PubMed Health⌕ Search

Biomedical subjects

W Hügel

Publications and source records attributed to W Hügel.

At least 19 recordsLinked to original sources
PubMed1990

[Hemodynamics and differentiated CO transfer following fulminant lung embolism and pulmonary artery embolectomy and following recurrent lung embolism].

Pulmonary embolectomy as an emergent surgical treatment after massive pulmonary embolism often is necessary in cardiogenic shock (CS) and even without previous diagnostic. If complete dissolution of the thromboembolus is possible or spreading of microemboli may occur is unknown. Therefore we studied 21 patients surgically treated by embolectomy, ten of these with consecutive cardiogenic shock (CS) and twelve patients after repetitive microembolism and cava-blocking. Besides lung-functional parameters for special CO-diffusion capacity (DLCO), differentiated in membrane (DM) and vascular (VC) component (Roughton and Forster), we measured mean pulmonary artery pressure (PAP) at rest and at exercise. Patients after repetitive embolism showed considerably more diminution of DLCO (-31%) than those after single massive embolic event (-15%) even concomitant by CS (-10%). Repetitive microembolism lowered VC by 21%. Slight decrease of DM was found after CS. Mean pulmonary artery pressure was elevated at rest (26 mm Hg) and exercise (33 mm Hg) after repetitive microembolism and normal after massive embolism or CS. Pulmonary embolectomy may prevent disturbances of DLCO or PAP even after CS. Damage of vascular integrity (VC) was found after microembolism. Pulmonary embolectomy seems to remove total embolic material and therefore seems to be optimal.

Adult↗
PubMed1990

Multicentric quality assurance in cardiac surgery. QUADRA study of the German Society for Thoracic and Cardiovascular Surgery (QUADRA: quality data retrospective analysis).

A method for initiating quality assurance in cardiac surgery was developed multicentrically by a commission of the German Society for Thoracic and Cardiovascular Surgery (QUADRA Study). To appraise the quality of cardiosurgical action, variables were compiled from the preoperative, intraoperative, and postoperative treatment course. The data collection was carried out at the same time as treatment. On the basis of unicentric data profiles, multicentric hospital profiles, and problem profiles, a quality comparison could be carried out and the variability of cardiosurgical action which may occasion interventions could be identified. A reduction of perioperative blood consumption during the study period could be observed in four out of five hospitals as the first result. The data collection also revealed epidemiological features. On average, women were older than men at the time of the heart-valve and coronary operations. To ensure data validity and the organization of quality assurance, a documentation assistant and a specially trained physician are necessary at every cardiovascular surgery center. The multicentric external comparison is indispensable and must be carried out by means of a central data collection, for which intrumental and staff capacities are also to be provided. With modern methods of data processing, an additional and new approach to the improvement of quality in cardiac surgery can thus be made.

Blood Transfusion↗
PubMed1990

[Tracheal instability in tracheo-esophageal abnormalities].

The clinical pattern of signs and symptoms of respiratory complications due to flaccid trachea has been analysed in 83 children treated in our hospital between 1983 and 1988 for tracheo-oesophageal malformations. These signs and symptoms are classified according to endoscopic findings, and are thus arranged according to various degrees of severity. Of the surviving children who were followed up and who were suffering from oesophageal atresia Vogt III B, only 5 of 57 were without a pointer towards flaccid trachea, whereas in oesophageal atresia Vogt II there were two of three. The two children with an isolated tracheo-oesophageal fistula showed abnormal findings both clinically and via endoscopy. 16 of the 20 children with very severely pronounced flaccid trachea--defined by the occurrence of life-threating apnoeas and an endoscopically identifiable tracheal collapse of more than two-thirds of the lumen--were subjected to surgery via aortosternopexy. A marked and identifiable improvement was obtained in 15 cases. Complications caused by surgery consisted of temporary phrenicus lesions in two cases.

Aorta, Thoracic↗
PubMed1990

[Aortic aneurysm and aortic injury--surgical treatment and follow-up].

This study summarizes our experience with 90 patients (68 male and 22 female, mean age 57.2 years). From Jan. 1980 to Feb. 1990, 51.1% underwent surgery for dissection of the aorta; the rest for acute aortic ruptures, false and true aneurysms. Procedures with reconstruction of the aortic arch were performed in cases of deep hypothermia and circulatory arrest (no fatal courses). The overall death rate was 18.8% (emergency 29.5%, elective 8.7%). Acute dissections Type I had the highest perioperative mortality with 29.4%. The leading causes of early death were myocardial infarction (23.5%) and cerebral injury (23.5%). Therefore coronary angiograms should be performed preoperatively in older patients. A major problem in our experience is the long-term followup examination which should remain the surgeon's responsibility.

Adolescent↗
PubMed1989

[Para-aortic pseudoaneurysm following aortic valve replacement. Its diagnosis by magnetic resonance tomography].

Para-aortic pseudoaneurysms after prosthetic replacement of an aortic valve was diagnosed by magnetic resonance imaging (MRI) in two patients and confirmed at surgery. The abscesses had not been visualized in either case by computed tomography and echocardiography, but in one it had been demonstrated by angiography. MRI can thus precisely define site and extent of a para-aortic pseudoaneurysm after aortic valve replacement without any interference by artefact, noninvasively and without use of contrast media.

Abscess↗
PubMed1989

Lysosomal enzyme activity influenced by various types of respiration during extracorporeal circulation.

The hypoxic damage of the lung as seen after extracorporeal circulation (ECC) is in correlation to lysosomal hydrolase and protease activation. In the recent study the effect of various types of respiration during ECC on lysosomal enzyme release were studied. 53 patients undergoing open heart surgery were divided into 4 groups: Apnoea, low frequency, continuous positive airway pressure, combination of low frequency and continuous positive airway pressure. Paired blood samples were withdrawn from the superior vena cava (SVC) and the left atrium (LA) throughout the cardiopulmonary bypass. A continuous increase of N-azetyl-beta-D-Glucosaminidase (NAG) in venous plasma and significant differences (SVC-LA) with higher activities in the LA in the apnoea group were detectable (p less than or equal to 0.05-p less than or equal to 0.01). In the other groups a time dependent course could also be evaluated, but the changes of the activities were not significant. The different types of respiration during ECC influenced the clinical course and outcome of the patients in correlation to the release of lysosomal enzymes from the lung. It is concluded that concentration gradients of lysosomal enzymes are an index for pulmonary damage due to the extracorporeal perfusion in open heart surgery. The activation of lysosomal enzymes in the lung circulation are positively influenced by "ventilation" during ECC.

Acetylglucosaminidase↗
PubMed1988

The clinical significance of coronary angioscopy in patients with coronary heart disease.

The feasibility and safety of coronary endoscopy was evaluated in three sets of investigations: in 7 cadaver hearts, in 11 patients undergoing coronary bypass surgery, and in 30 patients during routine cardiac catheterization prior to coronary balloon angioplasty (PTCA). In three of the seven cadaver hearts the lumen of the arteries appeared normal. In three diffuse atherosclerotic lesions, and in one, a high-grade, tight stenosis were observed. In nine of eleven patients in the operation room, the lesions of interest could be visualized, and high-grade stenoses were found in all. In addition, in three patients with unstable angina pectoris, fresh thrombi were seen at the site of stenosis. In six of the nine patients, the periphery of the native coronary vessel was found to have no further stenotic regions. During cardiac catheterization in 17/30 patients, the lesion of interest could be examined angioscopically, and in 13 instances the stenosis appeared excentric and irregularly shaped. In three instances, multiple ulcerations were seen in the stenotic area. In two of the five patients, intimal ruptures were found following PTCA, which could not be documented angiographically. Coronary endoscopy provides valuable additional information on the nature and appearance of atherosclerotic lesions. It can be performed clinically without great harm to the patients. Despite some limitations, it will probably become a routine diagnostic tool in patients undergoing routine coronary angiography, balloon angioplasty or high-frequency angioplasty, and coronary bypass grafting.

Angioplasty, Balloon↗
PubMed1988

Coronary angioscopy during cardiac catheterization and cardiac surgery.

Coronary angioscopy (CA) was performed in 30 patients (pts) during cardiac catheterization (Group 1) and in 11 pts during coronary bypass surgery (Group 2) using ultrathin fiberoptic angioscopes (phi 1.2-1.8 mm). For percutaneous CA (Group 1) the angioscope was introduced through a 9F guiding catheter from the femoral artery. The viewing field was cleared by flushing Ringer's solution and short-time occlusion of the coronary ostium by the guiding catheter. In Group 2 CA was performed retrogradely from the distal arteriotomy and through the bypass vein during flushing with cardioplegic solution. In Group 1 in 17/30 pts the coronary artery could be successfully examined by CA. In 13 pts the obstruction was eccentric and irregular shaped. In 2/5 pts, in whom CA was performed successfully pre and post balloon dilatation, CA after PTCA revealed an intimal rupture without clinical or angiographical signs of the intimal dissection. In Group 2 in 9/11 pts good visualization of stenoses could be achieved. At the obstruction site CA revealed thrombi in 3 pts and ulcer in 1 pts. In contrast to angiography, which estimates the lumen diameter of a segmental lesion, CA gives information about the luminal shape and the underlying substance of the obstruction (e.g. atheroma, thrombus, ulceration). The main problems in percutaneous CA are the insufficient intraluminal guidance, the insufficient depth of view of the angioscopes, and the limited examination time.

Cardiac Catheterization↗
PubMed1988

[Global and regional left ventricular function following acute coronary artery occlusion and emergency aortocoronary venous bypass operation].

Complications following percutaneous transluminal coronary angioplasty (PTCA), such as coronary artery occlusion, spasm, or dissection, frequently require urgent surgical intervention. Out of 26 patients from our hospital, 12 who underwent emergency coronary bypass grafting because of balloon catheter complications with a total ischemic time of 100-255 min, were restudied in the late postoperative period by clinical examination and by coronary and left ventricular angiography. Left ventricular angiograms were evaluated quantitatively for global and regional function using the AVD system (Siemens Elema, Erlangen). Electronmicroscopic results from myocardial biopsy samples, taken intraoperatively from the presumed center of the ischemic zone, were compared with the clinical results. An improvement of left ventricular function parameters could be seen in patients with reperfusion intervals within 130 min. In the case of intermittent perfusion of the occluded vessel (catheter perfusion with arterial blood, intermittent spasm) operative revascularization proved to salvage jeopardized myocardium. There was a close correlation between the degree of left ventricular dysfunction and histological results, coronary morphology and clinical staging. In conclusion, the efficacy of myocardial protection by emergency bypass surgery depends mainly on coronary morphology and above all on reperfusion intervals.

Adult↗
PubMed1988

[Diagnostic significance of angioscopy in patients with coronary heart disease].

Coronary angioscopy (CA) using ultrathin fiberscopes was performed in 30 patients with coronary heart disease during cardiac catheterization and in 11 patients during bypass surgery. For percutaneous CA the angioscope was introduced from the femoral artery through a 9F guiding catheter. During short-time occlusion of the coronary ostium by the tip of the guiding catheter the viewing field was flushed with Ringer's solution. Intraoperative CA was performed both by the retrograde and antegrade way during flushing with cardioplegic solution. Percutaneous CA was successful in 57% of patients. 13 patients showed eccentrically and irregularly shaped stenoses and 3 of these patients had an additional plaque rupture. In 2/5 patients CA after PTCA revealed intimal dissections not visualized by angiography. Intraoperative CA was successful in 9/11 patients. In 3 patients nonocclusive thrombi were found at the site of the coronary lesion. Additionally we studied the efficacy of angioscopic guidance during intravascular radiofrequency application. In 11/11 thrombotically occluded peripheral vessels this new method allowed a nearly complete recanalization. There was only one perforation of the vessel. We conclude, that CA is a powerful diagnostic tool providing prognostically relevant information in the diagnosis of coronary heart disease.

Animals↗
PubMed1987

Biochemical monitoring of the lung during and after extracorporeal circulation.

The activity of NAG, lysozyme and PMN-elastase has been investigated in the superior vena caval and left atrium blood collected from patients who underwent open heart surgery. The effect of various types of respiration on the enzyme release has been also documented. Concentration gradients between v. cava sup. and left atrium has been used as an index for pulmonary damage post operatively. We found a time dependent increase of all enzymes during extracorporeal circulation. However, only the release of NAG and lysozyme is characteristic for pulmonary damage. We observed significant higher enzyme release from the lung after Apnea ventilation compared with the PEEP and low frequency ventilation group. Also significant higher NAG and lysozyme activity was found in patients who needed longer respiration post-operatively. PMN-elastase seems to be not suitable for diagnosis of post perfusion lung because the main amount of elastase released by mechanical destroy of the granulocytes.

Acetylglucosaminidase↗
PubMed1986

[First clinical experience with coronary endoscopy].

In four different groups coronary endoscopy and endoscopy of peripheral vessels was carried out, using two ultrathin fibre endoscopes with a working length of 120 cm and a diameter of 1.4 or 1.8 mm. In a first series of seven cadaver hearts, normal vessels were found in three, one had high-grade stenosis and in the remaining three there were flat whitish atheromatous changes, rather scar-like in appearance. In a second series of 16 patients, the vascular wall in the iliac region was easily visualised in ten, while six showed diffuse atherosclerotic changes of the wall. In a third group of eight patients, coronary endoscopy was carried out at the time of balloon-catheter dilatation; endoscopy was successful in five patients. In two of them, the stenosis or occlusion to be dilated by balloon was visualised. In a fourth series, good visualisation of the vessels was obtained intraoperatively in seven out of nine patients, and in addition the course of the vessel distal to the stenosis as well as the site of anastomosis with the venous bypass graft could be seen. No serious side-effects of the procedure have yet been observed. Coronary endoscopy opens up a new dimension in the morphological assessment of coronary vascular changes. The method must, however, still be regarded as experimental.

Angioplasty, Balloon↗
PubMed1986

[Superior vena cava occlusion. Demonstration of surgical therapeutic possibilities].

Surgical problems in treatment of superior vena cava syndrome are discussed by our population of 15 patients and the literature. Nine patients which suffered from caval thrombosis were managed by thrombectomy. In four cases superior vena cava was bypassed or replaced by PTFE (Gore-Tex) tubular grafts successfully. Whereas autologous vein as spiral composite graft or complete venous conduit might be preferred by reason of excellent longtime patency rates, the every time available PTFE vascular prosthesis appears to be an efficient synthetic material for replacement of superior vena cava.

Adolescent↗
PubMed1984

The hemodynamics and contractility of the right ventricle in the early postoperative phase following correction of tetralogy of Fallot.

The hemodynamics, contractility and compliance of the right ventricle were examined during the early postoperative phase in 9 children operated for correction of tetralogy of Fallot. The same assessments were made in 5 patients after the transventricular closure of ventricular septal defects (control group). A further reduction of the PRV/LV quotient was observed in the Fallot group during the first 3 hours postoperatively. The contractility of the right ventricle (dp/dt max) was greatly reduced in all cases. The pressure/volume relationship of the right ventricle showed severe disturbance in compliance. The type of correction (with/without outflow tract patch or monocusp) did not appreciably affect the results. The hemodynamic changes observed in the control group (VSD) were considerably less pronounced. Apparently it is not the ventriculotomy but the infundibulectomy which is the traumatic factor of corrections in the area of the right ventricular outflow tract.

Blood Pressure↗
PubMed1982

[Passive prophylactic immunisation against post-transfusion hepatitis by immunoglobulin preparations: a prospective clinical study].

In the course of a randomised prospective study involving 98 patients who had undergone cardiac surgery, 51 patients were given 20 g human immunoglobulin i.v. over four months, 47 received merely blood transfusions, like all other patients, averaging 4.4 units per patient. Antibodies against HBs antigen or Hbc antigen were present in 20% of patients before operation. After operation (plus blood transfusions) antibodies against hepatitis-B virus were demonstrated in 43% of the control group but 94% of those treated with immunoglobulins. These antibodies persisted in the course of further immunoglobulin administrations, while they fell in the control group. Hepatitis-B infections occurred in ten patients of the control group, after 30-90 days; three of them developed acute hepatitis. In the group treated with immunoglobulins there were only two patients with an infection, one of whom developed hepatitis. Antibodies against cytomegalic virus increased in the control group but not in the treatment group. In both groups there was the same incidence of non-A-non-B hepatitis.

Cardiac Surgical Procedures↗