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Biomedical subjects

S Christiansen

Publications and source records attributed to S Christiansen.

At least 19 recordsLinked to original sources
PubMed2000

Preoperative immunoglobulin treatment in patients with Werlhof's disease undergoing cardiac operation.

BACKGROUND: Patients with Werlhof's disease and undergoing a cardiac surgical procedure with cardiopulmonary bypass are at increased risk for bleeding complications. We report the usefulness of preoperative immunoglobulin treatment in selected patients. METHODS: Between May 1995 and July 1998, 10 patients with Werlhof's disease underwent a cardiac surgical procedure with cardiopulmonary bypass in our department. Five patients with mean platelet counts of less than 80x10(9)/L received immunoglobulin therapy preoperatively (group 1). The other 5 patients with mean platelet counts higher than 80x10(9)/L were not so treated (group 2). RESULTS: In group 1, mean platelet count increased from 54x10(9)/L 5 days before operation to 112x10(9)/L after immunoglobulin treatment (p = 0.018) and did not fall to less than 60x10(9)/L postoperatively. Patients in group 1 received 16 units of packed red blood cells and 5 units of platelet concentrate. Patients in group 2 required 24 units of packed red blood cells, 5 units of platelet concentrate, and 23 units of fresh frozen plasma. Only 1 patient (group 2) had a surgical bleeding complication that required reexploration. Mean drainage loss was 1,100 mL in group 1 and 1,210 mL in group 2. CONCLUSIONS: Our data demonstrate that immunoglobulin treatment of patients with Werlhof's disease and mean platelet counts of less than 80x10(9)/L significantly augments platelet counts preoperatively. It may be useful in selected patients.

Adult↗
PubMed2000

Anticoagulative management of patients requiring left ventricular assist device implantation and suffering from heparin-induced thrombocytopenia type II.

BACKGROUND: Heparin-induced thrombocytopenia type II (HIT II) is a rare but life-threatening side effect of heparin therapy. We describe the perioperative anticoagulative management of patients tested positive for HIT II and requiring implantation of a left ventricular assist device (LVAD). METHODS: We report on 3 patients with a different perioperative anticoagulative management (preoperative, intraoperative, and postoperative anticoagulation with danaparoid-sodium; preoperative anticoagulation with recombinant hirudin, anticoagulation with danaparoid-sodium intraoperatively and postoperatively; preoperative anticoagulation with recombinant hirudin, intraoperative anticoagulation with heparin, and postoperative anticoagulation with danaparoid-sodium) and discuss the difficulties of the treatment. RESULTS: Anticoagulation with alternative drugs such as recombinant hirudin and danaparoid-sodium led to serious and life-threatening bleeding complications as well as to thromboembolic events in the first 2 patients. Therefore the third patient underwent LVAD implantation using heparin for intraoperative anticoagulation to avoid administration of high doses of recombinant hirudin or danaparoid-sodium. Despite very low anti-factor Xa activities, when using danaparoid-sodium postoperatively, the patient suffered from a bleeding complication on the 4th day after LVAD implantation requiring reexploration. CONCLUSIONS: In selected cases (negative heparin-induced platelet aggregation (HIPA) test at the time of LVAD implantation and continuation of postoperative anticoagulation with recombinant hirudin or danaparoid-sodium), heparin may be used for LVAD implantation in HIT II patients to reduce bleeding complications.

Adult↗
PubMed2000

Surgical management of extensive lipomatous hypertrophy of the right atrium.

Lipomatous hypertrophy of the right atrium is a rare lesion that is usually limited to the interatrial septum. The authors report on a patient that suffered from an extensive lipomatous hypertrophy, which protruded into the right and left atrium as well as the superior vena cava and caused inflow obstruction. Therapeutic management is discussed.

Cardiomegaly↗
PubMed2000

Impact of malignant hematological disorders on cardiac surgery.

BACKGROUND: Patients suffering from malignant hematological disorders may be at increased risk, when undergoing cardiac surgery. We report on our experiences with ten cardiac procedures in nine patients (3 males, 6 females, 19-85 yr old, mean age 61 yr). METHODS AND RESULTS: There were two patients with Hodgkin's lymphoma and one patient each with Waldenstrom's syndrome, multiple myeloma, polycythemia, myelodysplasia, chronic lymphocytic leukemia, non-Hodgkin's lymphoma and idiopathic aplastic anemia. Cardiac diseases included coronary artery disease in six, aortic stenosis in two, and mitral insufficiency in one patient. Consecutively, cardiac procedures were coronary artery bypass grafting in six, aortic valve replacement in two, and mitral valve replacement in one patient. No patient died. Postoperatively, one patient suffered from a pericardial tamponade requiring surgical removal and 5 months later from a prosthetic endocarditis necessitating change of the bioprosthesis. One patient developed a superficial wound infection, which was treated conservatively. Four patients received no blood products. Altogether, we transfused 32 packed red blood cells, seven units of fresh frozen plasma and 16 platelet concentrates. Total drainage loss was 883 ml (250-1510 ml). CONCLUSIONS: Cardiac surgery in patients suffering from malignant hematological disorders may be performed, but carries an increased morbidity. Therefore, indications for cardiac procedures must be carefully considered.

Adult↗
PubMed1999

Minimally-invasive versus conventional aortic valve replacement--perioperative course and mid-term results.

OBJECTIVE: We performed a case-control-study to compare perioperative and mid-term results of minimally invasive with conventional aortic valve replacement. METHODS: Between 8/96 and 7/97, 113 patients underwent isolated aortic valve replacement (minimally invasive: 29, conventional: 84) in our Department. Diagnosis, ejection fraction, pressure gradient/regurgitation fraction, age, gender and body-mass-index were used as matching criteria for the case-control-study. For qualitative data correspondence was requested, for quantitative data deviations up to 10% were accepted. With these criteria 25 patients of the minimally invasive group were matched to 25 patients of conventional group. All patients were reexplored 1 year after aortic valve replacement. Statistical analysis was done by the Fisher's exact test for qualitative data and the Mann-Whitney test for quantitative data. RESULTS: We implanted 15 (20) bioprosthesis' and 10 (five) mechanical prosthesis' in the minimally invasive, respectively, conventional group. There were no statistically significant differences between both groups with respect to the perioperative course, only duration of surgery (mean 201.6 vs. 143.9 min, P < 0.01) and extracorporeal circulation (mean 116.1 vs. 71.3 min, P < 0.01) as well as aortic-cross-clamp-time (mean 77.9 vs. 46.9 min, P < 0.01) were significantly longer in the minimally invasive group. Postoperative complications occurred in one patient of the minimally invasive group (dissection of the right coronary artery) and four patients of the conventional group (third degree AV block, pneumothorax, grand mal convulsion, cardiopulmonary resuscitation). Two patients, one of each group, died during follow-up for unknown reasons. Follow-up revealed no significant differences with respect to clinical and echocardiographic data, but the shorter skin incision was cosmetically more accepted by patients of the minimally invasive group. Minor paravalvular leaks occurred in four patients of the minimally invasive and three patients of the conventional group as diagnosed by transthoracic echocardiography. CONCLUSIONS: Both surgical techniques may be performed with comparable perioperative and mid-term results, but the better cosmetic result in the minimally invasive group is paid by a longer duration of surgery.

Adult↗
PubMed1998

Aortocoronary Vein Bypass in a Patient with Type II Heparin-Associated Thrombopenia: A Case Report

Two types of heparin-associated thrombopenia (HAT) can be distinguished. Patients with type II HAT (HAT II) present a particularly difficult management problem when they require full anticoagulation. There is no consensus about the proper anticoagulation management for patients with HAT II who have to undergo cardiopulmonary bypass (CPB). We present a HAT II patient who underwent successful aortocoronary saphenous vein grafting. Sodium-danaparoid (SD) was used for anticoagulation. The anti-factor Xa level was kept below the values reported in the literature for patients undergoing CPB. We did not observe any fibrin formation during the time of CPB or any severe postoperative hemorrhage, which is frequently described in the literature. We discuss the management of our patient with SD intra- and postoperatively.

Journal Article↗
PubMed1998

Implications of End-Stage Renal Disease on Cardiac Surgery.

End-stage renal failure requiring dialysis is considered a significant risk factor in cardiac surgery. To assess the risk we performed a retrospective analysis of 17 patients with end-stage renal failure who underwent open heart surgery during 1994 and 1995. Pre-, peri-, and postoperatively we evaluated the following factors: renal failure etiology, risk factors, concurrent diseases, previous heart diseases, complications, mortality, and long-term outcome. All patients were dialyzed on the day before surgery. Intraoperative hemofiltration was performed in each patient. The first postoperative hemodialysis was performed on the second postoperative day or earlier for hyperkalemia or pulmonary edema. Postoperative complications occurred in seven patients: three patients expired postoperatively of noncardiac and nonrenal causes and four died during follow-up. With an average follow-up of 16.5 months (range 7-30 months) NYHA class had improved by an average of 1.7 in the 10 patients who were alive and their quality of life was acceptable. Because of these acceptable short- and long-term results and relatively low operative risk, we support an approach of prompt diagnostic work-up and surgical intervention when necessary.

Journal Article↗
PubMed1998

Coronary artery bypass grafting in a patient with type II heparin associated thrombopenia.

Two types of heparin-associated thrombopenia can be distinguished. Patients with the type II condition present a particularly difficult management problem when they require full anticoagulation. There is no consensus about the proper anticoagulation management for type II patients who have to undergo cardiopulmonary bypass. The case is reported of a type II heparin-associated thrombopenia patient who underwent successful aortocoronary saphenous vein grafting. Sodium-danaparoid was used for anticoagulation. The anti-factor Xa level was kept below the value reported in the literature for patients undergoing cardiopulmonary bypass. No fibrin formation was observed during the time of cardiopulmonary bypass, nor was any severe postoperative haemorrhage seen, as is frequently described in the literature.

Aged↗
PubMed1998

[Measurement of the humidity of inspired air in ventilated patients with various humidifer systems].

INTRODUCTION: Humidification of inspired gas in artificially ventilated patients positively influences mucociliary function and secretolysis. We performed this study to examine the properties of heat and moisture exchangers in comparison with hot water humidifiers and dry artificial ventilation. METHODS: We measured inspired humidity with a special sensor in 41 patients after coronary artery bypass grafting with cardiopulmonary bypass. Three Heat and Moisture Exchangers (HME) and a hot water humidifier were used to humidity the inspired gas of artificially ventilated patients. Humidity measurements were compared. RESULTS: Hot water humidifiers produced the highest humidification (average of 38.4 mg/l, 37-43 mg/l); lowest humidification was produced by dry artificial ventilation (average of 8.7 mg/l, 6-11 mg/l). Heat and moisture exchangers (HME) produced humidity between 24 and 36 mg/l. Highest humidification was produced by HME hygrobac s (average of 32.2 mg/l, 31-36 mg/l) and hygrovent s (average of 31.4 mg/l, 29-35 mg/l); lowest humidification was produced by HME hygroster (average of 28.6 mg/l, 24-31 mg/l). Multifactorial analysis shows a significant impact of the humidification method on the humidity of inspired gas. The multiple comparison procedure (Tukey) shows significant differences (alpha = 0.05) between all humidification techniques on inspired gas except the heat and moisture exchangers hygrobac s and hygrovent s. CONCLUSIONS: Hygrobac s and hygrovent s may be an alternative to hot water humidifiers. Further clinical studies of HMEs and hot water humidifiers will be necessary to evaluate the influence of inspired gas humidity on the outcome of artificially ventilated patients.

Air↗
PubMed1998

Atopic dermatitis.

Explore the source record for details and available documents.

Child, Preschool↗
PubMed1997

Results of cardiac operations in five kidney transplant patients.

Because of the paucity of literature reports about cardiac operations in renal-transplant patients we performed a retrospective study encompassing all such patients operated upon in our institution in 1993 and 1994. During this time 5 renal transplant patients underwent cardiac surgical procedures between 1 and 9 years after transplantation: in 4 patients coronary artery bypass grafting (CABG) was carried out and in one patient aortic valve replacement. We analyzed pre-, peri-, and postoperative data. Late results were obtained by questionnaire from the patients' primary physicians. Short- and long-term results were excellent. Mortality was 0%. At late follow-up (8-23 months) all patients were in NYHA class II or better. Postoperatively all patients experienced a clear improvement of their cardiac symptoms. None of the transplanted kidneys deteriorated. One patient who had to undergo intermittent hemodialysis preoperatively improved so much that she did not require any dialysis postoperatively. Although the total number of patients in this study is limited we believe it can be stated that renal transplant patients can undergo cardiac operations with generally good results.

Adult↗
PubMed1997

Cardiac surgery in patients with end-stage renal failure.

End-stage renal failure is commonly considered a significant factor for an increased risk after coronary artery bypass grafting. This holds true for patients who have received a kidney transplant (NTX group) as well as for patients who require chronic hemodialysis (HD group). To assess the risk in our population we performed a retrospective analysis of 22 patients with end-stage renal failure (HD group: 17, NTX group: 5) who underwent cardiac surgery. The perioperative course was compared to a normal population. In addition to standard data we assessed the following factors: renal failure etiology, risk factors, concurrent diseases, duration of renal failure, function of renal graft, ECG (paying special attention to signs of previous myocardial infarctions and rhythm disorders), results of cardiac catheterization and coronary angiography, NYHA class and urgency of operative intervention. Complications and mortality were the main measures of the perioperative course. We analyzed the hospital charts retrospectively and requested the patients' physicians to complete a questionnaire about the patient's present condition. All HD group patients were dialyzed on the day before surgery. The first postoperative HD was performed for hyperkalemia or signs of volume overload (pulmonary capillary wedge pressure > 20 mmHg) when signs of pulmonary function deterioration were seen. HD was successful in treating these conditions. 3 of the 17 patients on HD expired postoperatively, 4 died within 3 years, all of unrelated diseases. Mortality and morbidity was 0% in the NTX group. In one NTX patient who required intermittent HD preoperatively because of poor renal graft function, renal function improved postoperatively, presumably secondary to better renal perfusion, and he did not require HD after his cardiac surgery. By surgical intervention the NYHA class of all patients improved (by 1.6 on the average) as well as their quality of life. Because of these good short- and long-term results and relatively low operative risk we support an approach of prompt work-up and surgical intervention when necessary in HD and NTX patients.

Adult↗
PubMed1996

An asexual fungus has the potential for sexual development.

The availability of cloned genes that control sexual reproduction (mating type genes) in high fungi has allowed us to consider the causes of failure to mate in asexual fungi. We report here that the asexual fungus Bipolaris sacchari has a homolog of the MAT-2 gene of its sexual ascomycete relative Cochliobolus heterostrophus. The B. sacchari MAT-2 sequence is highly similar to that of C. heterostrophus MAT-2 and, in fact, functions in transgenic C. heterostrophus. Thus, the asexual nature of B. sacchari is not due to absence or mutation of MAT. When either of the C. heterostrophus MAT genes was transformed into B. sacchari, the recipient could neither self nor cross with other B. sacchari strains, in contrast to transgenic C. heterostrophus strains which can do both. Persistent asexuality of B. sacchari, in spite of the presence of complementary functional MAT genes, suggests that this fungus lacks genes other than MAT which are essential for mating. Notably, the transgenic B. sacchari strains were sometimes able to initiate, but not complete, sexual development in interspecific pairings with C. heterostrophus. Transcript analysis showed that the B. sacchari MAT-2 gene is expressed in transgenic C. heterostrophus and that the C. heterostrophus MAT genes are expressed in transgenic B. sacchari. No transcript of the native B. sacchari MAT-2 gene was detected under any growth condition tested.

Amino Acid Sequence↗
PubMed1996

Isolation and characterization of two novel genes expressed in germinating conidia of the obligate biotroph Erysiphe graminis f.sp. hordei.

A cDNA library was constructed from germinating conidia of the obligate biotrophic fungus, Erysiphe graminis DC ex Mérat f.sp. hordei Em. Marchal (Egh). Subtractive hybridization and differential screening were carried out. Two cDNA clones, cEgh7 and cEgh16, which were highly expressed in germinating conidia, but not in ungerminated conidia, were selected for further characterization. The corresponding genomic sequences, gEgh7 and gEgh16, were isolated from a cosmid library and sequenced. The gEgh7 gene contains an open reading frame (ORF) that codes for a 249-amino-acid (aa), Pro-rich polypeptide with a repeated primary structure. Expression studies in planta indicated that gEgh7 may have a function in the development and maturation of conidia. The ORF of gEgh16 is interrupted by two introns of 91 and 119 bp. It encodes a 251-aa polypeptide of unknown function. This gene belongs to a multigene family and is expressed during all developmental stages of Egh in planta and may be associated with hyphal growth.

Amino Acid Sequence↗
PubMed1995

[Small intestine transplantation. Experimental microsurgical model in rats].

Small bowel transplantation may eventually become the definitive solution for those patients who suffer from irreversible intestinal failure and that currently depend on parenteral nutrition for survival. Microsurgical transplantation models in rats are widely used for the application of a great variety of immunological and physiological tests. Herein we report our experience after 30 intestinal harvestings and 12 intestinal transplantations in rats. The following criteria were established to assess the surgical procedures: operative time (harvesting and back table, cold ischemic time and warm ischemic time), vascular and intestinal complications and gut histology before and after transplantation. Average time for the donor surgery (harvesting and back table) was 97.19 min. Average warm ischemic time (includes vascular anastomoses) was 115 min. Histological assessment after 3, 4 and 5 hours of cold ischemia (lactated Ringer's solution with 2.4% mannitol at 4 degrees C) showed only mild ischemic changes. Two thrombotic complications were observed: one at the site of the portalcava anastomosis and one at the aortic suture. Hypovolemic shock was the most common cause of death (9/12) and there was no survival beyond 48 hours. Post-transplantation gut histology showed moderate ischemic injury. We conclude that the harvesting technique, as well as the preservation method used are adequate to obtain grafts in a fast and reliable fashion. However, the number of rats transplanted in this experience do not permit statistical analysis of morbidity and mortality at the present time.

Animals↗
PubMed1992

Secondary surgery in patients with malignant germ cell tumors.

A total of 102 men treated for germ cell tumor with chemotherapy containing cisplatin was referred for a secondary operation with signs of tumor in the retroperitoneum or chest. Of the patients 85 underwent laparotomy, 14 underwent thoracotomy and 3 had both operations. Residual tumors were completely resected in 66 patients and incompletely resected in 30, while no tumor was found in 6. The resected specimen was malignant in 18 patients, of whom 11 had complete removal of all malignant tissue. All patients with malignancy in the resected specimen received further chemotherapy. Long-term disease-free status was obtained in 75% of those patients who had a complete resection, compared with 14% in the group with incomplete resection. There was no evidence of malignant disease at operation in 78 patients but 5 of them later died of the disease. Malignant tissue was present in the residual tumor in only 1 of 15 patients whose primary tumor was seminoma alone. Resection was attempted in 14 patients despite abnormal tumor markers preoperatively. Only 5 of these patients achieved a disease-free status and 2 of them died later of malignant disease. Over-all 79 of the 102 patients are without evidence of disease (medium postoperative observation 23 1/2 months). We conclude that a secondary operation constitutes an important part of the treatment of patients with germ cell cancer.

Adolescent↗