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Biomedical subjects

E Struck

Publications and source records attributed to E Struck.

At least 37 records · Page 2Linked to original sources
PubMed1990

Multicentric quality assurance in cardiac surgery. QUADRA study of the German Society for Thoracic and Cardiovascular Surgery (QUADRA: quality data retrospective analysis).

A method for initiating quality assurance in cardiac surgery was developed multicentrically by a commission of the German Society for Thoracic and Cardiovascular Surgery (QUADRA Study). To appraise the quality of cardiosurgical action, variables were compiled from the preoperative, intraoperative, and postoperative treatment course. The data collection was carried out at the same time as treatment. On the basis of unicentric data profiles, multicentric hospital profiles, and problem profiles, a quality comparison could be carried out and the variability of cardiosurgical action which may occasion interventions could be identified. A reduction of perioperative blood consumption during the study period could be observed in four out of five hospitals as the first result. The data collection also revealed epidemiological features. On average, women were older than men at the time of the heart-valve and coronary operations. To ensure data validity and the organization of quality assurance, a documentation assistant and a specially trained physician are necessary at every cardiovascular surgery center. The multicentric external comparison is indispensable and must be carried out by means of a central data collection, for which intrumental and staff capacities are also to be provided. With modern methods of data processing, an additional and new approach to the improvement of quality in cardiac surgery can thus be made.

Blood Transfusion↗
PubMed1990

[Is preservation of erythrocyte concentrates with added solutions an alternative to deep freezing in heart surgery autologous blood donation?].

In patients undergoing cardiovascular operations the deep freezing of autologous red blood cells (RBC) was compared with the liquid storage in PAGGS-Sorbitol. On an average 3.9 units of blood were predeposited in the group with deep freezing and 3.4 in the group with liquid storage. The number of complications was the same in both groups despite the shorter intervals between the donations in the group with liquid storage. 58 out of 74 patients (= 78%) with deep frozen autologous RBC and 42 out of 65 patients (= 65%) with liquid stored RBC need no homologous blood. 12% of the liquid stored RBC were discared due to unforseen delaying of the operation.

Adenine↗
PubMed1988

Pilot study on quality assurance in cardiac surgery.

In 1986 development, testing and improvement of a multi-center based quality assurance procedure has been started by the German Society for Thoracic and Cardiovascular Surgery supplied by a research fund of the Federal Ministry of Research and Technology. Initially five cardiac surgery units took part in defining quality related items, collecting associated data and establishing a common data base. In the first year of its existence this data base received about 3800 records of patients undergoing cardiac surgery procedures using ECC. Preoperative clinical state, intraoperative actions and postoperative results including unexpected events sum up to an average record length of 300 items per procedure. Evaluation and representation of quality related data ist done in two ways: an overall quality profile consisting of 17 so called quality indicators accompanied by six patient-mix indicators enables each cardiac surgeon to get a quick global reference within the multicentrical data context, and several problem oriented profiles assist building and testing of special quality-related hypotheses towards improvement of procedure standards and performance.

Cardiac Surgical Procedures↗
PubMed1988

[Surgical aortic valve replacement for acute Streptococcus viridans endocarditis with simultaneous moderate hemophilia A].

This is a report of a 25-year-old patient with known aortic valve stenosis since early youth and hemophilia A, showing recurrent joint bleeding. Acute Streptococcus endocarditis induced aortic valve insufficiency resulting in cardiac failure. Aortic valve replacement was performed after substitution of factor VIII, during which intra- and postoperative bleeding was prolonged by pericardial adhesions. Heparin was administered during cardiopulmonary-bypass as usual, but usual postoperative cumarin therapy was not initiated due to prolonged PTT time. One year postoperatively, the patient was in an excellent condition and fully rehabilitated.

Adult↗
PubMed1986

[Hemolytic uremic syndrome following juvenile lupus erythematodes disseminatus].

A 12.5 year old girl was admitted to hospital with the typical signs of hemolytic uremic syndrome, and systemic lupus erythematodes as well. On the basis of clinical, blood chemistry, and histological findings we assumed an hemolysis-induced form of hemolytic-uremic syndrome as the most likely pathogenic mechanism. The child also suffered from congenital IgA-deficiency and produced an inhibitor against coagulation factor VIII. Congenital IgA-deficiency, systemic lupus erythematodes, inhibitor-induced hemophilia and hemolytic uremic syndrome are suggested to form a pathogenic sequence.

Child↗
PubMed1985

Human cardiac transplantation--evaluation of morphological changes in serial endomyocardial biopsies.

From May 1981 through July 1984 a total of 29 human allogenic orthotopic cardiac transplants were performed in Munich. The first two patients initially received conventional immunosuppressive treatment for 79 and 27 days, respectively; then treatment was continued with cyclosporine. All subsequent 27 patients received only cyclosporine treatment. Seventeen of the cardiac recipients are currently alive. Three of the recipients who died succumbed to immunological rejection. Twenty-five cardiac grafts were controlled by 355 sequential biopsy procedures, which yielded 1158 endomyocardial specimens for histological examination. The morphological findings and changes observed in the endomyocardium were analyzed. The interpretation of these findings and difficulties encountered in their interpretation are discussed. Special attention is attributed to findings possibly associated with the cyclosporine treatment.

Adult↗
PubMed1985

Open mitral commissurotomy. A new plea for an old operation.

From April 1974 through December 1982, 673 patients underwent surgery for isolated mitral valvular disease. Valve replacement was mandatory in 507 patients; of these, 255 received low-profile mechanical (mainly Björk-Shiley) prostheses and 252 bioprostheses. In 166 patients the mitral valve was amenable to reconstructive repair. This analysis is concerned exclusively with a subset of 127 patients, in whom open mitral commissurotomy was carried out (104 females and 23 males with a mean age at the time of operation of 45.5 years). There were 2 postoperative deaths, both due to intractable arrhythmias: one on the 4th postoperative day and one 6 years after surgery, giving a cardiac-related mortality of 1.5%. Thromboembolic complications were observed in 5 patients, none of whom developed permanent neurological deficits. There were 2 non-cardiac-related deaths: one of cancer and one of viral pneumonia. Mitral valve replacement was subsequently required in 2 patients at 2 and 7 years, respectively, after commissurotomy. Surgical intervention is pending for 2 further patients who appear likely to require valve replacement. Based on actuarial curves, the analysis of these results shows that, provided valvular morphology is suitable, open mitral commissurotomy is superior to valve replacement with respect to mortality rate and long-term survival.

Bioprosthesis↗
PubMed1985

Heart transplantation: limitations and perspectives.

The intrinsic limitations of heart transplantation are the restricted availability of donated organs, patient selection, hospitalisation costs, and the limited capacity of cardiac surgery clinics. With a better understanding of organ transplantation and heart transplants in particular, both by the general public and the medical profession, improvements in the care of patients with terminal myocardial disorders seem to be possible with heart transplantation. The one year survival rate for heart transplants is 80%. The success of the treatment is determined by the hemodynamic capacity of the transplanted organ, security against rejection reactions, effects of cellular transplant reactions, and side effects of immunosuppression. Within defined limits heart transplantation is the best standardised method of treatment for terminal myocardial failure.

Adolescent↗
PubMed1984

Tetralogy of Fallot. Development of hypoplastic pulmonary arteries after palliation.

Thirty-one patients with tetralogy of Fallot were studied angiographically before and after palliation with Blalock-Taussig operation (n = 9), Brock operation (n = 12), or enlargement of the right ventricular outflow tract with extracorporeal circulation (ECC) (n = 10). The relative diameter of the pulmonary vascular ring (PVR), pulmonary trunk (PT), and right and left pulmonary arteries (RPA, LPA) were measured before and 24.8 +/- 20.9 months after palliation. Using correlation analysis, the magnitude of growth of the pulmonary artery system was inversely related to its initial size. Mean pressure in the pulmonary artery after palliation as well as the period between date of surgery and recatheterization did not correlate significantly with growth. After Blalock-Taussig operation, the ipsilateral pulmonary artery predominantly increased in size without significant growth of PVR and PT. Brock operation and enlargement of the right ventricular outflow tract with ECC, improving the flow in the pulmonary vascular system centrally, induced a significant, symmetrical growth of the pulmonary vascular system and, therefore, are our methods of choice for palliation in patients with tetralogy of Fallow combined with hypoplastic pulmonary arteries.

Adolescent↗
PubMed1984

The treatment of tetralogy of Fallot: early repair or palliation?

Between 1974 and 1983, 380 consecutive patients with tetralogy of Fallot underwent surgery. In 73 patients, undergoing palliative surgery, the operative mortality and late mortality was 6.8%. Twenty-five of these patients have undergone subsequent complete repair, while 38 are awaiting correction. During the last 4 years we preferred operative procedures with enlargement of the right ventricular outflow tract (80%) to shunt operations (20%). In contrast to shunts, enlargement of the outflow tract induces a symmetrical growth of hypoplastic pulmonary arteries without the risk of acquired pulmonary atresia or peripheral stenosis at the site of anastomosis. Three hundred twenty-nine patients have undergone repair. In 101 patients, who had palliative operations before complete repair, the operative mortality was 12.9% and late mortality 2.9%. Those patients undergoing repair as a first operation had an operative mortality of 8.8%, and a late mortality of 1.3%. In the last 5 years the operative mortality for all patients, whether or not they had had previous palliative surgery, was 4.7%. The incidence of transannular outflow tract patching was not greater in children less than 2 years of age (16.9%) than in older children, 2 to 14 years of age (16.5%). However, in our experience the requirement for subvalvular outflow patches was higher in younger children (52.1%) than in the older children (34.1%). Because of this high incidence, particularly in younger patients, we have now begun to repair tetralogy of Fallot using the transatrial approach, thus reducing our use of subvalvular patches.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

[Early correction of the interrupted aortic arch].

Between 1974 and March 1983, 14 infants with interruption of the aortic arch (IAA), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) have been operated at our institution. In the beginning of our experience only palliative operations were performed, consisting in reconstruction of the aortic arch, closure of PDA and pulmonary artery banding (PBA). According to this procedure five patients were operated. Three of them died, the two survivors underwent successful closure of the VSD subsequently. Since 1979 the primary total correction, with repair of the extra- and intracardial anomalies in deep hypothermia and circulatory arrest, is the operation of choice. A total of nine patients underwent primary correction, in this latter group we observed two deaths only.

Aorta, Thoracic↗
PubMed1983

Phrenic nerve pacing for the treatment of central hypoventilation syndrome - state of the art and case report.

The application of phrenic nerve pacing is an effective method of respiratory support in adults with certain forms of acquired failure of automatic ventilation. The experience with one infant suffering from congenital central hypoventilation (Ondine's syndrome) is summarized in this report. Stimulation electrodes were implanted on the thoracic portion of each phrenic nerve. After a cumbersome period of intensive medical care and conditioning of the phrenic nerve-diaphragm-system, the patient could be weaned off the respirator. Severe upper airway obstruction, however, required tracheostomy. Bilateral simultaneous pacing has been effective now for more than 2 years providing the desired normal ventilation during sleep. The state of the art of phrenic nerve pacing is described.

Diaphragm↗