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Biomedical subjects

U Losert

Publications and source records attributed to U Losert.

At least 19 recordsLinked to original sources
PubMed1992

Cardiac function, morphology and chromosomal aberrations in a calf with ectopia cordis cervicalis.

A male calf with ectopia cordis cervicalis inferior was investigated clinically, hemodynamically, and morphologically from the 3rd day of age until slaughter at the age of 22 months. Arterial hypertension (mean AOP 140 mm Hg), concentric myocardial hypertrophy and good ventricular contractility with normal valve function were found. Normal clinical condition at rest (cardiac output 48 l/min in the 600 kg bullock), but cyanosis and dyspnea during physical exercise were observed. Variations in the large vessels, such as persistence of the right cranial caval vein and one common pulmonary vein emptying into the left atrium, were found. Abrupt caliber differences of large arterial vessels together with a right angled aortic arch were observed, presumably contributing to increased afterload. The cytogenetic analysis showed the presence of a small marker chromosome leading to a chromosome number of 61 in a fraction of metaphases (mosaicism). Moreover, chromosome breakages were observed in many cells. From the 5 cows which were inseminated, 3 became pregnant. Ectopia cordis was not observed in any offspring. We conclude that in this animal compensated cardiac insufficiency with peripheral hypertension was established.

Animals↗
PubMed1992

Long-term results of nervous tissue alterations caused by epineurial electrode application: an experimental study in rat sciatic nerve.

In order to evaluate the long-term effects of epineurial electrode application for functional electrical stimulation (FES) the left sciatic nerve of seven rats was exposed. Four ring-shaped stainless steel wire electrodes were sutured to the epineurium of each nerve in the same manner as performed clinically for carrousel stimulation in man. The nerves were reexposed 1 year after implantation and the stimulation threshold to obtain a tetanic contraction in the lower limb was determined for each electrode. Afterwards the animals were sacrificed. The electrodes were excised and cross sections of the sciatic nerve directly at site of the electrodes, 2-mm proximal and 2-mm distal to them were harvested for histologic and planimetric assessment of nerve lesions. The area of damaged neural tissue was expressed as a percentage of the total cross-sectional area within the perineural sheath. The sciatic nerves of the right side served as controls. The values for the stimulation thresholds ranged between 0.1 and 1.0 mA (mean 0.43 mA). By morphometric examination five of seven nerves were seen altered, the altered areas captured between 1% and 4.8% of the total cross-sectional area of the nerves within the perineural sheath. Besides two specimens, all altered nerve segments exhibited distinct signs of nerve fiber regeneration. The clinical implications of the results for long-term electrical stimulation, such as phrenic pacing, are discussed.

Animals↗
PubMed1992

[Direct diagnosis of the atherosclerotic vascular wall: possibilities and limits of intravascular ultrasound].

The clinical application of intravascular ultrasound still awaits established criteria for the interpretation of normal and diseased arterial wall structures. The aim of this preclinical study was to evaluate sonographic features of normal and atherosclerotic human arteries in vitro and to correlate these findings with histological cross-sections. Seventy-four segments from 33 human postmortem arteries of various anatomic locations were studied in saline solution using a mechanical 20-MHz transducer in a 6F catheter. In normal arteries, close correlations were found between sonographic and morphometric measurements of total wall thickness (r = 0.89), lumen circumference (r = 0.99), and of lumen area (r = 0.89, all p less than 0.001). Of 29 histologically verified atherosclerotic lesions, 19 were calcified, and all of them were correctly diagnosed with IVUS; however, acoustic shadowing prevented quantitative plaque evaluation. Of 10 fibromuscular lesions, six (60%) were correctly diagnosed with IVUS, using either direct morphologic criteria (n = 4) or indirect signs of vessel wall irregularity (n = 2), while the remainder (n = 4) were missed by IVUS due to a similar echodensity compared with the surrounding tissue. Thus, there was an overall sensitivity of 86% for the detection of atherosclerotic lesions by IVUS. In animal experiments in vivo, the feasibility of high-quality-imaging in pulsatile arteries was confirmed and pathologic changes in vein grafts were visualized. We conclude that IVUS carries the potential to directly assess arterial wall changes in vivo. The method appears very sensitive in the detection of calcified plaque, whereas fibromuscular lesions may often not be readily distinguished from normal surrounding tissue. This may limit the clinical usefulness of IVUS at the present time.

Adult↗
PubMed1991

The new small Viennese total artificial heart: experimental and first clinical experiences.

For bridging to transplantation, a new small total artificial heart (TAH) design has been developed. Function of the two membrane pumps (filling volume left: 87 ml, and right: 75 ml; four mechanical disc valves and screwed connectors) for orthotopic implantation were studied in calf experiments. A calf survival up to 180 days was achieved without problems by pumping with a rate of 117 +/- 2.4 beats/min and a cardiac output of 7.4 +/- 0.7 L/min. For bridging to transplantation, the New Small Viennese TAH was implanted into a small 45-year-old patient (height 160 cm, weight 75 kg) with end-stage coronary heart disease. The patient deteriorated suddenly [mean aortic pressure: 38 mm Hg; cardiac output (CO): 1.8-2.1 L/min; anuria and multiple organ failure] while waiting for a donor heart. Even though his pericardial space was not enlarged, no fitting problems appeared. By using pumping rates of 104.3 +/- 8.7 beats/min, a cardiac output of 5.8 +/- 0.63 L/min was achieved (free hemoglobin was 4.1 +/- 0.48 mg/dl). Even though blood circulation was reestablished, after a TAH duration of 12 days, multiple organ failure persisted, and TAH bridging had to be stopped. In November 1989, a 50-year-old deteriorating transplant candidate with idiopathic cardiomyopathy was bridged for 6 days. Adjusting the heart rate to 86.5 +/- 11.2 beats/min, a CO of 6.84 +/- 0.46 L/min was achieved (free hemoglobin was 5.9 +/- 1.7 mg/dl). Because of chronic liver dysfunction, the patient developed severe icterus while on the TAH, and it took 2 months after heart transplantation to achieve physiological bilirubin concentrations. The patient recovered fully and remains in excellent condition.

Animals↗
PubMed1991

First experimental application of multichannel stimulation devices for cardiomyoplasty.

The effect of long-term application of epineural electrodes to nerves was investigated in rat experiments. Neural damage reached a maximum of 6% shortly after implantation and decreased to 3% after 1 year. Impedance and threshold of epineural electrode were investigated in sheep experiments for up to 12 months. The mean impedance was in the range of 1 kohm, while the threshold less than 1 mA. The reduction in fatigue produced by multichannel stimulation was demonstrated by sequential isometric contractions of rectus muscles in sheep. The decrease in force was only 10% after 60 minutes of multichannel stimulation as compared to a reduction of 50% for single channel stimulation. Studies of cardiomyoplasty with single channel stimulation confirmed results reported by other investigators. In acute experiments with sheep, we demonstrated fiber-selective stimulation which led to isolated contraction of the left or right distal part or the right proximal part of the latissimus dorsi muscle. Potential advantages in the application of implantable multichannel stimulation devices as compared to single channel stimulation for cardiomyoplasty include: (1) fatigue-free stimulation at submaximal force level; (2) selection of hemodynamically effective electrode combinations; (3) potential for consecutive activation of muscle fiber groups, thereby allowing better simulation of the physiological contraction of the heart muscle; (4) redundancy of electrodes in case of technical failure or dislocation; and (5) stimulation of more than one muscle, if necessary.

Animals↗
PubMed1991

Histological assessment of nerve lesions caused by epineurial electrode application in rat sciatic nerve.

The left sciatic nerve of 36 rats was exposed and four ring-shaped stainless steel wire electrodes were sutured to the epineurium of each nerve in the same manner as performed clinically for "carousel stimulation" in man. The rats were sacrificed 10 days (Group 1), 3 weeks (Group 2), or 3 months (Group 3) after implantation. The electrodes were excised, the nerves were embedded in Epon, and semithin sections were obtained for histological and planimetric assessment of lesions caused by the epineurially sutured electrodes. The right sciatic nerves served as controls. The total area of neural tissue within the perineurium was determined at three levels: at the site of the electrodes, 8 mm proximal, and 8 mm distal. The area of neural tissue damaged by the surgical procedure was expressed as a percentage of the total area. In Group 1, nine of 12 nerves showed lesions ranging from 0.39% to 25.39% of the total area of neural tissue, in Group 2 eight of 11 sciatic nerves showed lesions ranging from 0.24% to 13.03% of the total area, and in Group 3 five of 12 nerves showed lesions ranging from 0.21% to 4.96% of the total area. The pathologically altered areas in Groups 2 and 3 exhibited distinct signs of nerve fiber regeneration. The reasons for the decrease in damage from Group 1 to Group 3 and the clinical implications of the results for long-term electrical stimulation are discussed.

Animals↗
PubMed1991

Biocompatibility of aldehyde-fixed bovine pericardium. An in vitro and in vivo approach toward improvement of bioprosthetic heart valves.

Aldehyde-induced side effects limit the clinical usefulness of bioprosthetic heart valves. Treatment of aldehyde-fixed pericardium with L-glutamic acid at pH 3.5 and storage in a nontoxic, bacteriostatic solution resulted in a lower degree of calcification in 63-day subcutaneous implants in rats (13.3 +/- 2 mg calcium per gram dry weight of tissue), as compared with commercially available tissue (169 +/- 24 mg/gm, p less than 0.05). Endothelial cells died within 1 day after seeding on the commercial tissue; however, considerable endothelial cell proliferation was measured, even 14 days after seeding on L-glutamic acid-treated pericardium. Improved biocompatibility of this alternative treatment may be due to stable chemical binding of free, reactive aldehyde groups.

Animals↗
PubMed1990

A method for constricting large veins for use in arterial vascular reconstruction.

A satisfactory biologic graft can be created if dilated, but otherwise unusable veins are wrapped with a constrictive mesh tube. The purpose of this study was to determine whether a resorbable constrictive tube creates an appropriately sized vascular graft by induction of neoarterial wall growth. In 8 sheep a 5 cm segment of the carotid artery was resected and the external jugular vein inserted as a tubular graft. The vein was either wrapped with a polydioxanon (PDS) reinforced polyglactin (Vicryl) mesh (n = 4), a Vicryl mesh (n = 4), or a Dacron mesh tube (n = 3) to achieve a diameter reduction to 7 mm. Or the vein was used without reinforcement (n = 3). At angiography after 6 months the unreinforced veins had a diameter of 19 mm (range 15-22). The Vicryl reinforced veins measured 9.4 (8.5-10) mm, but 3 of 4 developed aneurysmatic dilatations at sites of valve sinuses with a mean diameter of 19 (15-21) mm. PDS reinforced veins measured 7.4 mm (7.1-7.9). Two of 4 had minor aneurysms of 13 and 16 mm. The two remaining PDS reinforced grafts were indistinguishable from the native artery. Dacron tubes reduced the vein size reliably to 7.6 (7.5-7.9) mm, but showed narrowing at the proximal anastomoses (PDS 7.2 +/- 0.4, Dacron 6.1 +/- 0.4, p = 0.016). PDS wrapping reduced maximal graft diameter to 10.9 +/- 4 mm as compared to that of the native vein, 18.7 +/- 3.5 (p less than 0.05). Resorbable meshes can reduce the diameter of a venous graft by strengthening the vessel wall.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Effect of cardiac tamponade on plasma concentrations of atrial natriuretic peptide (ANP) in calves.

To study the effect of cardiac tamponade on plasma concentrations of atrial natriuretic peptide (ANP) female calves received an infusion of 450 ml of 0.9% saline into the pericardial space. This was accompanied by a parallel rise in both, right atrial pressure (from 4.5 +/- 2.6 mm Hg to 14.1 +/- 3.8 mm Hg (p less than 0.01] and in intrapericardial pressure (from 0.4 +/- 2.0 mm Hg to 12.9 +/- 3.9 mm Hg (p less than 0.01] and a fall in cardiac output from 11.4 +/- 1.9 l/min to 8.5 +/- 2.4 l/min (p less than 0.01). Plasma concentrations of ANP remained unchanged in 7 of 9 experiments. During these seven experiments plasma concentrations of renin and aldosterone increased from 0.65 +/- 0.27 X 10 E-4 GU/ml to 1.04 +/- 0.43 X 10 E-4 GU/ml (p less than 0.01) and from 2.7 +/- 0.9 ng/dl to 11.4 +/- 6.1 ng/dl (p less than 0.01), respectively. On two occasions, which were characterized by an excessive fall in cardiac output (to less than 40% of initial values) cardiac tamponade was followed by an extensive rise in the plasma concentrations of ANP, renin and aldosterone. These results indicate that an increase in intra-atrial pressure per se is not the decisive factor in the control of ANP secretion. Since atrial transmural pressure does not change during cardiac tamponade ANP concentrations are, as a rule, unaltered by that condition. An increase in plasma ANP is seen only during preshock hemodynamic conditions possibly due to a reduced intra-atrial volume.

Aldosterone↗
PubMed1989

Clinical total artificial heart bridging: Viennese strategy and experiences.

Worldwide the clinical use of total artificial hearts (TAH) for bridging the time until heart transplantation (HTX) has become part of HTX programs. At our clinic, TAH bridging has been performed in five deteriorating HTX candidates since 1986. Four patients suffered from dilative CMP and one patient from a large anterior wall infarction. Three times the ellipsoid heart and twice the Berlin TAH were implanted. After TAH implantation, the conditions of all patients improved. The accompanying dysfunctions of kidneys and other vital organs, which were due to cardiogenic shock, could be restored in the three patients who underwent subsequent HTX. Bridging periods lasted from 9 to 13 days. Two patients, however, could not be transplanted because of infection. Although three patients could be bridged until transplantation and were in good clinical conditions, the longest survival following two-stage HTX was 40 days. In the future, complications like infection, bleeding, and transplant rejection have to be prevented to improve the long-term results of Viennese TAH bridging.

Aged↗
PubMed1989

Control of the total artificial heart: new aspects in human versus animal experience.

Control strategies for total artificial heart application have generally been based on experience with healthy animals. Human patients in a bad state of health who have impaired organ functions and who are subjected to intensive care procedures can develop atypical hemodynamic behavior. In these patients, both unstable and hyperstable behavior of the vascular resistance were observed. Therefore, regulation of cardiac output (CO) by pressure parameters only was avoided and CO was adjusted to obtain an appropriate O2-utilization (O2U). Intending to keep the O2U within ranges of 20-25%, we obtained cardiac indexes between 3.3 and 4.4 L/m2/min (CO 6-8 L/min), which is higher than other cardiac indexes reported. A CO of 10.5 L/min was even necessary to obtain an O2U of 30% in a septic patient. This strategy caused a stable driving management and led to a rapid hemodynamic stabilization and general improvement of the patients' condition. Results indicate that it is also very important to monitor metabolic parameters for appropriate driver adjustment as well, especially in the early postoperative phase, and that O2-U is a sensitive and useful parameter for this purpose.

Animals↗
PubMed1989

Hemodynamic effects of mexiletine and disopyramide after cardioplegic arrest.

To study the hemodynamic side effects of mexiletine and disopyramide when administered before cardioplegic arrest 15 dogs underwent sham cardiac surgery with a 90-min period of aortic cross-clamping. 5 dogs served as control, 5 were given 8 mg/kg/day mexiletine and another five 11 mg/kg/day disopyramide for 1 week before surgery. On the day of surgery a continuous infusion was started. After reperfusion treated animals exceeded their preischemic blood pressure and regained their preoperative cardiac output. Compared to control animals left ventricular work was higher in the treated animals after reperfusion. The two tested type I antiarrhythmics tend to add to myocardial protection when given before cardioplegic arrest and do not exhibit negative inotropic side effects.

Animals↗
PubMed1987

Total artificial heart bridging: a temporary support for deteriorating heart transplantation-candidates--methods and results.

Since 1975 at the 2. Dept. of Surgery, University of Vienna, Austria, artificial circulation devices and artificial hearts have been constructed and in experimental use. We started a clinical heart transplantation (HTX) program in 1984, and up to now more than 40 HTXs have been performed. Since May 1986, 3 patients--all suffering from end stage dilatative cardiomyopathy--received total artificial heart (TAH) as a temporary support until HTX was possible. Two of them were transplanted after 9 and 10 days. The third patient, who additionally suffered from a postinfarctial lung abscess and had to undergo an indispensable lobectomy contemporary with TAH implantation, could not be transplanted due to an incurable infection, which he died of after 22 days on TAH. The temporary TAH implantation proved to be a valuable measure preventing life-threatening circulatory deterioration. After restoration of a sufficient circulation by the implanted system, the patients' general conditions improved and the concomitant dysfunctions of kidneys, brain, and other vital organs, due to cardiogenic shock, could be rectified in those two patients, who underwent transplantation. Thromboembolic complications were observed only in the third patient, who developed a small infarction in the anterior lobe of the left hemisphere caused by cerebral embolism after 3 weeks of TAH pumping. The use of TAH is liable to severe, even lethal, complications. At present it should be used only as a last resort. If a donor heart is not available, this measure can be a real chance to save the patient's life.

Adult↗
PubMed1987

[The esophageal tracheal Combitube (ETC): animal experiment results with a new emergency tube].

Prompt and effective ventilation, essential for patients with cardiopulmonary arrest, may be provided by a new airway for emergency resuscitation. The "Esophageal Tracheal Combitube (ETC)" offers endotracheal or esophageal obturator ventilation according to choice. Ventilation is therefore always possible after blind intubation. Experimental studies in dogs showed encouraging results during oesophageal placement of the ETC; blood gas analyses and cardiovascular parameters, in particular, were comparable to conventional endotracheal ventilation. Satisfying results were achieved during routine surgical operations in humans. We intend to use the ETC as a device for emergency cardiopulmonary resuscitation in humans. It is especially suitable for medical personnel not trained in endotracheal intubation. The ETC has been conceived to bridge the gap of the prehospital phase.

Animals↗