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Biomedical subjects

E Wolner

Publications and source records attributed to E Wolner.

At least 379 records · Page 21Linked to original sources
PubMed1982

[Improved myocardial protection in open heart surgery by massive preoperative insulin supply (author's transl)].

In this study we investigated, whether in addition to cooling and cardioplegia, preventive administration of massive doses of insulin with glucose exerts a protective effect on the myocardium by increasing myocardial glycogen stores and shifting myocardial metabolism towards (primarily anaerobic) glycolysis. Experiments were done on two groups of 5 dogs each (average 27 kg) undergoing experimental extracorporeal circulation (ECC) with 90 min aortic clamping, under cooling and cardioplegia. Cardiac output (CO), systolic ventricular blood pressure (Pventr), heart rate (HR) and mean central venous pressure (CVP) were recorded at LA-levels of 5, 10, 15 and 20 mm Hg before onset of ECC (preop. value), after termination of ECC, and after 2 periods of a 10 min. reperfusion. While the 1st group served as control, the 2nd group received a massive i.v. insulin supply (total 20 U/kg) every 10 min, as well as glucose to keep blood sugar level stable within 60 min. prior to the onset of ECC. It was shown that in the control group after termination of ECC and after 1st reperfusion Pventr and CO were significantly below the preop. values, and only after the 2nd reperfusion within the preop. range. In the insulin group, however, Pventr and CO were already within the preop. range at termination of the ECC. After the 1st and after the 2nd reperfusion CO was in part significantly above the preoperative value. HR and total peripheral resistance (TPR) were not significantly changed. It is concluded that preventive insulin application produces a more vital myocardial cell function immediately after termination of ECC, indicating increased myocardial protection and improved ischaemic tolerance.

Animals↗
PubMed1979

[Myocardial revascularization in threatening extension of myocardial infarction (author's transl)].

Myocardial revascularization was performed in 13 patients between two and 14 days following initial infarction because of impending re-infarction. The diagnosis of impending re-infarction was made on the basis of the following criteria: myocardial infarction; repeated stenocardia despite medical treatment; renewed ST-T changes in the ECG. The intra-aortic balloon pump was installed in 7 patients for haemodynamic reasons (shock, massively raised pressure in the pulmonary artery). 12 patients survived the surgical intervention and were eventually discharged free of stenocardia. The presented findings suggest that surgical intervention in impending re-infarction appears of value in those cases which have not been satisfactorily controlled by conventional medical treatment.

Adult↗
PubMed1979

[Radioimmunological determination of parathyroid hormone: regional localization in hypercalcaemic hyperparathyroidism (author's transl)].

Angiographic or scintigraphic localization of parathyroid adenomas is successful in only a small number of patients with hypercalcaemic hyperparathyroidism. This report is concerned with the preoperative localization of parathyroid adenomas by regional catheterization of the thyroid veins in patients with hypercalcaemic hyperparathyroidism (n = 7). PTH was determined radioimmunologically, using an antiserum specific for PTH1-84 and the carboxyl-terminal fragment of the hormone. Determination of regional differences in the plasma concentration of PTH permitted the preoperative localization of PTH secreting adenomas. The preoperative localization of parathyroid adenomas was confirmed in each instance by surgery. Thus, the regional determination of plasma PTH represents a tool to improve the preoperative localization of parathyroid adenomas in patients with hypercalcaemic hyperparathyroidism and, hence, to reduce the risk of an unsuccessful operation.

Adenoma↗
PubMed1979

[Surgery of the mitral valve (author's transl)].

A report is given on the results of different forms of mitral valve operations in 866 patients. Closed mitral valvulotomy was performed in 519 patients and mitral valve replacement in 291 cases. Open mitral valve anuloplasty was performed as reconstructive surgical procedure in 15 patients. The overall mortality was 10.4%. Follow-up of the surviving patients showed that the long-term results of mitral valve replacement are significantly worse than those of mitral valve reconstruction.

Austria↗
PubMed1979

[The research programme "Artificial Heart" at the 2nd Department of Surgery, University of Vienna: a ten year review (author's transl)].

The experimental and clinical results are presented of the research programme "Artificial Heart" carried out by the 2nd Department of Surgery, University of Vienna. In particular, an assessment of the clinical experience in 177 patients with the intra-aortic balloon pump is documented and it is concluded that only limited cardiac support is possible by this pump. In view of this fact more efficient methods of mechanical circulatory support, such as the interaortic auxilliary ventricle, the aortic "Windkessel" ventricle with guiding balloon, and two types of ventriculo-aortic bypass ventricle were tested with regard to their haemodynamic and long-time efficacy. The transatrio-aortic auxilliary ventricle (E-LVAD) was also clinically tested in 11 patients. In conclusion the problems of total mechanical heart replacement are discussed.

Animals↗
PubMed1978

[Injuries of the oesophagus (author's transl)].

34 cases of perforation of the oesophagus are reported, partly treated at the surgical and partly at the E.N.T. department. Air emphysema of the throat or of the mediastinum and/or escape of the contrast medium was observed in all patients. The main cause of perforation was endoscopic examination. The patients partly underwent conservative and partly surgical therapy, both groups showing similar mortality rates. Small perforations in the upper third of the oesophagus can be treated conservatively, whereas perforations in the lower two thirds, especially with involvement of the pleura, pericardium or peritoneum, need rapid surgical intervention, as the prognosis improves in relationship to the rapidity with which treatment is instituted following perforation.

Adult↗
PubMed1978

[Surgical therapy of postinfarct tachyarrhythmia (author's transl)].

Thirteen patients with ventricular tachyarrhythmias after myocardial infarction underwent surgery at the heart wall or at the coronary vessels. Ten of these patients had an aneurysm of the anterior wall or akinesia of the anterior wall which in some cases was associated with stenosis of the right coronary artery or of the circumflex artery. One patient showed an isolated stenosis of the right coronary artery. One patient died from recurrent ventricular fibrillation during hospitalization, another patient died from reinfarction 4 months later. All the other patients could be discharged and were improved significantly.

Female↗
PubMed1978

Clinical application of the ellipsoid left heart assist device.

The ellipsoid left heart assist device (E-LVAD) was implanted in eight patients suffering from intraoperative heart failure. It was not possible to remove these patients from extracorporeal circulation following an intracardiac procedure; therefore, implantation of the E-LVAD was performed during extracorporeal circulation. The inflow connector was pushed forward from a purse-string suture on the right superior pulmonary vein, across the mitral valve and into the left ventricle. The outflow connector was joined to the ascending aorta. In two patients, the artificial heart chamber was removed after complete recovery of the circulation; these patients, however, later died. In six other patients, untreatable right heart failure developed and these patients died with the pump in place. It is concluded, therefore, that the right heart must also be mechanically supported during postoperative heart failure.

Adult↗
PubMed1977

[Long-term results after isolated aortic and mitral valve replacement with a prosthesis (author's transl)].

111 patients with aortic valve replacement (AVR) and 159 patients with mitral valve replacement (MVR) were studied after hospital discharge. The late mortality was 20% after AVR and 32% after MVR. Of the survivors, 93% were greatly improved after AVR and 83% after MVR (functional class I or II). The calculated 5-year survival rate of the patients with AVR is 76% and with MVR 64%. The general state of health of the survivors, the thromboembolic rate and the fatal complications are discussed. Further improvement in the results can only be expected if valve replacement is performed before irreversible myocardial damage has occurred.

Adult↗
PubMed1977

[Thyroid function following thyroidectomy determined by the TRH-induced release of thyrotropin (author's transl)].

The response of hTSH to TRH (400 mug i.v.) was studied in 45 patients who underwent thyroid surgery for various reasons. Euthyroid values of T4 and ETI were observed in all but one patient. An increased response of hTSH to TRH (as compared with 15 control subjects) was observed in 12 out of 30 patients operated upon for non-toxic goitre, in one out of nine operated upon for toxic goitre and in three out of six patients who underwent thyroidectomy for thyroid carcinoma or proliferating adenoma of the thyroid. The necessity of specific replacement therapy in those individuals with increased release of hTSH upon TRH administration is discussed.

Adult↗