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Biomedical subjects

V Schlosser

Publications and source records attributed to V Schlosser.

At least 19 recordsLinked to original sources
PubMed1992

[Accusation of malpractice in cardiovascular surgery].

The reproach of malpractice in cardio vascular surgery seems to be up to now quite seldom in comparison with other While in cardiac surgery the acknowledgement was found extremely seldom in vascular surgery acknowledgement of malpractice reproach must be expected in about 50%. In cardiac surgery mainly new neurological deficits are content of malpractice reproach; in vascular surgery artery injuries and surgical procedures to correct varicose veins are most often involved. In order to prevent or to minimise those malpractice reproaches an optimal communication between the surgeon and the patient, an extensive informed consent and a very strict medical indication for surgery are imperative.

Cardiovascular Diseases↗
PubMed1992

Isolation of the membranes from secretory organelles (trichocysts) of Paramecium tetraurelia.

We present for the first time a method for isolation of the membranes of extrusive organelles (trichocysts) from sterile culture of different strains of Paramecium tetraurelia. First, trichocysts are isolated according to a new method (Glas-Albrecht, R. and Plattner, H. (1990) Eur. J. Cell Biol. 53, 164-172) with high purity and yield. Then the organelles are subjected to osmotic swelling. Since trichocysts then easily 'decondense' and entangle membranes, these cannot be isolated directly by centrifugation, but only by passage through a filter and subsequent centrifugation. Purity of membrane fractions is analysed by electron microscopy and SDS-PAGE, combined with silver staining or, after biotinylation, by avidin-peroxidase labelling. Molecular masses resolved in our gels are in a range from less than or equal to 15 to greater than or equal to 105 kDa. Main bands obtained with nd9-28 degrees C trichocyst membranes (most bands also being common to wild type trichocysts) are of about 16.5, 19-21, 27-29, 33-34, 44-45 (strong), 47-48 (strong), 57, 61, 65 (strong), 68-71, 75, 81, 94-95 (strong), 104 and greater than or equal to 110 kDa, from a total of approx. 23 bands resolved. There is no remarkable occurrence of dominant protein bands from trichocyst contents ('trichynins'), though these might represent up to 10(3)-times more of the total trichocyst proteins. The ratio of phospholipid/protein is approx. 0.2 mg/mg. The methodology developed might also be valuable for the isolation of extrusome membranes from some other protozoan species.

Animals↗
PubMed1992

The influence of obesity on perioperative morbidity: retrospective study of 502 aortocoronary bypass operations.

The incidence of perioperative complications after coronary artery surgery was investigated by a retrospective study of all 502 patients undergoing coronary artery bypass graft (CABG) surgery in our Department between January 1st and December 31st of last year (1990). Furthermore, the influence of obesity on the early results of surgery was assessed and the effect of preoperative weight reduction on perioperative complication rates examined. Obese patients had a greater incidence of left-stem coronary artery stenosis (p less than 0.001), hyperlipidaemia (p less than 0.05), hypertension (p less than 0.05), diabetes mellitus (p less than 0.02), and were in general younger at the time of operation (57.9 +/- 8.4 vs. 60.8 +/- 8.5 years). There were no differences in the surgery performed and in operative mortality, but there were some in perioperative morbidity. Obese patients had higher rates of infection (p less than 0.02), sternal dehiscence (p less than 0.02), arrhythmias (p less than 0.02) and myocardial infarction (p less than 0.02). No significant differences were identified in obese patients with or without preoperative weight reduction, although there was a trend of better postoperative recovery and results in patients having undergone preoperative weight reduction. Analysis of our results demonstrated obesity to be an independent risk factor for perioperative complications, hospital morbidity, and length of hospitalization.

Aged↗
PubMed1992

Added hospital stay due to wound infections following cardiac surgery.

To determine the prolongation of hospital stay due to postoperative wound infections following cardiac surgery, a prospective cohort study was performed by matching multiple control patients without infection to each infected patient (= case). Out of 22 cases, no patient died. No case had to be excluded from the matching process because of a lack of suitable control patients. The maximum number of controls per case was 10. The mean added stay was 12.2 days constituting a considerable prolongation of stay due to wound infection in cardiac surgery.

Adult↗
PubMed1992

[Non-cardiac complications after open heart surgery].

The most important complications after open heart surgery are neurological, gastrointestinal (GI), and renal complications. New neurological deficits may occur in 1%, and neuropsychiatric alterations may be observed in 40%. In 6% peripheral neurological damage occurs. Endoscopy in all patients whose clinical history suggests signs of gastric ulcer disease, and perioperative H2-blocking therapy are effective in reducing severe GI bleeding to 1%. Small-bowel ischemia is a rare but high risk complication. Hepatitis due to homologous blood transfusion is as low as 2%-3%. Postoperative renal insufficiency occurs in 1% needing hemodialysis. Good hemodynamic condition during and after surgery reduces the frequency of extracardiac complications as well as the reduction of use of homologous blood transfusions for open heart surgery.

Heart Diseases↗
PubMed1991

[Prolongation of hospital stay by nosocomial pneumonia and wound infection].

From June 1988 to September 1989, a prospective survey comprising a total of 1183 patients in a university hospital was carried out to ascertain the additional length of stay in intensive care units because of nosocomial pneumonia associated with artificial ventilation (418 patients, 296 men, 122 women, mean age 48.8 +/- 21 years, ventilated for more than 24 h) or by postoperative wound infections (765 patients, 501 men, 264 women, mean age 60 +/- 11 years, after operations on the large bowel, heart or biliary tract). Each patient with a nosocomial infection was matched against a variable number of control patients (for cases of pneumonia a maximum of 6, for wound infections a maximum of 10) without nosocomial infection. Pneumonia developed in 100 (23.9%) of artificially ventilated patients, and 46 of these patients together with 101 controls were entered into the matching procedure. 24 patients with pneumonia had to be excluded from analysis because no controls could be found for them, and also 30 patients who died while in the intensive care unit. 49 (6.4%) of the surgical patients contracted postoperative wound infections. 43 of them, together with 210 controls, were entered into the matching procedure. Among patients with pneumonia the average additional duration of stay was 11.5 days, and among patients with post-operative wound infections it was 13.9 days. The results confirm that nosocomial infections contribute substantially to prolongation of hospital stay and hence to the costs.

Adult↗
PubMed1991

Reduction of the risk of surgery for abdominal aortic aneurysms by extended coronary diagnostics and therapy.

The morbidity and mortality in the surgery of abdominal aortic aneurysms are essentially determined by the coronary risk profile of the patient. Preoperative coronary artery diagnostics with the potential consequence of a coronary revascularization as procedure before the aneurysmectomy seems to be mandatory to decrease the risk of treatment. Out of 223 patients treated at our institution for abdominal aortic aneurysm, 68 (30.5%) had to undergo extended cardiological diagnostic procedures, and 37 (16.6%) needed a coronary angiography; in 23 patients (10.3%) myocardial revascularization was performed prior to the aneurysmectomy. Since routinely performing this thorough investigation of the coronary risks, the mortality of surgery for aortic aneurysm has been clearly reduced.

Angioplasty, Balloon, Coronary↗
PubMed1991

[Histologic examinations of internal mammary artery, saphenous vein and aorta specimens collected during heart surgery].

133 patients with coronary heart disease were treated surgically. 60 patients had Internal Mammary Artery (IMA) grafting performed together with saphenous vein grafts (IMA group), another 70 patients had saphenous vein grafts only (SVG group). Material for histological examination was intraoperatively taken from saphenous vein and ascending aorta and in IMA group also from the distal part of internal mammary artery. The intensity of atherosclerosis was estimated with 5-grade scale from 0 to 4 (0-no atherosclerosis, 1-minimal, 2-insignificant, 3-moderate, 4-pronounced). To visualize and to assess the blood flow through the internal mammary artery Digital Subtraction Angiography (DSA) was performed between day 6 and day 8 postoperatively in the IMA group. Results obtained were correlated with the intensity of atherosclerosis estimated histologically and the numeric data were statistically analysed. In the IMA grafts mean atherosclerosis intensity was 0.94 which is the evidence of minimal atherosclerotic changes. In saphenous vein the corresponding value was in the IMA group 2.14 and in the SVG group 2.17, in aortic scraps 2.64 in the IMA group and 2.73 in the SVG group. Patients in the SVG group were average 8.4 years older than in the IMA group. The difference is statistically significant. Despite the age difference, the intensity of atherosclerosis was not statistically different in aortic and saphenous vein scraps. Among 63 patients in the IMA group in 31 patients (49.2%) no atherosclerosis was found during histological examination and in 32 patients (50.8%) changes ranged from minimal to moderate. There were no IMA grafts with the pronounced atherosclerosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Acute and chronic aortic rupture. Management without and with a protective bypass procedure].

The use of partial cardiopulmonary bypass in the surgery of thoracic aortic ruptures is still a matter of controversey. Since 1970, 38 patients with thoracic aortic rupture have been treated at our institution, 13 in a acute or subacute stage and 25 with traumatic aneurysm. Partial cardiopulmonary bypass was installed in 13 cases, and in 23 patients the "clamp and repair" technique was performed. Although there was no coherence between the occurrence of complications and the applied procedure, we prefer the use of partial cardiopulmonary bypass in view of the advantages in safe distal perfusion, direct retransfusion of blood, controlled decompression of the left heart, and the possibility to extend surgery to the aortic arch.

Adult↗
PubMed1990

Traumatic herniation of the heart into the right pleura.

This case report summarizes our experience with a 19-year-old male patient who suffered a blunt chest trauma during a traffic accident. On admission no serious injuries could be detected, but 12 hours later displacement of the heart to the right side combined with sudden cardiac failure appeared. Emergency operation showed a right-sided rupture of the pericardium with complete herniation of the heart into the right pleural cavity and consequent strangulation by the pericardial margin.

Adult↗
PubMed1990

[Significance of digital subtraction angiography for estimation of early results of myocardial revascularization after internal mammary artery grafting].

Between 1st January and 31st December 1987 126 consecutive patients underwent full myocardial revascularization using at least one internal mammary artery bypass grafting in Department of Cardiovascular Surgery of University of Freiburg. In 78 patients (75 males, 3 females) DSA was performed within 8 days after surgery to evaluate dynamics of IMA-graft. The age ranged from 38 to 67 years (mean 53.4 years). DSA study was performed through the brachial artery, contrast medium was injected with flow of 10 ml/sec. in counter current. It was only one series of angiograms necessary to visualise flow from subclavian artery, through IMA to coronary artery. Among 78 investigated patients in 61 (78%) the distal anastomosis appeared to be widely patent and flow through the IMA and anastomosed coronary artery was sufficient. Patency of one of the branches of IMA or stenosis of IMA graft contributed to inadequate flow in 12 patients (15.6%). In 5 (6.4%) operated patients the IMA graft was not patent. Counter current intraarterial DSA requires much smaller amount of contrast medium than classical angiography, moreover avoiding of aortic catheterization with all risks involved. The counter current intraatrial DSA is an excellent technics of estimation of the flow to grafted coronary arteries. The method is easy to perform, repetitive and carry very small risk for the patient. Early postoperative evaluation of IMA-graft patency is essential for estimation of effectiveness of myocardial revascularisation and prognosis for the patient.

Adult↗
PubMed1990

[Simultaneous carotid endarterectomy and coronary artery bypass. when is it indicated?].

In cases of concommitant coronary heart disease (CHD) and carotid artery stenosis (CAST) simultaneous correction has a higher risk. Transcranial Doppler flow measurements at the level of the arteria cerebri media did not detect any flow reduction during open heart surgery in patients with and without carotid lesions. New neurologic deficits during open heart procedures are mostly due to embolism from ECC or from the heart, rather than a high grade carotid stenosis. Simultaneous correction of CHD and CAST is only indicated in patients with severely unstable angina and symptomatic high grade stenosis of the carotid artery.

Blood Flow Velocity↗
PubMed1990

[Aneurysm of the aortic isthmus as a complication following dilatation of coarctation].

Balloon dilatation of acquired stenoses of aorta and large arteries is a widely used procedure. In case of congenital malformations such as coarctation, however, this method is not recommended as therapy of first choice. The frequently marked degenerative wall lesions of such cases may be responsible for subsequent aneurysm formation. This complication has been reported in 10-40% of cases treated by catheter dilatation. A later correction of an aneurysm by surgery is much riskier than the primary operation of a coarctation. A case report of a 28-year-old woman with a false aneurysm following catheter dilatation of a coarctation is presented.

Adult↗
PubMed1989

Reduction of blood transfusion requirement in open heart surgery by administration of high doses of aprotinin--preliminary results.

Reduction of homologous blood requirement in cardiac surgery is of increasing interest and may be achieved by various technical and pharmacological means. High-dose aprotinin (about 840 mg, equivalent to 6 million Kallikrein inactivator units), a serine proteinase inhibitor, was administered during open heart surgery to 60 patients refusing homologous blood transfusions or suspected to have an increased risk of bleeding. As a significant decrease in donor blood requirement could be observed, a prospective, randomised double blind study in 80 male patients undergoing primary coronary surgery with high-dose aprotinin administration was performed. Mean blood loss was reduced by 45.9% (652 ml in the treated vs 1204 ml in the untreated group, p less than 0.01) and the mean amount transfused was decreased by 74.2% (242 ml vs 937 ml, p less than 0.01). No homologous blood was needed in 57.9% of the aprotinin-treated patients and in 31.6% of patients not treated with aprotinin.

Aprotinin↗
PubMed1989

Coronary artery disease in a patient with a congenital pericardial defect.

This case report summarizes our experience with a 43 year old male patient with congenital pericardial defect, involving the left ventricular part of the pericardium, and additionally 2-vessel coronary-artery disease in the absence of any coronary risk factors. This patient underwent coronary-artery bypass grafting. Intraoperatively the heart was found to be rotated and herniated into the left pleural cavity, strangulated by the remaining pericardium causing a bridle stricture of the right as well as the left margin of the heart, with a subsequent local narrowing of the ventricle in these areas. Furthermore, assessment of the coronary arteries at operation by external palpation showed the location of an RCA- and LAD-stenosis to match exactly with the stricture area.

Adult↗
PubMed1988

Nonreversed saphenous vein grafts in coronary surgery.

The nonreversed saphenous venous graft in coronary surgery gives better match of diameters at the aortic as well as at the coronary anastomosis. The destruction of the valves is necessary and special valvulotomes are used. This preliminary report of a new technique in coronary surgery must be followed by long term results.

Aged↗