[Ca, Mg, Na, K and P content of 3 sections of the brain, the myocardium, musculus gracilis, liver, kidneys, lungs and spleen of calves and young cattle].
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Animals↗
Biomedical subjects
H Dittrich
Publications and source records attributed to H Dittrich.
[Fine structure of surviving heart muscle cells in ventricular aneurysms].
Surgically-obtained tissue specimens from 41 patients with ventricular aneurysm were studied electron microscopically. The tissue from the resected aneurysms showed substantially varied morphological differences. In some, there were extensive regions of scar containing increased fibrotic material and few cells, in others there were also larger contiguous regions of myocardium with an essentially normal appearance. In the preserved myocardial regions, the cardiac cells showed moderate hypertrophy. There was an increase in contractile substance in parallel with an increase in mitochondria and enlargement of the nucleus with frequent waves and invaginations in the cell membrane. The cells at the marginal regions between fibrous tissue and preserved myocardium were frequently isolated from adjacent cells. In particular, when the isolated cells were completely surrounded by fibrous tissue, clear degeneration was apparent. These cells showed mainly a fibrillolysis with dissolution of the cross-bands and loss of the entire contractile apparatus. In compensation, occasionally there was proliferation of other cell structures, especially the free sarcoplasmatic reticulum. The hypertrophy of the still intact myocardial cells is considered compensatory for the infarct-incurred loss of tissue. The degenerative appearance is mainly attributable to fibrous tissue invasion. The diminished oxygen supply, compromised or abolished impulse conduction, loss of function and passive stretch during systole may be regarded as causes of the degeneration.
Actin Cytoskeleton↗
[Potassium-sparing effect of triamterene in a 3-component combination preparation for the therapy of hypertension].
A new fixed-dose combination drug, Minotensin (1 film-coated tablet contains 120 mg bupranolol, 2.5 mg bendroflumethiazide and 25 mg triamterene) was tested in a long-term study. 20 patients with mild to moderate primary hypertension were treated for 6 months. Items of investigation were: influence on low range serum potassium, influence on serum magnesium concentration, blood pressure lowering effect, tolerance and side effects. Initial dosage of 1 tablet b.i.d. could be reduced to 1 tablet in the morning in 4 patients. The mean serum potassium concentration rose from 3.79 +/- 0.3 mmol/l to 4.15 +/- 0.55 mmol/l (p less than 0.01) after 4 weeks, and to 4.26 +/- 0.37 mmol/l (p less than 0.001) after 6 months of treatment, all single values remaining within normal limits. The serum magnesium concentration rose to a small, insignificant extent. Systolic and diastolic blood pressure were lowered highly significantly from 177 +/- 12/103 +/- 7 mm Hg by 19/11 mm Hg. The mean values were within normal limits (less than 160/95 mm Hg) after treatment. Heart rate fell simultaneously by 11 beats per minute, on average (p less than 0.01). Atrioventricular conduction time was slightly prolonged in 2 cases. Serum levels of sodium, BUN and creatinine rose slightly, but remained within the normal range during treatment. Uric acid and lipids were not influenced significantly. 1 patient complained of transient gastrointestinal discomfort. Generally the drug was tolerated very well.
Bendroflumethiazide↗
[Intracutaneous skin suture with a resorbable synthetic monofilament suture].
We report about our good experience with a monofile, synthetic, absorbable Polydioxanone thread used for skin suture in an intracutaneous technique, after we performed more than 1,500 sutures of 7 to 30 cm length in patients of any age. We consider the suture to be suitable for children to achieve a cosmetically fine scare without a subsequent necessity to pull out the thread. The breaking strength, the absorbtion rate and the loss of inflammatory reaction is so satisfactory that we could not see any disadvantage by using this absorbable, synthetic thread for skin closure. Especially there was no disturbance in wound healing. In contrast, because of the secure and undisturbed wound-edge adaptation a non-irritant, firm, and hairline-like scar could be achieved. The time to carry out the suture is no longer than for other techniques.
Dermatologic Surgical Procedures↗
[Closure of median sternotomy with resorbable synthetic sutures].
To date, the refixation of the bone halves after median sternotomy is accomplished with wire, steel bands or thick, not absorbable plastic threads. As the first, we used absorbable synthetic strings in 25 patients. During the absorbtion the development of a very strong bone scar was possible, because the absorbtion lasted very long. The refixation of the sternum in cases of aseptic instability was even possible. So we think to have found another range of application for absorbable synthetic material which recently has been used more and more in several parts of operative medicine, even in hard burdened connective tissue.
Adolescent↗
The Gorlin syndrome: a genetically determined disorder associated with cardiac tumor.
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Adult↗
Myocardial infarction in young patients: an analysis by age subsets.
We examined, in age subsets, 2643 patients with acute myocardial infarction. Clinical features and 1 year morbidity and mortality were compared in 203 young patients (less than 45 years), 1671 patients 46 to 70 years old, and 769 elderly patients (greater than 70 years). Ninety-two percent of young patients were men, and a family history of premature coronary artery disease was more common in young patients (41% compared with 28% of middle-aged and 12% of elderly patients). More young patients were currently smoking cigarettes (82% compared with 56% of middle-aged and 24% of elderly patients), and only 8% of young patients had never smoked. Previous myocardial infarction and history of angina pectoris or congestive heart failure were less common (p less than .001) in the young patients than in middle-aged and elderly patients. In-hospital mortality was only 2.5% for young patients, compared with 9.0% in middle-aged and 21.4% in elderly patients (both p less than .001). Postdischarge 1 year mortality was also strikingly low in young patients, at 2.6% compared with 10.3% in middle-aged and 24.4% in elderly patients. The incidence of reinfarction during the 1 year of follow-up was similar in all subsets. The statistical significance of 65 variables as predictors of 1 year mortality and reinfarction was tested and the following found to be significant (p less than .05): hospital discharge on antiarrhythmic drugs, digoxin, or diuretics; history of previous myocardial infarction or congestive heart failure; chest x-ray findings of heart failure; low ejection fraction; and atrial fibrillation. Thus, young patients entering the hospital have an excellent 1 year prognosis, but those with prior infarction in whom there are selected abnormal findings at hospital discharge comprise a subgroup that may benefit from early aggressive management.
Adult↗
[Pacemaker models].
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Arrhythmias, Cardiac↗
[Late reactions of the elbow and wrist joint following resection of the radius head].
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Adolescent↗
[Fe, Cu and Zn contents in various organs, tissues of the central nervous system and skeletal muscles of normally developed piglets and splayleg piglets of different body weight].
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Animals↗
[Surgical treatment of the abnormal origin of the left coronary artery from the pulmonary artery. The Bland-White-Garland syndrome].
Seven children aged 6 weeks to 9 months with anomalous left coronary artery originating from the pulmonary artery and a 46-year-old female patient with pronounced formation of collaterals in Bland-White-Garland syndrome and left-right shunt were operated between July 1976 and February 1984. All children had already experienced left ventricular anterior wall infarction. Angiocardiography in 6 cases established the diagnosis, in one case echocardiography had proved sufficient. In the children, close-to-origin ligation of the left coronary artery was done after median sternotomy. One child succumbed postoperatively whereas in all others preoperative cardiac insufficiency regressed satisfactorily. In the adult female close-to-origin cutting of the left coronary artery was followed by aorto-coronary venous bypass.
Cardiomegaly↗
[Indications for operative intervention in acute and acute recurring lung embolism].
From 1973 to 1983 10 patients suffering from pulmonary embolism were seen at our clinic. All 10 underwent cardiopulmonary bypass and embolectomy of the pulmonary truncus and its branches including exploration of the right heart. 6 patients survived. The embolectomy of the pulmonary artery was supplemented by clipping the inferior vena cava. In chronic recurrent pulmonary embolism we only performed the clipping procedure of the inferior vena cava.
Acute Disease↗
[Amputation neuroma as a rare cause of so-called post-cholecystectomy syndrome].
At the instance of a 30-year-old female patient a casuistic contribution to the differential diagnosis of the so-called "postcholecystectomy syndrome" by means of ERC is given. On condition after cholecystectomy an amputation neuroma had again led to colics. Amputation neuromas are rare, but not unknown causes for complaints after operations at the bile ducts. The origin of such a neuroma at the extrahepatic bile ducts is discussed.
Adult↗
Surgery of coarctation of the aorta: a nine-year review of 253 patients.
From 1973 to 1982, 253 patients--164 males and 89 females--underwent an operation for coarctation of the aorta in our clinic. Of the patients 72.3% presented with a circumscribed lesion and 58.5% with associated congenital cardiovascular defects. Resection with end-to-end anastomosis was performed in 138 patients (54.5%). Seventy-four patients (29.3%) had vascular graft prosthesis, 1.2% underwent the Clagett's operation, 9.1%, the indirect isthmoplasty and the rest (5.9%), the subclavian flap plastic. Ventricular fibrillation led to the intraoperative death of 3 infants with associated intracardiac and multiple somatic defects. The operative mortality was high in children under 15 months (13.2%), 1% in all the others taken together and 0% in all cases without concomitant lesions. Paraplegia occurred in only one patients (0.4%). One hundred twenty-eight patients were followed-up over a mean period of 3.6 years. The systolic and diastolic pressures decreased by a mean of 30 mmHg and 15 mmHg respectively. Eighty-seven patients (68%) had normal blood pressure at the time of examination. The rest (41 patients) had persistent postoperative hypertension necessitating medical management. The surgical technique elected did not influence the level and incidence of persistent postoperative hypertension, rather the level of the preoperative systolic right arm-to-leg pressure gradient (SPG) related closely to the incidence of persistent hypertension. Thirty patients (23.4%), among whom were 24 children under 10 years--some of them with preductal hypoplasia--presented with an SPG above 20 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Treatment of duodenal ulcer with pirenzepine and cimetidine.
The purpose of this single blind controlled multicentre trial was to compare the relative effectiveness of pirenzepine and cimetidine in healing endoscopically proven duodenal ulcers. One hundred and twenty six patients with duodenal ulcer were treated with a daily dose of 100 mg pirenzepine (50 mg each before breakfast and before the evening meal), and 128 patients were treated with 1000 mg cimetidine (200 mg with breakfast, lunch, and evening meal and 400 mg at bedtime). Endoscopy was repeated after four weeks by an endoscopist who had not been informed about the treatment. Pirenzepine showed a healing rate of 64.3%, cimetidine one of 73.4%. This difference is not statistically significant (one-sided test: chi 1(2) = 2.48). After four weeks a higher proportion of first ulcers than of recurrent lesions was healed. Pain relief was rapidly achieved with both drugs. A significant trend in favour of cimetidine may, however, not be clinically relevant considering the small difference in the absolute numbers of pain free days and nights. Adverse effects were rare and reversible. We conclude that the efficacy of pirenzepine is similar to that of cimetidine in healing duodenal ulcers.
Anti-Ulcer Agents↗
[Surgical treatment of anomalies of the thoracic aorta].
The surgical treatment of five patients aged from 15 to 25 years and affected with interrupted aortic arch without associated cardiac malformations is reported. Furthermore, 28 patients suffering from atresia of the aortic arch were operated upon. Vascular rings of the aorta were found with a double aortic arch in 4 children while 7 patients had an arteria lusoria.
Adolescent↗
The influence of non-coronary collateral blood supply on the electively arrested heart during ischemia and reperfusion.
To study the influence of non-coronary collateral blood circulation (NCCBC) on the integrity of the ischemic myocardium a right-sided thoracotomy was performed on 15 anesthetized dogs. Following a total cardiopulmonary bypass (CPB), ventricular fibrillation was induced, during which 2,000 ml calcium-free cardioplegic solution LK 352 was given at the aortic root over an 8-10 min period. Precautions were taken to prevent retrograde blood flow into the coronary system via the coronary sinus. After 90 min of ischemia, ten of the dog hearts were reperfused with systemic blood for the next 30 min. Transmural biopsies were taken from the apex of the left ventricle at the following intervals: (1) before CPB, (2) immediately after the infusion of LK 352, (3) following 90 min of ischemia, (4) after 5 min, (5) after 15 min, and finally (6) after 30 min of reperfusion and were then studied ultrastructurally. The presence of NCCBC was documented by the observation of erythrocyte-filled blood vessels in the biopsies corresponding to nos. 2 and 3 of the above. To assess the degree of ischemic injury and the extent of myocardial recovery during reperfusion, a scoring system based on a semiquantitative assessment of the characteristic morphological changes was used. The average result of the separately assessed subendo- and subepicardial layers represented the score, which was plotted on the ischemic injury and the recovery scale, thus making a direct comparison of the hearts possible. All the hearts generously supplied with blood via extracoronary routes during ischemia showed minimal and reversible ischemic injuries. They recovered more quickly and more completely following reperfusion than those hearts without NCCBC. From these results we conclude that despite its warming-up effect on the myocardium and its tendency to wash out the cardioplegic solution, the NCCBC generally protects the myocardium from serious ischemic injuries and shortens the period of recuperation during the reperfusion.
Animals↗
Myocardial intra- and extracellular calcium changes following cardioplegic cardiac arrest.
To study the behavior of myocardial cellular calcium during the course of myocardial ischemia following cardiac arrest induced by the chemical cardioplegia, LK352, transmural biopsies were made from the apex of the left ventricle of nine patients undergoing electric cardiac surgery. The biopsies were made before the onset of extracorporeal circulation, at the end of ischemia, and after the discontinuation of cardiopulmonary bypass following reperfusion and cardiac resuscitation. Ultrastructural studies focused on the pattern of distribution in the interstitial space of a certain combination of elements forming microcrystals, together with a quantitative intracellular calcium assay, based on electron probe X-ray microanalysis, presented the following results: In the course of ischemia, a highly significant depletion of intracellular calcium was associated with the pooling of calcium in the interstitial space. An intracellular calcium assay following coronary reperfusion with systemic blood demonstrated intracellular calcium replenishment in association with the depletion of the calcium which had accumulated in the interstitial space during ischemia. The intracellular concentration of calcium after reperfusion approximated the control value. Based on our results, we consider the intracellular calcium depletion a mechanism which keeps the heart arrested in the diastole.
Adult↗