema developed during the perfusion period and that this would appear to be a fairly critical problem with extended continuous isolated heart perfusion.

Animals↗
PubMed1991

[Perioperative complications in pacemaker surgeries].

In the years 1979 to 1985 (period I) 717 (102 per annum), in 1986 to 1989 (period II) 295 (73 per annum) pacemaker procedures had been performed at the cardiothoracic surgery division of Würzburg University. Indications for pacemaker therapy were in 35.4% vs. 36.6% (period I vs. period II) an atrioventricular block grade II or III, in 18.1% vs. 26.4% sick sinus syndrome, in 15.3% vs. 18.0% bradycardic rhythm disturbances, in 9.5% vs. 6.1% a sinuatrial block, in 6.5% vs. 2.4% a bradycardic sinus rhythm, in 12.4% vs. 3.7% others. While 41% of the procedures were performed under general anesthesia during the first period of observation, local anesthesia was predominant later on. Preferred venous access (79% vs. 74%) was the right cephalic vein followed by the subclavian vein (12% vs. 14%). The amount of the two chamber systems rose form 11% (period I) to 24% (period II). Intraoperative complications occurred in 2.5% vs. 5.8% and postoperative (within 14 days) complications occurred in 4% vs. 5.8%, respectively. No death was to be registered. The reasons for the increase of intra- and postoperative complications are discussed.

Aged↗
PubMed1990

[Surgical treatment and prognosis of lung metastases].

From 1979 through 1988, 215 patients with pulmonary metastases were treated in our department. Surgery was possible in 112 patients. Eighty-two patients were resected curatively, whereas 30 had only palliative surgery. The operation mortality was 1.8%. The essential prognostic factors were the complete removal of all pulmonary metastases, the portal or caval path of metastasis, involvement of the hilus lymph nodes and presence of clinical symptoms upon hospital admission. The 5-year-survival rate of patients undergoing potentially curative operations was 31%. This was significantly higher than in patients who underwent palliative operations (9%).

Follow-Up Studies↗
PubMed1990

[Peripheral round lesion of the lung: diagnosis, therapy, prognosis].

A total of 407 patients were hospitalized on account of a peripheral round lesion in the lungs (PR); 176 of these patients were inoperable for a wide range of different reasons. In 32.9% of the cases, a peripheral bronchial carcinoma presented, in 26.9%, the lesions were metastases, and in 2% malignant growths that were not further classified. All the remaining PR were benign. The following surgical procedures were performed: 39.8% lobectomies, 19.2% wedge resections, 20.6% enucleations, 6.4% segmental resections, 5.1% bilobectomies, 2.2% pneumonectomies, 6.7% various other procedures. The surgical mortality rate was 1.7% (0% in the case of the benign lesions); the re-thoracotomy rate for complications was 4.5%. The five-year survival probability for all bronchial carcinoma patients was 36%, and for all meta patients 47%. The poorest prognosis was seen in patients with PR when a small cell carcinoma or adenocarcinoma presented, and also in T3 tumours.

Carcinoma, Bronchogenic↗
PubMed1989

[Arteriovenous lung fistula--diagnosis and surgical therapy].

Congenital pulmonary arteriovenous fistula is a rare condition and, for this reason, is repeatedly misinterpreted despite the typical complaints it gives rise to. On the basis of seven cases diagnosed and treated surgically by the present authors, including follow-up, the clinical picture is discussed in detail. The diagnosis of pulmonary arteriovenous fistula can be established on the basis of pulmonary antiography or, more simply, with the aid of digital subtraction angiography with representation of multiple fistulas and accurate localisation. Employing segmentectomy, it usually proves possible successfully to treat even multiple arteriovenous fistulas in the lung, and to achieve lasting freedom from symptoms and recurrent disease. Even if it is asymptomatic, pulmonary arteriovenous fistula should always be resected, since life-threatening ruptures with followed by bleeding into the parenchyma and haemothorax (as was observed in one of our patients) can occur.

Adult↗
PubMed1988

Epithelial thymus tumors--therapy and prognosis.

One hundred and two patients with epithelial thymoma (ET) and carcinoma have undergone surgical treatment since 1957. In this series thymomas were classified according to Masaoka's clinical staging criteria (encapsulated, invasive) and according to Müller-Hermelink's histological criteria of the resected specimens (medullary and cortical differentiation) and compared to clinical symptoms and survival rates (mean follow-up time 66.4 months). We found that it is not always possible to differentiate intraoperatively fibrous adhesions from infiltrations of the thymic capsule or to recognise thymus carcinoma as such macroscopically if they have not already infiltrated the organ's capsule. All ETs with cortical differentiation after thymectomy showed a malignant course; in contrary ETs with medullary differentiation we found without relapses of metastases. ETs with both histological types (hybrid typs) and cortical dominance took in only two out of 57 cases a malignant course though five of them showed an invasion into the capsule according to clinical staging criteria stage II. Therefore classifying ETs only into two categories, encapsulated and invasive, according to surgical and gross findings, seems to be not always possible and insufficient for the clinical assessment of the malignity and prognosis.

Adult↗
PubMed1988

Nocardial endocarditis after aortic valve replacement. Reports of two cases.

Nocardial sepsis occurred after aortic valve replacement in two patients. A septic suture aneurysm of the aortotomy was resected and the prosthesis exchanged in one of them. The other received conservative treatment for sternal osteomyelitis and local mediastinitis. Clinical cure was followed by relapse and death from cerebral infarction, and necropsy revealed a septic suture aneurysm of the aortotomy. Radical surgical revision seems to be necessary for lasting cure in such infections.

Aged↗
PubMed1987

Predictive value of skin testing, neutrophil migration and C-reactive protein for postoperative infections in cardiopulmonary bypass patients.

Despite antibiotic cover for cardiac surgery the development of postoperative infection remains a feared complication. The present prospective study was designed to evaluate whether it is possible to identify preoperatively those individuals in whom the risk of a postoperative infection is significantly greater. Skin test response, chemotaxis and random migration of neutrophils, and serum levels of C-reactive protein (CRP) were chosen as indicators of host resistance. Pre-operatively and at defined postoperative time intervals, 80 patients undergoing open-heart surgery with the aid of cardiopulmonary bypass were examined. Of all the immunological variables measured in this study, the state of anergy proved the most reliable predictor of postoperative infection. Six of the nine pre-operatively anergic patients developed infections (P = 0.00026) representing one half of the postoperatively infected patients. No predictive role of CRP level or neutrophil chemotaxis can be derived from our data. The pre-operatively decreased random migration of polymorphonuclear leukocytes (PMN) from postoperatively infected patients, however, along with the significant defects in chemotactic and random PMN motility seen after cardiac surgery may partly explain the predisposition to bacterial infection in these patients. In conclusion, a pre-operative skin test makes a valuable contribution to the assessment of the patient's postoperative infectious risk.

Adult↗
PubMed1986

Successful management of dissection of the aortic root during aortic valve replacement.

We present a case of intraoperative dissection of the aortic root in a patient with non-calcified aortic valve incompetence. This complication led to life-threatening bleeding from the dissection line into the layers of the left ventricle as well as the aortic wall with formation of an increasing subadventitial hematoma. The only possible management was to remove the valve prosthesis and to close the entry site of the dissection when reinserting the valve implant. The mechanism of this complication is discussed.

Aortic Dissection↗
PubMed1986

Comparative effects of combined dopamine and nitroprusside versus dobutamine and nitroprusside infusions for computer-controlled management of low-output cardiac failure after open heart surgery.

In order to evaluate the possible differences in response to two currently preferable inotropic-vasodilator drug combinations, the hemodynamic effects of automated infusions of nitroprusside-dobutamine and nitroprusside-dopamine were studied in two clinically similar groups of patients with low-output syndrome after aorto-coronary bypass surgery. Nitroprusside, when infused in combination with dopamine, was effective in lowering filling pressures of both ventricles and systemic and pulmonary arterial pressures reflecting the reversal of deleterious rise of these parameters including determinants of myocardial oxygen consumption (mean arterial pressure rate by +6%, heart rate by +20%) caused by dopamine (6 micrograms/kg/min) infused alone. The combination of the more cardioselective catecholamine dobutamine with nitroprusside brought about similar increase in cardiac output by 50%, but derived its hemodynamic efficiency from the sum of separate effects of components and produced less in the way of elevation of determinants of oxygen consumption. Dobutamine when infused alone (6 micrograms/kg/min) has not affected systemic and pulmonary arterial pressures and stroke index rose more markedly (+9%) as a result of more moderate heart rate increase (+13%). Nitroprusside contributed in an additive manner to the achieved overall reduction of SVR and PVR by 43% and 50%, resp., the automated infusion being helpful in maintaining these values within close tolerances.

Cardiac Output, Low↗
PubMed1984

Effects of the automated management of hypertension after open heart surgery. The relevance of the initial systemic vascular resistance as index for predicting hemodynamic response to computer-controlled nitroprusside infusion.

In the study of hemodynamics of hypertensive patients with low-output syndrome after open-heart surgery (the closed loop control of mean arterial pressure with nitroprusside, n = 14), evidence was obtained that the baseline SVR is a valuable index for predicting the response to vasodilation. Patients with markedly elevated SVR (n = 11) (1800 dyn. s. cm-5) responded favorably to vasodilation with SVR fall (from 2300 +/- 500 dyn X cm-5 to 1400 +/- 300 dyn X cm-5, p less than 0.005, -37%), cardiac index rise (from 2.1 +/- 0.3 to 2.4 +/- 0.4 l/min. m2, p less than 0.05 + 14%), or stroke volume index elevation (from 23.4 to 26.7 ml/m2, p less than 0.05, +14%). In patients with slightly raised SVR close to the normal range a mild SVR reduction (by 10%) occurred but no cardiac index increase with vasodilation alone. These patients derived their hemodynamic benefit from a combination of NP with preload augmentation and possibly direct inotropic stimulation. By assessing SVR before and during treatment with nitroprusside we were able to monitor more closely the course of automated afterload reduction and provide an additional important parameter for this regulation.

Adult↗