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Biomedical subjects

E Struck

Publications and source records attributed to E Struck.

At least 73 records · Page 4Linked to original sources
PubMed1979

The diagnosis of acute renal failure (ARF) following cardiac surgery with cardio-pulmonary bypass.

The diagnostic value of renal concentrating capacity expressed as free water clearance (CH2O), in comparison with other routine criteria for the early identification of acute renal failure (ARF), was evaluated in 1,203 adult patients undergoing cardiac surgical procedures. On the basis of the appearance of pathologic CH2O values in the range of -20 to 0 ml/hour or more positive, reversible or irreversible ARF was observed in 90 (= 7.5%) of our patients. Mortality in the presence of ARF was 47%; total ARF mortality was 3.5%. CH2O was pathologic for the first time on an average of 1.6 days after operation. In contrast, routine ARF criteria reported in the literature, such as serum urea and creatinine at varying substrate levels or oliguria, allowed diagnosis 1 to 5.5 days later. Moreover, these parameters only partially and less frequently met the criteria for ARF at the different levels. Likewise, the incidence of ARF decreased to a minimum of 1.7% and the total ARF mortality to 1.3%, depending on the severity of the criteria used. Altogether, the occurrence of pathologic CH2O values proved to be the earliest, most frequent and most reliable criterion for the recognition of ARF following cardiac surgery with cardiac-pulmonary bypass.

Acute Kidney Injury↗
PubMed1978

[Three years experience with biological heart valve prostheses (author's transl)].

Increasing clinical experience has led to a world wide expansion of glutaraldehyde fixed aortic heterografts for valve replacement in patients. The distinct advantage of this valve is a very low rate of thrombembolic complications during the postoperative course. In our hospital 324 such prostheses of the types Hancock and Carpentier have been implanted in 290 patients. In 154 cases follow-up 6 months to 3 years after the operation have been obtained. Thrombembolic complications occured in 1,4%. Other postoperative complications were hepatitis (13,4%), and valvular endocarditis (1,5%). Postoperative control of patients after isolated mitral or aortic valve replacement revealed improved clinical conditions in 90,9%. Dysfunctions of the valve have not been observed. For aortic valve replacement prostheses of a diameter of 27 and 29 mm have been used. In mitral and tricuspid position generally size 31 mm and 33 mm valves were implanted. The decision to use glutaraldehyde fixed biological valves requires the observation of long time results demonstrating reliable mechanical stability of such valves for some decades.

Aortic Valve↗
PubMed1978

[Complications after pacemaker-implantation and their treatment (author's transl)].

Of the 1050 pacemaker-implantations in the German Heart Centre in Munich from April 1974 to December 1977 complications arose in 229 cases necessitating a renewed surgical intervention. In accordance with the literature the dislocation of electrodes was the most frequent complication in the first days and weeks after implantation in our patients wil 11,1%. In cases of electrode dislocation the repositioning of the electrode is necessary; in certain cases an epi-myocardial electrode must be substituted for the usual transvenous electrode. Essential causes of complications were disturbances in woundhealing, necrosis of the skin and infection of the pacemaker-system, which were seen in 3,7% of all cases. In the case of infection of therapy of choice is the explntation of the pacemaker and the implantation of a new system in another position. Technical complications due to material are electrode fractures and battery defects. Complications due to material defects necessitate the exchange of the pacemaker or the electrode. Rare indications for reoperation were increase in threshold, muscle stimulation and allergi reactions caused by pacemakers.

Electrodes, Implanted↗
PubMed1978

[Surgery in newborns and infants with cyanotic cardiac malformations: indication and technique of emergency operations and urgent early surgical interventions (author's transl)].

Between April 1974 and September 1977, 368 infants underwent surgery at the German Heart Center. 287 were less than 1 year of age, and 81 were between the ages of one and two years. In 90 patients (= 24.4%) surgery was necessary because of cyanotic lesions. Within this group corrective procedures were performed in 36 infants during the first year of life, and in 33 during the second year of life, while palliative measures were carried out in these age groups in 15 and 6 infants, respectively. Urgent corrective surgery is indicated as a life-saving measure in neonates with total anomalous pulmonary venous connection (TAPVC) since this lesion is not amenable to either medical nor palliative interventions. Of 10 neonates and young infants who underwent corrective surgery for TAPVC, 3 died during the early post-operative period and 1 subsequently. Balloon atrial septostomy palliatively employed for transposition of the great arteries (TGA) may render only temporary improvement in the clinical status of young infants. In these infants, more favourable results can be achieved through early, functionally-corrective surgery (Mustard-Brom procedure). In 7 infants who underwent correction of TGA during the first year of life there was 1 post-operative death. There was no post-operative mortality in 18 infants whose age at the time of operation was between 1 and 2 years. In the presence of TGA combined with ventricular septal defect there were 3 deaths in 8 infants operated on during the first year of life and none in the 3 who underwent surgery during the second year of life. In the same age groups, early correction of tetralogy of Fallot (TOF) was performed in 11 infants (with 2 deaths) and in 10 infants (with one death), respectively. Thus, in the absence of preclusive, complex anomalies, early surgical correction of congenital cyanotic lesions in young infants consistently yields results superior to that of palliation or two-stage procedures.

Age Factors↗
PubMed1977

[Intraoperative control of revascularisation and indication for reintervention (author's transl)].

Among the procedures of intraoperative control of revascularisation the simple method of probe passage for determination of technical mistakes during anastomoses is very valuable. More informative is the measurement of bypass-flow using an electromagnetic flowmeter. We compared this method with the results of intraoperative angiography, which is performed in our hospital routinely for immediate control of revascularisation. A comparison of 214 veins demonstrated a good statistically significant correlation between run-off and bypass-flow. The quality of the anastomosis can only be judged by intraoperative angiography and does not correlate with a low bypass flow. According to these measurements it was necessary in four cases to perfrom an intraoperative reintervention.

Angiography↗
PubMed1976

[Effects of short time extreme hemodilution with and without hypothermia on hemodynamic and biochemical parameters in the pig (author's transl)].

Extreme hemodilution as "Total Body Washout" (TBW) is a feasible method for the clinical therapy of endo- or exogenous intoxication. This method was modified for a simple and quick setup. Landrace pigs were hemodiluted with a special heart-lung-machine. Within 4 minutes the hematocrit was lowered to less than 1%. The rectal temperature fell hereby in a normothermic group (n = 15) to 35, 1 +/- 1, 1 degrees C and in a hypothermic one (n = 13) to 31,1 +/- 1,3 degrees C. The TBW was followed by a total exchange transfusion. Most of the parameters that were studied did not show significant differences between cold and warm perfusion. The proceeding was well tolerated by the animals, they were observed up to 6 weeks. Disadvantages of initial surface cooling may be avoided by extreme hemodilution with exclusive extracorporal cooling, when cardiac arrest in hypothermia is intended.

Animals↗
PubMed1976

[Hemodynamic studies after the implantation of Hancock-heart valves (author's transl)].

Velocity profile, pressure gradient across the valve and blood flow have been measured in 10 patients after the implantation of bioprostheses of the sizes 27 and 29 millimeters in aortic position. According to these hemodynamic measurements the use of bioprostheses for the aortic valve replacement is recommendable. The low flow velocities in the area of the muscle containing valve cusp did not effect a detectable stenosis intraoperatively under the conditions of rest. The hemodynamic data showed no differences between the Hancock-Zuhdi and the Edwards-Carpentier bioprostheses. Despite of good hemodynamic conditions and a low risk of thromboembolic complications after the aortic valve replacement with bioprostheses reservation is recommended to its clinical use until the long term mechanical stability (more than 6 years) of the biological heart valve prosthesis has been secured.

Adolescent↗
PubMed1975

[Instantaneous blood flow velocity profiles before and after aortic valve replacement (author's transl)].

In 17 patients the instantaneous velocity profile was recorded before and after aortic valve replacement (Starr-Edwards, Björk-Shiley, Lillehei-Kaster). A single gated pulsed Doppler Ultrasonic flownmeter was used for analysis. Distal of these valves a flat flow profile was recorded showing high velocity gradients near the walls. As a main cause of this, numerous eddies and turbulent flow have been suggested. Downstream of a Starr valve a flat profile appears with a slowing down of forward flow just behind the ball. The disk valves Lillehei-Kaster and Björk-Shiley demonstrated a higher flow velocity in direction to the larger opening. The "in vivo" studies have been supported by "in vitro" measurements. The highest flow velocities were above 100 cm/sec and thus, according to Reynolds definition, in the turbulent range. The turbulent flow produces a washing effect, which is emphasized during the cardiac cycle. The importance of these data can be discussed by clinical results only.

Aorta↗