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Biomedical subjects

H Reich

Publications and source records attributed to H Reich.

At least 91 records · Page 5Linked to original sources
PubMed1990

Emergency cardiopulmonary bypass for resuscitation from prolonged cardiac arrest.

After cardiac arrest (no flow) of more than approximately 5 minutes' duration, standard external cardiopulmonary resuscitation (CPR) basic, advanced, and prolonged life support (BLS, ALS, PLS) do not reliably produce cerebral and coronary perfusion pressures to maintain viability and achieve stable spontaneous normotension; nor do they provide prolonged control over pressure, flow, composition, and temperature of blood. Since these capabilities are often needed to achieve conscious survival, emergency closed-chest cardiopulmonary bypass (CPB) by veno-arterial pumping via oxygenator is presented in this review as a potential addition to ALS-PLS for selected cases. In six dog studies by the Pittsburgh group (n = 221; 1982 through 1988), all 179 dogs that received CPB after prolonged cardiac arrest (no flow) or after CPR (low flow) states had restoration of stable spontaneous circulation. The use of CPB enhanced survival and neurological recovery over those achieved with CPR-ALS attempts only. With CPB and standard intensive care, it was possible to reverse normothermic ventricular fibrillation (VF) cardiac arrest (no flow) of up to 15 minutes and to achieve survival without neurologic deficit; VF of 20 minutes to achieve survival but with neurologic deficit; and VF of 30 minutes to achieve transient restoration of spontaneous circulation followed by secondary cardiac death. CPB could restore stable spontaneous circulation after ice water submersion of up to 90 minutes. Other groups' laboratory and clinical results agree with these findings in general. Clinical feasibility trials are needed to work out logistic problems and to meet clinical challenges. Future possibilities for emergency CPB require further research and development.

Animals↗
PubMed1990

Cardiac resuscitability with cardiopulmonary bypass after increasing ventricular fibrillation times in dogs.

Previous studies in dogs have shown resuscitation from prolonged cardiac arrest to conscious survival to be more effective with the use of cardiopulmonary bypass (CPB) than with standard advanced cardiac life support. This study compared cardiovascular resuscitability with CPB only after varying periods of cardiac arrest without artificial circulatory support in a canine model. Group 1 (ten) was subjected to ventricular fibrillation for 15 minutes; group 2 (ten) for 20 minutes; and group 3 (ten) for 30 minutes. All received total CPB after ventricular fibrillation without advanced cardiac life support to defibrillation at two to five minutes and partial CPB to four hours. In all three groups CPB with epinephrine generated normal coronary perfusion pressure and increased ventricular fibrillation amplitude significantly. In groups 1 and 2, CPB reperfusion allowed for successful defibrillation in less than five minutes, weaning from CPB in all dogs at four hours, and stable spontaneous circulation thereafter. In group 3, only five of ten dogs could be weaned from bypass at four hours, and all died early with myocardial necroses. It was concluded that CPB may be of value in the setting of prolonged cardiac arrest when advanced cardiac life support has not been provided or is unable to restore spontaneous heart-beat.

Animals↗
PubMed1990

Laparoscopic management of stage I ovarian cancer. A case report.

A woman with stage I ovarian cancer refused traditional treatment and was managed laparoscopically. Both ovaries were removed intact via a culdotomy incision. Vaginal hysterectomy, omentectomy and laparoscopic lymphadenectomy followed. With the increasing frequency of laparoscopic oophorectomy, it clearly seems prudent to remove ovaries intact through the cul-de-sac whenever ovarian pathology is in doubt. Although the laparoscopic approach is as yet unproven, it is an alternative for a select group of well-informed women with borderline or low-grade ovarian malignancy.

Female↗
PubMed1990

Laparoscopic repair of bladder injury.

This case report describes laparoscopic suturing for bladder repair. This technique affords the laparoscopic surgeon another means of managing a surgical complication without resorting to laparotomy.

Adnexal Diseases↗
PubMed1989

Haemodilution with dextran 40 and hydroxyethyl starch and its effect on cerebral microcirculation.

The effect of haemodilution with Ringer's solution, hydroxyethyl starch (HAES) 200/0.5 10% and dextran 40 on cerebral blood flow (CBF) was measured in ten cats by means of the hydrogen clearance technique. As expected from theoretical considerations the haemodilution effect was short and not significant with Ringer's solution, but was 25% with HAES and 35% with dextrane 40. The corresponding rise in CBF was significant in both the latter but not with Ringer's solution. CBF was similarly highly correlated with diminution of haematocrit (Hct). The different effects of the substances on CBF could all be explained by their different effects on the Hct. Data analysis, together with recent literature, suggests that the dominating factor determining CBF was the O2-transport capacity, which in these experiments was in close relation to Hct. The results support the assumption that the increase of CBF by haemodilution is caused by a regulatory mechanism and not by a change of rheological parameters.

Animals↗
PubMed1989

Effect of excitatory amino acid receptor blocker MK-801 on overall, neurologic, and morphologic outcome after prolonged cardiac arrest in dogs.

Excitatory amino acids accumulating in the brain during ischemia may cause selective neuronal damage postischemia. This hypothesis was tested in a series of studies using MK-801, an N-methyl-D-aspartate (NMDA) receptor blocker, in a reproducible outcome model of prolonged cardiac arrest in dogs. After normothermic ventricular fibrillation cardiac arrest, the dogs were resuscitated with closed-chest femoral veno-arterial cardiopulmonary bypass. At 4 h they were separated from bypass, ventilation was controlled for 20 h, and intensive care was continued to 96 h. In Study I, ventricular fibrilation cardiac arrest (no-flow) was 17 min; starting immediately with reperfusion, MK-801 1200 mg/kg (n = 5) or an equal volume of placebo (n = 5) was infused over 12 h in blinded, randomized fashion. In Study II, the duration of the no-flow period was reduced to 15 min, and MK-801 2400 mg.kg-1 (n = 4) or placebo (n = 4) was infused. In Study III, no-flow lasted for 15 min, and MK-801 2400 mg/kg was started 30 min before ventricular fibrillation (n = 4); comparison was with Study II controls. In all three studies, MK-801 plasma concentrations peaked at greater than 50 ng/ml and were 15-30 ng/ml over 12 h. All 22 dogs of experiments within protocol survived with severe brain damage. MK-801 delayed return of pupillary reactivity, EEG activity, consciousness, and respiration, necessitating longer periods of controlled ventilation. Neurologic deficit scores, overall performance categories, and brain and heart morphologic damage scores at 96 h did not differ between placebo and MK-801 pretreatment or post-treatment groups. These negative outcome results after prolonged cardiac arrest do not negate the hyperexcitability hypothesis of selective vulnerability, but suggest the existance of additional mechanisms of secondary brain damage.

Animals↗
PubMed1988

Autoregulatory capacity and the effect of isovolemic hemodilution on local cerebral blood flow.

The effect of isovolemic hemodilution with dextran 40 on local cerebral blood flow was measured in eight cats by means of the hydrogen clearance technique. Under normotension the decrease of hematocrit from 35% to 25% causes a sudden increase of up to 30% in local cerebral blood flow. After lowering the mean arterial blood pressure from 140 to 80 mm Hg, hemodilution did not alter cerebral blood flow significantly. From this observation it is concluded that the increase of cerebral blood flow following hemodilution is caused by compensatory vasodilatation and not by reduction of blood viscosity. This could imply that hemodilution cannot improve blood flow in areas of impaired autoregulation.

Animals↗
PubMed1987

Laparoscopic treatment of tubal pregnancy.

Seventeen tubal pregnancies were treated successfully with a laparoscopic procedure over the past four years. Four different laparoscopic techniques were used: salpingectomy, partial salpingectomy (midtube resection), fimbrial expression, and salpingotomy. "Preventive hemostasis" using vasopressin has made salpingotomy our treatment method of choice. Ruptured tubal pregnancy was not considered a contraindication to laparoscopic treatment. Four of the six women who were trying to conceive and were followed for longer than six months have had documented intrauterine pregnancies; one woman subsequently developed a contralateral tubal pregnancy which was treated by laparoscopic salpingotomy. Tubal ectopic pregnancy, even in the presence of rupture, can be managed effectively by a variety of laparoscopic techniques with benefits including minimal incision, short hospitalization, early return to full activity, and in many cases, a patent tube.

Fallopian Tubes↗
PubMed1987

Laparoscopic treatment of extensive pelvic adhesions, including hydrosalpinx.

Sixty-seven women with extensive pelvic adhesions, including hydrosalpinx, underwent a laparoscopic surgical procedure over the past eight years. Only cases in which ovum pickup was greatly impaired by adhesions were included. Cases of extensive endometriosis or acute adhesions were excluded. Recent innovations in technique were used, including aquadissection, electrodissection, scissors dissection and laparoscopic suturing. Two women suffered transient unilateral brachial plexus injury; there were no other complications. No laparotomies were required. The viable pregnancy rate was 78% (21 of 27) for women who underwent salpingoovariolysis on the most favorable adnexa and 28.5% (2 of 7) for those with salpingostomy for hydrosalpinx. There was one ectopic pregnancy (3%). The outcome for 34 laparoscopically treated women compared favorably with that for 30 women with similar tubal factor infertility who were treated with laparotomy microsurgery; the viable pregnancy rate was 75% (9 of 12) for laparotomy salpingoovariolysis and 53% (8 of 15) for laparotomy salpingostomy, with an ectopic rate of 13% (4 of 30).

Adnexal Diseases↗
PubMed1987

Laparoscopic treatment of tuboovarian and pelvic abscess.

Twenty-five women with pelvic abscess were treated laparoscopically. Following intravenous antibiotic coverage, laparoscopic surgical techniques were utilized to lyse bowel adhesions, drain purulent fluid, and excise acute and necrotic inflammatory adhesions, including tuboovarian adhesions. Treatment during the acute phase and results per second-look laparoscopy were documented in five cases, with photomicrographs revealing relatively normal pelvic anatomy. One postappendectomy abscess with a peritoneovaginal fistula in a 10-year-old girl was also managed laparoscopically. Four of seven women desiring pregnancy conceived, and two women had unplanned pregnancies. The treatment of choice for acute pelvic abscess may be a combination of intravenous antibiotics and an early laparoscopic surgical procedure.

Abscess↗
PubMed1986

[Evoked potentials. Indications and diagnostic significance].

Visual, auditory and somatosensory evoked potentials are useful in the detection and localization of demyelinating lesions, which mainly cause a slowing of conduction and therefore a latency increase in the evoked potential. Primarily amplitude reductions or loss of the response are seen in partial or complete impulse conduction blocks due to a tumor e.g. Acoustic nerve tumors can be detected by AEP, orbit tumors or processes of the chiasm by VEP and spinal cord tumors by SEP. The use of evoked potentials for the evaluation of ophthalmologic disorders, for audiometry in children and for monitoring head-injured patients with coma have become a valuable aid to the physician too.

Brain Diseases↗
PubMed1986

Herpes simplex type II encephalitis in infancy presenting with focal encephalitis.

Herpes virus was recovered from a throat swab, nasopharyngeal washings as well as from brain tissue from a six-month-old infant, who presented with fever, left focal seizures and an enhancing right frontal CT-scan lesion. Cytopathic effect (CPE) as seen with genital herpetic infection was seen, suggesting HSV-2. Immunofluorescent typing of the virus isolate confirmed HSV-2. Early IgM positivity preceding a CF and SN titer rise was observed. The patient received a course of ARA-A and recovered with a left sided hemiparesis. HSV-2 encephalitis occurs beyond the newborn period as a primary infection. In adults however HSV-2 encephalitis occurs predominantly in the immunocompromised host. HSV-1 encephalitis probably is due to reactivation of a latent herpetic infection in previous virus exposed juvenile or adult immunocompetent hosts.

Antibodies, Viral↗
PubMed1986

Treatment of ovarian endometriomas using laparoscopic surgical techniques.

Seventy-nine cases of ovarian endometrioma were treated via the laparoscope. The surgical technique gradually evolved from drainage alone to fulguration and finally to excision of the endometrioma cyst wall. Indications for laparoscopy were infertility (35 cases), pain (33), hypermenorrhea (5) and pelvic mass (4); the condition was an incidental finding in 2 cases. There were no intraoperative or postoperative complications. The long-term results, especially the fertility outcome, have been promising: 12 of 20 women (60%) achieved a term pregnancy following a laparoscopic endometrioma procedure alone. Of the eight women with endometriomas who did not conceive, six had well-documented male factor infertility.

Adult↗
PubMed1986

[Iatrogenic aluminum osteopathy in a uremic infant].

An infant with uremia due to congenital renal hypoplasia was treated with oral aluminum hydroxide for 9 months in an attempt to reduce hyperphosphatemia. An increasingly painful osteopathy with pathological fractures ensued with loss of thoracic wall stability and respiratory failure. Increased serum aluminium levels and histochemically proved deposits of aluminium at the mineralisation front between calcified and noncalcified osteoid were demonstrated. In the context of recent findings concerning aluminium bone toxicity it is beyond doubt that this phosphate binding agent was detrimental for this child. Though a low phosphate diet normalized hyperphosphatemia after aluminium hydroxide treatment had been stopped, no effect on the progressive osteopathy was observed. Since aluminium hydroxide as a phosphate binder can be replaced by calcium carbonate or a low phosphate diet at least in young children, it should not be further recommended in this age group. This seems especially important in nondialyzed patients.

Aluminum↗