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Biomedical subjects

R Panzner

Publications and source records attributed to R Panzner.

At least 19 recordsLinked to original sources
PubMed1992

[Case reports of arteriovenous fistulas of coronary vessels in adulthood].

It is reported on the diagnosis and therapy of arteriovenous fistulae of coronary arteries. With the help of 5 casuistic instances external fistulae could be demonstrated by invasive diagnostic procedures. In three cases the fistulae drained from the left coronary into the pulmonary artery, at the second instance from the right coronary artery into the right ventricle, in the fifth instance from the right coronary artery into the right atrium. In addition to this there were coronary stenoses which needed a bypass. In all cases the tentative diagnoses were confirmed intraoperatively. The indication to operative ligatures of the congenital fistulae is discussed and supported depending upon the picture of the complaint.

Adult↗
PubMed1990

Perioperative assessment of cardiac energy metabolism by means of arterio-coronary venous difference in lactate concentration (acDL). A parameter for optimizing ventricular function of the postcardioplegic myocardium.

Fourty-three patients undergoing open heart surgery were subjected to extended hemodynamic and metabolic monitoring (arterial and coronary sinus (CS) lactate concentration). In 95% of patients investigated, a significant increase in CS lactate concentration above the arterial lactate concentration was established at the beginning of reperfusion (RPT). In these cases, a decrease in the CS lactate below the arterial concentration occurs within the RPT creating a cross-over point (COP) from negative to positive lactate extraction values. Whereas the initial rise in CS lactate is an expression of the expected ischemia-induced acceleration of anaerobic glycolysis, the onset of a positive lactate extraction can be related to reconsolidation of mitrochondrial oxidative phosphorylation. We found two groups with an early and late COP at 7.2 +/- 0.8 min (ECOP) and 42.5 +/- 5.2 min (LCOP) (P less than 0.005). Whereas a short cross-over time was associated with a normal postoperative outcome, cardiac recovery was delayed in the LCOP group. With the aid of metabolic monitoring it is possible to identify the COP and cardiac overload situations and so to optimize the perioperative outcome, especially in selected patients (NYHA stage III/IV, re-operation, high-risk operation).

Adenosine Triphosphate↗
PubMed1990

[Arterio-coronary venous difference in lactate concentration--a new objective and topical available parameter for the estimation of the energy metabolism status of the heart].

Cardiosurgical operations were tested experimentally by means of a perioperative metabolic-energetic monitoring and by the conventional method of the hemodynamic monitoring (Swan-Ganz-catheter). By that could be shown that a perioperative monitoring by means of the arterio-coronary venous difference of the lactate level is possible. Intraoperative information about the topical metabolic-energetic condition of the myocardium is to receive as the decisive advantage of this method. An improvement of the therapy results is possible in that way by an optimum of the treatment. A metabolic recovery of the heart during the operation was substantial more favourable for the postoperative myocardial restitution than an early application of catecholamins. This method for perioperative observation should be used specially in risk operations (NYHA-stadium III-IV, reoperations, etc.).

Biomarkers↗
PubMed1990

[Heart surgery interventions in risk patients. New possibilities for improving therapeutic results].

Perioperative therapy in conjunction with cardiac surgery had so far been guided by functional, paraclinical, and clinical parameters which only conditionally enabled objective appraisal of the present condition of the myocardium. Perioperative recording of the arterio-coronary-venous concentration difference of lactate (acDL) has now enabled the use of an objectivated parameter for accurate description of the metabolic-energetic situation of the myocardium. This will be helpful in metabolic-energetic condition monitoring (MESM) to optimise perioperative cardiotonic therapy. Stabilisation of the metabolic-energetic situation of the myocardium, objectivated by MESM, has proved to be superior to premature cardiac support, using catecholamines. It has been associated with improved restitution with high significance (p less than 0.005).

Adult↗
PubMed1988

[Quantitative and qualitative investigations on human pericardial fluid].

The quantity and the quality of the pericardial fluid (PF) were investigated in patients after cardiosurgery and thoracic surgery. The quantity of the pericardial fluid was described independent of the disease and dependent on the age of the patient. The behaviour of the concentration of the immunoglobulins was verified as independent of the illness. A passive distribution mechanism of the observed parameters in the pericardial fluid was discussed.

Age Factors↗
PubMed1988

[Acute surgery in heart surgery patients under preventive use of anticoagulants].

Studies were conducted into indications, courses of operations, and postoperative complications of 17 surgical patients hospitalised or treated in the outpatient department who were on anticoagulant medication because of previous cardiac surgery and required acute re-operations for manifestations of secondary surgical diseases. Particular attention was given to Quick values for an assessment of the present coagulation situations. The point is made that Quick values between 25 and 30 per cent do not yet constitute contraindications to surgical intervention. Reservation is recommended with values below 20 per cent. Therapeutic recommendations are given for treatment of surgical patients with low Quick values.

Anticoagulants↗
PubMed1987

[Surgical therapy of bacterial endocarditis].

On the basis of an own clinical material of 26 patients and in comparison to the literature indications and results of the operative therapy in bacterial endocarditis were discussed. The progressive, conservatively not controllable cardiac insufficiency is the most frequent indication for operation. Without valve replacement it causes death in 60-90% of the patients. In contrast to this there is a postoperative early lethality of 10-30%. Among our own patients the early mortality was 19%. Ill patients operated on were in an advanced stage of the disease, seven patients had to be operated on under emergency conditions. Postoperatively, an improvement of the clinical stages by on an average two degrees of severity (NYHA) could be established. For the purpose of a further improvement of the changes of survival in patients with bacterial endocarditis the demands for an early diagnosis, an adequate antibiotic therapy, a well-timed operation and a suitable operating technique have to be fulfilled.

Abscess↗
PubMed1985

[Early and late results after conventional mitral valvulotomy].

In comparison to the commissurotomy on the open heart the conventional cardiovalvulotomy even nowadays is a recommendable alternative. It is burdened by an insignificant early lethality (1.8%). After 10 years the calculated survival probability is 87.6%. Using the ultrasound cardiography, the image intensifier radioscopy and in exceptional cases the invasive ventriculography to a higher degree those patients can be comprehended preoperatively, in whom a more intensive calcification of the mitral valves or a shrinking of the subvalvular apparatus is present. In these cases primarily the valvulotomy and a substitute of the valve on the open heart, respectively, is to be aspired to.

Adult↗