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Biomedical subjects

H J Wüst

Publications and source records attributed to H J Wüst.

At least 19 recordsLinked to original sources
PubMed1995

Surgical treatment of septic deep venous thrombosis.

BACKGROUND: Septic deep venous thrombosis (SDVT) is an uncommon but occasionally lethal disease caused by systemic complications. In most cases reported in the literature SDVT is caused by intravenous drug abuse or transvenous catheter lines. Conservative management with antibiotic drugs and systemic anticoagulation is usually successful, and the surgical approach is regarded as not indicated or unnecessary. Occasionally, however, conservative management fails, thrombosis progresses, and septic embolism develops. METHODS: In a 7-year period five patients (three male and two female; mean age, 21.2 years), three with severe systemic complications of SDVT (femoropopliteal, 1; iliofemoral, 1; iliofemoral+vena cava, 3), were treated by venous thrombectomy in addition to intravenous antibiotic administration. Simultaneous transabdominal caval thrombectomy was performed twice. RESULTS: Two patients suffered from respiratory failure caused by previous septic embolization. One patient had experienced multiorgan failure before thrombectomy was performed. Intensive care was necessary for all patients (mean, 28 days). All patients survived. CONCLUSIONS: In complicated cases of SDVT without improvement or even impairment after conservative management, venous thrombectomy is a lifesaving treatment.

Adolescent↗
PubMed1990

Prostacyclin and right ventricular function in patients with pulmonary hypertension associated with ARDS.

Eight patients who developed pulmonary artery hypertension during the adult respiratory distress syndrome (ARDS) were treated with an infusion of prostacyclin (PGI2, 12.5-35.0 ng.kg-1.min-1) for 45 min. We examined whether reducing the right ventricular (RV) outflow pressures by PGI2 infusion would increase the right ventricular ejection fraction (RVEF) measured by thermodilution. PGI2 reduced the pulmonary artery pressure (PAP) from 35.6 to 29.1 mmHg (p less than 0.01). The cardiac index (CI) increased from 4.2 to 5.81.min-1.m-2 (p less than 0.01) partly due to an increased stroke volume. The decreased PAP together with the increased CI resulted in a fall of the calculated pulmonary vascular resistance index (PVRI, from 5.1 to 2.5 mmHg.min.m2.1-1, p less than 0.01). In the patients with subnormal baseline RVEF the increased stroke volume was associated with an increased RVEF (from 47.6% to 51.8%, p less than 0.05) suggesting improved RV function. This result was underscored by a significant relationship between the changes in PVRI and RVEF (r = 0.789, delta % RVEF = 2.11.delta PVRI-1.45). Despite an increased venous admixture from 27.8% to 36.9% (p less than 0.05) the arterial PO2 remained constant resulting in an increased oxygen delivery from 657 to 894 ml.min-1.m-2 (p less than 0.01). We conclude that short term infusions of PGI2 increased CI concomitant to improved RV function parameters when baseline RVEF was depressed. Since improved oxygen availability should be a major goal in the management of patients with ARDS PGI2 may be useful to lower pulmonary artery pressure in ARDS.

Adult↗
PubMed1990

Prostacyclin for the treatment of pulmonary hypertension in the adult respiratory distress syndrome: effects on pulmonary capillary pressure and ventilation-perfusion distributions.

Nine patients who had developed pulmonary artery hypertension during the adult respiratory distress syndrome (ARDS) were treated with an infusion of prostacyclin (PGI2) (12.5-35.0 ng.kg-1.min-1). Whether PGI2 might decrease the pulmonary capillary pressure (PCP) obtained by analysis of the pulmonary artery occlusion pressure decay curve and improve systemic oxygen delivery was examined. Gas exchange alterations induced by PGI2 were analyzed by using the multiple inert gas elimination technique. PGI2 reduced the pulmonary artery pressure from 35.6 to 28.8 mmHg (P less than 0.001) and the PCP from 22.9 to 19.7 mmHg (P less than 0.01) without changing the contribution of the pulmonary venous resistance to the total pulmonary vascular resistance. The cardiac index increased from 4.2 to 5.7 1.min-1.m-2 (P less than 0.001) due to both increased stroke volume and heart rate. Despite a marked deterioration of ventilation-perfusion (VA/Q) matching with increased true intrapulmonary shunt flow from 28.6% to 38.6% (P less than 0.01) of the cardiac output, the PaO2 was unchanged due to increased mixed venous oxygen content indicated by an augmented mixed venous PO2 (from 37.0 to 41.9 mmHg, P less than 0.01). This caused a 35% (P less than 0.001) increase of the systemic oxygen delivery rate. Thus, short-term infusions of PGI2 reduced PAP and PCP without deleterious effects on arterial oxygenation in patients with ARDS. Hence, PGI2 may be useful to lower pulmonary vascular pressures in patients with ARDS.

Adult↗
PubMed1984

The kinetics of bupivacaine (Carbostesin) plasma concentrations during epidural anesthesia following intraoperative bolus injection and subsequent continuous infusion.

Plasma levels of bupivacaine were measured in 25 patients undergoing major abdominal surgery. The pharmacokinetic analysis of these data shows: (1) under a short term treatment, i.e. in the initial phase where multiple injections are given, the kinetic properties are in accordance with linear kinetic theory. The data can best be fitted to a two-compartment-model. (2) under a longterm treatment, i.e. infusion for more than 50 h, a very high accumulation occurs in contradiction to this theory. Therefore, the calculation of plasma levels from initial kinetic data is not feasible.

Adult↗
PubMed1982

[Fibrinolysis and complement-system profiles during aorto-femoral bypass implantation].

In 51 patients undergoing either implantation of an aortofemoral bypass (38 patients) or of an saphenous bypass (13 patients) the fibrinolytic and complement system profiles were determined. During the course of an aortofemoral bypass the plasminogen concentration decreased by 40%, alpha 2-macroglobulin by 25%, the complement factor C3c by 20% and the complement factor C4 by 40%. Antithrombin III concentration remained stable until the third postoperative day. The alpha 1-antitrypsin concentration increased postoperatively by 40% compared to the preoperative control. The concentrations of plasminogen, antithrombin III, alpha 2-macroglobulin and complement factor C4 did not change in the patients undergoing saphenous bypass operation. Intraoperatively the complement factor C3c decreased by 20%, while alpha 1-antitrypsin showed postoperatively an increase by 30%. Anaesthesia (neuroleptanaesthesia, halothane- or continuous thoracal epidural anaesthesia) had no influence on the fibrinolytic and complement system profiles. Neither could a correlation be shown between the intraoperative haemodynamic changes and the concentrations of the factors of the fibrinolytic and complement system.

Anesthesia, General↗
PubMed1982

[Blood volume in aorto-femoral bypass operation. Effects of continuous thoracic epidural-, halothane- or neuroleptanesthesia].

49 patients with obliterative arteriosclerotic disease of aortic or iliac artery were tested with three different types of anaesthesia, epidural, halothane, and neuroleptanaesthesia. A normal blood volume was found preoperatively in these patients, i.e. of 75.8 +/- 14.9 ml/kg weight. Connections between blood volume and age or factors of risk were not traced. A patient with a-v fistula showed an obvious increased blood volume (120.2 ml/kg). Intraoperatively the blood volume varied widely during the different types of anaesthesia: while the blood volume increased in epidural anaesthesia (+17%) and remained unchanged by halothane (+1%), it decreased at the same volume load during neuroleptanaesthesia (-17%). A clear connection between changes of cardiac output and changes of the filling potential of the heart (cvp x bv) was found during epidural anaesthesia (r = 0.93). There was no functional connection in the neurolept group (r = -0.08). With halothane changes of filling potential correlated negatively with changes in cardiac output (r = 0.72). A connection between changes of the blood volume and the central venous pressure is evident only in the epidural group (r = 0.59). At the same time these reactions are dependent on the extent of the individual alterations of the vegetative tonus by the epidural block. Those individual changes are even more evident under halothane (r = 0.32) and especially neuroleptanaesthesia (r = 0.28). Therefore we question the control of blood volume by measurement of the central venous pressure for these patients.

Anesthesia, Epidural↗
PubMed1980

[The effects of different anaesthetic technics on lactate under the course of aorto-femoral bypass operation (author's transl)].

46 measurements of lactate during aorto-femoral bypass-operation were performed under epidural analgesia, halothane- and neurolept anaesthesia. Independent of the metabolic parameters a significantly higher lactate rate was found under halothane anaesthesia than in the two other groups even though - at the same perfusion volume in all three groups - a significantly lower arterial mean pressure and peripheral resistance was measured under halothane- and epidural anaesthesia than under neurolept anaesthesia. The authors come to the conclusion that under aorto-femoral bypass operations a moderate hypotension can be carried out even in patients, showing arterio-sclerotic changes of the vessels, without a significant influence on metabolism.

Aged↗
PubMed1980

[Tachyphylaxis in continuous epidural anaesthesia with bupivacaine 0.125% and 0.25% (author's transl)].

Based on the results in 105 patients under continual thoracic epidural analgesia differences in the dose response relationship of bolusinjections are found. While under bupivacaine 0.25% a decrease of the effectivity of additional bolusinjections can be stated, the dose response relationship does not change under bupivacaine 0.125%. Moreover the effectivity of bupivacaine 0.25% increases after an interruption of the local anaesthetic infusion. The pH-value of bupivacaine 0.25% was 6.0 and that of bupivacaine 0.125% 6.3. Even so the differences of the pH-values between the two solutions are rather small, a possible key to the problem of the dose response relationship, concerning tachyphylaxis, can be suggested. But further investigations have to show, whether the use of local anaesthetic solutions, being stable at pH-values of 7 to 8, makes the continuous epidural analgesia easier to handle for postoperative pain relief.

Aged↗
PubMed1980

[Cardiovascular changes caused by nicotinic acid (author's transl)].

The effect of i. v. administered nicotinic acid was examined in 23 patients. Before the patients had undergone an AFB-operation. 11 cardiovascular parameters were quantitatively examined, calculated and statistically controlled. The authors observed a short but clear decrease of pressure and resistance in the arterial system after the injections of nicotinic acid. The aim of increasing the blood supply to poststenotic regions can however not be attained in this way. The decrease can rather lead to a lack of the blood supply of these regions. The authors could verify that the vascular effect of nicotinic acid is not caused by adrenergic blockade. We are of the same opinion as other authors who maintain that nicotinic acid could be used in the therapy of the "shock lung". It is said that nicotinic acid as a fibrinolytic substance might counteract the Disseminated Intravascular Coagulation and that it could counteract the danger of oedema in the pulmonary system by decreasing pressure and resistance for a short time.

Adult↗
PubMed1980

[Modification of the analgetic effects (buprenorphine, pentazocine, pethidine) on respiration and haemodynamics by epidural, halothane- or neuroleptanaesthesia (author's transl)].

In 38 patients buprenorphine, meperidine and pentazocine were given in a single dose for postoperative pain relief 20 hours after the end of anaesthesia. Measuring the parameters of the high- and low-pressure system as well as the metabolism the authors found that the effects of these analgetic medicaments, intravenously injected were significantly influenced by fentanyl, halothane or diazepam, given under the course of operation. Especially buprenorphine, injected after epidural anaesthesia in combination with diazepam sedation, proved to have a rather negative effect, because it caused a strong depression of respiration and circulation. On the other hand buprenorphine had, given after neuroleptanaesthesia, a neutralizing - and pentazocine and pethidine in combination with neuroleptanaesthesia a stimulating influence on the circulation. After halothane-anaesthesia the effect of the analegtics on the cardiovascular system was, when buprenorphine was given, depressing and when pentazocine was given indifferent. Similar reactions, but more pronounced, could be seen in the epidural group. With certain reservations, caused by the preliminary character of this study, the following conclusions can be drawn for the anaesthetic practice: 1 Choosing analgetic drugs for postoperative pain relief, the anaesthesist has to be aware of the interactions, possibly resulting from the medicaments, given during anaesthesia. 2. The number of medicaments, given during anaesthesia, should be kept small, considering the eventual interactions and the unintentional secondary effects.

Aged↗
PubMed1980

[Cardiovascular changes caused by atropine in epidural-, halothane- and neuroleptanaesthesia (author's transl)].

The authors could verify the heart rate increasing effect of atropine. The different sympathetic and parasympathetic activity caused by the method of operation and the kind of anaesthesia had a modifying effect on the heart frequency increase. In contrast to a small heart rate increase in halothaneanaesthesia, the increase in epidural- and neuroleptanaesthesia was higher. In addition medical treatment with pancuronium modified the effect of atropine. The frequency increase in patients who had got pancuronium was significantly smaller - the basic rate being higher - than in patients who hadn't got pancuronium. Those patients reacted vice versa. The authors found out that by giving 1 mg of atropine a maximum effect could be expected and that there couldnt be spoken of an overdosage.

Anesthesia, Epidural↗
PubMed1977

Miconazole in systemic candidiasis.

Based on our experience with our first patients, miconazole is now the drug of choice in cases of systemic and pulmonary candidal infection. Initially we prefer the parenteral route of administration which is continued for only one or two weeks after a negative finding in culture. The dosage is 1.2 g per day for a 70 kg patient. Thereafter the treatment is continued orally for another four weeks. Miconazole is well documented as a drug without serious side-effects, but the incidence of candidal infections in about 1% of our surgical patients does not justify its prophylactic administration. Like antibiotics, miconazole is given only when there is a clinical manifestation and a positive finding in culture.

Candidiasis↗
PubMed1976

[Postoperative analgesia with continous epidural analgesia and with dolantin (author's transl)].

Hemodynamic reactions to the discontinuation of epidural analgesia and to the injection of Dolantin were studied in 16 patients. One of every three patients reacted to the postoperative pain with an increase in mean arterial pressure(+30%) and in the mean pressure in the arteria pulmonalis (+40%) associated with an increase in stroke volume (+41%) and cardiac output (+49%). The administration of Dolantin did not influence either pressure measurement. In such cases the administration of antihypertensive drugs (alpha-blocking agents) or the reinstitution of epidural analgesia is neccessary.

Analgesics↗
PubMed1976

A computer module for the continuous monitoring of cardiac output in the operating theatre and the ICU.

A new pulse contour method to determine stroke volume and cardiac output continuously in patients on a beat-to-beat basis from the aortic pressure wave has been implemented in the form of a simple, inexpensive, fully automatic computing module for a commercially available patients monitoring system (Philips Medical Systems). Its reliability has been tested and shown in a computer analog, in experimental studies in 10 dogs (not reported here), in 22 hemodynamic studies on 20 young healthy volunteers and during 41 days in 20 postsurgical patients in the ICU, the most important result being that erros figures (15 and 19% respectively in the two human studies) are of the same order as when two standard methods, Fick and dye dilution are compared. The clinical studies have further indicated the easy applicability of the module 1 degree in the monitoring of critically ill patients in ICU's, 2 degrees as a monitor of the systemic circulation during anesthesia, and 3 degrees as a tool for studying the hemodynamic effects of pharmacological agents. The instrument consitutes no burden to the patients and has, several times during the course of the evaluation, provided an early warning of a deteriorating hemodynamic status of the patient to the physician.

Age Factors↗
PubMed1976

[Cardiovascular changes caused by atropine in normo- and hypothermic methoxyflurane anaesthesia (author's transl)].

The authors examined in 25 patients, of which 15 were normo- and 10 in hypothermic, the cardiovascular effects of 1 mg atropine i.v. In normothermia the heart rate increased significantly from 100 to 110 beats/min after atropine. At the same time the stroke index and stroke work decreased significantly. The mean arterial pressure, the heart index, the left ventricular minute- and stroke work and the total peripheral resistance did not change. In two patients with an arteriovenous fistula and hypervolaemia, the atropine injection caused an increased of heart- and stroke index. Arrhythmias did not occur after atropine. In hypothermia on the other hand atropine was shown to have no effect on heart frequency and all other examined parameters. In one patient in which the P-R interval was shortened, the atropine injection was followed by an total atrio-ventricular block. The authors cannot recommend atropine therapy in cases of hypothermic bradycardia, because of its lack of effect on the heart rate in hypothermia.

Adult↗