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T Busch

Publications and source records attributed to T Busch.

At least 55 records · Page 3Linked to original sources
PubMed2000

Chyloperitoneum. A rare complication after abdominal aortic aneurysm repair.

We report a case of chylous ascites as a rare complication following elective aortic aneurysm repair in a 66-year-old male. After its early development on the second post-operative day, re-laparotomy was performed with ligation of fistulas and omentumplasty. After recurrence of chylous ascites, conservative treatment for three months including parenteral nutrition and low-fat diet under continuous peritoneal drainage led finally to success.

Aged↗
PubMed1999

[Traumatic pulmonary hernia].

The traumatic pulmonary hernia is a rare and uncommon observation. We report a case of a 52-year-old patient who had a car accident. Beside multiple polytraumatic injuries we were able to diagnose an incarcerated pulmonary hernia. Hernia size, incarceration and the respiratory insufficiency of the patient necessitating immediate surgical intervention. We relocated the hernia into the chest and stabilized the thoracic wall. The postoperative course was uneventful.

Female↗
PubMed1999

Unsuspected idiopathic mediastinal fibrosis complicating coronary bypass operation.

A 66-year-old woman was referred for coronary bypass operation to the left anterior descending and the circumflex arteries. She had a systemic inflammatory process of unknown origin. On opening the pericardium, fibrotic plaques encircling the entire ascending aorta were found. Aortic cannulation and proximal anastomosis of the planned vein graft were impossible. The right internal mammary was anastomosed to the left anterior descending artery, the left to the obtuse marginal after femoral arterial cannulation. Pathologic examination revealed idiopathic mediastinal fibrosis.

Aged↗
PubMed1999

Combined approach for internal carotid artery stenosis and cardiovascular disease in septuagenarians--a comparative study.

OBJECTIVE: The best surgical approach for concomitant carotid artery and cardiac disease remains controversial. Many studies proved the safety and efficiency of simultaneous surgery. We aimed to demonstrate the same benefits for patients > or = 70 years. METHODS: We retrospectively evaluated 205 patients simultaneously operated upon between 1988 and 1998. Group A comprised patients < 70 years (n = 110), group B > or = 70 years, (n = 95). Risk factors, neurologic and cardiac history, angiographic findings, operative data, morbidity and mortality (30-day-postoperatively) were analysed. The mean age was 62 years in group A and 75 years in group B. All patients with symptomatic carotid artery disease, stenosis > 70% or ulcerative carotid disease had simultaneous surgery. Always, the carotid artery was addressed first. RESULTS: Patients in group B had a higher prevalence of peripheral vascular disease (P = 0.0005), renal insufficiency (P = 0.0011) and COPD (P = 0.03). Urgent operation was indicated in 19% of group A patients vs. 37% in group B. In group A 70% were asymptomatic regarding the carotid vs. 48% in group B. Left ventricular dysfunction was present in 45% (group A) and 58% (group B). In the present study 4% in group A and 7% in group B suffered a perioperative myocardial infarction. Pathologic changes of the contralateral carotid were found in 42 vs. 57% (A vs. B). Mortality due to cardiac causes was 1 and 5%, respectively. The combination of persistent neurologic deficit and neurologic death occurred in 3% in group A (n = 3) and 5% in group B (n = 5). Postoperative neuro-cognitive dysfunction was more common in group B (35 vs. 16%; P = 0.01). CONCLUSIONS: The incidence of persistent neurologic deficits and neurologic mortality in patients > or = 70 years is acceptable, and low in patients < 70 years. Preoperative risk factors are increasing with age and are related to the higher mortality in elderly patients. Due to our results we will conclude that the combined approach for carotid stenosis and cardiovascular disease is the method of choice in this high-risk population.

Aged↗
PubMed1999

Exhaled nitric oxide in patients with Wegener's granulomatosis.

In Wegener's granulomatosis (WG), a pathogenic role of infections, in particular of a chronic colonization of the nasal mucosa with Staphylococcus aureus, has been postulated. Nitric oxide (NO), which is thought to play a role in primary host defence and inflammation, is produced endogenously within the respiratory tract, mainly from the paranasal sinuses. In order to further characterize its role in WG, nasal and pulmonary NO excretion in WG patients in comparison to healthy volunteers was measured. Seventeen patients with WG were included in the study. Five patients had active disease (bloody rhinitis with ulceration and crusting) and immunosuppressive therapy (IST), and 12 were in remission (six with, and six without, IST). S. aureus was found in the swabs of all patients with active WG and in three patients in remission. NO was measured in exhaled gas using a chemiluminescence analyser. The NO excretion rate in nasally sampled gas was significantly reduced (p<0.05) in patients with active WG ((mean+/-SD)102+/-100 nL x min(-1)) compared to healthy controls (299+/-13 nL x min(-1)), and patients in remission (281+/-86 nL x min(-1) with IST, 280+/-133 nL x min(-1) without IST). Pulmonary NO excretion in active or nonactive WG patients did not significantly differ from that of healthy volunteers (48+/-21 nL x min(-1)). These results demonstrate a reduced nasal NO excretion in active Wegener's granulomatosis. This may be caused by destruction and/or functional impairment of sinus epithelium. The reduced NO concentration may well compromise host defence in the upper airways, thus contributing to colonization with Staphylococcus aureus and further promoting Wegener's granulomatosis.

Adult↗
PubMed1999

Nitric oxide diffusion across membrane lungs protects platelets during simulated extracorporeal circulation.

BACKGROUND: The absence of a protective endothelial surface on membrane oxygenators during extracorporeal circulation (ECC) promotes platelet trapping and damage, leading to increased bleeding complications. We investigated the effects of transmembranous diffusion of gaseous nitric oxide (NO) on platelets during simulated ECC. MATERIAL AND METHODS: Two paired circuits were run in parallel with fresh, heparinized (1 U mL-1) blood from healthy human donors for 240 min. To one of the paired circuits, 20 ppm NO was added transmembranously. RESULTS: NO significantly attenuated platelet trapping and reduced intracircuit platelet activation evaluated by the release of beta-thromboglobulin, platelet factor 4 and soluble P-selectin. Furthermore, NO significantly preserved platelet reactivity to stimulating agents (ADP and adrenaline), evaluated as the ability to expose P-selectins and activate glycoprotein (GP)-IIb-IIIa. Nevertheless, circulating activated platelets expressing P-selectin or activated GPIIb-IIIa were not different and were not significantly increased. The mean fluorescence intensity of GPIb and GPIIb-IIIa decreased in both circuits equally. CONCLUSIONS: Transmembranous diffusion of gaseous NO revealed protective effects on platelets by reducing thrombocytopenia/pathia and preserving platelet reactivity.

Adenosine Diphosphate↗
PubMed1999

Incidence and importance of lower extremity nerve lesions after infrainguinal vascular surgical interventions.

OBJECTIVES: To determine the incidence of peripheral nerve lesions after arterial vascular surgery of the lower extremity. MATERIALS AND METHODS: 436 patients who underwent peripheral vascular surgery from January 1992 until December 1996 underwent a detailed postoperative neurological examination. RESULTS: 147 patients underwent profundaplasty, 140 above-knee femoropopliteal bypasses, 106 below-knee femoropopliteal bypasses and 56 femorotibial bypasses. There were 182 women and 254 men. Peripheral nerve lesions were observed in 11 patients (4%) after primary operations. 166 patients underwent reoperations (38%) and 55 of these developed nerve lesions (33%). CONCLUSIONS: Reoperation carries an 8-fold increased risk of nerve lesions compared with patients undergoing primary surgery. Detailed explanation of the risk of peripheral nerve lesions before vascular surgery of the lower limb is advisable.

Aged↗
PubMed1999

Chest re-exploration for complications after lung surgery.

BACKGROUND: Review of the most recent chest re-explorations for lung surgery complications may show methods by which risks can effectively be reduced. METHODS: The data on rethoracotomies following lung surgery over the past 14 years in our department were retrospectively reviewed. The indication, the type of operation, the outcome, and various factors influencing the postoperative mortality were analyzed. From 1983 to 1996, 1960 patients underwent primary thoracotomies for various lung diseases. Among these, 73 (3.7%) patients required re-exploration for various postoperative complications. RESULTS: Mean age was 56.8 years (15-80 years). There were 66 (90.4%) men and 7 (9.6%) women. The most common indication for rethoracotomy was hemorrhage in 38 (52%) patients. The source of bleeding was a mediastinal and/or bronchial blood vessel in 8 patients and an intercostal blood vessel in 6 patients. Six patients had to be reoperated because of hemorrhage from a major artery of the hilus. In 14 cases the postoperative hemothorax occurred without evident surgical origin. Further indications for rethoracotomy were bronchopleural fistula (BPF) in 13 (17.8%) patients, and persistent parenchymal leak in 8 (10.9%) patients. There were 8 additional causes distributed among the remaining 14 (19.3%) patients. The overall mortality rate was 17.8% (13/73), with the highest (38.4%) among BPF patients. CONCLUSIONS: Postoperative complications following lung surgery which require rethoracotomy are rare. The most common complication is postoperative bleeding. This is followed by bronchial stump insufficiency which is associated with the highest mortality and morbidity. Our experience shows that the need for re-exploration can hardly be reduced but the indication for re-exploration should be established as early as possible to avoid late complications.

Adolescent↗
PubMed1999

Fatal pulmonary embolism after atrial septal defect closure in a paediatric patient.

A four-year-old girl died of massive acute bilateral pulmonary embolism 11 days after direct closure of a secundum atrial septal defect (ASD II), despite postoperative anticoagulation until the patient was ambulatory. An autopsy showed thrombotic deposits on the suture line of the ASD closure, bilateral 90% occlusion of the pulmonary arteries, and haemorrhagic ulcerative ischaemic colitis of the descending colon and the sigmoid.

Anticoagulants↗
PubMed1999

Exhaled nitric oxide does not provide a marker of vascular endothelial function in healthy humans.

In the lung, nitric oxide synthase (NOS) has been found in both alveolar epithelial and vascular endothelial cells. Nitric oxide (NO) in the exhaled air stemming from the lower respiratory tract has been claimed to represent a marker of the vascular endothelial NO production. Experimental evidence for this concept, however, is lacking. We compared, in eight healthy volunteers, effects on exhaled NO of epithelial NOS inhibition by N (G)-monomethyl-L-arginine (L-NMMA) inhalation (6 mg/kg over 15 min) with those of endothelial NOS inhibition by L-NMMA infusion (25 microgram/kg/min for 30 min). We also measured blood pressure, heart rate, and L-NMMA plasma concentration. The major new findings were that L-NMMA inhalation which did not have any detectable effect on hemodynamics and L-NMMA plasma concentration, decreased the pulmonary exhaled NO by almost 40%. In contrast, L-NMMA infusion that inhibited endothelial NOS, as evidenced by an increase in blood pressure and a decrease in heart rate, had only a barely detectable effect on exhaled NO (-11 +/- 4% from baseline). Pulmonary exhaled NO is mostly of epithelial rather than endothelial origin, and does not provide a marker for vascular endothelial NO production and/or endothelial function in healthy humans.

Administration, Inhalation↗
PubMed1999

Childhood asthma: exhaled nitric oxide in relation to clinical symptoms.

Bronchial asthma is associated with increased levels of exhaled nitric oxide which are suppressible by glucocorticosteroid inhalation. Children with bronchial asthma were studied to elucidate the relation between endogenous NO release and recent symptoms of bronchial obstruction. Twenty-five children with atopic asthma and 11 healthy control subjects were enrolled and exhaled NO was studied using chemiluminescence analysis. The subjects breathed purified air (<0.5 parts per billion (ppb) NO) exclusively through their mouths. Orally expired NO was measured during continuous nasal aspiration (1.3 L x min(-1)) to remove nasally produced NO. Nasal NO concentration was determined within the aspirated gas. Orally expired NO concentration was 2.5+/-0.3 ppb (mean +/-SEM) in healthy control subjects, 3.19+/-0.88 ppb (NS) in symptom-free children, and 8.28+/-0.81 ppb (p< or =0.01) in children with bronchial asthma who had had recent symptoms of bronchial obstruction. Similarly, in the subgroup of children treated regularly with inhaled glucocorticosteroids those with recent symptoms had significantly higher orally exhaled NO concentrations than healthy control subjects (9.5+/-1.5 ppb, p<0.05). The nasal NO concentration was 152.8+/-12.7 ppb in healthy control subjects and not significantly different in asthmatic children. In this group of asthmatic children, recent symptoms of bronchial obstruction were linked to significantly higher concentrations of NO in orally exhaled gas and to increased oral NO excretion rates. If substantiated by further studies, measurement of orally exhaled NO during nasal aspiration may become useful to monitor disease control in asthmatic children.

Asthma↗
PubMed1999

Fluctuations of inspired concentrations of nitric oxide and nitrogen dioxide during mechanical ventilation.

BACKGROUND: Nitric oxide (NO) is a very reactive agent with potentially toxic oxidation products such as nitrogen dioxide (NO2). Therefore, during NO inhalation a constant inspired concentration and accurate measurement of NO and NO2 concentrations are essential. The objective of this study was to test the NO concentrations at various positions along the inspiratory limb of the breathing circuit using a recently developed system to administer NO in phase with inspiratory flow during mechanical ventilation (Servo 300 NO-A, Siemens, Sweden). Furthermore, we tested whether an active heating system would interfere with inspired NO concentrations. RESULTS: A sharp decline in the NO concentration was found between the respirator's inspiratory outlet and more distal points along the inspiratory limb of the circuit. This finding was most evident when an active heating system was mounted between those points. CONCLUSIONS: The concentrations of NO and NO2 should be measured as near to the patient as possible, as significant fluctuations of these concentrations might be found along the inspiratory limb of the respiratory circuit especially when an active heating system is used.

Journal Article↗
PubMed1999

Heart transplantation after successful donor postpartum pulmonary embolectomy.

A fulminant pulmonary embolism can be treated surgically if thrombolytic therapy is contraindicated. A 31-year-old woman developed a fulminant pulmonary embolism after right-sided deep venous thrombosis 1 day after undergoing a cesarean section. A pulmonary embolectomy with cardiopulmonary bypass was performed, but the patient was brain-dead. After 2 days of echocardiographic observation, her heart was explanted for a 61-year-old man with ischemic cardiomyopathy. His right heart data were unremarkable, and he remains well 16 months after transplantation. Despite the sudden strain on the right ventricle that occurs with a pulmonary embolism, such a heart may be transplanted successfully after a pulmonary embolectomy.

Adult↗
PubMed1999

Coronary artery bypass procedures in septuagenarians are justified. Short and long-term results.

BACKGROUND: Elective coronary artery bypass surgery can be performed with low operative mortality. There is a controversial discussion whether short-term and long-term results of CABG justify this procedure in elderly patients. METHODS: To add to this discussion, we evaluated retrospectively, the clinical profile, operative technique, short- and long-term results of 1127 patients over 70 years of age who underwent myocardial revascularization between January 1985 and December 1996. RESULTS: Mean age of the cohort was 73.9 years and it rose continuously. In 1996, septuagenarians represented 21.5% of our coronary patients, in comparison to 6.4% in 1985. Analysis of risk factors showed an increasing prevalence of renal failure, obesity, hyperuricemia and a history of smoking. Preoperatively, 87% of our patients were in NYHA-class III or IV, and thus operated to relieve severe symptoms. The percentage of emergent operations decreased over the observed period by 10.3%. The internal mammary artery was used with rising frequency (44.8% in 1985-1992 vs 61.5% in 1993-1996). The number of simultaneous valve replacements increased, too. Postoperatively, we noted a rising incidence of respiratory failure (17.1%) and neurological disorders (13.7%). On the other hand, the need for intra-aortic balloon pumping and hemofiltration declined by 6.6% and 2.9%, respectively. Perioperative mortality (< or =24 hrs) was 3.65%, hospital mortality (< or =30 days) was 9.64%. The actuarial survival (standard error) at 1 year was 82% (+/-4.3%), and 65.7% (+/-3.8%) at 5 years. CONCLUSIONS: Our data suggest that coronary artery bypass grafting can be performed in septuagenarians at an acceptable risk. Since the large majority of patients improve symptomatically, surgery is a recommendable option for a growing number of elderly patients suffering from severe angina.

Aged↗
PubMed1999

Mitral valve replacement through dilated aortic annulus in Marfan's syndrome.

A 30-year-old man presented with severe aortic regurgitation due to an ascending aortic aneurysm and mitral valve insufficiency in conjunction with active endocarditis. He underwent combined aortic root replacement by a composite graft and mechanical mitral valve replacement. After excision of the aortic valve cusps the mitral valve was approached through the extremely dilated aortic annulus. This technique is seldom used. Mitral valve replacement through the aortic root can be advantageous in selected patients to minimize trauma and reduce myocardial ischemic time.

Adult↗
PubMed1999

Development of cardiovascular procedures before abdominal aortic aneurysm repair over 16 years.

INTRODUCTION: Preoperative screening, interventional and surgical therapy of cardiovascular diseases are of pivotal importance for a successful outcome after abdominal aortic aneurysm (AAA) surgery. METHODS: In a retrospective study all patients who underwent surgery for AAA were reevaluated for preoperative diagnostic and therapeutic interventions for cardiovascular diseases. Two study periods 1980-1989 and 1990-1996 were defined. Of 603 patients operated upon because of AAA between 1980 and 1996, 449 were operated on an elective basis and 154 as an emergency. Preoperative diagnostic studies for coronary artery disease (CAD) were performed in electively operated patients only and were positive in 76.8% (1980-1989: 76.1%, 1990-1996: 77.5%). Coronary angiography was performed in 108 patients (29.6%). Medical therapy of CAD declined by 2.3%, interventional procedures by 18.8%. In contrast, myocardial revascularization with subsequent aneurysm resection increased by 26. 6% and 12 patients (16%) required urgent simultaneous cardiac and aortic surgery. Early mortality after AAA surgery dropped from 4.2% to 2.9%, the frequency of primary cardiac failure as the cause of death was reduced from 33.3% to 22.2% (p < 0.05). CONCLUSIONS: 42.6% more cardiac surgical procedures were performed before AAA surgery since 1990 compared with the period 1980-1989. In contrast, the number of interventional procedures fell by 18.8%. Surgical therapy of cardiac disease reduces early mortality after elective AAA surgery.

Aged↗
PubMed1999

Incarcerated postraumatic intercostal lung hernia. Case report and review of the literature.

Traumatic lung hernia is a rare diagnosis. A 52-year-old female motorvehicle passenger was admitted as a trauma patient after a motorvehicle accident. She was found to have an incarcerated lung hernia. Size of the hernia, incarceration and respiratory insufficiency mandated immediate surgical intervention with reposition, drainage and stabilisation of the chest wall. The postoperative course was uneventful. The management of the patient is discussed and the available literature reviewed.

Female↗