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Biomedical subjects

P Neidhart

Publications and source records attributed to P Neidhart.

27 records · Page 2Linked to original sources
PubMed1986

[Coronary revascularizations using multiple mammary anastomoses compared to classical vein grafts].

In a series of 100 consecutive patients the internal mammary arteries have been used whenever possible for revascularization of the coronary arteries. At least one internal mammary artery was used in 89% of cases; both internal mammary arteries were used in 30% and in 17% sequential internal mammary-coronary artery anastomoses were performed. The results in this group of patients were compared to another group of 250 consecutive patients in whom the coronary arteries were revascularized by classical saphenous vein grafts. In-hospital mortality was 3% for the internal mammary artery group and 2.5% for the saphenous vein group (NS). The follow-up was complete for 89% of the patients after a mean duration of 6 months. At control the mean NYHA functional class was assessed as 1.0 +/- 0.2 for the internal mammary artery group and 1.2 +/- 0.2 for the saphenous vein group (p less than 0.01). Stress test was electrically positive in 7.1% of the internal mammary artery group and in 15.3% of the saphenous vein group (p less than 0.05). Although the method is technically more demanding, the results after internal mammary-coronary artery anastomoses appear to be superior.

Coronary Artery Bypass↗
PubMed1986

[Measurement of extravascular lung water: a toy or tool?].

We examined the reproducibility of the results of extravascular lung water measurements obtained by the double indicator dilution method. The coefficient of variation (delta) for 82 EVLW-measurements was 13 +/- 8%. The delta of the 3 variables measured and used to calculate the EVLW value i.e. cardiac output, mean transit time for dye (MTTD) and mean transit time for the thermal signal (MTTT) were all below 10%. Our results suggest that the important coefficient of variation of the EVLW-measurements is overall due to the variability of the difference between the 2 transit times measured. The temperature exchange between the intravascular cold bolus and the extravascular thermal volume is flow dependent especially at high EVLW-values.

Cardiac Output↗
PubMed1985

Pulmonary bulla and sudden death in a young aeroplane passenger.

We report a case of a young passenger who during a flight in an aeroplane suddenly lost consciousness and eventually died. The only pathologic finding was a lung bulla. The routine decompression in the passenger room during the flight may have caused expansion of the bulla with mediastinal compression or an increase of the pressure inside the bulla above lung bursting pressure resulting in systemic air embolism. Both mechanisms could have caused the patient's sudden collapse.

Adult↗
PubMed1985

Simultaneous measurement of serotonin and propranolol pulmonary extraction in patients after extracorporeal circulation and surgery.

To evaluate the use of markers of pulmonary endothelial cell function in humans, we simultaneously measured the pulmonary extraction of serotonin (SER) and propranolol (PROP) in patients before and after extracorporeal circulation (ECC) for coronary bypass surgery. No change was seen in SER extraction ratio after anesthesia, ECC, and surgery. Twenty-four hours after ECC and surgery, PROP extraction ratio was decreased by 11%. It remained low for as long as 5 days thereafter. A similar drop in PROP extraction was found in 6 patients 24 h after ilioaortic bypass surgery, without ECC (from 81 to 66%, p less than 0.01). Treatment of 11 other patients with a 30-min period of continuous positive airway pressure (CPAP), 24 to 48 h after ECC, resulted in a significant increase in PROP extraction ratio from 61 to 67% (p less than 0.01). Measurement of PROP extraction appears to be more sensitive than that of SER to lung changes related to postoperative atelectasis.

Adult↗
PubMedDate not supplied

A comparative study of cefamandole and ceftriaxone as prophylaxis in cardiac surgery.

We compared the prophylactic use of cefamandole and ceftriaxone in 40 patients undergoing elective cardiac surgery. Postoperative wound infection occurred in one and two patients, respectively, in each group (n.s.), and bronchial superinfection in one patient in each group. In 12 additional patients drug concentrations in plasma and pericardial fluid were measured at different times following the administration of ceftriaxone. Plasma and pericardial fluid concentrations of ceftriaxone were above the minimal inhibitory concentration of susceptible microorganisms for up to 24 h after intravenous administration. We conclude, firstly, that the incidence of infection after cardiac surgery is low with both cefamandole and ceftriaxone prophylaxis. Secondly, efficient plasma and pericardial fluid levels of ceftriaxone last for up to 24 h after intravenous administration.

Bacterial Infections↗
PubMedDate not supplied

Low systemic vascular resistance after cardiopulmonary bypass: incidence, etiology, and clinical importance.

BACKGROUND: Low systemic vascular resistance during and immediately after cardiac surgery in which cardiopulmonary bypass is utilized is a well-known phenomenon, characterized as vasoplegia, which appears with an incidence ranging between 5% and 15%. The etiology is not completely elucidated and the clinical importance remains speculative. METHODS: In this prospective clinical trial, we assessed the incidence of postoperative low systemic vascular resistance in 800 consecutive patients undergoing elective coronary artery bypass grafting and/or valve replacement. We have attempted to identify the predictive factors responsible for the presence of low systemic vascular resistance and we have examined the subsequent postoperative outcome of those patients who developed early postoperative vasoplegia. The severity of vasoplegia was divided into three groups according either to the value of systemic resistance and/or the dose of vasoconstrictive agents necessary to correct the hemodynamic. RESULTS: Six hundred twenty-five patients (78.1%) did not develop vasoplegia, 115 patients (14.4%) developed a mild vasoplegia, and 60 patients (7.5%) suffered from severe vasoplegia. Low systemic vascular resistance did not affect hospital mortality but was the cause for delayed extubation and prolonged stay on the intensive care unit (ICU). Logistic regression analysis identified temperature and duration of cardiopulmonary bypass, total cardioplegic volume infused, reduced left ventricular function, and preoperative treatment with angiotensin-converting enzyme (ACE)-inhibitors, out of 25 parameters, as predictive factors for early postoperative vasoplegia. CONCLUSION: The occurrence of low systemic vascular resistance following cardiopulmonary bypass is as high as 21.8%. The etiology of this clinical condition is most probably multifactorial. Mortality is not affected by vasoplegia, but there is a trend to higher morbidity and prolonged stay in the ICU.

Aged↗
PubMedDate not supplied

Complement activation in the adult respiratory distress syndrome following cardiopulmonary bypass.

We investigated complement fractions in patients after extracorporeal circulation for coronary bypass operations or cardiac valve replacement, and in two cases developing an adult respiratory distress syndrome (ARDS) after this type of intervention. The patients presenting an ARDS had significantly increased levels of C3d (p less than 0.001), the small molecular breakdown product of C3, associated with decreased levels of total classic haemolytic activity (p less than 0.05) and of the complement component C1q (p less than 0.001) when compared to a group of 10 patients who had uneventful evolution after bypass. However, all patients undergoing cardiopulmonary bypass had significantly increased levels of C3d (p less than 0.005 or less) associated with significant decrease of various complement components within 24 h after bypass, when compared to a control group of 5 patients investigated after aorto-iliac bypass graft surgery. We conclude that significant complement activation can persist in patients 24 h after bypass and--at higher levels--be a pathogenic and biological marker of ARDS after extracorporeal circulation.

Adult↗