Biomedical subjects

T Schröder

Publications and source records attributed to T Schröder.

At least 19 recordsLinked to original sources

PubMed2001

[The impact of morbid obesity on the peri- and postoperative course after aortocoronary bypass surgery].

BACKGROUND AND OBJECTIVE: Excessive obesity is considered to be a risk factor in coronary bypass grafting. The aim of the current study was to examine if grossly overweight patients with a body mass index (BMI) > 35 suffer from higher morbidity and mortality when compared with patients with normal body weight (BMI = 20-25). PATIENTS AND METHODS: 206 extremely obese patients (group A) and 206 patients with normal body weight (group B) originating from a total of 5614 patients undergoing coronary bypass grafting in the time span between 1.4.1996-1.10.2000 were studied retrospectively and consecutively. The data were obtained from case histories, questionnaires and interviews. Statistical analysis was performed by the chi 2 test after Pearson, the t test and the Kaplan-Meier method depending on the statistical problem analysed using the SPSS software v. 8.0. RESULTS: The comparison of group A with group B revealed a significantly higher incidence of diabetes mellitus (p < 0.001), hypertension (p < 0.001) and hyperlipidaemia (p < 0.01) in group A. The only significant differences regarding the surgical procedure were the longer operation time (212.3 +/- 44.6 min, mean +/- SD) and aortic cross-clamp time (53.8 +/- 17.4 min, mean +/- SD) in group A (p < 0.05). The duration of mechanical ventilation, the incidence of respiratory insufficiency and the stay in the intensive care unit were not significantly different. The disorders of wound healing both in the sternal and the graft removal regions occurred significantly more frequently in group A (p < 0.001). The 30 days mortality rate in group A (1.5%) was not significantly different from group B (p < 0.001). The 30 days mortality rate in group A (1.5%) was not significantly different from group B (2.9%). The follow-up analysis of the 30 days mortality rate in different age groups revealed no significant differences in patients aged between 60 and 75 years. The mean survival rate after 4 years was 87.2% in group A and 86.4% in group B. CONCLUSION: In spite of higher morbidity our results did not reveal significantly higher mortality in extremely obese patients. After operation the patients considered their state improved, therefore elective coronary surgery in grossly overweight patients seems to be indicated also without previous weight reduction.

Adult↗

PubMed2001

[Short and long term results of aortic valve replacement in patients 80 years of age and older].

BACKGROUND: Due to demographic changes in average life expectancy the age of patients undergoing cardiac surgery is increasing as well. We have reviewed the short- and long-term outcome in patients over 80 years of age after aortic valve replacement with or without concomitant coronary grafting. PATIENTS AND METHOD: From 1.1.1995 until 31.12.1999, 126 patients (93 women, 33 men between 80 and 89 years, 82.8 +/- 2.4) underwent aortic valve replacement. 64 patients (group A) received isolated valve replacement, 62 (group B) underwent myocardial revascularization as well. RESULTS: The 30-day hospital mortality rate was 6.3% for group A and 14.5% for group B. The follow-up time ranged between 3 and 63 months (32 +/- 16). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulation therapy were observed by one patient from group A 3 years after the operation. Of the 15 deaths during the follow-up period seven (47%) were cardiac in nature and two (13%) related to stroke. Acturial survival rates for group A were 89%, 85% and 77% at 1, 2 and 3 years, and for group B 76%, 72% and 70%. Permanent nursing care was not required 1 year after the operation by 100% of patients in group A (2 years: 98%, 3 years 95%) and by 100% of patients in group B (2 years: 93%, 3 years: 90%). At an interval of 1 year after the operation 96% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years: 96%, 3 years: 94%). The rates for group B were 88%, 81% and 75%. CONCLUSION: Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, functional status as well as life expectancy in this age group seem to be positively influenced by aortic valve replacement.

Actuarial Analysis↗

PubMed2001

[Anesthesia in extreme obesity].

BACKGROUND: Approximately 1-2% of all anesthetized patients are morbidly obese (body mass index > 35 kg/m2). The perioperative mortality is significantly elevated (up to 20%) compared with lean patients. Morbidly obese patients are at high risk for cardiopulmonary dysfunction. Difficult airway management is reported in 13-20% of obese patients. Hypoxia is often observed due to faster desaturation during induction of anesthesia. After surgery, patients are endangered by a high incidence of obstructive sleep apnea syndrome (50%), pulmonary atelectasis (5%) and acute pulmonary embolism (5-12%). ANESTHESIA: Individualized perioperative management is required based on preoperative history and physical examination. Modern anesthetic drugs (desfluran, sevoflurane or propofol, and remifentanil, respectively) allow rapid recovery and early postoperative mobilization. Adequate monitoring, e.g. by an intraarterial blood pressure monitoring and repetitive blood gas analyses, improves patient safety prior the onset of complications. POSTOPERATIVE MANAGEMENT: Postoperative admission on an intensive care unit of morbidly obese patients is based upon concomitant diseases and surgical requirements. The main reason for admission is an inadequate pulmonary gas exchange. This interdisciplinary approach will reduce the risk of anesthesia and avoid complications in morbidly obese patients.

Anesthesia, General↗

PubMed2001

Evaluation of results derived from the analysis of certified reference materials--a user-friendly approach based on simplicity.

Certified reference materials (CRMs) have now been in regular use for several decades. Their production and certification are regulated by international standards. But, even today there are no agreements on procedures for evaluating results obtained by the users. As a consequence, the way CRM results are treated in the literature leaves a lot to be desired. A statistical evaluation is rarely, if ever, described in published reports. The most common approach is to compare the found mean and/or range with the certified range and then state if the mean falls within the certified range, or if the two ranges overlap. If this happens, the analyst is usually satisfied. In addition, usually no regard is paid to the fact that the certified interval is based on a 95% confidence interval (CI) and the found interval on standard deviation and that this evaluation has little, if any, statistical relevance. Long-term evaluation of a CRM often consists in nothing more than producing a control chart, which relates the found results to the certified mean and CI. This paper is an attempt to improve the situation by providing a set of easy-to-use guidelines for evaluating results from CRMs. During the process we have identified different areas in which there is a need for such guidelines: 1. short-term evaluation of a single, or multiple, determination at one or several specific times; 2. identification of systematic and random errors; 3. evaluation of CRMs when used in a collaborative trial of a method; and 4. long-term evaluation for monitoring an analytical process over extended periods of time. It is important that the guidelines do not require expert competence in statistics from the analyst. Such obstacles would probably render most guidelines unused.

Animals↗

PubMed2001

Aortic valve replacement with or without concomitant coronary artery bypass grafting in the ninth decade of life.

Due to demographic changes in average life expectancy, the age of patients undergoing cardiac surgery is increasing. We have reviewed the short- and long-term outcome after aortic valve replacement with or without concomitant coronary artery bypass grafting in patients over 80 years of age. From 1 January 1995 until 30 June 1999, 114 patients (83 women and 31 men, 80-89 years of age, 82.8+/-2.4 years) with symptomatic aortic valve disease underwent aortic valve replacement. Of these patients, 54% (group A) received isolated valve replacement and 46% (group B) underwent myocardial revascularization as well. The perioperative mortality rate was 4.8% for group A and 7.7% for group B. The 30-day hospital mortality rate was 4.8% for group A and 15.4% for group B. The follow-up time ranged between 3 months and 63 months (32+/-15 months). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulation therapy were not observed. Of the 15 deaths during the follow-up period, seven (47%) were cardiac in nature and two (13%) were related to stroke. Actuarial survival rates for group A were 90%, 84%, and 76% at 1, 2, and 3 years, respectively, and for group B were 75%, 71%, and 68%. One year after the operation, permanent nursing care was not required by 100% of patients in group A (2 years, 98%; 3 years, 95%) and by 100% of patients in group B (2 years, 95%; 3 years, 91%). At a 1-year interval after the operation, 98% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years, 98%; 3 years, 95%). The rates for group B were 90%, 85%, and 85%. Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that, considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, functional status as well as life expectancy in this age group seem to be positively influenced by aortic valve replacement.

Actuarial Analysis↗

PubMed2001

Effects of epinephrine on the myocardial performance and haemodynamics of the isolated rat heart during moderate hypothermia--importance of calcium homeostasis.

Controversies exist concerning myocardial performance in hypothermia. We have studied the effects of epinephrine on myocardial function at various calcium concentrations in moderate hypothermia (28 degrees C) and normothermia (37 degrees C) using an isolated antegrade perfused rat heart. The maximum pressure velocity (dP/dt(max)) developed was significantly higher in normothermia compared with hypothermia and was improved by the addition of calcium in both circumstances. Peak negative pressure velocity (dP/dt(min)) was significantly higher at 37 degrees C compared with 28 degrees C, and was increased by the addition of calcium in normothermia; in contrast to hypothermia, in which no change of dP/dt(min) was observed. A reduction in cardiac output and stroke volume by hypercalcaemia was observed in hypothermia. The addition of epinephrine improved dP/dt(max) and dP/dt(min), but had a depressive effect on stroke volume and cardiac output at normal and elevated calcium concentrations. Myocardial efficiency was significantly higher during hypothermia compared with normothermia, but was impaired by epinephrine during hypothermia. The variable or even paradoxical effects of epinephrine suggest the need for careful haemodynamic monitoring and determination of calcium levels in hypothermia. The impairment of myocardial performance may be explained by impaired diastolic relaxation and calcium overload.

Animals↗

PubMed2001

Completion pneumonectomy: current indications, complications, and results.

OBJECTIVE: Completion pneumonectomy is reported to be associated with high morbidity and mortality, especially when done in patients with benign disease. We review our 9 years of experience with this operation to evaluate the postoperative outcome and long-term results of various indications. METHODS: Between January 1990 and December 1998, 66 consecutive patients underwent completion pneumonectomy (6.8% of all pneumonectomies), and their cases were retrospectively reviewed. The indication was benign disease in 17 patients and malignant disease in 49 patients. In patients with malignant indications there were 14 local recurrences, 4 second primary tumors, 5 metastatic diseases, and 26 indications because of incomplete initial resection. RESULTS: There were no intraoperative deaths, and the postoperative mortality rate was 7.6%. Complications were encountered in 32 (53%) patients, without any significant difference between benign indication (71%) and malignant indication (47%; P =.0923). Bronchopleural fistula was encountered in 5 (7.6%) patients, and empyema was encountered in 7 (11%) patients. The actuarial 5-year survival was 57% for all patients, 65% for those with benign indications, and 54% for those with malignant indications (60% for local recurrence, 50% for second primary tumor, and 56% for incomplete resection), without any difference between benign and malignant indications (P =.9478). CONCLUSIONS: Completion pneumonectomy can be performed with acceptable mortality and morbidity, even in patients with benign disease. Patients with preoperative infection can be managed with bronchial stump covering and adequate postoperative drainage. Although complications are common, they can successfully be managed with a proper understanding of them.

Adult↗

PubMed2001

Enoximone in contrast to dobutamine improves hepatosplanchnic function in fluid-optimized septic shock patients.

OBJECTIVE: To investigate the impact of dobutamine and enoximone on hepatosplanchnic perfusion and function in fluid-optimized septic patients. DESIGN: Prospective, randomized, double-blinded interventional study. SETTING: Intensive care unit of a university hospital. PATIENTS: Forty-eight septic shock patients were examined within 12 hrs after onset of septic shock. Patients were conventionally resuscitated, achieving an optimal pulmonary artery occlusion pressure at which the left ventricular stroke work was on the maximal plateau. Liver blood flow was estimated by venous suprahepatic catheterization using the continuous indocyanine green infusion technique. Microsomal liver function was assessed by the plasma appearance of monoethylglycinexylidide, and release of hepatic tumor necrosis factor-alpha (TNF-alpha) was measured to estimate the severity of hepatic ischemia-reperfusion syndrome. INTERVENTIONS: Patients were randomly treated with dobutamine or enoximone. Within the first 10 hrs after baseline measurements, the dosage was increased until no further increase in the left ventricular stroke work index occurred. Then, positive inotropes were kept constant throughout the study. MEASUREMENTS AND MAIN RESULTS: Measurements were performed at baseline and after 12 and 48 hrs after baseline measurements. Cardiac index, systemic oxygen delivery, systemic oxygen consumption, and liver blood flow increased significantly in both groups during treatment (p <.01) without a significant difference between groups. Fractional liver blood flow (liver blood flow/cardiac index) did not change in the enoximone group and showed a significant but only minor (median, 10%) decrease in the dobutamine group (p <.05 after 12 hrs and p <.01 after 48 hrs vs. baseline). After 12 hrs of enoximone treatment, monoethylglycinexylidide kinetics and hepatosplanchnic oxygen consumption demonstrated a significant increase (p <.05). The release of hepatic TNF-alpha after 12 hrs of dobutamine treatment was twice as high (p <.05) as during enoximone. CONCLUSION: The increase in hepatosplanchnic oxygen consumption, together with an increased lignocaine metabolism and decreased release of hepatic TNF-alpha, indicates improved hepatosplanchnic function and antiinflammatory properties after 12 hrs of enoximone treatment. Therefore, if the inflammatory response should be attenuated in high-risk patients, administration of enoximone in fluid-optimized septic shock patients may be favorable compared with dobutamine.

APACHE↗

PubMed2001

Quantitative evaluation of the performance of different electrical tomography devices.

Two widely used electrical tomography systems, the Sheffield Mark I and the DAS-01P, were quantitatively evaluated and compared to the newly developed Goe-MF system. The performance was quantified using a hardware phantom which closely matches the real input and transfer impedances of the human thorax and allows measurements equivalent to different states of lung inflation. Our results demonstrate that adequate averaging is necessary for noise reduction for the Mark I and especially for the DAS-01P system to get meaningful results even in visualizing maximal respiratory manoeuvres. The Goe-MF system showed a notably improved signal-to-noise ratio which allows also dynamic measurements at low levels of lung volume changes, e.g., in intensive care lung injury patients.

Calibration↗

PubMed2001

Osseointegrated implants in patients treated for generalized chronic periodontitis and generalized aggressive periodontitis: 3- and 5-year results of a prospective long-term study.

BACKGROUND: The successful use of osseointegrated implants in periodontally healthy patients has been documented in numerous longitudinal studies in recent years. However, the extent to which these positive results apply to periodontally diseased patients remains unclear. The aim of the present prospective longitudinal study of partially edentulous patients treated for generalized chronic periodontitis and generalized aggressive periodontitis was a clinical, microbiological, and radiographic comparison of teeth and implants and assessment of the implant success rate. METHODS: Five partially edentulous patients treated for generalized aggressive periodontitis (GAgP) and 5 treated for generalized chronic periodontitis (GCP) were enrolled in this study. The GAgP patients received 36 implants, and the GCP patients 12 implants. The teeth were examined 2 to 4 weeks before extraction of the non-retainable teeth (baseline), and 3 weeks after insertion of the final abutments (second examination). All further examinations were performed during a 3-month recall schedule over a 5-year period for the GAgP patients and over a 3-year period for the GCP patients. At each session clinical parameters were recorded at teeth and implants and the composition of the subgingival microflora was determined by dark-field microscopy and DNA analysis. Intraoral radiographs of the teeth and implants were taken for control purposes at baseline; after insertion of the superstructure; and 1, 3, and 5 years later. RESULTS: The clinical findings indicated healthy periodontal and peri-implant conditions in both patient groups throughout the study. However, an increased probing depth and an attachment loss were recorded in the GAgP patients after the third year (P<0.001). The distribution of the microorganisms revealed no significant differences between the patient groups or between implants and teeth. Moderate bone loss at teeth and implants was registered in both groups. The success rates recorded were 100% in the GCP patients and 88.8% (maxilla: 85.7%; mandible: 93.3%) in the GAgP patients. CONCLUSIONS: The 3-year and 5-year follow-ups show that osseointegrated implants may be successful in oral rehabilitation of partially edentulous patients treated for generalized aggressive periodontitis and generalized chronic periodontitis. However, as no significant differences were recorded between conditions at teeth and at implants, progression of the disease cannot be ruled out.

Adult↗

PubMed2000

C-MYC expression in medulloblastoma and its prognostic value.

To identify prognostic factors in medulloblastoma, a common malignant brain tumor of childhood, expression of the oncogene c-myc was examined at the mRNA level by in situ hybridization. c-myc mRNA expression was observed in 30 of 72 tumors (42%). The c-myc gene copy number was determined by quantitative PCR from genomic DNA of paraffin-embedded tumors. c-myc gene amplification was present in 5 of 62 cases (8.3%). Therefore, c-myc amplification was obviously not the cause of c-myc mRNA expression in most samples. Kaplan-Meier estimation revealed a significant correlation between c-myc mRNA expression and survival (total mean follow-up 4.6 +/- 3.6 years, log-rank p = 0.02). Multivariate logistic regression analysis including sex, age, histological type, degree of surgical resection and expression of synaptophysin, GFAP and c-myc, was carried out on 54 patients who received both radiotherapy and chemotherapy. The analysis identified expression of c-myc as an independent predictive factor of death from disease.

Adolescent↗

PubMed2000

[Aortic valve replacement in 80- and over 80-year-old patients. Short-term and long-term results].

Due to demographic changes in average life expectancy, the age of patients undergoing cardiac surgery is increasing as well. We have reviewed the short- and long-term outcome in patients over 80 years of age after aortic valve replacement. From 01 Jan 1995 until 31 Dec 1998, 105 patients (76 women, 29 men between 80 and 89 years, median: 83) underwent aortic valve replacement. 42% presented with aortic stenosis, 58% with combined valve disease with leading stenosis. 53% (group A) received isolated valve replacement, 47% (group B) underwent myocardial revascularization as well. The in-hospital mortality rate was 8.9% for group A and 14.3% for group B. The follow-up time ranged between 10 and 243 weeks (median: 112 weeks). None of the patients had to be reoperated for prosthetic valve dysfunction or endocarditis. Bleeding complications due to anticoagulant therapy were not observed. Of the 11 deaths during the follow-up period, 5 (45%) were cardiac in nature and 2 (18%) related to stroke. Actuarial survival rates for group A were 98, 95 and 88% at 1, 2 and 3 years, and for group B 92, 84 and 84%, respectively. Permanent nursing care was not required 1 year after the operation by 98% of patients in group A (2 years: 95%, 3 years: 88%) and by 100% of patients in group B (2 years: 95%, 3 years: 88%). At an interval of 1 year after the operation 98% of patients in group A had not been hospitalized as a result of cardiac disorders (2 years: 98%, 3 years: 94%). The rates for group B were 90, 82 and 82%. Compared with younger age groups, aortic valve replacement in patients 80 years of age and older is associated with a distinctly increased mortality and morbidity. However, our data suggest that considering the poor prognosis of conservative therapy of symptomatic aortic valve disease, the functional status as well as life expectancy in this age group seems to be positively influenced by aortic valve replacement.

Aged↗

PubMed2000

[Isolated coronary bypass operation in the 9th decade of life].

The average age of patients undergoing cardiac surgery has increased continuously during the last three decades due to a progressively increasing number of older people in the population and the advances in operative and perioperative treatment in open heart surgery. Consequently we have investigated the short- and long-term results of isolated myocardial revascularization in patients who are in their ninth decade of life. Between 1 January 1995 and 31 December 1998, 121 patients (51 women, 70 men, age 80 to 88 years, median: 82 years) underwent isolated coronary artery bypass grafting. As part of the revascularization, a unilateral internal mammary artery graft (IMA) was used in 87% of cases. The in-hospital mortality was 6.6%. Analysis of predictors of mortality unveiled the following factors: ejection fraction less than 50%; history of recent left ventricular failure; extent of coronary artery disease; perioperative use of an intraaortic balloon pump (IABP) and symptomatic pericardial effusion. Use of the IMA revealed no influence on in-hospital mortality. The median follow-up time was 20 months (range: 2-48 months). Survival rates after 1, 2, and 3 years were 93.1%, 87.3% and 73.7% for women and 86.9%, 82.5% and 65.1% for men. These survival rates were comparable with those of the entire 82 year old population. Predictors for late death were male gender, history of stroke, history of arterial embolism, and postoperative pulmonary failure resulting in mechanical ventilation. During the follow-up period myocardial infarcts were subsequently not observed. Freedom from angina after 1, 2 and 3 years was 90.1%, 82.6% and 78.1%, respectively. At an interval of 1 year after the operation 87.6% of patients had not been hospitalized as a result of cardiac disorders (2 years: 80.1%, 3 years: 73.2%). Permanent nursing care was not required 1 year after the operation by 94.3% of patients (2 years: 91.5%, 3 years: 91.5%). Four percent of the survivors suffered from permanent delirium, 3% from depression, 5% from lack of concentration, and 6% from vertigo. In summary this study has revealed that, in patients over eighty years of age suffering from ischemic heart disease, coronary artery bypass grafting has acceptable short- and long-term results. Yearly mortality rates during the first 3 years after the operation are comparable with the expected mortality rate in an age-matched population.

Aged↗

PubMed2000

Primary malignant fibrous histiocytoma of the lung: IGF-II producing tumor induces fasting hypoglycemia.

Augmented glucose utilisation or secretion of insulin-like-growth-factor II (IGF-II) are discussed as important pathogenetic factors in tumor-associated hypoglycemia (Doege-Potter Syndrome) with suppressed insulin and C-peptide levels. Primary malignant fibrous histiocytoma of the lung is an uncommon neoplasia and its association with hypoglycemia is rare and the causal relationship remains unclear. - We report a 57-year-old male with spontaneous hypoglycemia (1.67 mmol/l) due to a primary malignant fibrous histiocytoma of the lung, secreting IGF-II. Insulin (0.10 nmol/l; normal range 0.33-1.2) and C-peptide (3.0 mIU/l; 5-25) levels were suppressed in combination with low levels of growth hormone (<0.5 ng/ml; <7 ng/ml) and IGF-I (<66.0 ng/ml; 70-246). The elevated IGF-II level (787 ng/ml; 300-500) and decreased IGF-binding protein 3 (1.6 mg/l; 2-5) indicated a high free IGF-II activity. After surgery (resection of the right upper lobe), glucose (4.4 mmol/l), insulin (9.0 mIU/L) and C-peptide (0.84 nmol/l) levels returned to normal. Serum IGF-I (289 ng/ml) and the IGF-I/IGF-II ratio (<0.08 preoperative vs. 0.41 postoperative; >0.20) increased to the normal reference range. - In conclusion, malignant fibrous histiocytoma (MFH) is rarely described presenting as tumor-induced hypoglycemia. Doege-Potter Syndrome in MFH seems to be related to tumor-associated IGF-II production.

Adult↗

PubMed2000

A simple method to check the dynamic performance of electrical impedance tomography systems.

The test concept as well as the design of a simple resistor phantom suitable for the evaluation of the properties of electrical impedance tomographic (EIT) systems is presented. Input and transfer impedance of the phantom are matched with those of the human thorax. Amplitude of the local impedance variations similar to in vivo conditions (ventilation) can be intentionally set to perform measurements on different states. The theoretical potential differences between the electrodes are calculated. The evaluation procedure is performed in terms of the local amplitude of the relative impedance change as well as the local distribution of noise. The whole procedure can be applied either to compare quantitatively the performance of different EIT data acquisition systems or to determine the amount of measurement disturbance caused by the external electrical environment in clinical settings.

Cardiography, Impedance↗

PubMed2000

[Multiple myocardial revascularization on the beating heart: risks, benefits and outlooks].

INTRODUCTION: Avoidance of extracorporeal circulation during beating heart surgery (OP CAB = Off-Pump Coronary Artery Bypass Surgery) for aortocoronary bypass grafting (ACBG) is gaining increasing importance in modern cardiac surgery. With the development of new mechanical stabilization devices, the revascularization of the posterior wall of the heart and the distal right coronary artery became feasible. Especially high-risk patients with multiple risk factors for open heart surgery will profit from this approach, because the negative effects of the extracorporeal circulation are avoided. METHODS: From 7/97 until 12/99 a total of 158 patients with multivessel-coronary artery disease were operated on the beating heart. In the same time course, a total of 2869 patients were operated conventionally using the extracorporeal circulation as a standard procedure. RESULTS: Due to patient selection, the two groups differ in the preoperative data concerning previous neurologic deficits. None of the patients in the OP CAB group suffered a permanent neurologic deficit after the operation, whereas in the CAB group the rate of stroke was 1.3%. The rate of temporary neurologic deficits, such as TIA (temporary ischemic attack) or PRIND (prolonged reversible neurologic deficit), was higher in the OP CAB group due to patient selection. No surgcially associated aortic dissection was seen in the OP CAB group. CONCLUSIONS: This and other studies have shown the effectiveness of OP CAB surgery concerning perioperative complications and survival rates. Especially high-risk patients with multiple risk factors for a cardiac operation profit from a beating-heart operation avoiding extracorporeal circulation. The question in how far the higher rate of reoccurring angina and the larger number of interventional treatments in OP CAB patients reported in the literature are due to the learning curve remains unanswered. Long-term studies will show whether the result of beating heart surgery is as good as the result of conventional "on-bypass" surgery.

Coronary Artery Bypass↗

PubMed1999

Low frequency of defective alleles of cytochrome P450 enzymes 2C19 and 2D6 in the Turkish population.

BACKGROUND AND OBJECTIVES: The genetically polymorphic cytochrome P450 enzymes 2Cl9 (CYP2Cl9) and 2D6 (CYP2D6) contribute to the metabolism of about 30% of all drugs. For analysis of the ethnic-related differences in drug disposition and as a preparation for routine genotyping, we examined CYP2C19 and CYP2D6 mutations in a large Turkish population. METHODS: CYP2C19 and CYP2D6 alleles were determined with use of genomic deoxyribonucleic acid from 404 unrelated Turkish individuals. CYP2C19 alleles *1 to *5 and CYP2D6 alleles *1 to *12, and *14, *15, and *17 were measured by polymerase chain reaction-restriction fragment length polymorphism assays. RESULTS: From 404 subjects genotyped for CYP2C19, allele frequencies of CYP2C19*1 (wt), CYP2C19*2 (ml), and CYP2C19*3 (m2) were 0.88, 0.12, and 0.004, respectively; mutations m3 and m4 were not found. Four individuals (1.0%) were predicted to be poor metabolizers (CYP2C19*2/*2), a significantly lower frequency compared to Middle European populations. Among 404 subjects genotyped for CYP2D6, most frequent alleles were CYP2D6*1 (allele frequency 0.37), *2 (0.35), *4 (0.11), *10 (0.06), duplications *1x2, *2x2, or *4x2 (0.06), *5 (0.01), and *17(0.01). Overall, six subjects (1.49%) were predicted to be CYP2D6 poor metabolizers, and 35 subjects (8.66%) were predicted to be ultrarapid metabolizers as a result of CYP2D6 gene duplications. CONCLUSION: Obviously, within Europe there is a north-south gradient, with decreasing frequency of poor metabolizers of CYP2C19 and CYP2D6 to the south and a corresponding increase of ultrarapid metabolizers of CYP2D6. As in other white groups, only CYP2C19*2 plays a relevant role for the CYP2C19 poor metabolizer phenotype. The mutational spectrum of CYP2D6 indicated partial ethnic relationships to Asian and African populations.

Adult↗

PubMed1999

Phospholipase A2 activity in body fluids and pancreatic tissue in patients with acute necrotising pancreatitis.

OBJECTIVE: To measure pancreatic and non-pancreatic phospholipase A2 activity in human acute necrotising pancreatitis. DESIGN: Prospective study. SETTING: University hospital, Finland. SUBJECTS: 20 patients with acute necrotising pancreatitis. INTERVENTIONS: Serum and urine samples were taken daily for a week and fluid from peritoneal lavage for six days after admission. Samples from the pleural cavity were taken from patients in whom pleural drainage was considered necessary. Pancreatic tissue was recovered from the patients who were operated on for acute pancreatitis or for pancreatic tumour. MAIN OUTCOME MEASURES: Serum phospholipase A2, amylase, and lipase activities. RESULTS: Serum phospholipase A2 activity increased up to eightfold, 25.0 (5.4) IU/L (n = 20, range 9.0-77 IU/L) (reference value <3 IU/L) and remained high during the first week, whereas serum amylase and lipase returned to the reference range during the first four days. The maximal phospholipase A2 activity in urine was 4.5 IU/L, in the fluid from peritoneal lavage 16.9 IU/L, and in the fluid from the pleural cavity 37.0 IU/L. Phospholipase A2 activity in necrotic pancreatic tissue ranged from 0.25 to 5.70 IU/g and in normal pancreatic tissue from 9.85 to 15.0 IU/g. Preincubation at 60 degrees C showed non-pancreatic phospholipase A2 activity predominated in serum, whereas part of the enzyme activity in the fluids from pleural cavity and peritoneal lavage proved to be of pancreatic derivation. CONCLUSIONS: The results suggest a role for both pancreatic and non-pancreatic phospholipase A2 in acute pancreatitis. Preincubation at 60 degrees C proved useful in the differentiation between pancreatic and non-pancreatic phospholipase A2 activity.

Adult↗