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Biomedical subjects

W Saggau

Publications and source records attributed to W Saggau.

At least 73 records · Page 4Linked to original sources
PubMed1981

Is more heparin necessary for low-dose heparin prophylaxis in uremic patients?

Heparin dose requirements for s.c. heparin prophylaxis were investigated in control individuals and in uremic patients. Heparin levels (neutralisation of factor Xa activity, neutralisation of Xa amidolytic activity; PTT and thrombin time) at timed intervals after single and repetitive s.c. doses of 5,000 or 7,500 IU were measured in 11 uremic patients and 9 individuals with normal renal function. At a dose of 2 x 5,000 IU/d heparin s.c. no difference between controls and uremic individuals was found. In contrast, in uremic patients, peak concentrations and area under the curve (AUC) were significantly lower and plasma half life shorter after 3 x 5,000 IU heparin s.c. After repeated administration of heparin, heparin concentrations (24 hrs) had fallen to nil in uremic patients whereas in controls measurable activity was still demonstrable. After i.v. bolus injection of heparin, peak concentrations were identical in controls and in uremic patients, but elimination half life was prolonged in uremic patients. It is therefore suggested that lower plasma heparin concentration after heparin s.c. is the result of diminished net absorption from the subcutaneous depot. It is concluded that in order to achieve a given plasma activity, higher s.c. doses of heparin must be administered to uremic patients than to non-uremic individuals. But further studies are required to demonstrate safety and efficacy of heparin prophylaxis in uremic individuals.

Adult↗
PubMed1981

[Apico-aortic conduit for surgical treatment of supravalvular aortic stenosis with hypoplastic ascending aorta (author's transl)].

Surgical treatment of two patients with diffuse supravalvular aortic stenosis including hypoplastic aortic valve ring was undertaken. In both patients a left ventricular apical-thoracic aorta conduit containing a bioprosthesis was used. Intra- and postoperative pressure measurements demonstrated relief of the systolic pressure gradients present preoperatively between left ventricle and ascending aorta distal to the stenosis. Both patients are asymptomatic at four and eleven months after surgery, respectively.

Adult↗
PubMed1981

[Metabolism of myocardial catecholamines and plasma catecholamine levels in patients with chronic aortic regurgitation (author's transl)].

In 17 patients suffering from severe chronic aortic regurgitation (class III N.Y.H.A.), during aortic valve replacement right atrial biopsies were taken. In these samples myocardial content of norepinephrine, normetanephrine, epinephrine and dopamine were determined. 2-4 days before valve replacement, plasma catecholamines were measured at rest and during isometric exercise. 15 patients with atrial septum defect (foramen secundum) served as controls. In patients with aortic regurgitation demonstrating no clinical signs of cardiac failure, myocardial content of norepinephrine, normetanephrine and epinephrine was significantly reduced compared to tissue content of patients with atrial septum defect. Right atrial content of dopamine did not reveal any difference between the two groups. In all patients, plasma catecholamines at rest were within normal limits. During isometric exercise, however, the increase of plasma norepinephrine in patients with aortic regurgitation was significantly higher compared to the control group. It is concluded from these data that patients with aortic regurgitation, demonstrating an exaggerated increase in sympathetic activity during exercise, probably show a decrease in myocardial norepinephrine tissue content. Therefore, clinical demonstration of hyperadrenergic response during exercise represents a simple metabolic parameter indicating alteration in myocardial metabolism in patients with chronic aortic incompetence. Since decision for aortic valve replacement should be done before irreversible damage of myocardium has established, it is supposed that assessment of sympathetic activity, at rest and during exercise, may reveal practical clinical importance.

Adult↗
PubMed1980

[Clinical findings on heart myxoma (authors' translation)].

Clinical findings, diagnosis, and pathology of heart myxoma are discussed on the basis of personal experience with nine patients. There was a striking variety of signs and symptoms caused by tumor embolization, hemodynamic obstruction, and autoimmunologic reactions. Echocardiography is the method of choice, although angiography may still be necessary in atypical or negative echocardiographic findings. The tumor should be removed as soon as possible after diagnosis. There is danger of tumor embolization in the course of the operation. Long-term results are good, if resection of the tumors is performed before catastrophic complications occur. Morphologically, myxomas are genuine tumors characterized by myxomatous stromata and cells.

Adult↗
PubMed1980

[Clinical and experimental studies on pulsatile and continuous flow during extracorporeal circulation (author's transl)].

In 20 patients who underwent open-heart surgery, the plasma concentrations of glucose, insulin, glucagon, growth hormone, free hemoglobin, and cholinesterase were measured before, during and after pulsatile and continuous perfusion. Pulsatile flow was achieved by modification of a roller pump to effect rapid acceleration and slowing. The driving motor was interfaced with a control module to enable ECG-triggered perfusion. In addition to the clinical studies, investigations were performed in 9 dogs to assess the effects of pulsatile and continuous perfusion on liver and pancreas flow during total bypass. During pulsatile perfusion there was a significant increase in insulin which, however, was clearly diminished in relation to glucose levels. The response of the beta-cells was markedly more compromised after continuous than pulsatile perfusion. The secondary postoperative increase in insulin can be accounted for by intravenous administration of glucose and, particularly, after pulsatile perfusion, indicates an almost completely normal response of pancreatic beta-cells. As opposed to the effects of continuous perfusion, the low glucose, glucagon, and growth hormone levels, the insulin increase during and after pulsatile perfusion as well as normal cholinesterase values observed in association with pulsatile perfusion appear to be the result of improved pancreatic and hepatic function. This contention is supported by the experimental finding of significantly increased pancreas and liver perfusion during pulsatile perfusion.

Animals↗
PubMed1980

[Effects of various forms of myocardial protection on cardiac function, metabolism, and blood flow (author's transl)].

The myocardial protective effect of two cardioplegic solutions was studied after an ischemic period of 2 h in eight dogs. Group I received a high potassium solution (St. Thomas Hospital) and group II a sodium withdrawal solution with high colloid osmotic pressure (Eppendorf solution). With the exception of a prolonged myocardial K+ washout (10 min) in group I, which was presumably responsible for fibrillation in the early reperfusion period, no major metabolic or perfusion differences between the two groups were observed. After 30 min of reperfusion, postischemic LV function (-43%) and O2 uptake (-43%) were equally reduced in both groups.

Animals↗
PubMed1979

[Comparative studies on pulsatile and continuous flow during extracorporeal circulation. Effects on liver function and endocrine pancreas secretion].

The effects of pulsatile and nonpulsatile flow pattern on pancreas and liver blood flow were studied in nine dogs on cardiopulmonary bypass (CPB). Furthermore, plasma levels of glucose, insulin, glucagon, growth hormone, and cholinesterase were compared in 20 patients subjected to open heart surgery with either pulsatile or nonpulsatile perfusion. Impairment of liver and pancreas function was significantly greater at the end of CPB and 48 h afterwards with nonpulsatile flow as compared with the pulsatile flow pattern. A decrease of intestinal blood flow that was demonstrated in dogs subjected to nonpulsatile perfusion could at least in part be responsible for the difference in postoperative organ function observed in patients after CPB.

Animals↗
PubMed1979

[Surgical management of traumatic thoracic aortic aneurysms using the TDMAC-heparin shunt].

Rupture of the aorta frequently occurs in major blunt trauma to the thorax, but few patients survive long enough to develop a chronic aneurysm. A TDMAC-heparin-coated shunt was used for operative procedures on the thoracic descending aorta in 5 patients aged 18--40 years. The lesions constituted in 4 recent ruptures and 1 chronic aneurysm. In 3 cases the aneurysm was resected and replaced with a prosthetic graft. End-to-end aorta sutures were performed in the other two cases. One patient died of renal and pulmonary insufficiency. There have been no complications attributable the shunt. The advantage of this shunt include elimination of the need for systemic heparin, avoidance of hypertension during crosslamping, and adequate perfusion of the distal circulation without an interposed pump. Because of the ease of handling and low risk we consider the use of this shunt the preferred method for operative procedures on the thoracic descending aorta.

Accidents, Traffic↗
PubMed1979

[Subdiaphragmatic pacemaker implantation of pacemakers - results of 1150 implantations].

Permanent pacemaker are presently used on patients with chronic disease of the cardiac conduction system, with recurrent Adams-Stokes attacks, and with bradycardia. 1865 pacemakers have so far been implanted in the unit for special thoracic surgery in the University of Heidelberg from 1965 to 1978. In 1.150 (or 61%) patients the pacemaker was implanted using the subdiaphragmatic method. A lower transverse pericardiotomy was performed and the battery was located in the rectus abdominis sheath. In the remaining 715 (or 39%) patients, the electrodes were introduced transvenously and implanted in the endocardium. The battery unit in this case was located beneath the pectoral muscle. The transvenous approach was the method of choice until 1971; from that time onward the subdiaphragmatic approach gradually replaced it as the method of choice. Between 1971 and 1978 80% of the pacemakers were implanted directly into the myocardium whereas only 20% were introduced transvenously. The subdiaphragmatic method completely eliminates the frequent complications of the transvenous approach, such as dislocation of electrodes and others so that it now is our method of choice.

Diaphragm↗
PubMed1978

[Haemochron--a simple method of monitoring heparin level during extracorporeal circulation].

Tow forms of heparin management during cardiopulmonary bypass were compared in order to analyze the role of the heparin level in relation to postoperative blood loss. The study was divided in three groups: In group I, the control group, 3 mg/kg body weight heparin was given as an initial dose and maintained at a dose of 1.0 mg/kg every 60 min during cardiopulmonary bypass; group II received the same initial dose, but additional doses were based upon the activated clotting time measured with a Haemochron; in group III, the Haemochron time was measured at 10-min intervals to establish a base value. In group II we found a significant decrease in postoperative blood loss as well as a decrease in the amount of heparin administered during cardiopulmonary bypass. In addition, fewer transfusions were required in the immediately postoperative period. In group III, wide variations in the activated clotting time curve were observed. No patients was underheparinized, but some had markedly prolonged Haemochron times.

Blood Coagulation Tests↗
PubMed1976

[Endarterectomy versus vein bypass grafts in femoropopliteal occlusions (author's transl)].

On the basis of our experience with 1827 femoropopliteal arterial reconstructions performed from 1959 through 1974 we have worked up a system of strict guidelines for the choice of procedure. The vein bypass is the method of choice in all cases at stages III/IV (i.e. resting pain or gangrene), in lengthy occlusions of the femoral arteries continuing into the distal popliteal arteries or in stenotic lesions or occlusions of the tibial arteries, in all recurrent occlusions, and in cases with calcification or dilatation of the arterial wall. The indication for endarterectomy is restricted to stage II (i.e. intermittent claudication) and to segmental occlusions of the femoral or popliteal arteries as well as transitional or lengthy occlusions of the femoral artery continuing to the proximal popliteal artery. Under these guidelines a total group of 645 patients underwent 721 femoropopliteal reconstructions-307 endarterectomies and 414 vein grafts-from 1971 through 1974. The average age of the patients was 60 years. In 50% of all cases operations were carried out for advanced ischemia treatening the extremity. For all the series the patency rate of vein bypass was 79% and of endarterectomy 71%. Accumulative patency rates by the life table method according to the preoperative degree of arterial insufficiency and the postoperative follow up period of 4 years do not show statistically significant differences between both procedures under the given guidelines.

Adult↗
PubMed1976

[Pulmonary hemodynamics, coagulation and morphological changes in the lung after thrombocyte aggregation inhibition and intravasal coagulation in experimental trauma and hemorrhagic shock].

26 mongrel dogs are subjected to a standardized bone trauma followed by a hypotonic hemorrhagic shock. Compared with a control and heparin group prophylactic treatment with Dipyridamol and Acetylsalicylic Acid decreases pulmonary vascular resistance significantly. After an initial period of hyperocagulability secondary fibrinolysis develops. The decrease of the fibrinogen level and the fall of total platelet count after trauma and hemorrhage can partly be prevented by the application of heparin, likewise the development of pulmonary microthrombosis. Histological examination shows a markedly diminished pulmonary microthrombosis.

Airway Resistance↗
PubMed1975

[Postoperative prevention of thrombosis through the tonicizing of the caudal venous system. A new principle of drug therapy].

Haemostasis of the lower extremities is among the constituent factors of postoperative thrombosis risks ("Virchow's Trias"). Therapeutical efforts have, therefore, ever since focused on the idea of accelerating vein circulation. An equivalent effect is produced by Dihydergot which is thus qualified for postoperative thrombo-prophylaxis. This investigation proves the efficiency ofDihydergot. Results are based on 148 patients subject to longitudinal section tests along the 125-J-fibrinogen-test lines, from the 1st through to the 6th day after operation. In comparison with a control group, the results with the members of the therapy group gave evidence of a highly significant reduction of thrombosis frequency in the leg veins. Side-effects have not been noted. Tonus of the vessels and acceleration of the vein backflow by Dihydergot form a new therapeutical principle within the scope of postoperative thrombo-prophylaxis. The method is advantageous because it is highly efficient, practicable without complications, and is riskfree.

Blood Circulation↗
PubMed1975

[The femoro-crural venous bypass in chronic arterial block of the leg (author's transl)].

A report on 58 reconstructive vascular operations in chronic blocks of arteries of the leg. 4 different types of block in these arteries can be distinguished. Operation is indicated only in severe disturbances of circulation of stage III and IV. The criterion for reconstruction is not found in the proximal part of the arteries. Angiographic proof of at least one leg-artery down to the periphery being patent and permitting free flow is required. The various techniques applicable to each type of block, early and late results are reported on. Suring a period of up to 3 years block recurred in 26%. Most recurrences (46%) were seen within the first 30 days.

Adult↗
PubMed1975

[Significance of intravascular coagulation and acidosis on increase of pulmonary vascular resistance following trauma and hemorrhagic shock].

24 anesthetized mongrel dogs are subjected to a standardized trauma followed by a hypotonic hemorrhagic shock. Compared with the control group (n equals 8) prophylactic treatment with heparin in the second group (n equals 8) reduces the rise of pulmonary vascular resistance only insignificantly. The correction of the metabolic acidosis with Tris does not prevent a rise of PVR in third group (n equals 8).

Acidosis↗