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Biomedical subjects

G Fraedrich

Publications and source records attributed to G Fraedrich.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Significance of digital subtraction angiography for estimation of early results of myocardial revascularization after internal mammary artery grafting].

Between 1st January and 31st December 1987 126 consecutive patients underwent full myocardial revascularization using at least one internal mammary artery bypass grafting in Department of Cardiovascular Surgery of University of Freiburg. In 78 patients (75 males, 3 females) DSA was performed within 8 days after surgery to evaluate dynamics of IMA-graft. The age ranged from 38 to 67 years (mean 53.4 years). DSA study was performed through the brachial artery, contrast medium was injected with flow of 10 ml/sec. in counter current. It was only one series of angiograms necessary to visualise flow from subclavian artery, through IMA to coronary artery. Among 78 investigated patients in 61 (78%) the distal anastomosis appeared to be widely patent and flow through the IMA and anastomosed coronary artery was sufficient. Patency of one of the branches of IMA or stenosis of IMA graft contributed to inadequate flow in 12 patients (15.6%). In 5 (6.4%) operated patients the IMA graft was not patent. Counter current intraarterial DSA requires much smaller amount of contrast medium than classical angiography, moreover avoiding of aortic catheterization with all risks involved. The counter current intraatrial DSA is an excellent technics of estimation of the flow to grafted coronary arteries. The method is easy to perform, repetitive and carry very small risk for the patient. Early postoperative evaluation of IMA-graft patency is essential for estimation of effectiveness of myocardial revascularisation and prognosis for the patient.

Adult↗
PubMed1989

Reduction of blood transfusion requirement in open heart surgery by administration of high doses of aprotinin--preliminary results.

Reduction of homologous blood requirement in cardiac surgery is of increasing interest and may be achieved by various technical and pharmacological means. High-dose aprotinin (about 840 mg, equivalent to 6 million Kallikrein inactivator units), a serine proteinase inhibitor, was administered during open heart surgery to 60 patients refusing homologous blood transfusions or suspected to have an increased risk of bleeding. As a significant decrease in donor blood requirement could be observed, a prospective, randomised double blind study in 80 male patients undergoing primary coronary surgery with high-dose aprotinin administration was performed. Mean blood loss was reduced by 45.9% (652 ml in the treated vs 1204 ml in the untreated group, p less than 0.01) and the mean amount transfused was decreased by 74.2% (242 ml vs 937 ml, p less than 0.01). No homologous blood was needed in 57.9% of the aprotinin-treated patients and in 31.6% of patients not treated with aprotinin.

Aprotinin↗
PubMed1988

[Surgical indications in asymptomatic internal carotid artery stenosis and in relation to heart surgery interventions].

In the last 30 years, carotid endarterectomy has been employed on a wide-spread basis with the intention of providing surgical prophylaxis of stroke. Currently, however, there is no evidence available from prospective, randomized comparative studies indicating a clear superiority of surgical treatment versus medical treatment with respect to stroke prophylaxis or improvement in survival. Based on recent publications with sufficiently large patient populations, operative mortality appears to be about 1% and the rate of perioperative stroke about 3.4%. In those with symptomatic internal carotid stenosis, without surgery there is a 5% yearly risk of cerebral infarction such that carotid endarterectomy possibly appears warranted. In contrast, in association with asymptomatic internal carotid stenosis, that is, in the absence of any symptoms indicative of cerebral hypoperfusion, based on several recent prospective studies, the yearly rate of cerebral infarction is 1 to 2% and, consequently, less than that of the prophylactic surgical intervention. Additionally, carotid endarterectomy does not render complete protection against stroke and the follow-up curves for the respective treatments do not differ meaningfully, even during longterm observation. Accordingly, for asymptomatic internal carotid stenosis, the indication for surgery has not been clearly established. Among those with asymptomatic carotid stenosis, there may be a subgroup of individuals with high-grade luminal obstruction or multiple vessel disease, who according to several studies, appear to be at a higher risk of subsequent complications even though this has not yet been confirmed by prospective, randomized studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid Artery Diseases↗
PubMed1987

[Cardiovascular operations in patients with perioperative reduced kidney function].

Acute renal failure (ARF) following cardiovascular surgery represents a serious complication in view of the multimorbidity in such patients. 8 out of 16 patients with ARF requiring hemodialysis after cardiac surgery died; the degree of preoperative renal insufficiency could not be recognized as predisposing factor. 17 out of 21 patients with ARF following aortic vascular surgery died; the severity of the preoperative disease seems to be of prognostic value. Open heart surgery had to be performed in 9 patients out of the chronic dialysis program; perioperative complications did not occur, suggesting that cardiovascular operations can be performed without increased risk in this patient group.

Acute Kidney Injury↗
PubMed1987

Acute surgical intervention for complications of percutaneous transluminal angioplasty.

Since 1979, percutaneous transluminal angioplasty (PTA) resulting in an overall improvement of 80.3% has been performed in 4380 patients with occlusive atheroma of the lower extremities. Complications requiring immediate surgical treatment occurred in 123 (2.8%) of the cases, consisting of occlusion (16%), dissection (13%), perforation (10%), embolisation (15%) and haematoma at the puncture track (69%). Of the group treated surgically, 18 (14.6%) patients underwent amputation of a lower limb. Since 1980 348 percutaneous transluminal coronary angioplasties (PTCAs) have been performed for coronary artery disease. In 15 cases (4.3%) emergency coronary bypass surgery was necessary because of complications encountered with PTCA. Two patients died and perioperative myocardial infarction occurred in 7 (subendocardial-3: transmural-4). In spite of a low complication rate and good results from PTA and PCTA acute surgical intervention for complications carries a significant operative morbidity and mortality. We conclude that selection for PTA and PTCA has to involve vascular and cardiac surgeons, their presence being mandatory at institutions in which therapeutic radiological procedures are undertaken.

Angioplasty, Balloon↗
PubMed1986

[Acute and delayed aortocoronary bypass operations following transluminal angioplasty].

Since 1980 348 PTCAs and 1288 CABs were performed at our institution (relation 1:4). In 15 cases (4.3%) emergency CAB was necessary because of complications encountered with PTCA. Two patients died, i.e. a mortality rate of 43.3% out of the emergency CABs or 0.6% out of the PTCA group; in 46.6% myocardial infarction occurred. In the same period 12 patients received CAB because of unsuccessful PTCA after a mean time of 4.6 months without increased operative morbidity. Interdisciplinary indication and experience, operation permanence and temporary coronary perfusion may decrease the complication rate.

Angioplasty, Balloon↗
PubMed1985

Intraoperative somatosensory evoked potentials as a prognostic factor of neurologic state after carotid endarterectomy.

Somatosensory evoked cervical and cortical potentials (SEP) were analyzed under general anesthesia in 106 patients undergoing carotid endarterectomy. Cortical electrical silence occurred in 5 patients without an inlying shunt; all developed a new neurologic deficit postoperatively. Analysis of the SEP in these patients revealed progredient cerebral ischemia as indicated by an increase in central conduction time (CCT) and a decrease in amplitude of the primary cortical response N20P25 resulting in a complete loss of cortical SEP later on during the clamping period. In 6 patients the insertion of a shunt restored the deteriorated SEP, these patients and those with unchanged SEP after carotid clamping showed an uneventful postoperative recovery. Taking the presence or absence of N20P25 as the sole parameter, the sensitivity of this technique was 83%, specificity 99% and predictability 83%. A normal range for CCT and amplitude of N20P25 during anesthesia and criteria for shunt insertion were developed. The presented monitoring regimen appears to be rational and is based on current concepts of cerebrovascular physiology and pathophysiology.

Adult↗
PubMed1985

[Experiences with a new EEG spectral analyzer in carotid surgery].

Spectral analysis with the compressed spectral array display (CSA) and calculation of spectral edge frequency (SEF) was performed in 43 cases undergoing endarterectomy of the carotid bifurcation. New neurologic deficit appeared in 2 patients (= 4.6%). One of them died postoperatively (= 2.3%), the other suffered from permanent paralysis of the hand. Another 9 patients showed loss of high frequency activity (= decrease in SEF) without a new deficit in the postoperative period. A significant EEG event was defined as a decrease in SEF after carotid cross clamping for at least 5 min. Fisher's exact probability test revealed a close correlation between these EEG events and neurologic outcome. The sensitivity of the test, which was calculated on true positive and false negative events, was 100%, the specificity, based on true negative and false positive events, was 76%. The predictability of the test, based on all EEG events, was 18%; respectively 40% when calculated on significant events.

Anesthesia↗
PubMed1984

Sarcoma of the lung in a pacemaker pocket--simple coincidence or oncotaxis?

An 82-year-old man developed a soft-tissue sarcoma in the subpectoral pocket of a titanium-covered pulse generator that had been replaced 8 months previously without evidence of tumor. The tumor represented a metastatic manifestation of a malignant fibrous histiocytoma situated in the contralateral lower pulmonary lobe. The patient died some weeks postoperatively due to cachexia. Autopsy revealed no further metastases. The appearance of cancer in patients with pacemakers is probably coincidental and not related to material or electrochemical stimulation, although the site of the generator pocket might be oncotactic because of the irritation that would trap tumor cells and provide disruption in the intracellular endothelial barrier allowing migration of the tumor cells into tissues. Possible causes and relationships are reviewed.

Aged↗
PubMed1984

Intraoperative detection of cerebral ischemia with somatosensory cortical evoked potentials during carotid endarterectomy--presentation of a new method.

Somatosensory evoked potentials (SEP) are an objective measure of cerebral function. They depend on the integrity of cortical blood flow. After stimulation of the median nerve, SEP of subcortical and cortical origin can be recorded within a short time during carotid surgery by means of 3 scalp electrodes. Intraoperative SEP recordings are more resistant to anesthetic influence than is the EEG. In a 69-year-old woman, monitoring with SEP gave an early warning of cerebral ischemia during carotid endarterectomy. The cortical SEP disappeared immediately after carotid cross-clamping. The entire loss of the cortical SEP was associated with a new neurologic deficit postoperatively. This technique is simple and convenient to use and appears to be predictive of neurologic outcome.

Aged↗
PubMed1982

Instillation of fibrinolytic enzymes in the treatment of pleural empyema.

Acute pleural empyema which is not amenable to pleural puncture or closed thoracic drainage should be treated operatively by decortication or, in persistent cavities, by open thoracostomy drainage. In the last 2 years we have instilled 500,000 IU of fibrinolysines (streptokinase and streptodornase) per day into the pleural cavity of 27 patients with pleural infections requiring closed intrapleural drainage. By means of this treatment, pus and fibrinous membranes are liquefied and necrotic tissue is discharge. Therapeutic success is indicated by considerably increased fluid drainage about one hour after instillation. This therapy was performed for an average of 5 days. In 12 patients (44%) pleural empyema could be cured. In the other 15 cases decortication, and in 3 of them open thoracostomy drainage, was necessary. In our opinion intrapleural instillation of fibrinolytic enzymes should be added to the well-recognized method of treatment of pleural empyema, although not replace them.

Acute Disease↗