Biomedical subjects
Publications and source records attributed to R Juchems.
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Cardiorespiratory arrest occurred in a 64-year-old man with severe triple-vessel coronary artery disease (status after two myocardial infarctions) and heart failure (ejection fraction of 20%). After intubation and starting resuscitation measures, transoesophageal echocardiography (TE) was performed to exclude electromechanical dissociation with ventricular tamponade. During the thoracic compression of closed-chest cardiac massage the aortic valve opened, while the mitral and tricuspid valves closed. During the relaxation phase the mitral and tricuspid valves rapidly opened, the aortic valve closed. When the cardiac massage was stopped (wide, fixed pupils) echo density increased spontaneously in all four cardiac chambers due to the cessation of blood flow. On resuming thoracic compression after about 30 sec the echo density decreased, first in the right ventricle, then right atrium, followed by left atrium and finally left ventricle. This is the first time that the wash-out of spontaneous echo-contrast has been reported in these circumstances. It makes it possible, together with the movements of the cardiac valves during thoracic compression, to state precisely the localization and direction of blood flow during closed-chest cardiac massage in man. The observations confirm the correctness of the cardiac pump theory rather than the thoracic pump one.
There are two theories to explain the mechanism of blood flow during cardiopulmonary resuscitation: The 'Cardiac Pump Theory' and the 'Thoracic Pump Theory'. We have performed transesophageal echocardiography during the resuscitation of a patient with cardiopulmonary arrest. By this method we could study the motion of the aortic, mitral and tricuspid valves and the changes in ventricular size during cardiopulmonary resuscitation in man. We demonstrated an opening of the aortic valve during thoracic compression with simultaneous closure of the mitral and tricuspid valves. During relaxation of the chest, a rapid opening of the atrioventricular valves and closure of the aortic valve was noted. Short interruption of cardiopulmonary resuscitation to test for spontaneous heart action lead to echocontrast in all four heart chambers through stasis of blood, which resolved on continuation of cardiopulmonary resuscitation. This 'washing out' phenomenon enables visualization of blood flow through the aortic valve during compression, and through the mitral valve during relaxation. These observations favour the Cardiac Pump Theory as the predominant hemodynamic principle of blood flow during cardiopulmonary resuscitation in man.
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A 53-year-old man died on the eight day of an acute enteritis caused by Salmonella typhimurium. Clinical signs of shock were pronounced; the electrocardiogram, initially not pathological, showed a peripheral low voltage with decreased R-amplitudes and distinct disturbances in repolarization. Laboratory findings demonstrating Salmonella typhimurium in blood cultures and stools and 45% band forms in the differential count were remarkable. The autopsy showed deep, fibrin-covered ulcera in the colon area and a dense submucous lympho-histiocyte cell infiltration. Histologically, a granulomatous myocarditis of the left ventricle with lymphocyte and histiocyte infiltration and a focal myolysis was observed. In the right ventricle, however, only a minimal interstitial edema was found.
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The prophylactic means and general modes in the treatment of the bronchitic syndrome in geriatric patients are outlined. The therapy is discussed with respect to the use of broncholytics, secretolytics and steroids on the basics of a detailed lung function test. The altered health condition of the geriatric patient needs an intensive and detailed therapy program and must include limitations caused by the old age.
The cumulation of exogenic factors on the basis of an endogenic disposition and the addition of physiologic aging processes cause an increase of the "bronchitic syndrome" in old age. Heart insufficiency, tuberculosis, lung embolism and bronchial carcinoma are the important differential diagnostic aspects in these patients. The structural and functional changes of the lung in old people and the polypathy, resp. multimorbidity of the whole organism cause the complications and disadvantageous interferences. The prognostic important disturbances of the ventilation mechanics are early recognizable with new diagnostic tools, particularly with the whole body plethysmography.
The product of minimal transit time (MTT) and heart frequency (HF) defines the number of heart beats which are necessary to transport the blood in a determined region of the circulatory system. According to own studies in physiological (stress) and pharmacological conditions this product is constant, independent from body size, length, age etc. In proportion to the degree of heart failure the MTT X HF increases. Measuring appropriate regions of the circulatory system, right and left heart failure can easily be determined. The method has the advantage of a noninvasive procedure and gives exact quantitive accessment of the pump performance of the heart. In view of the increasing use of radio-nuclides this procedure can be recommended because of its good reliability causing little or no discomfort to the patient, and making it applicable, even under extreme conditions, for instance in a CCU.
Report of two patients with pachydermia, clubbing of the fingers and hyperostosis. This clinical syndrome corresponds to the pachydermal periostosis. Etiologic factors, clinical and radiologic symptoms, differential diagnosis, histological alterations, prognosis and therapy are discussed.
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