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Biomedical subjects

H Jellinek

Publications and source records attributed to H Jellinek.

At least 37 records · Page 2Linked to original sources
PubMed1993

[Pseudo-faulty location of a Swan-Ganz catheter in a persistent left superior vena cava].

The insertion of a Swan-Ganz catheter may cause various complications including intravascular malpositioning due to congenital anomalies of the large veins. A persistent left superior vena cava is the most frequent anomaly of the large vessels. It is usually diagnosed either as an incidental finding at autopsy or during X-ray imaging for confirming proper position of central venous and pulmonary catheters. The incidence of this condition based on autopsy series is approximately 0.3%. CASE REPORT. A 52-year-old patient was admitted to the surgical ICU with the diagnosis of acute pancreatitis. Because of haemodynamic instability, a pulmonary artery flotation catheter was inserted via the left subclavian vein without difficult. The chest radiograph showed the catheter along the left border of the heart going into the right pulmonary artery. An angiographic examination with bolus contrast injection confirmed a persistent left superior vena cava. CONCLUSION. This type of malposition calls for further detailed diagnosis of the vascular status, as the knowledge of accompanying congenital cardiovascular defects is essential for further invasive diagnostic and surgical procedures. The intensivist should be aware of its occurrence in order to not mistake catheters as being present in the arterial circulation or malpositioned outside the venous circulation.

Catheterization, Swan-Ganz↗
PubMed1992

[A complete ventilation-perfusion mismatch following one-sided lung transplantation and postoperative hemothorax].

Eight days after single-lung transplantation for pulmonary hypertension, a patient presented with a hemothorax on the side of the transplanted lung that required acute thoracotomy. Pulmonary artery pressure had decreased from 78/32/58 mmHg prior to the transplant to 42/18/27 mmHg on the 2nd postoperative day. Therefore, a predominance of perfusion to the transplanted lung was expected. During induction of anesthesia, in spite of ventilation with pure oxygen the patient developed a hypoxic cardiac arrest (paO2 26 mmHg, 40% saturation measured by pulse oximetry) requiring external chest compression. Auscultation and chest movements suggested that the transplanted lung was not ventilated. Because blood flow went mainly to the transplanted lung, ventilation of the native lung was almost totally dead-space ventilation. To enable ventilation of the compressed transplanted lung, the patient was intubated using a single-lumen bronchial blocker tube to block the mainstem bronchus of the native lung. The transplanted lung could then be ventilated. Saturation increased and epinephrine re-established a stable circulation; 2500 ml blood were removed from the pleura without further complications. On the 7th postoperative day the patient was discharged from the intensive care unit without neurological deficits. A perfusion scan 28 days post-transplant revealed 89% of the perfusion going to the transplanted lung. Atelectasis of this lung resulted in a large intrapulmonary right-to-left shunt. Hypoxic pulmonary vasoconstriction could not ameliorate the shunt because of the high pulmonary vascular resistance of the native lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1991

Changes of DNA-acridine orange binding in monocytes and endothelial cells of hypertensive arteries.

The interactions of monocytes and endothelial cells were examined employing acridine orange (AO) binding to chromatin as an electron microscopic probe for studying changes in nuclear activity. The number of AO labeled nuclei were determined in adherent and sub-endothelial monocytes, and endothelial cells either associated with or devoid of monocytes in mesenteric arteries of renal hypertensive and normotensive rats. No AO-positive cell nuceli were found in the few adherent monocytes in the normotensive rats while in hypertensive rats 63% of the adherent monocytes and 86% of the subendothelial monocytes were labeled by AO. The number of AO-positive cell nuclei increased in the endothelium from 2% in normotensive rats to 17% in hypertensive animals. Fifty-seven percent of these endothelial cells were associated with monocytes adhering to their surfaces. Thirty-nine (52%) of AO-positive and 24 (52%) of AO-negative cell pairs represented 84% of cell pairs with identical nuclear activity. These findings indicate a sequential interaction of monocytes and adjacent endothelial cells recognized at the nuclear level. According to other experimental work the binding capacity of chromatin for AO increases as cell nuclei are reactivated by stimulation of cell proliferation. In addition, AO labeling of chromatin visualized electron microscopically is confined to three of the four stages of the cell cycle. Therefore AO labeling in the present experiments might indicate the reentrance of monocytes and endothelial cells into the cell cycle.

Acridine Orange↗
PubMed1991

[Uni- and bilateral lung transplantation: surgical results and experiences of the 1st year. Vienna Lung Transplant Group].

Transplantation of the lung has gained increasing importance during the last years and is now an established therapy for end stage lung disease. After a 3 years period of preparation the first single lung transplantation (SLTX) was performed at the Second Surgical Department of the University of Vienna in November 1989, followed by the first double lung transplantation (DLTX) in April 1990. Until the end of 1990 11 patients underwent SLTX and 6 DLTX. 7 of the 11 SLTX patients and 4 of the 6 DLTX patients are at present alive with significantly improved lung function and therefore markedly improved quality of life.

Adult↗
PubMed1991

Passive geometric and elastic properties of human cadaver common carotid artery segments after intraluminal enzyme digestion with the aid of a four-way double balloon catheter.

A combined intraluminal nonenzymatic-enzymatic digestion procedure was carried out in situ on the common carotid arteries of 21 human cadavers with the aid of a four-way double balloon catheter. Denaturing pretreatment with NaOH, 2.5 mol for 20 min followed by crude pancreatic extract, 20 mg/ml for 20 min were used. Mechanical properties of cylindrical segments were measured in vitro, and compared with contralateral control segments. The inner radius increased and wall thickness decreased significantly at each pressure level in the 0-200 mmHg (0-26.7 kPa) intraluminal pressure range. Volume of wall material per unit length of the segment decreased by 11.6%, cross-section of the lumen at 100 mmHg (13.3 kPa) intraluminal pressure increased by 13.6%. These results show that the internal layers of human arteries can be removed by enzyme digestion increasing the lumen, while intact (medial and adventitial) layers still can give sufficient strength to the arterial wall.

Arterial Occlusive Diseases↗
PubMed1991

Lymphatic arteriopathy: damage to the wall of the canine femoral artery after lymphatic blockade.

The effect of lymph stasis on the histological, biochemical, and elastic properties of the femoral artery were studied after regional lymphatic blockade in 36 dogs. Dogs were sacrificed 4-21 days after operation. Histologic changes of the femoral arterial wall (interstitial edema, degeneration in the muscle layer or media, thickened adventitia with dilated lymph vessels, and fibrosis) developed after regional lymphatic blockade. Characteristic metabolic alterations of the arterial wall (anaerobic catabolism of carbohydrate, increased lactate and glycosamine content) accompanied the morphological changes. Distensibility of the femoral artery decreased and greater elastic stiffness developed after regional lymphatic blockade. These results in conjunction with other experimental and clinical data support the concept that insufficient lymphatic transport within the blood vessel wall may contribute to the genesis and progression of arteriopathies.

Animals↗
PubMed1990

[Tramadol in postoperative pain therapy. Patient-controlled analgesia versus continuous infusion].

UNLABELLED: Patient-controlled analgesia (PCA) is a well-proven procedure for individual pain relief in the post-operative period. Despite its superior approach regarding pharmacokinetic and pharmacodynamic considerations, PCA equipment is not available to many in the clinical practice. The goal of this study was to compare the efficacy and safety of PCA with continuous infusion (CI), an easily feasible method, using tramadol (T) as a centrally acting opioid with minor side effects on circulation and ventilation. METHODS: The study was conducted on 20 ASA I or II patients aged 20-60 years undergoing gynecological operations under standardized general anesthesia. They were randomly allocated to two groups receiving i.v. T for postoperative pain relief via Lifecare PCA 4200 Infuser. Group 1 (G1, PCA, n = 10): loading dose 3 mg/kg T, demand dose 30 mg T, lock-out time 5 min, concurrent infusion 5 mg/h T; group 2 (G2, CI, n = 10): loading dose 3 mg/kg T, continuous infusion 0.35 mg/kg per h T. If the analgesia was inadequate, additional doses of 50 mg T were available in G2. During a mean trial period of 20 h, the heart rate, blood pressure, respiratory rate and blood gas analysis were documented. The plasma levels of T and beta-endorphins were determined. The quality of analgesia was assessed by using a verbal and a visual analogue scale. RESULTS: The mean applied doses of T were 339 +/- 100 mg and 364 +/- 46 mg (G1 and G2, respectively) after 6 h and 565 +/- 243 mg and 707 +/- 139 mg (G1 and G2, respectively) in total (NS). Interindividual differences were substantial in G1. Five patients in G2 required an additional dose of 50 mg T. Pain scores decreased rapidly in both groups. The pain relief achieved was comparable and excellent after 6 h. The next morning, G2 reported significantly better analgesia in accordance with the higher availability of T as CI during the sleeping period. Mean plasma T levels were 994 +/- 440 ng/ml and 1170 +/- 357 ng/ml (G1 and G2, respectively). No correlation was found between T-levels and pain scores. The plasma levels of beta-endorphins were substantially elevated after the operation. They returned to normal during T-administration in both groups. No correlation was found between plasma levels of beta-endorphins and pain scores or T-consumption. Hemodynamic changes were minor and without clinical significance. PaO2 and paCO2 remained within small deviations from the physiological range. The respiratory rate, which was initially increased, dropped slightly in both groups. A high incidence of nausea and vomiting was observed, starting in the early phase of the loading dose. CONCLUSIONS: T is well suitable for postoperative pain relief after major gynecological surgery using both PCA and CI. PCA ensures adjustment of the medication to the individual demand, whereas CI provides better analgesia after sleeping periods. We recommend antiemetic prophylaxis before treatment with T.

Adult↗
PubMed1990

[The effect of calcium antagonist nitrendipine on the morphological picture of experimentally-produced myocardial injuries in rats].

Malignant renal hypertension was induced to Wistar rats by means of two methods (Lörincz-Gorácz and Rojo-Ortega-Genest procedures), and hypoxaemia was produced by application of two ligatures to an aortic segment, for two hours. The lesions caused by these experimentally established pathological conditions were analysed by the following criteria, after treatment with a Ca-blocking agent (Nitrendipine, Bayer, Leverkusen): Changes in systematic blood pressure; Histochemical detectability of myocardial and vascular lesions as a consequence of artificially induced hypertension and hypoxaemia; Assessment by means of the tracer technique (Ferrlecit, Nattermann, Cologne) of alterations to vascular permeability in small cardiac vessels of rats treated and not treated with the Ca-blocking agent; Detection of lesions in small vessels of other organs, such as intestine, mesentery, and pancreas, in rats treated and not treated with the Ca-blocking agent. This study has been conducted for the purpose of elucidating vascular lesions resulting from lasting hypertension and short-term hypoxaemia, with particular attention being given to effects of therapeutic intervention on morphological expression of vascular damage. The Ca-blocking agent had a favourable effect on vascular alterations due to long-term and short-term injuries, since the animals treated with Nitrendipine exhibited drop in blood pressure and developed very mild vascular lesions, if any. The cardioprotective action of Nitrendipine was readily obvious under the above experimental conditions.

Animals↗
PubMed1990

[The effect of endothelial interaction on the binding capacity of DNA acridine orange in hypertension].

Interaction of monocytes and endothelial cells were examined by acridine orange reaction in arteries of normotensive and hypertonic rats. The method is suitable for electron microscope study of DNA template activity. Activity of gen was compared in surface bound and subendothelial and in nonadhesive endothelial cells bound to monocyte. Acridine orange positivity, indicative of genic activity, was not found in few monocytes adhered in arteries of normotensive animals, while 62% of adhesive monocytes of hypertonic and 86% of ones accessed to endothelial space contained the products of acridine-orange-chromatin reaction in its nuclear, showing with it the gene derepression quickly ensuing in acute hypertensive vascular lesions. Only 2% of endothelial cells of pseudo-operated normotensive animals showed acridine orange positivity, while 17% of endothelial cells of hypertonic animals were positive. In the latter animals, 57% of endothelial cells showed acridine orange positivity, if monocytes adhered to their surface. In 84% of monocyte-endothelial pairs connected to each other, the nuclei have activity of same sign. Results show intensive activation of genes of monocytes in relation with adhesion and migration to vascular wall. Presumably, both hypertonia and monocyte adhesion have contributed to the increase of template activity of endothelial cells.

Acridine Orange↗
PubMed1989

Experimentally induced acute changes in veins studied by scanning microscopy.

Endothelial damage caused by hypoxia and the local administration of Varicocid, or by using vascular clamps on the jugular vein of rabbits, was studied under a scanning electron microscope. Adhering platelets and fibrin were found only in the acutely damaged veins with endothelial defects. Swelling and vacuolization of endothelial cells did not induce intravascular coagulation. Adhering thrombocyte aggregates and fibrin strands can be found on the venous wall after acute changes under a scanning microscope only if part or all of the endothelial lining has been lost. Intravascular coagulation is not induced by swelling or vacuolization. The jugular vein of rabbits was studied after hypoxia, the administration of Varicocid and the use of vascular clamps.

Animals↗
PubMed1989

[Intima and subintimal space as the site of the initial lesions in the formation of arteriosclerosis].

Experiments were conducted under various conditions, including hypoxaemia, endothelial damage by means of balloon catheterisation, cholesterol feeding, administration of lipofundin, and obstruction of lymphatic drainage. As a result, damage to endothelial cells along with increase in permeability is considered to be the initial process in the development of arteriosclerosis. This is followed by penetration of plasma, formation of fibrinoid in the subendothelial layer and in the media as well as by a number of cellular phenomena, the latter including adhesion of thrombocytes, penetration of monocytes into the intimal space, and proliferation of smooth muscle cells. Cellular, fibromuscular lesion is, eventually, caused as a result of those processes.

Arteries↗
PubMed1987

Development of arteriosclerosis after i.v. administered fat in rabbits.

In our previous studies performed in rats sclerotic alterations were induced in the vessel wall by Lipofundin-S 20% (Braun, Melsungen) administration for 8 or 16 days, respectively. In order to elucidate eventual species dependency, studies on rabbits were also performed. Alterations were examined in rabbits after Lipofundin treatment for 8 days. Electron microscopic studies revealed the accumulation of granular basement membrane-like material in the subendothelial space due to the activity of immigrated smooth muscle cells. The formation of elastic granules and elastic laminae was also observed among others due to the coalescence of microfibrillary structures formed from glycoseaminoglycans. The lesion developed was similar to that observed in the rat, the only difference was that in the rabbit the accumulation of the collagen fibres was more prominent. Results of our studies obtained in rabbits appear to support our previous findings: Lipofundin-S treatment induces aortic smooth muscle cell mobilization, fibrillogenesis and enlargement of the subendothelial space, namely sclerotic manifestations are induced.

Animals↗
PubMed1987

Further studies on the intravenously administered fat arteriosclerosis model.

30 rats were divided into 3 experimental groups. These included 8 days of Lipofundin treatment + 8 days recovery period (Group I), 16 days of Lipofundin treatment (Group II), and 16 days of Lipofundin treatment + 8 days recovery period (Group III). After sacrifice semi-thin and ultra-thin sections prepared from the aorta segments were examined light and electron microscopically. In addition to the development of alterations characteristic of the Lipofundin-model, the accumulation of collagen fibres was also observed. After 16 days of Lipofundin treatment the alterations were much more advanced than after 8-day treatment. Subsequent migration of smooth muscle cells through the newly formed internal elastic lamina was apparent and led to thickening of the sclerotic plaque. When the 16-day Lipofundin treatment was followed by a recovery period of 8 days prior to sacrifice, no signs of regression were seen. The alterations were present in unchanged form and the only difference was in the extent of accumulation of collagen fibres.

Animals↗
PubMed1986

Ultrastructural study of canine aortic damage caused by disturbance of transmural transport.

Lymph congestion was produced experimentally in canine aorta. It was demonstrated that the disturbance of lymph circulation resulted in morphological changes mostly in the outer third of the aortic media and in the adventitia. The smooth muscle cells of these areas showed mitochondrial or cytoplasmic edema and in the interstitium, ghost body formation could be seen, as well. The role of lymphatic circulation in the transmural transport of the aorta is stressed. The blocking of lymph drainage interferes with normal transmural transport and results in damages that contribute to the initiation of atherosclerotic lesions.

Animals↗