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Biomedical subjects

T U Cohnert

Publications and source records attributed to T U Cohnert.

11 recordsLinked to original sources
PubMed2002

Outcome of patients after cardiac surgery transferred to other hospitals following prolonged intensive care stay.

BACKGROUND: The steady rise in complex cardiac procedures as well as the increase in comorbidity often result in a prolonged intensive care unit (ICU) stay. As a consequence, considerable numbers of patients have to be transferred to other hospitals so that the primary institution can maintain its capacity. The purpose of this study was to investigate the outcome of these patients. METHODS: 1,175 consecutive patients underwent various open heart procedures. 115 patients (9.8 %) requiring prolonged ICU treatment were retrospectively analyzed. 74 patients (EuroSCORE 8.1) underwent transferral to either rehabilitation units with ventilation capacity, multidisciplinary ICUs, or cardiac ICUs. 41 patients (EuroSCORE 7.9) remained in our hospital. Morbidity, mortality, and clinical condition were assessed and compared. RESULTS: Transferred patients exhibited an overall mortality of 38 % compared to only 17 % in patients who remained. Mortality was 81 % in rehabilitation units, 30 % in multidisciplinary ICUs, and 16 % in cardiac ICUs. 66 % of the survivors among the transferred patients showed significantly impaired clinical condition (NYHA III-IV) compared to 33 % who showed a good postoperative condition (NYHA I-II). The patients who remained exhibited 44 % NYHA III-IV and 56 % NYHA I-II. CONCLUSION: Transferral of patients after prolonged intensive care stay to external hospitals carries significant risks for early death and impaired outcome. However, transferral to cardiac ICUs appears to be an adequate option. Further studies may identify potential subgroups of patients who do not benefit from transferral.

Adult↗
PubMed2001

Retrograde versus antegrade crystalloid cardioplegia in coronary surgery: value of troponin-I measurement.

BACKGROUND: The optimal route for delivery of cardioplegia is still in debate in patients with ischemic heart disease. Cardiac troponin-I is a new marker with the potential for detection of minor differences in myocardial ischemia. METHODS: In a prospective randomized trial 58 patients undergoing elective coronary artery bypass grafting for two- or three-vessel coronary artery disease were divided into groups with antegrade (group A, n = 29) and retrograde (group R, n = 29) application of crystalloid cardioplegia (St. Thomas II). Patients with major risk factors were excluded. In addition to routine electrocardiogram monitoring, cardiac troponin-I and creatine kinase-MB activity were measured in all patients preoperatively at 2, 5, 8, 24, and 48 hours after aortic cross-clamp release, and at hospital discharge. RESULTS: In both groups, there were no differences regarding operative parameters. A significantly higher cardiac troponin-I concentration was observed in the antegrade group at 24 hours after cross-clamp (8.2 +/- 8.5 microg/L vs 3.2 +/- 3.1 microg/L; p = 0.02). Patients with subtotal stenosis or occlusion of one or more main coronary arteries showed significantly lower cardiac troponin-I levels after retrograde application. CONCLUSIONS: Lower concentrations of the cardiac troponin-I marker after retrograde application of cardioplegia indicate advantages of myocardial protection in ischemic heart disease.

Aged↗
PubMed2000

Endoluminal grafting of abdominal aortic aneurysms: experience with the Talent endoluminal stent graft.

The aim of this study was to evaluate the Talent endoluminal stent graft (TESG) in treating abdominal aortic aneurysms (AAA). The TESG is a polyester-covered nitinol endograft (proximal diameters 20-38 mm and iliac limb diameters 8-22 mm). Twenty-two men were treated with the TESG via bilateral femoral arteriotomies. Pre-implantation, coil embolization of various vessels arising from the aneurysm was performed in 6 patients. Plain radiographs and spiral CT angiograms (CTA) were carried out at 7 days, 3, 6, and 12 months following TESG implantation or re-intervention. Median aortic and iliac diameters were 27 mm (range 20-34 mm) and 14 mm (range 10-19 mm). The corresponding graft diameters were 30 mm (range 24-38 mm) and 14 mm (range 12-20 mm). No patient was rejected purely on the basis of too large aortic or iliac diameters. Eight patients required custom-made grafts. Graft implantation was successful in all patients. There were no blood transfusions, distal embolic episodes, or conversions to open surgery. Re-intervention was necessary in 1 patient. Complications included one fatal myocardial infarction, one inguinal hematoma, and two superficial wound infections. The aneurysm thrombosed completely following implantation in 14 patients and at 3 or 6 months in 4 other patients. One patient with endoleak is awaiting his 3-month control and 2 patients show tiny endoleaks but reduction of aneurysm size. The mean aneurysm size decreased significantly from 58 +/- 10 to 53 +/- 13 mm (p < 0.0005). Due to the large sizes available and the option of custom-made grafts, the TESG helps widen the spectrum of patients who can be treated with endoluminal grafting. The treatment is associated with a significant reduction in aneurysm size.

Aged↗
PubMed2000

Simultaneous treatment of thoracic and infrarenal aortic aneurysm using a combination of conventional surgery and endoluminal stent grafting.

INTRODUCTION: Patients with multiple aortic aneurysms represent a small subgroup with the need for extensive surgical treatment at considerable risk. Endovascular treatment in combination with conventional operation is possible. We demonstrate a case with simultaneous exclusion of aneurysms of the descending thoracic and the infrarenal aorta to outline the technical obligations. CONCLUSION: Simultaneous exclusion of a thoracic and an abdominal aneurysm can be performed successfully by conventional infrarenal aortic replacement with bifurcated dacron prosthesis and endovascular implantation of a thoracic stent-graft within one operation.

Anastomosis, Surgical↗
PubMed2000

Matched-pair analysis of conventional versus endoluminal AAA treatment outcomes during the initial phase of an aortic endografting program.

PURPOSE: To investigate whether endovascular stent-grafts implanted during the early phase of an aortic endografting program have advantages over conventional surgical procedures for treatment of infrarenal aortic aneurysm (AAA). METHODS: In the first months of an endografting program, 37 patients (36 men; mean age 67.9 +/- 7.1 years, range 55 to 86) underwent AAA repair with endovascular implantation of a Vanguard (n = 17) or Talent (n = 20) bifurcated stent-graft. Data collected during the perioperative period and in follow-up were compared retrospectively to a matched group of 37 elective surgical patients. RESULTS: All endograft implantations were completed. Two type I and 6 type II endoleaks (21.6%) were seen postoperatively. Five type II sealed without intervention; 1 type I endoleak was corrected with an additional stent, but 1 type I and 1 type II endoleaks persisted despite attempts with coil embolization. Two (5.4%) endograft patients died during the perioperative period; however, this was not significantly different (p = 0.15) from the control group. In the mean follow-up of 12 +/- 6 months for both groups, 1 (2.7%) late conversion was necessary at 2 years for aneurysm expansion in an endograft patient with an unsealed type I endoleak. CONCLUSIONS: In our learning curve experience with aortic endografting, postoperative morbidity and mortality were higher in endograft patients compared to conventionally treated controls. Only in the endograft group was reoperation required during follow-up. Careful monitoring with periodic imaging studies is mandatory after endoluminal AAA treatment.

Aged↗
PubMed1997

Preoperative risk assessment of hepatic resection for malignant disease.

Clinical, laboratory, functional, and volumetric data of 340 consecutive patients undergoing hepatic resection for malignant disease between November 1990 and June 1995 were analyzed. The operative mortality was 3.3% (8/244 patients). Among 178 patients with liver metastases and 66 with primary hepatobiliary tumors the hospital mortality was 4.1% (10/244 patients) and morbidity 22.0% (54/244 patients). Survival after hepatectomy was strongly influenced by the extent of resection quantified by the parenchymal hepatic resection rate. The prediction of fatal postoperative complications can be improved for patients with hepatic metastases by calculating the liver resection index (sensitivity 75%, specificity 83%).

Adult↗
PubMed1996

[Liver resection with the water jet: conventional and laparoscopic surgery].

In a prospective study 60 patients underwent liver resection. Two different resection techniques, ultrasonic aspirator (CUSA, n = 30) and Jet-Cutter (n = 30), were compared, Speed of resection, blood loss, transfusion rate, liver hilus clamping time and tissue damage were evaluated on the basis of the area of transsected liver. Liver resection with the Jet-Cutter was significantly faster with a resection time of 0.35 min/cm2 in comparison to the CUSA (0.77 min/cm2, p < 0.001) and associated with less blood loss of 18.4 ml/cm2 (p < 0.05) than the CUSA technique (34.4 ml/cm2). Tissue damage in respect to levels of transaminases SGOT and SGPT was comparable with both techniques. The Jet-Cutter is a promising new instrument in liver surgery, and challenged by these results we used the Jet-Cutter in 7 patients performing laparoscopic liver resections.

Adult↗
PubMed1995

Laparoscopic liver resection with the water-jet dissector.

Laparoscopic liver resection requires careful patient selection. Tumor size and location have a major influence on the feasibility of a laparoscopic operation. Isolation and ligation of blood vessels and bile ducts after selective liver dissection by suitable techniques are important for visual control of the operating field. Since the Jet-Cutter has proven to give excellent clinical results in conventional liver surgery, we carried out laparoscopic liver resections with the Jet-Cutter in six patients. Five tumors were located in the left liver lobe; the fifth was in segment 6. There were no intra- or postoperative complications. The patients were discharged from the hospital after a mean of 5.4 +/- 2.1 days.

Adult↗
PubMed1995

A comparison of different techniques for liver resection: blunt dissection, ultrasonic aspirator and jet-cutter.

In a prospective study 116 patients underwent liver resection. Three different resection techniques, blunt dissection (n = 61), ultrasonic aspirator (CUSA) (n = 27) and jet-cutter (n = 28) were compared. Speed of resection, blood loss, transfusion rate, liver hilus clamping time and tissue damage were evaluated on the basis of area of transected liver surface. Liver resection with the jet-cutter was significantly faster with a resection time of 0.33 min/cm2 in comparison to blunt dissection (0.57 min/cm2) and CUSA (0.50 min/cm2) (P < 0.01) and associated with lower blood loss of 17.7 ml/cm2 (P < 0.01) than the other techniques (blunt dissection 32.5 ml/cm2, CUSA 24.3 ml/cm2). Tissue damage with respect to transaminases SGOT and SGPT was comparable to the other techniques. The jet-cutter is a promising new instrument in liver surgery.

Adult↗
PubMed1990

Effect of low-dose bradykinin on glucose metabolism and nitrogen balance in surgical patients.

Acute effects of a low-dose bradykinin infusion (30 ng/kg per min) on carbohydrate metabolism were studied in five patients after major burn injury. Peripheral glucose uptake was not affected but glucose oxidation and alanine flux were increased by 15% and 10%, respectively. These findings are compatible with an increase in glycolytic flux by an action of bradykinin. Nineteen patients who had undergone major gastro-intestinal surgery were studied in a randomised trial of chronic (6 day) bradykinin administration. Patients in the bradykinin group had a significantly improved rate of nitrogen retention (cumulative N balance, -0.014 [SE 0.064] vs -0.175 [0.048] g N/kg) in controls and significantly better nutritional indices. Manipulation of metabolism in surgical patients by bradykinin may have beneficial effects on nitrogen and protein dynamics, possibly mediated by improved aerobic and anaerobic glycolysis.

Adolescent↗