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Biomedical subjects

U Raute-Kreinsen

Publications and source records attributed to U Raute-Kreinsen.

At least 19 recordsLinked to original sources
PubMed2006

Unusual case of an 18-year-old heart transplant recipient with endocardial fibroelastosis.

An 18-year-old female Japanese patient who suffered from heart failure and severe pulmonary hypertension was referred to our clinic. The etiology of her cardiomyopathy was unclear. Inhaled prostacyclin therapy resulted in an improvement of pulmonary arterial pressure and allowed us to avoid lung transplantation. Heart transplantation resulted in a complete remission of her respiratory function. Autopsies of the explanted heart revealed massive endomyocardial fibroelastosis. We concluded that endomyocardial fibroelastosis has to be considered a cause of heart failure in young adults with unclear cardiomyopathy.

Adolescent↗
PubMed2006

[Malignant eccrine poroma].

INTRODUCTION: Malignant eccrine poroma is a very rare tumour of the sweat glands with high malignancy and presenting with a polymorph clinical and histological picture. CASE REPORT: We describe the case of a 99-year-old patient with a malignant poroma on the buttock. Despite the large size of the tumour, no metastasis was found with standard examination techniques. Radical excision and defect closure with a Limberg flap was performed. RESULT: The healing course was uneventful and without complications. CONCLUSION: The malignant poroma is a tumour of high malignancy which can easily be misdiagnosed because of its different forms of presentation. Radical surgical therapy is the only known effective treatment.

Acrospiroma↗
PubMed2000

Transcoronary ablation of septal hypertrophy (TASH): a new treatment option for hypertrophic obstructive cardiomyopathy.

In 1991, our group started to develop a catheter interventional therapy for hypertrophic obstructive cardiomyopathy (HOCM). The new concept was proposed in 1994. It is based on the conventional PTCA technique with the aim of inducing an artificial myocardial infarction by instillation of 96% ethanol into the most proximally situated septal branch of the left anterior descending coronary artery. This leads to a subaortic contraction disorder with subsequent decrease of the intraventricular pressure gradient, shrinkage of the hypertrophied septal bulge and widening of the outflow tract ("therapeutic remodeling"). The subaortic defect is small and well demarcated as assessed by left ventricular angiography, transesophageal echocardiography and 18 F-glucose positron emission tomography. The term transcoronary ablation of septum hypertrophy (TASH) was suggested. Our patient cohort that now comprises 215 therapeutic procedures in 187 patients underwent a large variety of prospective studies (maximum follow-up 4.5 years) including invasive controls at regular intervals, investigation of hemodynamics at rest and at exercise, transesophageal and transthoracic echocardiography, Doppler echocardiography during bicycle exercise, electrophysiologic testing, Holter monitoring and measurement of myocardial metabolism and perfusion, assessment of microembolic events by transcranial Doppler sonography and histological examinations. This article gives an overview and reports our increasing experience in applying TASH. The following post-TASH findings were obtained: significant hemodynamic and clinical improvement at rest and at exercise, decrease of septum thickness, increase of outflow tract area and decrease of induced ventricular tachycardia. There were well-demarcated, histologically atypical subaortic myocardial defects, no microembolic events, abnormal early peak of infarct related enzymes, and no change of baroreflex sensitivity. Pre-/post-TASH evaluations of the patients should be based in particular on clinical symptoms correlated to the intraventricular gradient measured by bicycle exercise Doppler echocardiography and to outflow tract area as assessed by transesophageal echocardiography. Since 1994, as a roughly estimate, worldwide 1000 patients in 20 countries have been treated. According to published articles, abstract presentations and workshops, TASH consistently leads to a pronounced clinical and hemodynamic benefit for patients with HOCM. TASH has become an established technique. At least in centers with a high level of expertise, it is no longer experimental but a routinely performed alternative to surgical treatment for HOCM, i.e., the previous gold standard of therapy. Of course, patient outcome needs further careful clinical and prognostic evaluation. With respect to complications, TASH appears to be superior to surgery (transaortic septal myectomy) for HOCM. Like surgical treatment, TASH is currently indicated in critically ill patients with typical HOCM (subaortic form), who exhibit with drug refractory symptoms, including patients, who preferred DDD pacemaker therapy as a first therapeutic step but in whom this produced no subsequent clinical benefit.

Adult↗
PubMed1999

Acute and long-term results after transcoronary ablation of septal hypertrophy (TASH). Catheter interventional treatment for hypertrophic obstructive cardiomyopathy.

AIMS: To evaluate acute and long-term symptomatic, haemodynamic (at rest and during exercise) and electrophysiological results of transcoronary ablation of septal hypertrophy (TASH), a catheter interventional treatment for hypertrophic obstructive cardiomyopathy. METHODS AND RESULTS: Sixty-two transcoronary ablations of septal hypertrophy were performed by injection of 4.6+/-2.6 ml 96% ethanol into septal branches in 50 patients with hypertrophic obstructive cardiomyopathy and severe symptoms. Serial left and right heart catheterization, transoesophageal echocardiography and electrophysiological investigations were repeated 2 weeks and 7+/-1 months (n=37) after intervention. Transcoronary ablation of septal hypertrophy led to a reduction in septal thickness, sustained elimination of the outflow obstruction (51+/-41 vs 6+/-10 mmHg at rest, P<0.001; 134+/-48 vs 28+/-32 mmHg, P<0.001, post-extrasystolic), a decrease in left ventricular filling pressures at rest and during exercise and a pronounced clinical improvement. There was no evidence for the creation of an arrhythmogenic substrate as assessed by serial programmed electrical stimulation in 39 patients. However, permanent high-grade atrioventricular block occurred in 17% of the patients. There were two early, but no late deaths during a mean follow-up time of 10. 6+/-5.6 months. CONCLUSION: Transcoronary ablation of septal hypertrophy is a promising new treatment for hypertrophic obstructive cardiomyopathy in patients with severe symptoms. It should now be compared with alternative treatment strategies in prospective randomized studies.

Adult↗
PubMed1998

Vascular hamartoma of the left ventricle.

Primary tumors of the heart are very rare. We report a case of a 28-year old female patient in whom a tumor of the left ventricle was first diagnosed by transthoracic echocardiography. Angiography, nuclear magnetic resonance imaging and fasting positron emission tomography with 18-fluorodesoxyglucose suggested the diagnosis of a well vascularized tumor. The tumor was subtotally excised during heart surgery under total cardiopulmonary bypass and histological examination identified a predominantly vascular hamartoma.

Adult↗
PubMed1995

The pharmacological effect of sodium phosphate after absorption from the peritoneal cavity.

Hyperosmolar solutions are frequently used in clinical practice for enemas. In a review of the literature we found 43 published cases of severe complications connected with the use of hyperosmolar enemas. The absorption of sodium phosphate led to a raise of the temperature up to 41.1 degrees C, massive acidosis and electrolyte disturbances with hypocalcemia and hypernatremia. The clinical picture was dominated in most of the cases by somnolence or coma. In our experiment the absorption of sodium phosphate from the peritoneal cavity of rats led to similar clinical symptoms and--depending on the amount of sodium phosphate absorbed--to the death of the animals. Hypovolemia, hypernatremia, hypocalcemia and a direct toxic effect of phosphate on the kidneys is responsible for the complex mode of intoxication. Sodium phosphate solutions should not be used in patients with inflammatory bowel disease with a high risk of laceration of the mucosa or perforation of the bowel.

Animals↗
PubMed1995

[Emboliform sarcoma of the right pulmonary artery].

Sarcoma of the pulmonary artery is a rare tumor. The histopathologic features of these tumors differ widely, with leiomyosarcomas representing less than 20% of all pulmonary sarcomas. Diagnosis is very difficult because most of the cases have no specific clinical signs: the major differential diagnosis is that of pulmonary thromboembolism. We report the case of a 45-year-old woman, who was first treated for pulmonary thromboembolism until the diagnosis of an intravascular growing tumor was made by means of computed tomography, pulmonary angiography and nuclear magnetic resonance tomography. The patient underwent right pneumonectomy and microscopically a leiomyosarcoma of the right pulmonary artery was found.

Diagnosis, Differential↗
PubMed1992

[Incidence of carcinoma in follicular neoplasia of the thyroid gland].

Within four years 1376 thyroid operations were performed. In 152 = 11% a follicular or oncocytic tumor was found, 20 = 13% of these were classified as carcinoma. Seven of these were of the grossly invading type, raising suspicion of malignancy already pre- and intraoperatively while 13 encapsulated tumors were found by the pathologist only. If preoperatively a cold nodule or a nodular goitre was described, the carcinoma incidence was about 16%, while warm or hot nodes showed a carcinoma in 2%. Besides tumors of < 1 cm in diameter where we found no carcinoma the size of follicular tumors had no influence on the incidence of carcinomas.

Adenocarcinoma↗
PubMed1991

[Metastasizing round-cell sarcoma of the right atrium].

The chest roentgenogram in a 46-year-old woman with dyspnoea for several months revealed global cardiac enlargement. Echocardiography demonstrated a tumour in the right atrium, about 4 x 5 cm, as well as circular pericardial effusion. Septic temperatures occurred in the further course, and blood cultures grew Staphylococcus aureus. Recurrent pulmonary emboli and cerebral emboli with hemiparesis, especially of the brachiofacial region, occurred despite heparinization. Shortly after hospitalization a chest roentgenogram revealed a round shadow, about 1 cm in diameter, in the left upper lobe. The patient died in cardiogenic shock on the 16th hospital day. Autopsy showed the tumour to be a poorly differentiated round-cell sarcoma, originating from the wall of the right atrium, infiltrating the myocardium through to the epicardium and extending to the tricuspid orifice. The foramen ovale was open, making paradoxical emboli at atrial level possible.

Dyspnea↗
PubMed1988

[Steroid-refractory amiodarone-induced pulmonary fibrosis. Clinical features and morphology after an amiodarone-free interval of 3 months].

Amiodarone-induced bilateral diffuse pulmonary fibrosis developed in a 47-year-old woman with idiopathic hypertrophic subvalvular aortic stenosis who had been treated with amiodarone (Cordarex), 300 mg daily for about 18 months. Although the drug was discontinued and cortisone treatment begun, the pulmonary fibrosis did not regress. When gentamicin (Refobacin) and cefotaxime (Claforan) were administered for suspected fibrosis-induced right-sided bronchopneumonia, gentamicin-induced acute tubular renal damage occurred, requiring dialysis. The patient died soon after of myocardial electro-mechanical dissociation. At necropsy there was, in addition to the idiopathic hypertrophic subvalvular cardiomyopathy, extensive bilateral pulmonary fibrosis, lamellar bodies in foam-cell intraalveolar macrophages, in hepatocytes and in the epithelium of the proximal and distal tubules. Although amiodarone had been discontinued three months previously, high concentrations of the drug were still present, especially in both lungs, fat tissue and the liver.

Adipose Tissue↗
PubMed1986

Pathophysiological and morphological aspects of cellular lesions.

Cell injury can result in cell death with sufficient intensity and prolongation of various noxae. Cell death exhibits specific local characteristics but is generally monomorphic. Since a cell cannot be considered as an individual unit, knowledge of the interactions among various cells and their systems provides the basis for effective cell and organ protection. In the case of cell or organ injury which threatens to generalize, with far-reaching consequences for the entire organism, the following therapeutic measures should be considered: timely intervention in the disturbed prostaglandin metabolism; activation of the RES; for example, substitution of opsonins; minimizing of the secondary invasion of enterogenic toxins.

Animals↗
PubMed1986

Protective effect of fibronectin in temporary liver ischemia: an experimental study.

Only 50% of rabbits survive 90 min hepatic ischemia in spite of decompression of the gut. The remainder die within 36 h after operation. A single application of fibronectin before hepatic ischemia delays death for only a few hours. However, three postischemic applications of fibronectin--immediately after operation and 5 h and 24 h later--are associated with a statistically significant rise in the survival rate. Analysis of the transaminases indicates that fibronectin obviously limits the extent of ischemic liver cell necrosis. Of major significance is the fact that fibronectin supplement enables the RES of the liver to improve its phagocytic capacity, as shown by the RES clearance test. The presented experimental model shows that the liver with its RES, located between the splanchnic and the systemic circulation, is of particular significance for the entire organism. Hepatic ischemia or shock, independent of the initial cause, leads to significant reduction of hepatic phagocytosis. The results indicate that substitution of opsonins supports the phagocytic capacity.

Alanine Transaminase↗