Experience with PTFE-prostheses for construction of Blalock-Taussig shunts.
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Adolescent↗
Biomedical subjects
P Rehak
Publications and source records attributed to P Rehak.
[Role of the pericardium in acute volume overload].
The function of the pericardium in acute volume overloading may be defined as protection against ventriculo-atrial regurgitation at high filling pressures, limiting transmural pressures and, therefore, protecting against ventricular distension as well as supporting the filling of the ventricles by suction in the systolic contraction. Thus, it may be important to close the open pericardium carefully after open heart surgery. Pericardial drainage should prevent cardiac tamponade.
Animals↗
[Hyperbaric oxygen therapy in experimental necrotising pancreatitis (author's transl)].
In the last years non operative and surgical efforts could not diminish the high lethality of severe acute haemorrhagic necrotising pancreatitis. While majority of patient die in consequence of pancreatitis-shock, hyperbaric oxygen therapy (HBO) can improve all hypoxic circulation situations. Therefore the value in treatment of experimental necrotising pancreatitis in pig is examined. 5 pigs were treated with, 5 without HBO and 5 served as control. With HBO liquid sequestration was diminished and total protein loss prevented significantly, but foremost survival time was significantly prolonged. In consequence demarcation of necrosis with connective tissue was possible, but nevertheless operative treatment remain necessary. Without HBO all pigs and with HBO only 2 pigs died in consequence of necrotising pancreatitis. It is demonstrated, that HBO as additive therapy can improve the prognosis of necrotising pancreatitis.
Acute Disease↗
[Clinical experience in a case of orthotopic liver transplantation by use of an atypical caval vein anastomosis (author's transl)].
The two main indications for liver grafting are primary malignancy and parenchymatous liver disease. In both cases orthotopic transplantation remains the preferred technique. Since graft rejection was considered not to be the main problem in clinical liver transplantation, recent improved survival rates were reported to be due to a more aggressive diagnostic management and consequent treatment of postoperative complications nonrelated to graft rejection. Because of the limited number of organs available for organ grafting sometimes technical modifications may become necessary. This was the case in a 40-year old male patient suffering from primary malignant hepatoma. The donor was a child, and during operation a great difference between organ size and length and diameter of the hepatic vessels became evident. Orthotopic transplantation was performed using an unusual method of caval vein anastomosis. Initially the patient did very well, but later on liver function deteriorated and the patient died in the eighth postoperative week because of hepatic artery thrombosis. The autopsy showed that all other vascular anastomosis were patent and no signs of portal hypertension were evident. The surgical technique used in this case is described in detail and some interesting aspects are discussed.
Adult↗
[Comparison of the analgesic effect of nicomorphine in two different solutions (author's transl)].
The analgesic effect of nicomorphine in two different solutions was tested in 120 patients after cholecystectomy. The patients were divided into three groups: group I was given nicomorphine diluted with water, group II nicomorphine diluted with propylenglykol, group III propylenglykol alone. The degree of pain sensation was determined by interrogation. Pulse, respiratory rate, blood pressure as well as capillary pO2 and pCO2 were measured 10 and 30 minutes after medication. No difference in pain relief could be established in the two groups receiving nicomorphine. Respiratory depression with a significant decrease of respiratory rate together with an increase of pCO2 was observed in the two nicomorphine groups. In the placebo group there was no significant change in the tested parameters. A small decrease of pO2 was observed in all patients after laparotomy.
Adult↗
[Age at correction and postoperative hypertension in isolated coarctation of the aorta (author's transl)].
A follow-up study of 46 cases of isolated coarctation of the aorta (age at surgical treatment 1 to 48 years) is presented. The late postoperative blood pressure was the higher the later surgical treatment was carried out. When surgical treatment was carried out at an age of more than 14 years, an increase of the residual hypertension rate was observed. A relatively low rate of residual hypertension can be expected after correction at about 6 to 10 years. Surgical treatment in infancy does not seem to have beneficial effects since according to other reports correction at this age does not reduce the residual hypertension rate essentially. Apart from the elevated residual hypertension rate surgical treatment at an advanced age generally has a lowering effect on blood pressure values.
Adolescent↗
The impact of overweight on the development of diabetes after heart transplantation.
BACKGROUND: Overweight is defined with a body mass index (BMI) >25. A BMI >25 is known as an independent risk factor for increased morbidity and mortality. The influence of an increased BMI on the development of diabetes and on survival after heart transplantation (HTX) was investigated. METHODS: A total of 137 patients (116 men, 21 women), who underwent HTX at our Department from 1986 to 2002, were included in the study. For group stratification, the pre-operative BMI values were taken (group I: BMI 25). Groups were compared for primary disease, age and sex, development of renal failure, development of diabetes, and survival. The probability of survival and the freedom-from-diabetes interval were calculated by the use of Kaplan-Meier method. RESULTS: No significant differences between groups I and II were found concerning primary disease, age and sex, and occurrence of renal failure. There was a tendency towards increased survival (p = 0.18) in group I. Patients of group II developed diabetes after HTX more frequently than those of group I (p < 0.001). Cox regression revealed that pre-operative BMI >25 is a highly significant independent risk factor for post-operative development of diabetes mellitus (DM) (p < 0.001). CONCLUSION: Overweight prior to HTX appears to negatively influence long-term survival after HTX, although this difference did not reach statistical significance. Pre-operative overweight is a significant and independent risk factor for the development of post-transplant diabetes.
Adult↗
The effect of external beam irradiation after endoscopic palliation of esophageal carcinoma.
The aim of this study was to verify the value of additional external beam irradiation (EBR) after endoscopic palliation, regarding quality of life and survival rate. From January 1988 to December 1995, 99 patients with esophageal carcinoma (squamous cell carcinoma 61; adenocarcinoma 38) were reviewed, there were 84 males (mean age: 67 years) and 16 females (mean age: 65 years). Seventeen patients were in stage IIb, 45 stage III and 37 patients in stage IV. HDR-brachyradiotherapy (mean: 14.7 Gy) was carried out in all patients. Additional EBR (mean: 47.8 Gy) after endoluminal palliation was done in 51 cases. At 6-months follow-up swallowing of a semi-solid diet at least was possible in all patients and dysphagia was found with significant difference in favour to EBR only in stage IV (p=0.011). The Karnovsky performance status showed a difference in favour of EBR for stage III and IV (p=0.040 and p=0. 049, respectively). The median overall survival for EBR compared to no EBR was 10 and 7 months, with a 12 months survival rate of 60% and 16% (p=0.0012). However, considering different stages and EBR versus no EBR a significant difference in survival could only be found for stage IIb (p=0.031), a trend in favour of EBR could be found for stage III (p=0.0985) and stage IV (p=0.0543). Tumor regrowth 6-12 months after treatment occurred in 31 cases and was successfully treated with Nd-YAG laser in 25 and stenting in 6 cases. Postirradiation fibrotic stenosis occurred in 12 cases. Improved survival rates after additional EBR can only be expected in stage IIb. However, in case of advanced esophageal carcinoma and fair performance status, EBR after endoluminal palliation help to maintain quality of life.
Adenocarcinoma↗
Prostaglandin E1 reduces the frequency of rejection after heart transplantation.
This retrospective study was carried out to evaluate the effect of prostaglandin E1 on the frequency of rejection in 36 heart transplant recipients who survived orthotopic heart transplantation for 60 days or longer. The therapy for both groups was the same except group 1 (n = 12) was given PGE1 for 6 to 14 days. Indication for the PGE1 was right ventricular mismatch or failure. The prostaglandin administration started during the transplantation procedure. The dosage was 28 to 64 ng/kg/min and was tapered down from 14.7 to 32 ng later. No major side effects related to PGE1 have been observed. During the first 60 days after heart transplantation, in the group treated with prostaglandin, rejection grade 2 or higher was evident in 0.91 biopsies/patient versus 2.2 in nontreated patients, (p less than 0.05). A prolonged interval free from rejection (p less than 0.05) was observed in the patients treated with prostaglandin.
Alprostadil↗
Hemodynamics during experimental induced cardiac tamponade in minipigs.
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Animals↗