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H Heinrich

Publications and source records attributed to H Heinrich.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Changes in the redox potential of serum samples following in vitro irradiation--an indicator of malignant tumor growth].

In serum samples of healthy persons and patients with malignant neoplasia the reduction-oxidation-potentials were determined. Measurements were made in untreated sera and after irradiation with different doses. Sera of healthy persons showed a decrease that of tumor patients an increase of redox-potential values. With this method malignant tumor growth can be demonstrated. It does not yet permit any statements on tumor localisation. On the other hand conclusions seem to be possible on growth speed of neoplasia. To our hitherto existing experiences estimations of redox-potential are applicable to the diagnosis of fast growing recurrences and metastases in tumor after-care, but can also support the therapeutic procedure decisively in defined differential diagnostic problems and in tumors of dignity in question.

Blood↗
PubMed1989

Intravenous prostaglandin E1 versus pentoxifylline therapy in chronic arterial occlusive disease--a controlled randomised multicenter study.

In a controlled multicenter study 70 patients with chronic arterial occlusive disease stage IV according to Fontaine's classification were randomised to treatment with prostaglandin E1 (PGE1) or pentoxifylline (PX), administered over 4 weeks. Parameters of effectiveness were the reduction of analgesics, the relief of rest pain according to an analogue scale, the improvement of the ulceration according to an ulcer score and the healing of necrotic area. The results show that both forms of treatment produced a significant reduction in analgesic consumption and rest pain. Moreover in both groups a significant reduction of the ulcer score and healing of the necrotic area were observed. Side effects occurred in six patients of the PGE1-group and in ten patients of the PX-group, which required premature discontinuation of treatment in four patients of the PX-group. The study also demonstrated that PGE1 is more effective in the treatment of severe arterial occlusive disease than PX. With respect to the analgesic consumption, the reduction of ulcer score and the healing of necrotic area a significant difference was found in favour of PGE1. In accordance the six months follow-up examinations showed a marked deterioration in the PX-group opposed to the PGE1-group. The intravenous application of PGE1 over a period of 4 weeks in patients with severe arterial occlusive disease seems to be an effective therapeutical principle.

Aged↗
PubMed1987

Assessment of contractility changes in humans by transoesophageal echocardiography: the peak-systolic pressure end-systolic diameter relationship (PSPESDRS).

The peak-systolic pressure end-systolic diameter relationship (PSPESDRS) was determined in ten healthy subjects under general anaesthesia by using the radial artery pressure tracing (peak-systolic pressure) and transoesophageal 2d-and m-mode echocardiography (left ventricular diameters) without blocking of autonomic reflexes. Left ventricular load was changed by injection of a single intravenous dose of 0.2 mg nitroglycerin (NTG). Linear regression analysis showed a close linear relationship during the pressure decrease between peak-systolic pressures and end-systolic diameters. During infusion of dobutamine 5 micrograms/kg/min there was also a close linear relationship during pressure decrease with increased slope and unchanged Do (D0 = diameter at theoretical pressure zero). Values taken during pressure returning to control level were shifted leftward indicating transient increased contractility. We conclude, that the PSPESDRS can reliably be measured in humans without autonomic blockade during the decrease of arterial pressure after NTG, where reflex changes in inotropy are not yet present. This relationship increases in slope with dobutamine, reflecting the increased contractile state.

Blood Pressure↗
PubMed1986

Intraoperative transesophageal two-dimensional echocardiography in total hip replacement.

A number of studies in medical literature suggest that during implantation of hip prostheses pulmonary embolism of medullary contents and of air may occur. Proof of this suggestion was based on histological examination of lung tissue in animal experiments as well as on post mortem examinations of human tissue. In vivo evidence of this suspected embolism has been lacking so far, since an appropriate technique has not been available. Using transesophageal two-dimensional echocardiography, continuous imaging of the right atrium and the right ventricle can be performed in order to prove this suspected embolization in vivo. Thus, in a prospective randomized study of 26 patients undergoing hip surgery, the right atrium and right ventricle were continuously imaged. Simultaneously, the end-expiratory CO2 partial pressure was recorded. The medical literature suggests that a venting hole in the shaft of the femur prevents the rise in pressure in the medullary space and thus also averts embolism. Therefore, prior to the implantation of the shaft prosthesis, and in order to vent the medullary space, in 13 patients a 4.5-mm lateral borehole was drilled into the femoral shaft, located two finger breadths distal to the point were the end of the prosthesis would be positioned. In 12 of 13 patients in the control group without boreholes, transesophageal two-dimensional echocardiography revealed that air bubbles formed during the implantation of the shaft. In the group with boreholes, however, presence of air could be demonstrated in only four patients (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Marrow↗
PubMed1986

[The eventration syndrome: prostacyclin liberation and acute hypoxemia due to eventration of the small intestine].

In 13 patients undergoing infrarenal aortic bypass operation under neuroleptic anaesthesia, prostaglandins (KH2PGF2 alpha, PGF2 alpha, 6-keto-PGF1 alpha) and thromboxane (TXB2) were measured immediately prior to, 5 min after and 15 min after eventration of the gut. Blood gas analyses were performed at the same points in time. The levels of PGF2 alpha, although slightly elevated, remained stable, as did the levels of TXB2 (more than half the values being below the limit of detection). In 9 patients there was an immediate increase in the level of 6-keto-PGF1 alpha (a stable metabolite of prostacyclin), associated with a significant fall in the arterial oxygen tension. In 4 patients, the levels of 6-keto-PGF1 alpha remained low and no decrease in arterial oxygen tension was observed. KH2PGF2 alpha levels remained within the normal range, indicating that there was no stimulation of general prostaglandin secretion, but an isolated release of prostacyclin. In 7 patients, a mild, moderate or pronounced flush developed which did not, however, correlate to increases in the concentration of 6-keto-PGF1 alpha. These findings indicate that eventration of the gut is followed by prostacyclin liberation in considerable amounts due to the manipulation involved or to the impairment of the intestinal circulation. The concomitant fall in the oxygen tension is caused by pulmonary vasodilation, which increases the perfusion of underventilated parts of the lung.

Adult↗
PubMed1986

[Comparative echocardiographic studies on the negative inotropic effect of halothane, enflurane and isoflurane].

Using the afterload-independent end-systolic pressure-dimension-relationship a study was performed in order to investigate whether there are differences in the negative inotropic effects of halothane, enflurane and isoflurane at 1 MAC in 70% N2O. 30 patients of ASA-groups I and II were studied. Using transoesophageal 2d- and m-mode echocardiography the end-systolic-pressure-dimension-relationship was established and the slope (parameter of contractility) determined. The slope decreased significantly (paired Wilcoxon-test 2 alpha less than 0.01) with halothane (68.5/46.5 mmHg/cm), enflurane (56/48 mm Hg/cm) and isoflurane (63/35 mmHg/cm). There is no difference between the three groups (Kruskal-Wallis-test 2 alpha greater than 0.05). The negative inotropic effects of halothane, enflurane and isoflurane at 1 MAC in 70% N2O are the same. The vasodilation caused by isoflurane enables better pump function compared to halothane and enflurane, but may cause severe hypotension. We conclude that for cardiac risk patients isoflurane has no outstanding advantages in comparison to halothane and enflurane.

Adult↗
PubMed1986

[Aortofemoral bifurcation bypass. Effect of the anesthesia procedure (NLA, thoracic continuous catheter peridural anesthesia) on circulation, respiration and metabolism. Homeostasis and oxygen transport].

50 patients were investigated during induction of anaesthesia and infrarenal aortic bypass surgery. 26 were operated on under neuroleptanaesthesia (NA group) and 24 under continuous epidural combined with a light general anaesthesia (epidural group). Blood losses were replaced with 5 per cent human albumin, red cell concentrates, and fresh frozen plasma. Ringer lactate solution was used to replace the functional extracellular fluid volume. During induction and maintenance of anaesthesia body temperature fell (NA group from 36.7 to 35.3 degrees C; epidural group from 36.7 to 34.9 degrees C) but no statistically significant difference could be found between the groups, in spite of better surface perfusion of the lower part of the body in the epidural group. The increase of plasma glucose concentration was lower in the epidural group as compared to the NA group. Stress mediated hypokalaemia was of the same degree in both groups, the median values of the plasma potassium concentrations being in the lower reference range (3.5-3.7 mmol X 1(-1], although large amounts of red cell concentrates were given. During clamping of the aorta a moderate compensated acidosis developed in both groups. Declamping caused a more marked increase of paCO2 and a greater fall of pH in the NA group as compared to the epidural group. Induction of anaesthesia was followed by a fall in oxygen uptake (NA group from 221 to 163 ml X min-1; epidural group from 230 to 189 ml X min-1) which appears to be delayed in the epidural group, with a short lasting statistically significant difference between the groups after eventration of the gut (NA group: 162 ml X min-1 less than epidural group 184 ml X min-1). Later on, oxygen uptake was equal in both groups, with no further changes due to clamping or declamping of the aorta. At the end of the operation, when nitrous oxide had been turned of, the oxygen uptake increased considerably in several patients, despite continuing artificial ventilation and intravenous hypnotics and analgesics having been given. Eventration and exterioration of the gut caused the most marked changes in haemodynamics and oxygen transport with significant differences between the groups. Immediately after eventration there was a sudden fall in paO2 in both groups (NA group from 99 to 83 mm Hg; epidural group from 96 to 84 mm Hg) and an increase of the calculated intrapulmonary right-to-left-shunt (NA group from 7 to 21%; epidural group from 10 to 19%).(ABSTRACT TRUNCATED AT 400 WORDS)

Acid-Base Equilibrium↗
PubMed1985

[Aortofemoral bifurcation bypass--effect of the anesthesia procedure (NLA, thoracic continuous catheter peridural anesthesia) on circulation, respiration and metabolism. Intraoperative circulatory reactions].

51 patients who were selected for aorto-bifemoral bypass operation (infrarenal aortic aneurysm, iliac or iliofemoral occlusive disease) were randomized into two groups. 26 patients were operated on under neuroleptanaesthesia and 25 patients had a continuous thoracic epidural, which was supplemented with a light general anaesthesia during the operation. All patients were optimally volume loaded prior to surgery. The most marked haemodynamic alterations (tachycardia, arterial hypertension, increase of cardiac index, left ventricular stroke work index and cardiac minute work) were provoked by eventration of the gut. In the epidural group, these changes were attenuated and in contrast to the neuroleptanaesthesia group, there were a few patients who had a serious fall in blood pressure. These reactions were regularly accompanied by a generalized flush which led to the hypothesis that they were caused by the release of intestinal hormones, reactive peptides and neurotransmitters, from the mechanically irritated gut. Clamping of the aorta was relatively uneventful. Heart rate and cardiac index decreased in both groups but mean arterial pressure and pulmonary capillary wedge pressure remained stable. Systemic vascular resistance increased slightly in the neuroleptanaesthesia, but not in the epidural group. Declamping was followed by significant but transient falls in systemic vascular resistance and arterial pressure in both groups, despite sufficient volume loading before opening the clamp. In the neuroleptanaesthesia group these changes spontaneously returned to normal; in the epidural group 6 patients received vasopressors or positive inotropic drugs. These results indicate the following: Epidural anaesthesia prevents hypertension and tachycardia and lowers cardiac minute work. Eventration of the gut, acute blood losses and declamping of the aorta may be critical situations, which can lead to profound hypotension. Under neuroleptanaesthesia eventration of the gut is followed by tachycardia and hypertension whereas blood losses and declamping are not as critical as when an epidural is used. Only experienced anaesthetists should use epidural anaesthesia for aortic surgery. An intensive monitoring of haemodynamic function during this form of anaesthesia is mandatory.

Adult↗
PubMed1985

[Intraoperative monitoring using transesophageal 2-dimensional echocardiography].

Currently used monitoring techniques, such as measurements of blood pressure and heart rate, provide incomplete information about cardiac function during surgery. Invasive monitoring like intraoperative pulmonary artery pressure measurement with flow-directed balloon catheters may be more sensitive to detect cardiac instability, but they are associated with potentially fatal complications such as dysrhythmias and pulmonary artery rupture. In search of a more informative and yet safe intraoperative hemodynamic monitoring system, we have investigated the use of 2-D transoesophageal echocardiography (TEE). So far more than 400 patients were studied by TEE for up to 12 hours during elective surgery without any complications. High quality recordings of the left ventricle (LV) could be obtained in 87% of all patients. On the basis of the results presented below, we believe that TEE holds three fundamental advantages over the existing monitoring systems: it is inherently safer than intravascular measures, it allows direct assessment of LV filing, and it provides direct information on global and regional LV wall motion.

Abdomen↗
PubMed1985

[Transesophageal 2-dimensional echocardiography in hip endoprostheses].

Previous studies indicate that during total hip replacement intraoperative pulmonary embolization of air and medullary bone marrow occurs. This was based on histological examination of lung tissue obtained during animal investigations and postmortem in human tissue. In vivo proof of this embolization has not as yet been found because of the methodological problems involved. Using transoesophageal two-dimensional echocardiography continuously direct imaging of the right atrium and the right ventricle can be carried out and the embolization thus visualized. In a prospective randomized study in 26 patients having to undergo total hip replacement operation the right atrium and right ventricle were continuously scanned. Endexpiratory CO2-partial pressure was simultaneously recorded. A venting hole in the femur is said to prevent the pressure rising in the medullary space and therefore prevents embolization. In 13 patients therefore, a 4.5 mm lateral drill hole 4 cm distal the tip of the prosthesis was made in order to vent the medullary space. Transoesophageal two-dimensional echocardiography revealed air bubbles in 12 of 13 patients in the control group during implantation of the femoral prosthesis. This is significantly different to the group of vented patients where bubbles were only seen in 4 cases (p less than 0.01). Emboli were visible in 8 patients in the control group in contrast to only 2 cases in the vented group (p less than 0.05). The endexpiratory CO2-pressure of the control group fell from 35 mmHg to 33 mm Hg (Median, p less than 0.001). The CO2 of the vented patients remained constant.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Aortofemoral bifurcation bypass--effect of anesthesia procedure (NLA, thoracic continuous catheter peridural anesthesia) on circulation, respiration and metabolism. Hemodynamic changes caused by peridural anesthesia and anesthesia induction].

UNLABELLED: In 50 patients scheduled for infrarenal aortic bypass surgery the cardiovascular effects of two anaesthetic regimes were investigated prior to surgery. A Swan-Ganz-catheter was used for haemodynamic measurements. These patients, having been randomized into two groups, were optimally volume loaded (PCWP 10 mmHg) before anaesthesia. In 24 patients a thoracic epidural was induced with 12-15 ml 0.25% plain bupivacaine. When segmental anaesthesia had extended from T4/5 to L1/2 general anaesthesia was additionally applied (flunitrazepam 1.5-2 mg, pancuronium bromide 0.1 mg/kg). In 26 patients neuroleptanaesthesia was induced (droperidol 0.1-0.2 mg/kg, fentanyl 0.01 mg/kg, pancuronium bromide 0.1 mg/kg, and thiopentone 100-150 mg. Haemodynamic measurements were made before injection into the epidural catheter, after complete spread of anaesthesia, before commencing general anaesthesia and 10-15 min thereafter. RESULTS: Neither of the two procedures were associated with severe haemodynamic alterations. In the epidural group HR fell slightly during latency of complete spread and increased to the same extend following general anaesthesia. The epidural caused MAP (104 to 88 mmHg), mean PAP (20 to 14 mmHg), PCWP (10 to 7.5 mmHg), and RAP (4.5 to 2.5 mmHg) to decrease moderately but no further changes were effected by the subsequent general anaesthesia. SVR and PVR were not influenced by either epidural or by general anaesthesia. CI (3.6 to 3.41 . min-1 . m-2), LVSWI (67 to 52 p . m-1), and cardiac minute work index (55 to 40 J . min-1 . m-2) decreased during latency of complete spread but were no further influenced by general anaesthesia. The haemodynamic changes of neuroleptanaesthesia were almost identical to those of the combined epidural-general anaesthesia. For the operation which followed, a continuous infusion of 0.125 per cent plain bupivacaine (0.25 ml/kg X h) via epidural catheter (in combination with N2O/O2-anaesthesia) was sufficient for complete analgesia in the epidural group. These findings lead to the conclusion that a small bolus volume and a low concentration of bupivacaine result in good anaesthesia while avoiding serious haemodynamic alterations.

Adult↗
PubMed1984

[Possibilities and limitations of ventilation monitoring during anesthesia of the newborn and infants].

The following methods for monitoring the ventilation in general anaesthesia can theoretically be applied for neonates and small infants: The use of a precordial stethoscope, measurements and observation of the ventilation pressure, analysis of the inspiratory oxygen concentration, measurement of the expiratory volume, analysis of end-tidal CO2, transcutaneous O2 and CO2 measurement and blood gas analysis. These methods are evaluated and their limitations discussed. Special attention is paid to the application of these methods used in the different paediatric anaesthetic systems. A three graded plan which classifies the risks for the patients and/or the operations is presented in order to rationalize the use of these methods, some of which require expensive equipment. The basic ventilation monitoring includes, even for short operations in healthy patients (Grade I), the precordial stethoscope, the measurement of the inspiratory oxygen concentration, the measurement of the ventilation pressure and, for school age children also measurement of the expiratory volume. For operations lasting longer than one hour (Grade II) end-tidal CO2 analysis should be used when the ventilation-perfusion ratio is undisturbed. Transcutaneous O2 is desirable, but at the present time not accurate for conditions of general anaesthesia. For all high risk patients and/or operations (Grade III), particularly in the neonates, arterial blood gases are indispensable as well as the other methods for monitoring ventilation.

Age Factors↗