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Biomedical subjects

G Wollenek

Publications and source records attributed to G Wollenek.

At least 55 records · Page 3Linked to original sources
PubMed1992

Psychosocial problems of donor heart recipients adversely affecting quality of life.

Heart transplantation has become an accepted therapy for patients suffering from terminal heart disease for whom neither standard forms of medication nor the usual surgery are of any benefit. Although results regarding postoperative quantity and quality of life are encouraging, it must not be overlooked that the patient and his family face, and have to overcome, profound psychosocial problems. The main stressors were identified in interviews with 47 heart transplant patients. The main preoperative problems were: the way of being informed about the diagnosis, the waiting period for transplantation, anguishing doubts about the decision to have a transplant, being a body without heart ('zombie'), guilt and shame regarding the donor, the reactions of others. Postoperatively the patients have to cope with: re-entering social systems, reactions of friends, neighbours and colleagues, rejection episodes, death of a fellow patient, the need to redesign family life. All the problems reported by the patients interviewed are discussed regarding their psychosocial implications, and hints are given on how to minimize them.

Adaptation, Psychological↗
PubMed1992

Does changing the heart mean changing personality? A retrospective inquiry on 47 heart transplant patients.

Heart transplantation is not simply a question of replacing an organ that no longer functions. The heart is often seen as source of love, emotions, and focus of personality traits. To gain insight into the problem of whether transplant patients themselves feel a change in personality after having received a donor heart, 47 patients who were transplanted over a period of 2 years in Vienna, Austria, were asked for an interview. Three groups of patients could be identified: 79% stated that their personality had not changed at all postoperatively. In this group, patients showed massive defense and denial reactions, mainly by rapidly changing the subject or making the question ridiculous. Fifteen per cent stated that their personality had indeed changed, but not because of the donor organ, but due to the life-threatening event. Six per cent (three patients) reported a distinct change of personality due to their new hearts. These incorporation fantasies forced them to change feelings and reactions and accept those of the donor. Verbatim statements of these heart transplant recipients show that there seem to be severe problems regarding graft incorporation, which are based on the age-old idea of the heart as a centre that houses feelings and forms the personality.

Adolescent↗
PubMed1992

One and one-half year experience with unilateral and bilateral lung transplantation.

Lung transplantation has now become an established form of treatment for end-stage pulmonary parenchymal and vascular diseases. Despite its wide acceptance, technical aspects are still in discussion. We report on the initiation of our own lung transplant program and the technical changes we have performed during our first 1 1/2-year experience. During that period of time, we have performed 26 lung transplantations (16 single lung [SLTX] and 10 bilateral lung transplantations [BLTX]). Three-month survival for the whole group was 74% (69% for the SLTX group and 77% for the BLTX group). No instance of bronchial dehiscence was observed; however, there were eight cases of bronchial stenosis: six were managed by silicone stent insertion, one by bronchoplastic correction, and one by retransplantation. Changes in the technique of the bronchial anastomosis together with the addition of prednisone to the immediate postoperative immunosuppressive regime resulted in almost complete avoidance of these problems.

Adult↗
PubMed1992

The determinants of elevated total plasma cholesterol levels in cardiac transplant recipients administered low dose cyclosporine for immunosuppression.

Elevated total plasma cholesterol level is a frequent finding after cardiac transplantation. To identify risk factors for the development of hypercholesterolemic states, we applied multivariate statistics in a logistic and linear manner. Six-month posttransplantation levels of total plasma cholesterol in 57 adult heart recipients were available for analysis. Maintenance immunosuppression was carried out with either cyclosporine and azathioprine or both agents plus low-dose steroids. Total plasma cholesterol levels were dichotomized for the logistic analysis (1) by the age- and sex-matched 75th and 90th percentiles of a reference population according to National Institutes of Health treatment guidelines and (2) by the cut point 250 mg/dl. Twelve potential risk factors were evaluated as covariates: recipient age, body weight after 6 months, body weight gain over 6 months, body mass index after 6 months, body mass index gain over 6 months, current cyclosporine dosage, trough level of cyclosporine in whole blood according to high-performance liquid chromatography after 6 months, cumulative cyclosporine dosage over 6 months, serum bilirubin, type of original cardiac disease, maintenance steroids, and steroid bolus treatment. Multivariate logistic regression yielded the type of original cardiac disease as a significant predictor of posttransplantation hypercholesterolemia exceeding the 90th percentile (p = 0.019) and of hypercholesterolemia exceeding 250 mg/dl (p = 0.032). Maintenance steroids were identified as a second significant cofactor (p = 0.069) for total plasma cholesterol levels exceeding 250 mg/dl. Multiple linear regression again revealed the type of original cardiac disease and maintenance steroids as significant predictors by p values of 0.005 and 0.013, respectively. Patients with coronary artery disease as the original cardiac pathology and low-dose maintenance steroids had the greatest risk for the development of elevated total plasma cholesterol levels after cardiac transplantation. However, the overall predictive quality of the linear model was limited (multiple r value 0.43), which indicates that other variables besides the tested ones attributed to elevated total plasma cholesterol levels. These results confirm the adverse role of maintenance steroids on posttransplantation hypercholesterolemia and demonstrate the type of original cardiac disease as the most important risk factor. They suggest that abnormalities of lipoprotein metabolism and dietary factors continue to affect total plasma cholesterol levels after cardiac transplantation.

Adult↗
PubMed1991

Early results with the anatomical correction of transposition of the great arteries.

From November 1984 to April 1991, 38 children underwent an arterial switch operation for transposition of the great arteries (TGA). In 24 infants (mean age 8 days) TGA with intact ventricular septum was present, in 14 patients (mean age 75 days) TGA was combined with a ventricular septal defect (VSD). There were 11 in-hospital deaths with an overall mortality of 29%, mainly due to technical problems. Whereas the group TGA + VSD showed a mortality rate of 50%, simple TGA and the subgroup simple TGA younger than 14 days had a mortality rate of 16.7% and 17.4%, respectively. Mortality was not influenced by coronary artery morphology and age. In simple TGA, the data presented suggest that this operation can be performed with good short-term clinical results. Most children are asymptomatic and without medication at a mean follow-up time of 2.5 years; but as there are pathological postoperative findings in echocardiography, the long-term benefit remains a matter of concern. Considerable perioperative problems are present in cases of TGA + VSD so surgical management is more differentiated, including other options.

Follow-Up Studies↗
PubMed1991

The progression of mild acute cardiac rejection evaluated by risk factor analysis. The impact of maintenance steroids and serum creatinine.

The natural course of mild acute cardiac allograft rejection (MAR) under cyclosporine-based therapy is generally considered benign, and usually antirejection therapy is not instituted. The present study was undertaken to determine the frequency of and the risk factors for progression of MAR into a clinically significant (moderate or severe) rejection on subsequent endomyocardial biopsy (EMB). Among 167 cardiac recipients, transplanted from 3/1984 to 4/1990, MAR under cyclosporine-based therapy was diagnosed on 220 EMBs. Depending upon the outcome on the subsequent EMB, MAR was categorized as progressive or nonprogressive. This served as the dependent variable for a stepwise logistic regression analysis evaluating 11 covariates as potential risk factors: perioperative antibody prophylaxis (ATG vs. OKT3), maintenance therapy, underlying disease, HLA-mismatches for A- and B + DR-loci, serum creatinine (mg/dl) and cyclosporine HPLC blood level (ng/ml) at diagnosis of MAR and at subsequent biopsy, recipient age, donor age. 40 (18.2%) of 220 MARs became progressive as opposed to 37 (7.3%) of a control cohort of 507 negative EMBs (P less than 0.0001). Stepwise logistic regression yielded the type of maintenance therapy (P = 0.0019) and serum creatinine level at diagnosis of MAR (P = 0.0615) as independent predictors of progression of MAR. After adjustment for influence of maintenance therapy and serum creatinine none of the cyclosporine variables provided any additional information. MARs without maintenance steroids and low serum creatinine levels had the highest risk (37.2% observed incidence) to develop moderate or severe rejection on subsequent EMB. This analysis supports evidence that diagnosis of MAR on EMB is associated with a considerable high progression rate into clinically significant rejection when compared to negative EMBs. Progression particularly occurs in MAR under steroid-free maintenance therapy and suggests early augmentation of immunosuppression. In terms of progression of MAR serum creatinine values, obviously indicating cyclosporine nephrotoxicity, appear to reflect the extent of cyclosporine-mediated immunosuppressive activity more properly than parameters of its bioavailability by measuring cyclosporine HPLC blood levels.

Adrenal Cortex Hormones↗
PubMed1991

["You need a new heart". The problem of diagnostic disclosure from the viewpoint of the affected cardiologic patient].

Heart transplantation has become a reasonable therapeutic option in treatment of patients with terminal heart diseases. Though it offers increased quantity as well as improved quality of life, information about needing a donor heart is a turning point in the patient's life. The aim of the study was to evaluate through postoperative interviews how that information was given by the doctors and how the patients had coped with it. It could be shown that 19 of the 49 interviewed patients took the information about needing a new heart as an expected event and chance, while for the remaining 30 it absolutely meant an unexpected information and a shock. Furthermore, only 3 persons reported about having had a helpful and empathic talk to their doctors. 26 about nothing but a short, cool information, and 10 held the shock about the way of information given by the doctors responsible for their bad preoperative psychical condition. Statements of patients are given to elucidate the results, which were discussed from the point of psychosomatics as well as from the communication sciences. At last, summarizing, rules for a helpful pretransplant-information to the patients were given.

Adaptation, Psychological↗
PubMed1991

[Unilateral lung transplantation as an effective therapy in primary lung emphysema].

Unilateral lung transplantation is the treatment of choice for terminal restrictive lung disease. We report about three patients with end-stage pulmonary emphysema treated by single lung transplantation. All patients are alive 3, 6 and 7 months after the operation with good quality of life. Blood gases have normalized and lung function parameters have markedly improved. We conclude, that single lung transplantation can be an effective treatment for selected patients with end-stage obstructive lung diseases in the absence of chronic infections.

Adult↗
PubMed1991

[Quality of life and personal satisfaction following heart transplantation: an indicator of treatment results].

Cardiac transplantation is an established method of treatment to prolong survival in terminally-ill patients with severe heart disease. This study was undertaken to evaluate the quality of life and its best expression as satisfaction in patients who had undergone cardiac transplantation one year previously. From a total of 47 patients (14 with coronary artery disease, 27 with dilated cardiomyopathy and six with valvular heart disease), self-assessment questionnaires were completed to judge postoperative improvement/deterioration (change of status) and satisfaction with the level achieved as designated on the basis of visual analogue scales. Quality of life and satisfaction were assessed in nine categories: physical, emotional, mental, vocational, sexual status, financial situation, leisure activities, partnership and overall quality of life. The data was analyzed with the Wilcoxon and Kruskal-Wallis tests. The patients reported a consistent improvement in quality of life and satisfaction with respect to all categories except financial situation. Accordingly, quality of life after cardiac transplantation can be regarded as substantially improved. While most marked improvement was incurred in physical status and, consequently, overall quality of life, there was also a meaningful salutary effect on psychosocial aspects of life such as emotional well-being and leisure time activities. There were significant differences between change of status postoperatively and satisfaction with the level achieved in the categories of mental and vocational status, financial situation and partnership as well as family relations. Statistical analysis showed that outcome with respect to quality of life and satisfaction was not dependent on the underlying disease or the age of the patient at the time of transplantation.

Activities of Daily Living↗
PubMed1991

[Risk factors for local recurrence of rectal carcinoma].

The impact of distal resection margins and the mode of operation on pelvic recurrence rate was assessed in 331 cases following abdomino-perineal resection (APR; n = 134), and anterior resection (AR; n = 197) for rectal cancer. Local recurrence was observed in 55 cases (16.6%) after a median interval of 16 months. Only 20 of 212 patients (9.4%) without positive lymph nodes developed a local recurrence, but 35 of 119 (29.4%) with nodal involvement. The recurrence rate was 33% (10/30) in cases with local spread to adjacent structures (T4), and 15% in cases with less extensive penetration. Of 59 poorly differentiated cancers 15 developed pelvic failure (25%), as opposed to 40 of 272 (14.7%) well or moderately differentiated tumours. 17.7% developed local recurrence after AR, and 14.9% after APR. The recurrence rate following AR was 30% in 33 cases with resection margins less than or equal to 10 mm and 17.4% in 115 cases with margins from 11 to 40 mm, and 10% in 49 cases with wider margins. Cox's multiple proportional hazards regression revealed that nodal involvement (p = 0.0003), local invasion (p = 0.0055), poor differentiation (p = 0.066), and AR vs. APR (p = 0.099) were independent risk factors for pelvic failure. For the AR cases the factors were nodal involvement (p less than 0.0001), local invasion (p = 0.0043), and a resection margin less than or equal to 25 mm on the fixed specimen (p = 0.0039). For patients with negative lymph nodes local invasion was the only independent risk factor, whereas the variables "anterior resection" and narrow resection margin were significant only in node positive cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[The hyperventilation syndrome as psychosomatic components of heart transplantation: case study].

The case study presents a patient with severe disturbance of self-esteem, suicidal family-background, narcissistic trauma and psychosomatic illness in form of a hyperventilation syndrome in the light of his heart transplantation. Helplessness and hopelessness of his psychological situation, his fear of separation, his paralyzing inability to come to any decision are seen against the background of a situation of absolute stress in which he had to struggle against his anxieties and fears and presumptions about the donor organ. There also is discussed whether a patient with such severe disturbances should really be accepted as a donor organ recipient, as well as whether in this case a supportive or analytic therapy would have been the appropriate choice. Annotations of the author about personal difficulties in therapy and at last its failing are added.

Cardiomyopathy, Dilated↗
PubMed1989

[Acute poisoning caused by sodium azide].

Until now, only few cases of intoxication with sodium azide have been published. The case of suicidal sodium azide ingestion reported here and a survey of the relevant literature serve to demonstrate the pharmacological mode of action and the symptoms of acute poisoning, as well as the diagnostic proof of the toxic agent. Only symptomatic treatment can be implemented at present. Due to the restricted accessibility of the azide there is a close connection in the known cases of intoxication to the patient's profession or his (her) place of work: 17 out of 20 cases involved persons working in laboratories, whilst in 2 cases sodium azide was administered to patients by mistake. Knowledge of this connection may be of great help in making the diagnosis of acute sodium azide poisoning.

Adult↗
PubMed1989

[Orthotopic heart transplantation at the 2d Surgical Department of the University of Vienna: 4-year experience].

Between March 1984 and August 1988, 89 orthotopic cardiac transplants were performed in 87 patients at the Second Department of Surgery, University of Vienna. 2 patients underwent retransplantation and 3 patients received previously a total artificial heart bridge. Recipients were immunosuppressed with low dose cyclosporine, azathioprine and since May 1986 with additional low dose prednisolone; all patients were supplemented perioperatively with either ATG or OKT3. 1-year survival rates continuously increased from 33% in 1984 to 88% in 1987 (p = 0.07). The one-year survival rate in recipients given double drug therapy (cyclosporine and azathioprine) was 43% as compared with 77% on triple therapy (cyclosporine, azathioprine and prednisolone, p = 0.003). Acute rejection was the leading cause of death. These data indicate that the substantial improvement in survival rates is attributable to augmented immunosuppression and to improved patient management and recipient selection.

Adolescent↗
PubMed1989

Characteristics of 308 nm excimer laser activated arterial tissue photoemission under ablative and non-ablative conditions.

The present study was designed to assess the characteristics of tissue photoemission obtained from normal and atherosclerotic segments of human postmortem femoral arteries by 308 nm excimer laser irradiation of 60 ns pulsewidth. Three ablative (20, 30, and 40 mJ/pulse) and three non-ablative (2.5, 5, and 10 mJ/pulse) energy fluences were employed. Both the activating laser pulses and the induced photoemission were guided simultaneously over one and the same 1,000 micron core optical fiber that was positioned in direct tissue contact perpendicular to the vascular surface. The spectral lineshape of normal arterial and noncalcified atherosclerotic structures was characterized by a broad-continuum, double-peak emission of relevant intensity between wavelengths of 360 and 500 nm, with the most prominent emission in the range of 400-415 (407 nm peak) and 430-445 nm (437 nm peak). Fibrous and lipid atherosclerotic lesions, however, exhibited a significantly reduced intensity at 437 nm compared to normal artery layers (P less than 0.001), expressed as a 407/437 nm ratio of 1.321 +/- 0.075 for fibrous and 1.392 +/- 0.104 for lipid lesions. Normal artery components presented with approximately equal intensity at both emission peaks (407/437 nm ratio: intima, 1.054 +/- 0.033; media, 1.024 +/- 0.019; adventitia, 0.976 +/- 0.021). Comparison of spectral lineshape obtained under various energy fluences within a group of noncalcified tissues disclosed no substantial difference using the 407/437 nm ratio (P greater than 0.05). In contrast, calcified lesions revealed high-intensity multiple-line (397, 442, 461, and 528 nm) emission spectra under ablative energy fluences, whereas a low-intensity broad-continuum, single-peak spectrum resulted from irradiation beyond the ablation threshold. Thus, these findings suggest fluorescence phenomena for broad-continuum spectra, and plasma emission for multiple-line spectra as an underlying photodynamic process. Regardless of the activating energy fluence, spectral analysis of 308 nm activated photoemission provides accurate information about the laser target under standardized in vitro conditions. It is demonstrated that direct contact ablation and simultaneous spectral imaging of the target tissue via the same optical fiber is feasible.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1989

[A transition zone phenomenon of the skin in cadavers lying in bath water].

In three cases a phenomenon is reported, seen on the skin of bodies found dead after a longer time of lying in bathtubs filled with water. The sign was parallel to the surface of the water and showed a breadth up to about 1 cm. Contrary to the surrounding skin, the mark was characterized by paleness and clearly les distinct formation of postmortem alterations as put-refaction. Searching for an explanation, temperature measurements were performed in model. The results showed the marginal paleness of the skin to be a thermal phase transition phenomenon. This mark has a forensic message too: it demonstrates a longer remaining of the corpse in the corresponding position, is a statement concerning the high of the water level, and allows a reconstruction of the original situation after manipulation, but is no sign of vital reaction.

Adult↗
PubMed1989

Experimental photoablation of meniscus cartilage by excimer laser energy. A new aspect in meniscus surgery.

Excimer lasers have been demonstrated to provide a very precise and circumscribed ablation of synthetic polymers and biological tissues. We investigated in vitro the use of ultrashort pulsed ultraviolet excimer-laser energy for controlled removal of meniscus cartilage under the aspects of arthroscopic meniscectomy. A krypton-fluorine gas mixture was used to achieve laser emission of 248-nm wavelength. A total of 22 human menisci obtained either by operation or necropsy were irradiated over a range of energy fluence (2.15-3.07 J/cm2/pulse), repetition rates (5-20 Hz), and exposure time (15-60s). Ablation rates of 4.00-5.76 microns per pulse were obtained. Light-microscopic examinations demonstrated tissue ablation without any evidence of pathological changes associated with continuous-wave laser irradiation. Effects of laser energy were clearly limited to the target of the laser beam, and tissue removal proceeded without production of heat or smoke. Due to the lack of pathological alterations observed, excimer-laser irradiation of meniscus cartilage may prove to be advantageous for precisely cutting and removing menisci without injury to the surrounding normal tissue. Clinical application of excimer-laser irradiation includes the development of suitable fiberoptics and laser coupling, as well as modification of fiber tips.

Humans↗
PubMed1989

[A modified laser system for laser angioplasty using a sapphire tip].

This study deals with 26 patients on whom successful laser angioplasty of peripheral vascular occlusions had been carried out, using an Nd-YAG high energy laser system (100 watts) with a sapphire point. The technical requirements are presented and the primary success and complication rates in our material are discussed.

Angioplasty, Balloon↗