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Biomedical subjects

E Bauer

Publications and source records attributed to E Bauer.

At least 19 recordsLinked to original sources
PubMed1992

New aspects in the staging of lung cancer. Prospective validation of the International Union Against Cancer TNM classification.

BACKGROUND AND METHODS: To validate the new TNM definitions for lung cancer (International Union Against Cancer [UICC] TNM classification, 4th edition, 1987), the data of 3823 patients were analyzed prospectively in terms of concordance between clinical (TNM) and pathologically confirmed classification (pTNM), the value of the various diagnostic techniques in estimating the pathologically confirmed classification, and the prognostic relevance of the new TNM definitions. RESULTS: With regard to the primary tumor (T), clinical and pathologic classifications were identical in 63%; with regard to lymph node involvement (N), the agreement was 47%; for distant metastasis agreement occurred in 91% of cases and for the stages it occurred in 56%. As to the primary tumor (T), the accuracy of radiography (59%) was nearly identical to that of computed tomography (CT) (58%). Both techniques were less precise in determining the extent of lymph node involvement (CT, correct assessments in 50%; radiography, correct assessments in 43%). The statistically significant differences in the prognosis for the T, N, and M categories and for the stages and the categories of the new R classification could be confirmed. Allowance should be made for the different prognosis between T1N0M0 and T2N0M0 by the new Substages IA and Ib of Stage I. CONCLUSIONS: By the new TNM definitions for bronchus carcinoma, international conformity became feasible and practical, and the improvement of its prognostic relevance provided a more reliable basis for establishing guidelines for individual oncologic concepts.

Bronchial Neoplasms↗
PubMed1992

[Pericardectomy and acute infectious pericarditis].

Between 1980 and 1990 12 patients (5 male, 7 female) were operated on for acute infectious pericarditis at a mean age of 42 years. The infections were 6 bacterial (purulent 4, abscess 2), 4 tuberculous, 1 viral and 1 Candida. Pericarditis resulted from contiguous spread of infection from bilateral pneumonia in 3 patients, from subphrenic abscess in 2 and followed bacteremia in 1. Clinical signs were: tamponade/shock in 9, elevated jugular venous pressure in 11, edema in 6, hepatomegaly in 6, ascites in 1, and pericardial friction rub in 3. A preoperative pericardiocentesis in 9 patients allowed only 4 positive microbiological diagnoses and was an insufficient drainage in all cases. The preoperative mean NYHA class was 3.3. The pericardectomy was total in 9 patients and partial in 3. Total mortality was 1/12 patients (8%) with one late death due to recurrent tuberculous pericarditis. No patient with purulent pericarditis died. Another recurrence occurred 6 months after acute viral pericarditis. Atrial fibrillation in one patient was the only postoperative complication. After a mean follow-up period of 48.5 months no cardiac constriction had occurred in 11 surviving patients Actuarial survival after pericardectomy is 100% after 1 month and remains 91% after 5 years. The mean NYHA class has significantly improved to 1.2 (p less than 0.05) at the end of the follow-up. We conclude that pericardectomy combined with a specific antimicrobial therapy is a safe treatment for acute infectious and especially purulent pericarditis with low mortality and excellent longterm results. Early pericardectomy allows rapid decompression of the heart, removal of intrapericardial adhesions and infected tissue and prevents late constriction.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

Surgical treatment of cardiovascular complications in Marfan syndrome: a 27-year experience.

Fifty-two patients with Marfan syndrome and ascending aortic pathology were treated surgically between 1964 and 1990. The indication for primary operation was true aneurysm of the ascending aorta with or without aortic insufficiency in 35 patients (67%) and dissection in 17 (33%). Composite grafts were used in 28 patients (54%; group I) and other procedures on the ascending aorta in 24 patients (46%; group II). The latter included supracoronary graft replacement with or without aortic valve replacement or reconstruction (n = 13), and reconstruction of the ascending aorta with or without aortic valve replacement (n = 11). Composite graft insertion was combined with mitral valve surgery at the same operation in 3 patients (6%). The early mortality after primary operations was 7.7% (4 deaths) and the late mortality was 27% (14 deaths). Eight late deaths were related to cardiovascular complications. The mean follow-up was 6.7 years (range 1-27 years). The actuarial 5-, 10-, and 15-year survival rates for all patients were 82%, 63%, and 44%, respectively; for group I (composite grafts) they were 87%, 76%, and 57%; and for group II (other types of operations) they were 73%, 53%, and 37%. The incidence of late complications was much higher in group II than in group I (50% vs. 16%). At 5 and 10 years, the actuarial rates of freedom from late complications related to the primary operation were 88% and 80%, respectively, in group I and 65% and 18% in group II. Composite graft insertion is the operation of choice when approaching the ascending aorta and/or aortic valve in Marfan syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Axillo-femoral bypass and simultaneous removal of the aorto-femoral vascular infection site: is the procedure safe?

In a retrospective analysis 12 patients treated for aorto-femoral vascular infections between 1984 and 1990 were evaluated. They were all male with a mean age of 63 years. Indications for treatment were: mycotic aneurysms-3, primary aorto-enteric fistula-2 and graft infection-7. Surgical treatment consisted of implantation of an extra-anatomic bypass, carefully avoiding the infected area, followed by removal of the infected graft and tissue at the same session. There was no early mortality (less than 30 days) but the first year mortality was 42% (n = 5). Causes of death were: aortic stump disruption (n = 1), recurrence of aorto-enteric fistula (n = 2), axillary anastomosis disruption (n = 1), cardiac failure (n = 1). Orthotopic reconstruction of the aorta after 12 months, as we advocate, was accomplished in two patients and is scheduled in another one. In two patients their poor condition precluded this second step, and in two further patients above-knee amputation with subsequent extra-anatomic graft removal was needed. Only one of the 12 extra-anatomic bypasses became infected. Reconstruction by axillo-femoral bypass combined with removal of the aorto-femoral graft at the same session is a practicable procedure with good early results. However, the rate of successful orthotopic reconstruction of the aorta after 12 months is low because of a high mortality rate, especially in the presence of aorto-enteric fistulas, and because some patients with well functioning axillo-femoral grafts are in too poor condition for another large operation.

Aged↗
PubMed1992

Valve replacement in octogenarians: increased early mortality but good long-term result.

Between January 1983 and December 1990, 20 patients aged 80 years or older underwent valvular surgery. The patients' ages varied from 80 to 87 years (mean, 82 +/- 1.5 years). The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a bioprosthesis in one. There were 15 elective, two urgent, and three emergency operations. Four of these patients had aortic valve replacement plus coronary artery bypass grafting. Six patients (30%) had an uneventful hospital stay, and the other 14 (70%) experienced several post-operative complications. The operative mortality rate was 15% (three patients). All patients before operation were in NYHA (New York Heart Association) class III and IV and all survivors remained in NYHA class I or II. The survivors have been followed from 6 to 70 months (mean 20 +/- 8 months). The actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. Valvular replacement in octogenarians can be performed, despite the high rate of post-operative complications, with increased but acceptable mortality. Long-term results are good.

Aged↗
PubMed1992

ESWL of stones in the mid-ureter.

Two hundred and twenty patients with a ureteric calculus were treated by in situ ESWL; in 60 of these the stone was located in the mid-ureter. Treatment was given without anesthesia or with sedoanalgesia only. Complete or partial stone clearance at the time of discharge from hospital was achieved in 95% irrespective of the site of the stone and there were no complications. It is suggested that in situ ESWL is effective in the treatment of stones in mid ureter as well as those in upper and lower ureter.

Algorithms↗
PubMed1992

[Prevention of cytomegalovirus infection following heart transplantation].

Cytomegalovirus (CMV) infection after heart transplantation (HTx) is a severe complication, which leads to long treatment and hospital stay. Even if prophylactic therapy with anti-CMV IgG antibodies is performed, there is a high incidence of infection, especially when the heart from a CMV positive donor is transplanted to a CMV negative recipient (high risk constellation). This study evaluates the prophylactic antiviral therapy with ganciclovir in CMV high risk constellation at HTx. Out of 108 HTx, 29 CMV negative recipients (IgG and IgM) received a heart from a CMV positive donor (IgG pos., IgM neg.). The control group (CO) (n = 8) was treated with anti-CMV IgG antibodies (Cytotect 2 ml/kg at day 0, 1, 2, 7, 14, 21,), whereas the study group (GAN) (n = 13) was treated with ganciclovir (7.5 mg/kg single dose n = 8, or 5 mg/kg in twice daily doses n = 5 from day 1 to 14). Urea, creatinine, white blood cell count and platelet count was controlled daily. No side effects on renal and bone marrow function were noted. Therapy was well tolerated. Both groups had similar immunosuppressive protocol (prophylactic cytolysis, prednisone, azathioprine and cyclosporin A) and were similar in age, sex, preoperative diagnosis and NYHA class. Seroconversion for CMV (IgM and IgG) was observed in 75% of CO and 31% of GAN (p less than 0.05). Clinical manifestations of CMV infection started in the second month after HTx with fever in both groups CMV-organ manifestations developed in 50% (or 67% of infected) in CO (enterocolitis 2, pneumonitis 3, tonsillitis 1), and in 15% (or 50% of infected) in GAN (pneumonitis 2, epididymitis 1) NS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Arrhythmogenic Takayasu disease].

The Authors report a case of Takayasu disease in a woman who died at the age of forty-six, in whom the histological examination of the cardio-vascular system revealed giant cells granulomatous arteritis localized in the aortic arch and collateral arteries; endocarditis and granulomatous coronaritis. The bases of arrhythmogenic alterations, in this study, take into account the thrombosis of the conduction system arteriolar vessels and the phlogosis extending to the cardiac plexus.

Adult↗
PubMed1992

[Technique and organization of heart removal from the multi-organ donor].

The orthotopic heart transplantation is an accepted treatment for terminal cardiac disease. The technique of heart procurement and preservation is explained and the primary graft function in 108 subsequent heart transplantations is assessed. The mean ischemia time is 41 +/- 10 min in local, 98 +/- 19 min in distant (< 100 km) and 114 +/- 16 min in distant (> 100 km) organ procurement. Our method of preservation consists of cold cardioplegic arrest with potassium (30 mEq/L) cardioplegic solution. The incidence of the indication for high dose katecholamine-treatment after surgery and the maximal creatininekinase levels rose with ischemia time. All hearts recovered within a few days and the stay in the intensive care unit was not prolonged. We conclude that the heart preservation with cold cardioplegic arrest results in a good primary graft function. It is important to keep the ischemia time as short as possible.

Graft Survival↗
PubMed1992

[Valve replacement in patients over 80 years of age].

Between January 1983 and October 1990, 20 patients age 80 years or older (mean 82 +/- 1.5 year, range 80 to 87 years) underwent valvular surgery at Clinic for Cardiovascular Surgery Zurich. The indication for operation was aortic stenosis in 19 patients, and mitral insufficiency after previous mitral valve replacement with a bioprosthesis in one. There were 15 elective operations, 2 urgent, and 3 emergency operations. Four of these patients had aortic valve replacement plus coronary artery bypass grafting. The operative mortality rate was 15% (3 patients). All patients were preoperative in NYHA classes III and IV. All survivors remained in NYHA classes I or II. The survivors have been followed from 6 to 70 months (mean 20 +/- 8 months). The actuarial survival rate at 1 and 5 years was 78.5% and 67%, respectively. Valvular replacement can be performed with increased but acceptable mortality and morbidity. Long-term results are encouraging.

Aged↗
PubMed1992

[Surgery of infectious pericarditis].

Between 1980 and 1990 34 patients (pat.) (21 male, 13 female) were operated for infectious pericarditis (P.) at a mean age of 48 years (min. 2, max. 70 years). The infection was acute in 12 pat. (7 bacterial, 4 Tbc, 1 viral). A chronic constrictive P. was found in 22 pat. (15 history of Tbc, 7 history of viral P.). The preoperative mean NYHA class was 3.0. Cardiac catheterization was performed in 22 pat. and confirmed restrictive pericardial disease in all cases with elevated and equalized diastolic pressures in all 4 cardiac chambers. Mean cardiac index was 2.7 l/min m2 and the ejection fraction 53%. Pericardectomy (Pe.) was performed through an anterolateral left thoracotomy in 31 pat. and through a sternotomy in 3 pat. Total and partial Pe. were performed in 31 and 3 pat., respectively. Total mortality was 3/34 pat. (8.8%) with no operative death (one early and two late deaths). There were two recurrent P. (1 Tbc, 1 viral) and no recurrent constriction. Long-time follow-up of 31 surviving pat. is known in 28 cases with a mean follow-up of 4.6 years (min. 1 month, max 10.5 years). At the end of the follow-up the mean NYHA class ist 1.3 (p less than 0.005). Actuarial survival after Pe. is 97% after 30 days and 90% after 5 and 10 years. In our retrospective study we conclude that Pe. is a safe treatment for infectious P. with low mortality and excellent long-time results with improvement of cardiac function. Pe. should be performed early for purulent or constrictive P. There is no conservative treatment for progressive myocardial constriction and the resulting cardiomyopathy. After total Pe. there is a low rate of recurrent P. or constriction.

Adolescent↗
PubMed1992

[Retroperitoneal approach in selective surgery of the infrarenal aorta].

In recent years, there has been a resurgence of interest in the retroperitoneal approach to the aorta; however, there has been only few prospective studies in the literature and the results are controversial. For this reason, we assessed peri- and postoperative problems associated with both procedures and compared the results of each one in a prospective study. Between 1989 and 1990, 163 patients underwent operative procedure because of an aortic or aorto-iliac lesion. 121 were operated on through the "classical" transperitoneal method (87 had aortic aneurysm, 34 aorto-iliac occlusive disease) whereas in 42 patients, retroperitoneal approach of the aorto-iliac bifurcation was performed (28 because of aortic aneurysm and 14 because of occlusive disease). Early mortality was 0 in the group with retroperitoneal approach, despite the fact that 66% of these patients were classified as high-risk patients (American Society of Anesthesia risk classification III or IV); it was 0.8% in the group with classical approach. Retroperitoneal group demonstrated significant decrease in blood (630 vs 1300 ml) and crystalloids (1700 vs 3250 ml) requirement, shorter nasogastric intubation time (1.6 vs 4.4 d) and quicker peroral intake. Significant pulmonary and cardiac complications were less often observed in the group of patients after retroperitoneal approach to the abdominal aorta. Mean postoperative hospital stay was significant shorter when compared with the transperitoneal group (8.5 vs 13.9 d). Our results confirm that retroperitoneal approach is an excellent alternative to the transperitoneal method for elective reconstructive surgery of the abdominal aorta. It is associated with better tolerated incisional pain, decrease in cardiac and pulmonary complications and thereby decreased hospitalization time.(ABSTRACT TRUNCATED AT 250 WORDS)

Aorta, Abdominal↗
PubMed1992

[Blood substitution in aorto-iliac surgery].

To determine the amount of blood substitution required we evaluated in a retrospective analysis 68 consecutive patients that were operated on the infrarenal abdominal aorta 1990, 60 men with a mean age of 66 years (40-87) and 8 women, aged 73 years (62-85). Indications for treatment were: aneurysm (55) and occlusive disease (13). 21 aneurysms (45%) were ruptured and had to be operated as an emergency. Early lethality (less than 30 days) in this group was 19% (n = 4). In the other 47 patients there was no early mortality. Mean blood products transfusion requirements in patients with ruptured abdominal aortic aneurysm was: 18 (9-34) units of concentrated red cells, 16 (3-43) units of fresh frozen plasma (FFP) and 5 (0-19) units of concentrated red cells, 2 (0-7) units of FFP in the elective group. Main determinants of blood loss in the elective group were: the number of anastomoses and the preoperative status of the coagulant system. We conclude that in elective surgery of the infrarenal aorta homologous transfusion can be virtually eliminated if an entire autologous transfusion concepts is applied (predonation, intraoperative salvage, hemodilution and plasmapheresis).

Aged↗
PubMed1992

[Mycotic aneurysm of the infrarenal aorta: surgical possibilities and results].

Between 1973 and 1990 eleven patients with mycotic aneurysm of the abdominal aorta underwent surgery. Extra-anatomic axillobifemoral bypass with aortic ligation and aneurysm excision was performed in 5 patients, and in situ reconstruction in 6. There were 3 early and 3 late deaths. Regardless of the type of operation, surgery of mycotic aneurysm is followed by severe postoperative complications with high the early and the late mortality rates.

Aged↗
PubMed1991

[Late results following surgical repair of aneurysm of the descending thoracic aorta].

A consecutive series of 74 patients was analyzed after repair of descending thoracic and thoracoabdominal aortic aneurysms. After hospital discharge there were 13/71 deaths (18%) during a mean follow-up of 60 +/- 20 months (range: 28-107). Actuarial analysis showed a mean survival rate of 89% after 1 year, 78% after 5 years and 71% after 9 years. During the same time period there were reoperations of the aorta in 10/71 patients (14%). Actuarial analysis showed freedom of reoperation in 97% after 1 year and in 80% after 5 years. Elective repair of these aneurysmal lesions can be recommended.

Actuarial Analysis↗
PubMed1991

[Aortocoronary bypass surgery in patients older than 70 years].

From January 1981 to December 1990, 204 patients aged between 70 and 81 years underwent aortocoronary bypass surgery. Operative mortality (30-day mortality) was 6.8%. Actuarial survival rate at 1 and 5 years was 92% and 86% respectively. A higher incidence of postoperative complications was observed (arrhythmias in 19%, reoperation for bleeding in 5.4%, respiratory and neurological complications in 13% and 3% respectively, perioperative infarction in 4.4%). The mean follow-up was 25 months. Preoperatively most patients (71%) were in New York Heart Association (NYHA) functional class III and IV, and at the end of following-up in NYHA functional class I and II (95%) (p less than 0.001). A rapid rise in coronary artery surgery in the elderly is evident. It is associated with an increased but acceptable operative risk. Long-term results and postoperative improvement of functional status are very satisfactory.

Age Factors↗
PubMed1991

[Vascular complications associated with aortic dissection].

Aortic branch occlusion may constitute the mode of presentation or become an important focus of treatment in patients sustaining acute aortic dissection. The optimal therapeutic approach in patients with acute aortic dissection complicated by cerebral, visceral and peripheral vascular problems, and the implications of such complications, are not well established. We review the outcome in 187 consecutive patients (149 males and 38 females, mean age 58 years) with acute dissection of the thoracic aorta who were admitted and operated on in our department over a 13-year period. We assess the incidence, consequences and specific management of significant stenotic and obstructive lesions of the aorta and its branches. Noncardiac vascular complications occurred in 59 patients (32%); of these complications, 38 were associated with type A dissection (incidence 28%) and 21 with type B dissection (incidence 48%). A trend towards decreasing overall surgical mortality was observed in the second part of the study (1983-1989) compared with the first part (1977-1982) i.e. 28% versus 12%. Although aortic rupture and cardiac tamponade were the strongest correlate of morbidity and mortality, death specifically related to vascular complication was more common when such malperfusion occurred in the carotid, celio-mesenteric and renal circulation. Proximal aortic repair at the site of the intimal tear with obliteration of the false lumen may have restored adequate distal circulation in 27 patients in whom improvement of the visceral or peripheral ischemia was observed after the thoracic aortic repair. Additional procedures (immediately after the thoracic repair or later) were necessary in 15 patients to restore adequate perfusion in the compromised area.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗