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Biomedical subjects

W Kuckelt

Publications and source records attributed to W Kuckelt.

14 recordsLinked to original sources
PubMed2000

[Dilated coronary sinus. A preoperative transesophageal echocardiographic diagnosis].

A 36-year old woman was presented to our hospital with congenital ventricular septal defect and one-vessel coronary artery disease (75% proximal left main coronary artery) for CABG and repair of the VSD. After induction, a transesophageal echocardiographic (TEE) baseline examination was performed, showing a severely dilated coronary sinus (CS) measuring approximately 3 cm (abnormal >1 cm). We suggested a persistent left superior vena cava (PLSVC) draining into the CS. PLSVC is a common venous congenital anomaly, with a reported incidence of 0.5% in general population and in 3-5 % of patients with congenital heart defect. Injection of echo-contrast solution in a left arm vein, visualizing microbubbles passing through the PLSVC into the CS confirmed our suspicion. The diagnosis of a PLSVC and dilated CS is a contraindication for retrograde cardioplegia because of the loss of cardioplegia into the PLSVC resulting in a inadequate myocardial protection. It may be difficult to pass a pulmonary artery catheter (PAC) through a left internal or left subclavian vein and it may be associated with arrhythmias. A chest radiograph shows the anomalous course of the PAC along the left heart.

Adult↗
PubMed1992

[Spontaneous bacterial peritonitis without ascites].

A 34-year-old woman with acute pain in the lower abdomen and a history of non-A-non-B-hepatitis underwent laparotomy. A diffuse light redness of the small bowel without ascites was the only abnormal finding. An appendectomy was performed. The patient deteriorated into a sepsis during the next 60 hours. Relaparotomy established acute diffuse peritonitis with ascites and without any apparent intra-abdominal source of infection. Tracheal, blood, and intraperitoneal cultures of both procedures grew group A streptococci and proved a haematogenous spread of the infection. The sepsis was successfully treated with antibiotics and peritoneal lavage. The course of the infection and the findings are discussed and the case is interpreted as a spontaneous bacterial peritonitis without ascites.

Adult↗
PubMed1981

Effect of PEEP on gas exchange, pulmonary mechanics, and hemodynamics in adult respiratory distress syndrome (ARDS).

The effect of positive end-expiratory pressure on a value resulting in maximum static effective compliance was studied in 13 artificially ventilated patients suffering from adult respiratory distress syndrome. Applying positive end-expiratory pressure in this manner resulted in improvement of oxygen delivery and left ventricular stroke work. In the patients with high venous admixture under zero end-expiratory pressure cardiac output increased but in those with moderate pre-existing venous admixture cardiac output decreased. We conclude that the response to positive end-expiratory pressure depends on the importance of the venous admixture. Artificial ventilation with positive end-expiratory pressure on a level resulting in maximum static effective compliance is indicated in cases with high venous admixture.

Adult↗
PubMed1981

Experimental investigations in adult respiratory distress syndrome (ARDS). Repeated pulmonary lavage in LEWE-mini-pigs. I. Pulmonary mechanics, gas exchange, and pulmonary hemodynamics.

Disturbed water balance at the alveolo-capillary membrane resulting in decreased pulmonary compliance is one of the functional characteristics in the Adult Respiratory Distress Syndrome (ARDS). In artificially ventilated LEWE Mini Pigs repeated pulmonary lavage was performed. The aim was to produce a state like ARDS by affecting the lung alveolar surfactant system which is included into the sum of factors which are responsible for the normal water balance of the alveolo-capillary membrane. This condition was supposed to be maximized if the lung compliance reached its lowest value after pulmonary lavage. Regarding this the pathophysiologic changes in this ARDS model were characterized by increased airway resistance and dead space ventilation as well as decreased arterial oxygenation. Severe ventilation perfusion abnormality was represented hemodynamically by the increased pulmonary vascular resistance and the decreased pulmonary non-shunt blood flow. The morphological (macroscopic, light-and electronmicroscopic) changes indicate strongly that in this type of ARDS model all functional compartments of the alveolocapillary membrane are severely affected. Decreased colloid osmotic pressure of blood plasma samples underlines the severity of changes in the water balance at the alveolo-capillary membrane in this type of lung injury.

Airway Resistance↗
PubMed1980

Application of bromhexine metabolite VIII (NA 872) and bromhexine-glucose in treatment of adult respiratory distress syndrome; experimental and clinical results .

The authors study the changes in cardiopulmonary function after application of bromhexine metabolite VIII (NA 872) in an animal model of adult respiratory distress syndrome (ARDS) and bromhexine glucose solution (BGS) in ARDS patients. After damage of the lung alveolar surfactant by intratracheal atomization of 0.2 M HCl in LEWE Minipigs significant changes in lung compliance, dead space ventilation, venous admixture, alveolo-arterial oxygen tension difference, pulmonary vascular resistance, and oxygen uptake are present under application of NA 872 in comparison to untreated animals. In ARDS patients treated with BGS, pulmonary function is significantly ameliorated indicated by changes in static effective compliance, oxygen exchange ratio, and alveolo-arterial oxygen tension difference.

Animals↗
PubMed1979

Gas exchange, pulmonary mechanics and haemodynamics in adult respiratory distress syndrome: experimental results in Lewe miniature pigs.

Adult respiratory distress syndrome (ARDS) is a common medical emergency in respiratory care complicating a great variety of traumas and diseases. An animal model from Lewe miniature pigs has been developed to study the ARDS under standardized conditions; it is based on aspiration pneumonitis, a disorder often observed in ARDS, injuring the lung alveolar surfactant system. The experimental study was conducted under neuroleptanalgesia. ARDS was produced by intratracheal application of hydrochloric acid (0.2 mol/l) in an amount of 1.0 ml/kg body wt. The animals were ventilated automatically by a standardized ventilatory pattern in IPP mode. In all animals the time course of oxygenation ratio (Pa,O2/F1O2), arterial CO2 tension (Pa,CO2), ratio of alveolo--arterial oxygen tension difference to inspired oxygen fraction (Aa,DO2/F1O2), oxygen exchange ratio ((AaDO2/Pa,O2), lung compliance (CL), inspiratory airway resistance (RrsI), dead space ratio VD/VT), pulmonary artery pressure (PAP) and systemic blood pressure were studied. Changes in quasi-static volume--pressure curves, percentage change in lung water content and gross pathological finding were used to integrate the findings into a system of pathophysiological changes in ARDS. The animal group to which hydrochloric acid was administered shows severe pulmonary distress leading to death within 3.5--7.5 h. No significant changes in the measured parameters could be observed in the control group over a 14 h period. The results suggest that aspiration pneumonitis in Lewe miniature pigs is very suitable to investigate various problems in pathogenesis of ARDS. The model provides reproducible results which correlate very well with findings in different ARDS states. The models serves both to compare clinical states and to search for newer therapeutic manoeuvres.

Animals↗
PubMed1979

[Animal model of acute respiratory insufficiency by HCl aspiration in Lewe mini-pigs].

Acute respiratory insufficiency or adult respiratory distress syndrome is a common medical emergency in intensive medicine complicated by high mortality. To study the acute respiratory insufficiency under standardized conditions an animal model in Lewe-mini-pigs has been developed. This model is based on aspiration pneumonitis produced by intrabrochial atomisation of 0.2 N hydrochloric acid. General anesthesia was performed by neuroleptanalgesia. In all animals the profound changes in gas exchange, pulmonary mechanics and hemodynamics as well as quasi-static volume-pressure relationships after hydrochloric acid aspiration were described. The results suggest that this model is suitable to outline the profound changes in pulmonary function in this type of acute respiratory insufficiency.

Acute Disease↗
PubMed1978

[The lipids of the lungs in experimental aspiration pneumonitis (author's transl)].

In the lungs of LEWE-Mini-Pigs with aspiration pneumonitis, which was produced by intratracheal application of 0,2 n hydrochloric acid, the following parameters were determined post-mortally: Total phospholipid-, water- and cholesterol content and sphingomyelin-, lecithin-, phosphatidylethanolamine- and phosphatidylserine concentration. Furthermore thin-layer- and gelchromatographic investigations were performed. The water- and the cholesterol content are increased (about 4 respectively 40 percent). The total phospholipid- and the lecithin content are decreased (about 10 respectively 30 percent). The lysolecithin concentration is very low in the lungs. By therapy with bromhexine metabolite VII the water- and cholesterol content are reduced, the total phospholipid- and lecithin content are increased in comparison to the lungs without therapy. In this case the total phospholipid- and lecithin content are raised in the liver simultaneously. The biochemical changes are caused probably by a disorder of the surfactant system of the lung (disturbance of phospholipid-protein-interaction) and impairment of the alveolar epithelial cells typ II (decreased lecithin biosynthesis) in consequence of the action of the hydrochloric acid.

Ambroxol↗