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Biomedical subjects

E Hauptmann

Publications and source records attributed to E Hauptmann.

At least 19 recordsLinked to original sources
PubMed1996

Transesophageal atrial pacing in anesthetized patients with coronary artery disease. Hemodynamic benefits versus risk of myocardial ischemia.

BACKGROUND: Transesophageal atrial pacing (TEAP) provides prompt and precise control of heart rate and improves hemodynamics in anesthetized patients with bradycardia and hypotension. The authors' purpose in this study was to examine the hemodynamic benefits of TEAP versus the risk of myocardial ischemia in patients about to undergo coronary artery bypass surgery. METHODS: Hemodynamics, ventricular filling pressures, mixed venous oxygen saturation, and end-diastolic, end-systolic, and fractional area change of the left ventricle, determined by transesophageal echocardiography (TEE), were measured after anesthesia induction with 30 micrograms/kg fentanyl and at incremental TEAP rates of 65, 70, 80, and 90 beats/min (bpm) in 40 adult patients. Monitoring for myocardial ischemia was accomplished with 12-lead electrocardiograms and biplane TEE assessment of left ventricular regional wall motion. Hemodynamics, electrocardiograms, and TEE measurements at each TEAP rate were compared with baseline awake measurements (except TEE) and with measurements obtained after anesthesia induction before TEAP. RESULTS: Sinus bradycardia occurred in 15 patients after anesthesia induction and was associated with a hypotensive response and a decrease in cardiac output in 10 patients. In these patients, TEAP restored diastolic blood pressure and cardiac output to baseline values at TEAP rates of 65 and 80 bpm, respectively. Stroke volume was similar to baseline measurements after anesthesia induction and at TEAP rates of 65, 70, and 80 bpm, but was significantly reduced from baseline at TEAP 90 bpm. Myocardial ischemia was detected in 7 and 5 patients at a TEAP rate of 80 and 90 bpm, respectively. CONCLUSIONS: Control of heart rate with TEAP restores intraoperative hemodynamics to baseline in patients in whom bradycardia and a hypotensive response develop before coronary artery bypass surgery. When using TEAP for patients with severe coronary artery disease, these results support using the lowest TEAP rate titrated to achieve optimal hemodynamics, while closely monitoring for myocardial ischemia, especially at TEAP rates > 80 bpm.

Adult↗
PubMed1995

Successful treatment of bleeding pseudoaneurysms of chronic pancreatitis.

A ruptured pseudoaneurysm is the most rapidly fatal complication encountered in patients with chronic pancreatitis, with a reported mortality rate of 12.5% in treated patients to > 90% in those untreated. Although reportedly a rare complication of chronic pancreatitis, a pseudoaneurysm is encountered in 6-9.5% of patients with chronic pancreatitis and as many as 17% of all patients operated on for chronic pancreatitis. Timely diagnosis and treatment seems to result in markedly reduced mortality. Four patients with bleeding pseudoaneurysms associated with chronic pancreatitis and pseudocysts were encountered recently at Virginia Mason Medical Center. These patients' charts, as well as the English literature, were reviewed in detail. All of our cases occurred in alcoholic males. Pseudocysts with pancreatic ductal or pseudocyst rupture were seen in three cases. All had a history of crescendo-decrescendo pain episodes and had evidence of bleeding or were bleeding at presentation. Splenic vein occlusion was identified in 50% of the cases. A pseudoaneurysm was documented by angiography in all patients. Embolization was successfully attempted without complication in two patients. Three patients were ultimately treated with a pylorus-sparing (2) or standard (1) pancreaticoduodenectomy. These three are alive and doing well at 16, 26, and 52 months from the time of their procedure. A fourth patient was treated nonoperatively, because of severe comorbid disease and aberrant anatomy, with successful embolization of the pseudoaneurysm and biliary and pancreatic stenting. The pseudocyst resolved and he is asymptomatic 12 months after therapy. We advocate preoperative arteriography in all patients with suspected or known arterial pseudoaneurysm.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Preoperative visceral angiography alters intraoperative strategy during the Whipple procedure.

To determine the importance of preoperative visceral angiography prior to pancreaticoduodenectomy, all Whipple procedures performed between 1985 and 1991 at the Virginia Mason Medical Center were retrospectively reviewed. During this period, 77 pancreaticoduodenectomies were performed for both neoplastic disease (n = 54, 70%) and chronic pancreatitis (n = 23, 30%). Sixty-four preoperative angiograms were obtained, of which 39 (61%) were abnormal findings. Thirty percent (19 of 64) of the angiograms revealed a significant vascular abnormality that required specific preoperative or intraoperative measures that might not have been performed without knowledge of these findings. Examples include celiac axis revascularization for celiac occlusion, hepatic artery preservation for replaced vessels, preoperative embolization for pseudoaneurysm or arteriovenous fistula, and splenectomy for splenic vein thrombosis. Because of the high percentage of significant findings requiring an intraoperative or preoperative technical change, we recommend the use of angiography in order to diminish morbidity in all patients preparing to undergo pancreaticoduodenectomy.

Angiography↗
PubMed1991

The roles of age and sex in the prognosis of chronic leukaemias. A study of 373 cases.

The roles of age and sex and their relationship to other prognostic factors were studied in 117 chronic myeloid leukaemia (CML) and in 256 chronic lymphocytic leukaemia (CLL) patients. Survival in CML was not related either to age at diagnosis or to sex. In contrast, the CLL patients classified into four age strata (less than 50, 50-59, 60-69, greater than 70 years) had an expected median survival (EMS) of 142, 101, 85 and 33 months respectively (chi 2 for heterogeneity = 35.59, P less than 0.0005; chi 2 for trend = 25.09, P less than 0.0005). Prognostic power was independent of sex, Rai stages, total tumour mass score (TTM), TTM distribution pattern, anaemia, thrombocytopenia, serum immunoglobulins and response to therapy. The relative survival rate (the ratio of patient's EMS and EMS in age- and sex-matched general population) was 0.40 in CLL patients and 0.13 in CML patients. Relative survival was more reduced in older CLL patients than in younger ones (0.37 vs 0.47, respectively), whereas relative survival was less reduced in older CML patients than in younger ones (0.18 vs 0.12, respectively). The results show that the age is a significant independent prognostic factor in CLL but not in CML. The difference in the effects of age on prognosis in CLL and CML most probably reflects the fundamental differences in their respective pathogeneses.

Age Factors↗
PubMed1990

High dose ARA-C as induction therapy of acute myeloid leukaemia.

Twenty-one newly diagnosed adult AML patients were treated with high dose Ara-C (HD-ARA-C) as a single induction treatment with the dose of 2 g/m2 q 12 hours x 12. Seventy-six percent (16/21) responded with complete remission. Three patients died in induction in pancytopenia, another one died on day 44 in CR due to bleeding of pulmonary aspergilloma. This treatment seems to be highly efficient for remission induction, but requires an adequate transfusion and other supportive measures. The overall toxicity was transient and seems acceptable. However, the remission duration is unacceptably short, the consolidation with the same treatment seems to be inadequate. More aggressive treatment in postinduction period seems to be warranted.

Adult↗
PubMed1987

Endoscopic studies of nabumetone in patients with rheumatoid arthritis. A comparative endoscopic and histologic evaluation.

Gastric tolerance to 1 g of nabumetone administered in a single nightly dose was assessed in two trials in patients with rheumatoid arthritis. Gastroscopy and histology of mucosal biopsy specimens were performed before and after the end of treatment in both trials. Trial 1 was an open study that compared the effects of 1 g of nabumetone at night with those of naproxen (dose, 500 mg twice daily) and indomethacin (dose, 50 mg three times daily) in 41 hospitalized patients. After three weeks of treatment, nabumetone was significantly better tolerated than naproxen or indomethacin. Trial 2 was a randomized trial with 24 patients per group that compared 1 g of nabumetone given at night with 250 mg of naproxen given in the morning and 500 mg given at night for a period of three months. This single-blind study revealed that the number of patients with microscopic or macroscopic mucosal lesions was significantly smaller following intake of nabumetone. Concerning efficacy, as judged clinically by a rheumatologist, treatment with nabumetone was superior as well.

Adult↗
PubMed1986

Cytomorphological and cytochemical classification of acute myeloid leukaemia (AML).

One hundred cases of adult AML were classified cytomorphologically (FAB-classification) and cytochemically (Loeffler's classification). From this combined analysis it could be shown that some corrections have to be made in the FAB-classification; particularly groups M-1 and M-4 had to be reclassified. The authors, therefore, advocate that the final FAB-classification should be the result of cytomorphologic as well as cytochemical analysis.

Female↗
PubMed1981

Influence of splenectomy upon immunologic reactivity of patients with Hodgkin's disease.

Since most patients with Hodgkin's disease benefit from splenectomy, a study was designed to explore whether these beneficial effects could be attributed to the recovery of patients' immunologic reactivity. Using a series of ordinary skin test (PPD-tuberculine, Varidase and Candidin) determination of absolute T and B lymphocyte counts in peripheral blood and their mitogenic responsiveness, assessment of immunologic reactivity was performed in 28 Hodgkin's disease patients, prior to and 14 days after splenectomy. The results showed that overall immunologic reactivity of these patients was suppressed as judged by low absolute lymphocyte counts (1747.2 +/- 171.9), lower counts of T (592.0 +/- 92.1) and B cells (295.9 +/- 40.5) and their poor capacity to respond to phytohemagglutinin (PHA) (20342.6 +/- 3662.8 cpm), although the reactivity towards skin test antigens seemed to be well preserved. After splenectomy the reactivity improved, absolute lymphocyte counts raised to 2654.9 +/- 468.8 and were parallelled by an increase in T (936.7 +/- 138.0) and B cell counts (402.2 +/- 81.2). PHA reactivity recovered as well (26965.5 +/- 4035.6 cpm), however, its remained lower than in control cultures. Furthermore, the immunocompetence of patients' spleens was assessed. The possible influence of some suppressive mechanisms such as serum-blocking factor and prostaglandins is discussed.

Adolescent↗
PubMed1979

[Analysis of the use of blood and blood components at the Dr. O. Novosel Internal Medicine Clinic in Zagreb].

The use of blood and components was analysed during the period of two years in the Dept. of Med. "O. Novosel", Med. Fak. of Zagreb. The blood use factors were compared with those from other hospitals and hospital staff's transfusion practice was judged by them. The use of blood was higher than in the compared hospitals due to the extremly high use in the Dept. of Haematology. This department is highly specialised with predominancy of patients with haematologycal malignancies. The blood factors of other departaments compare well with these from other hospitals. Blood component therapy in an accepted principle and is fully practiced. 77% of all transfusons were given as PRC. Difficulity in management of haemotherapy is clearly seen by the fact that only 72% of reqested doses were supplied by Blood Transfusion Service. For each Rhesus positive received dose of blood it was neccessary to order 1,4 doses and for each A Rhesus negative dose, 2 doses. The worst situation was with B and AB Rhesus negative blood. For one received dose it was neccessary to order 2.9 and 2,8 doses respectively. Similar situation was with blood components. Only 64% of requested platelet concentrates and less than 42% of granulocyte concentrates were obtained. The shortage of blood and blood components is a serious hindrance to the optimal treatment of patients.

Blood Transfusion↗
PubMed1977

Treatment of acute non-lymphoid leukemias: comparison of two protocols.

The results of treatment of 57 patients suffering from acute non-lymphoid leukemia by two protocols are compared. The more aggressive Coap protocol rendered a higher remission rate (57.1%), than the mild Guyer protocol where the remission rate has been 25%. The best results have been achieved in the former group in the younger population; in the latter group there has been no age-effect relationship. Although the remission rate differed in both protocols there has been no statistically significant difference in survival.

Cyclophosphamide↗