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At least 991 records · Page 55Linked to original sources
PubMed2004

Extended myectomy for hypertrophic obstructive cardiomyopathy after failure or contraindication of septal ablation or with combined surgical procedures.

BACKGROUND: Surgical correction of hypertrophic obstructive cardiomyopathy in severely symptomatic patients has been proven to be effective over the long term. The introduction of catheter-based procedures restricts surgical therapy to a subset of patients not suitable for septal ablation or requiring concomitant cardiac surgery. METHODS: Between 8/2001 and 8/2003, 25 patients (58 +/- 15 years) underwent extended transaortic septal myectomy with partial excision and mobilization of the papillary muscles. Concomitant surgical procedures were performed in 40 % (CABG n = 9, aortic valve replacement n = 2). In 24 %, prior septal ablation was ineffective. Intraventricular gradient was 80 +/- 29 mm Hg at rest and 143 +/- 35 mm Hg during exercise. Mitral regurgitation affected 72 % of patients, and 88 % were NYHA functional class III or IV. RESULTS: No hospital death, no postsurgical ventricular septal defect, and no complete atrioventricular block occurred. Severe nonfatal complications occurred in 24 % of patients. Intensive care was necessary for 1.8 +/- 1.7 days; total hospital stay was 11.8 +/- 3.8 days. Early follow-up was complete in 100 % (15 +/- 6 months, total of 376 months) with no late deaths, no relevant mitral regurgitation, or intraventricular gradients. Functional status was markedly improved (NYHA class I 40 %, class II 56 %, class III 4 %). CONCLUSIONS: Early results of extended surgical myectomy and reconstruction of the subvalvular mitral apparatus in hypertrophic obstructive cardiomyopathy remain excellent with respect to mortality, morbidity, and functional capacity even when restricting surgery to patients earlier supposed to be at high risk.

Adult↗
PubMed1992

[Round-headed spermatozoa--contraindication for IVF].

A couple is presented suffering from primary sterility for 20 years and who were selected for an IVF test, since conservative methods failed to induce a pregnancy. The ejaculate of two semen samples revealed exclusively round-headed spermatozoa in each sample. Contrary to this diagnosis, however, asthenoteratozoospermia had been diagnosed in previous investigations and the patient had been treated with tamoxifene. However, no therapy exists for the phenomenon of round-headed spermatozoa, because this defect is genetic of origin and correlates with irreversible infertility.

Adult↗
PubMed1989

[Detection of cyclosporin A in breast milk--is breast feeding contraindicated?].

Cyclosporin A (CyA) was measured simultaneous in breast milk and maternal and fetal blood with a new monoclonal specific radioimmunoassay in a patient who was treated with Cyclosporin A during pregnancy because of kidney transplantation. CyA-levels in breast milk were 15 to 90% higher than in maternal blood. In case of breast feeding a child would take up less than 5 percent of an immunosuppressive dose. However, we would recommend ablactation because of the toxicity and the unknown side effects of CyA for the child's immunologic system.

Adult↗
PubMedDate not supplied

[Indications and contraindications for patellectomy].

We analyzed 40 patients (42 knees) who underwent patellectomy an average of 12 years ago. Although there was good relief of pain with very good function in several patients, we felt that only 48% of the patients could be rated as good or very good, overall. Prognosis was best in patients under the age of 30. Bad prognostic signs were preexisting gonarthrosis and previous total meniscectomy. There was no difference in results for patients who underwent patellectomy acutely, as compared to those who had patellectomy as a secondary procedure. Therefore, we recommend that patella-sparing procedures be utilized first before consideration of patellectomy.

Adolescent↗
PubMed1984

[Indications and contraindications of beta blockaders in the treatment of glaucoma].

Local administration of beta-blockers to the eye has proven effective in the treatment of chronic simple glaucoma. However, varying degrees of impaired ventilation, even to the point of being life-threatening, have been reported. The effect of 1% pindolol and 0.5% timolol eye-drops, twice daily applied locally to the eye, on eyeball pressure and airway resistance was measured in 19 patients with chronic glaucoma. Compared with timolol eye-drops, pindolol had little effect on ventilatory functions, i. e. there was a significant difference between them. But the two preparations had similar effects in lowering eye-ball pressure. The likely explanation of this divergent action is the intrinsic sympathomimetic activity of pindolol.

Adrenergic beta-Antagonists↗
PubMed1992

Are gram-negative bacteria a contraindication to selective preservation of infected prosthetic arterial grafts?

Management of infected prosthetic arterial grafts has traditionally included total graft excision especially when gram-negative bacteria were cultured. Between 1973 and 1991 we treated 42 patients with infected prosthetic grafts (33 polytetrafluoroethylene (PTFE), 9 Dacron) by complete graft preservation when the graft was patent, the anastomoses were intact, and the patient did not have sepsis. The infection involved the anastomosis (36 cases) or the body (6 cases) of 33 peripheral grafts and the distal segment of five aortofemoral and four iliac-distal grafts. Cultures of the 42 infected grafts grew gram-positive bacteria in 33 cases and gram-negative bacteria in 22 cases. Treatment adjuncts included repeated, radical operative wound debridement and rarely (7 of 42) rotational muscle flaps. This management resulted in a 10% (4 of 42) hospital mortality rate and an amputation rate in survivors of 3% (1 of 38 threatened limbs). All four deaths were due to sepsis: gram-positive bacteria were cultured in all cases and gram-negative bacteria in two cases. Of the 38 survivors, 29 (76%) wounds healed and remained healed after average follow-up of 3 years (range, 1 to 18 years). Nine other patients required total graft excision for nonhealing wounds (7 cases) or delayed anastomotic hemorrhage (2 cases). Gram-negative bacteria were cultured in four, and gram-positive bacteria were cultured in six of these nine wounds. Four of nine (44%) graft infections that cultured Pseudomonas organisms healed without complications versus 23 of 33 (70%) wounds that cultured gram-positive bacteria, and 12 of 13 (92%) wounds that cultured gram-negative bacteria other than Pseudomonas organisms.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Vessel Prosthesis↗