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Biomedical subjects

P Kalmar

Publications and source records attributed to P Kalmar.

At least 19 recordsLinked to original sources
PubMed1991

Delayed coronary occlusion following primary successful angioplasty: management and outcome.

The treatment of delayed coronary occlusion after primary successful percutaneous transluminal coronary angioplasty (PTCA) is more difficult because surgical standby is often not available. The purpose of this study was to assess the therapeutic approaches and outcome of patients with delayed coronary occlusion from 30 to 180 minutes after successful PTCA. A delayed occlusion occurred in 18 (0.9%) (61 +/- 11 years; male n = 14, female n = 4) out of 2065 consecutive patients after PTCA. In 11 patients the dilated stenoses were located in the left descending artery, while seven patients had the stenosis in the right coronary artery. Twelve patients had unstable or postinfarction angina. The time interval between completion of PTCA and the onset of chest pain was 64 +/- 39 minutes. Immediate i.v. nitroglycerin resulted in no relief of the symptoms in any patient. One patient was operated upon at once, and one was given i.v. thrombolysis resulting in pain relief and reversal of ECG changes. The remaining 16 patients returned initially to the catheterization laboratory, where the occluded vessels were opened by mechanical recanalization. Three of them remained in stable condition. Due to impending reocclusion surgery was necessary in four patients and thrombolysis was performed in nine. After thrombolysis the vessel remained open in four patients. The other five needed bypass surgery on the day of PTCA. Myocardial infarction developed in nine patients (maximal CK 673 +/- 488 units/l). In conclusion, delayed occlusion after successful PTCA is a rare complication occurring primarily in patients with unstable angina. Mechanical recanalization opened the occluded vessel in most patients, and myocardial infarction was prevented in 50%.

Adult↗
PubMed1991

New nomenclature and computerized programme of graphics for the description and recording of aortocoronary bypasses.

In the process of drawing up a computerized operation reporting system, a nomenclature for the precise description of recently fitted or existing aortocoronary bypasses has been developed. This is based on a sequence of letters showing in one line which type of bypass has been fitted, the graft material used, the central anastomosis (source) as well as the peripheral anastomoses on the coronary arteries (objective). For this purpose, abbreviations of the customary terms in use in cardiac surgery have been used. A computer graphics programme has been created in parallel, enabling all bypasses (existing and/or new) to be sketched into the diagram of a heart with the aid of a mouse. The bypass nomenclature is automatically generated from the diagram, which can also be printed out as a sketch of the operation. The complete diagram of the heart plus data input forms enable the operation report to be compiled automatically. The nomenclature and the graphics programme are easily learnt, simplify work, can readily be incorporated into a computerized hospital organization and enhance documentation quality.

Abbreviations as Topic↗
PubMed1991

Abdominal aortic aneurysm repair after renal transplantation with extracorporeal bypass.

The successful resection of an abdominal aortic aneurysm is presented in a patient who had undergone kidney transplantation 4 years previously. Because the transplanted kidney is more sensitive to ischemia than a normal one, a femoro-femoral bypass with a pump oxygenator was used for perfusion of the transplanted kidney during crossclamping. During the clamping time of 40 minutes kidney perfusion was maintained with a perfusion pressure of 60 to 80 mmHg and the flow was 600 to 1000 ml/min. A collagen-seeded Dacron graft (diameter: 18 mm, length: 12 mm) was interposed. The postoperative course was uncomplicated. We believe that performing the femoro-femoral bypass with a pump oxygenator is an effective and simple method for kidney protection in such operations.

Aorta, Abdominal↗
PubMed1991

[Blunt aortic injury/choosing appropriate time for surgery].

Based on our experience in a cohort of 39 patients and also on the results of post-mortem findings obtained from the department of forensic medicine in Hamburg, we prefer to perform emergency surgery only in cases of aortic aneurysms over 6 cm in diameter, in cases of hemorrhage, or in coarctation syndrome. Because of the high incidence of concomitant multiorgan injuries, surgery for aortic lesions with only radiologic symptoms is not performed until a period of 2-8 weeks has elapsed since the injury, according to the degree of stabilisation. With this strategy, the mortality in surgical management of aortic injuries in our department is about 15%.

Aortic Aneurysm↗
PubMed1991

[Results of emergency bypass operation following percutaneous transluminal coronary angioplasty].

Between 1980 and 1988, percutaneous transluminal coronary angioplasty (PTCA) was performed in 1,514 patients. Fifty-five patients (3.6%) underwent emergency coronary bypass surgery because of an acute occlusion of the vessel or a dissection with sustained angina and signs of ischemia on the electrocardiogram. Twenty-five of these 55 patients had a myocardial infarction and 5 patients died, 3 perioperatively, 2 after hospital discharge. The degree of stenosis of the dilated vessel significantly influenced the incidence of infarction, while left ventricular ejection fraction prior to PTCA significantly influenced mortality. Patients who underwent surgery with an occluded vessel experienced myocardial infarction significantly more often (87%) than patients with a patent vessel (24%). The incidence of infarction was 27% when reperfusion of the vessel occluded during PTCA was achieved with a reperfusion catheter, repeated PTCA or intracoronary lysis. The patients' age, presence of unstable angina, left ventricular ejection fraction prior to PTCA, the dilated vessel, the extent of coronary artery disease, collateralization of the dilated vessel, and the time between the onset of the event necessitating bypass surgery and the beginning of extracorporeal circulation were found to have no influence on the incidence of infarction. Patients who died had a significantly lower ejection fraction before PTCA than survivors and all patients who died had experienced a large perioperative myocardial infarction.

Adult↗
PubMed1990

Multicentric quality assurance in cardiac surgery. QUADRA study of the German Society for Thoracic and Cardiovascular Surgery (QUADRA: quality data retrospective analysis).

A method for initiating quality assurance in cardiac surgery was developed multicentrically by a commission of the German Society for Thoracic and Cardiovascular Surgery (QUADRA Study). To appraise the quality of cardiosurgical action, variables were compiled from the preoperative, intraoperative, and postoperative treatment course. The data collection was carried out at the same time as treatment. On the basis of unicentric data profiles, multicentric hospital profiles, and problem profiles, a quality comparison could be carried out and the variability of cardiosurgical action which may occasion interventions could be identified. A reduction of perioperative blood consumption during the study period could be observed in four out of five hospitals as the first result. The data collection also revealed epidemiological features. On average, women were older than men at the time of the heart-valve and coronary operations. To ensure data validity and the organization of quality assurance, a documentation assistant and a specially trained physician are necessary at every cardiovascular surgery center. The multicentric external comparison is indispensable and must be carried out by means of a central data collection, for which intrumental and staff capacities are also to be provided. With modern methods of data processing, an additional and new approach to the improvement of quality in cardiac surgery can thus be made.

Blood Transfusion↗
PubMed1990

[Dissecting aneurysm of the thoracic aorta. Diagnosis--surgical management--results].

From 1980 to 1989, 84 patients underwent surgery for dissection of thoracic aortic aneurysms. According to the DeBakey classification there were 23 dissections of type I, 35 of type II and 26 of type III. Magnetic resonance imaging and combined transesophageal and transthoracic echocardiography are highly sensitive and specific methods for diagnosis and followup of aortic dissection. 10% of the patients had to undergo surgery again during the first 5 years. The 5-year-survival rate was 56.1% and the 10-year rate was 40.1%.

Adult↗
PubMed1990

[Central nervous system risk factors in heart surgery].

Serious complications involving the central nervous system in the course of cardiac surgical procedures have become rare. Nevertheless, CNS dysfunctions still are observed in a considerable number of patients, exceeding by far the number of those at risk from preoperative neurological hazards. The influence of extracorporeal circulation performance and hypothermia on the physiology of cerebral autoregulation, as well as microembolization events seem to be crucial factors in this context. The resulting regional or global posthypoxic changes in brain metabolism may lead to the manifestation of various neurologic and psychiatric disorders in the postoperative course. These often minor disturbances of CNS function can only be detected regularly and diagnosed correctly in a prospective way by consulting specialists in neurology, psychiatry and psychology, as performed at the Department of Thoracic- and Cardiovascular Surgery of the University Hospital in Hamburg since 1974, and currently in use an international multicenter study. We found postoperative neurological abnormalities in more than 50% of our patients. While irreversible brain damage occurred in only 0.5% of cases, about twothird exhibited transient symptoms that were no longer apparent after 8-10 days postoperatively. Obvious psychopathological symptoms were noted in 10% of cases after surgery, and minor, likewise transient, psychiatric disturbances were seen in up to 50% of patients; 20% suffered from long-lasting psychic problems. The subjective complaints in these cases exceeded the results of objective assessments to a remarkable amount. The discussion focuses on a critical valuation of clinical and supplementary examination techniques and on the potential pathophysiologic mechanisms induced by extracorporal circulation.

Brain Damage, Chronic↗
PubMed1989

[Disorders of fascicular conduction following coronary surgery: etiology and clinical relevance].

Seventy-one consecutive patients undergoing coronary artery bypass grafting (CABG) were studied prospectively. New fascicular conduction defects (FCD) were evident in 51 patients (72%) 1 h after cardioplegic cardiac arrest, in 40 patients (56%) after 2 h, in 29 patients (41%) on the first postoperative day, and in 14 patients (20%) on the seventh postoperative day. Right bundle branch block was the most common type of FCD, followed by left anterior hemiblock. FCD were related to longer aortic cross-clamp time, higher age (p less than 0.025), frequency of wall motion abnormalities (p = 0.033), the number of diseased (p = 0.007) and bypassed vessels (p less than 0.0005), a greater intra- (p = 0.018) and postoperative (p = 0.017) demand for catecholamines, a more complicated postoperative course (p = 0.005), and a longer stay in the intensive care unit (p less than 0.01). Ischemic damage to the conduction system during cardioplegic cardiac arrest appears to be the most likely explanation for new FCD after CABG. Severe coronary heart disease contributes to their development. Hence, adequate myocardial preservation is of crucial importance. FCD are associated with increased perioperative morbidity, according to other studies, also with poorer long-term prognosis, especially in case of a left bundle branch block. In this subset a closer follow-up may be indicated.

Arrhythmias, Cardiac↗
PubMed1988

Increase in myocardial Gi-proteins in heart failure.

The contractile response and myocardial content of Gi-proteins were examined in cardiac preparations from explanted hearts of four different patients with end-stage heart failure. Three patients had idiopathic dilated cardiomyopathy and one patient had inflammatory heart disease. Preparations from patients with idiopathic dilated cardiomyopathy showed reduced contractile response to the cAMP-increasing agent isoprenaline and an increase in myocardial Gi-proteins, compared with preparations from non-failing hearts. Therefore it is conceivable that an increase in myocardial Gi-proteins is causally related to heart failure due to idiopathic dilated cardiomyopathy. In the preparation from the patient with inflammatory heart disease the contractile response to isoprenaline was not reduced and likewise content of Gi-proteins was not changed.

Cardiomyopathy, Dilated↗
PubMed1988

'Head and heart'--neurological and psychological reactions to open heart surgery.

Neurological and psychological reactions to open-heart surgery are widely underestimated phenomena and occur in a much higher incidence than one might expect. When analyzed retrospectively, up to 3.8% of patients who underwent cardiac surgery at the Hamburg University Hospital exhibited these reactions, whereas 35%-50% presented with symptoms and signs of perioperative CNS dysfunctions in prospective studies at our department. About the same percentages are detected in prospective studies of the patients' perioperative psychopathology, stating that a great number of cardiac patients exceed the normal range of anxious, tense, and depressive moods in this setting. The consequences of these findings for the patients' quality of life and the impact for the perioperative management of patients undergoing open-heart surgery are discussed. The current prospective studies, preliminary results of which are presented here, are part of an international interdisciplinary study, initiated to bring more light into the complicated relations between ECC-assisted cardiac surgery, anaesthesiology, neurology and psychology.

Adaptation, Psychological↗
PubMed1987

[Intracoronary thrombus in patients with unstable angina pectoris].

Intracoronary thrombi were found in 20 of 52 patients (38%) who had coronary angiography because of treatment-resistant unstable angina. Unrelated to the angiographic finding, eight patients (15%) sustained a myocardial infarction, and two died during their hospital stay. Only one patient (5%) with and six patients (19%) without intracoronary thrombi were stabilized and discharged from hospital. The remaining patients either had an aortocoronary bypass (n = 31) or transluminal balloon angioplasty (n = 13). These findings underline the importance of intracoronary thrombus formation in the pathogenesis of treatment-resistant unstable angina.

Adrenergic beta-Antagonists↗