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H Teufelsbauer

Publications and source records attributed to H Teufelsbauer.

28 records · Page 2Linked to original sources
PubMed1989

Beta 2-microglobulin. A reliable parameter for differentiating between graft rejection and severe infection after cardiac transplantation.

We investigated the role of beta 2-microglobulin as a noninvasive parameter to monitor acute rejection and severe infection in 45 consecutive heart transplant recipients. Endomyocardial biopsy revealed moderate (41 patients) or severe (three patients) rejection in 44 patients. Severe infections of bacterial septicemia (11 patients), bronchopneumonia (two patients), and viral infection (seven patients) were detected by a meticulous schedule of various clinical and laboratory tests. beta 2-Microglobulin levels in serum, generally corrected for serum creatinine, were significantly elevated in patients with infections (median, 6.3 mg/l; range Q10-Q90, 3.47-10.27 mg/l) compared with levels in patients with rejection (p less than 0.0001) or in patients in obviously good condition (p less than 0.0001). At the onset of acute rejection, the median corrected beta 2-microglobulin serum level was 1.56 mg/l (range Q10-Q90, -0.05-3.46 mg/l) and was significantly different from the control group (p less than 0.01). In addition, density function and empirical quantile analyses allowed us to define ranges of beta 2-microglobulin levels that would differentiate between rejection (2.05-3.46 mg/l) and infection (greater than 3.46 mg/l). With these values, sensitivity and specificity were 0.9 and 0.938 for detection of infection and 0.23 and 0.925 for detection of rejection, respectively. By means of beta 2-microglobulin, two cases of infection were misinterpreted as rejection (10%), and four of 44 rejections were mistaken for infections (9%). We conclude that measurements of beta 2-microglobulin may improve the management of heart transplant patients.

Adult↗
PubMed1987

[Orthotopic heart transplantation--experiences at the University Surgical Clinic II in Vienna (status: June 1986)].

Since 1984 27 heart transplantations (HTX) were carried out in 25 patients at the 2nd Department of Surgery, University of Vienna. The classic orthotopic technique of Lower and Shumway was used in all cases. Routine immunosuppression consisted of azathioprine and cyclosporin-A. In order to treat the main complications successfully, i.e. rejection and infections, we were compelled to establish an extensive follow up regimen. The early recognition of acute rejection was based on the findings obtained by cutaneous as well as epicardial ECG leads, in conjunction with cytoimmunological monitoring on the basis of RIA measurements of the serum levels of Neopterin and gamma-Interferon. Furthermore, we recorded some parameters of ventricular performance, such as the isovolumetric relaxation time and the radiologically measured heart volume. An endomyocardial biopsy was carried out to secure the diagnosis. Pulsed doses of methylprednisolone were used for the treatment of rejection, facultatively combined with ATG in the absence of improvements. Infections were pinpointed by comprehensive serum tests and various blood, sputum and urine cultures. The management consisted of treatment with the requisite antibiotics. Of 25 primarily transplanted patients 15 patients are still alive. 5 persons, amongst them 2 children, have survived already for more than 1 year. 6 patients died at an early stage. In 3 cases the cause of death was intractable infection. In 1 case multi-organ failure occurred and 1 patient died due to acute organ failure. 4 patients died at a late stage and acute severe rejection was responsible in all these cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Cyclosporin-A induced heart failure after orthotopic heart transplantation.

Two patients suffering from dilated Cardiomyopathy (CMP) had to undergo orthotopic heart transplantation (HTX). In both cases, the postoperative period was without any complications. The immunosuppression consisted of Cyclosporin-A and Azathioprine including a one week prophylactic treatment with Antithymocyte Globuline (ATG). Four months postoperatively, they developed clinical signs of heart failure. The endomyocardial biopsies showed rejection at stage I according to Billingham's grading plus a fine interstitial fibrosis. Therefore, the Cyclosporin treatment was suspended and replaced by conventional immunosuppression consisting of Prednisolone and Azathioprine. Acute heart failure was managed by catecholamines in combination with aggressive diuretic therapy. After three weeks, both patients recovered. 12 weeks later, one died because of an acute rejection episode. The other is in good condition, with conventional immunosuppression at the present time. A vascular process caused by Cyclosporin-A as the pathogenic mechanism is considered. The absence of rejection signs in the biopsies as well as the remarkable improvement of heart failure after withdrawal of Cyclosporin-A support this possibility.

Coronary Disease↗
PubMedDate not supplied

Decreasing use of donated blood and reduction of bleeding after orthotopic heart transplantation by use of aprotinin.

Twenty patients undergoing orthotopic heart transplantation were randomized preoperatively to receive either the serine proteinase inhibitor aprotinin in a low dose (560 mg; n = 10) or a placebo (control group, n = 10) at the time of transplantation. Blood loss 24 and 48 hours after transplantation was significantly lower in the group treated with aprotinin (i.e., 510 ml vs 820 ml, p less than 0.01, and 690 ml vs 1000 ml, p less than 0.03, respectively. Accordingly, the aprotinin group required significantly less transfused blood in the first 48 postoperative hours 0 to 250 ml versus 0 to 1000 ml (p less than 0.04). Seventy percent of the patients treated with aprotinin underwent transplantation without the need of nonautologous blood, compared with only 30% in the control group.

Aprotinin↗
PubMedDate not supplied

Quality of life after orthotopic heart transplantation.

During the last decade heart transplantation has become the chosen method to treat terminally ill patients suffering from severe cardiac illness. It was the aim of our study to retrospectively survey life quality of donor organ recipients who underwent heart transplantation during the first years of transplantation at our center (1984 through 1987). Thirty-five patients were asked to evaluate their postoperative improvement or deterioration and their satisfaction with the level reached on visual scales. Life quality was defined in nine areas: physical, emotional, mental, vocational, and sexual status, financial situation, leisure activities, partnership, and overall life quality. The following results were obtained: (1) our former patients informed us about a distinct improvement in almost all dimensions (except financial situation). We found an absolute increase in life quality after heart transplantation. (2) Although improvement was ranked best for physical status, there was also a high amelioration in psychosocial fields. (3) A significant difference was seen between changes in condition and satisfaction in the financial situation (z = 2.3) and in partnership (z = 2.9), in which the latter was ranked higher. (4) The date of transplantation (less/more than 2 years ago) had no influence on the evaluation of postoperative life quality.

Adult↗
PubMedDate not supplied

Neopterin as a new marker to detect acute rejection after heart transplantation.

Neopterin is excreted at high levels in the course of activation of the immunologic system during allograft rejection or viral infection. This pteridine therefore may be considered as a specific indicator of T cell-mediated immunity. With radioimmunoassay we analyzed both serum and urine levels of neopterin in 43 patients after orthotopic heart transplantation. These data were correlated to the histologic finding at routine endomyocardial biopsies (EMB). In case of rejection (that is, grades I to II or more in EMB) serum levels of neopterin increased about 156% +/- 94% within 1 week before EMB, whereas urine levels increased about 215% +/- 137%. The most marked increase was seen 2.8 days before the corresponding EMB. The predictive value theory was used to elaborate the reliability of the correlation between an increase of neopterin levels and the occurrence of an acute rejection episode. With regard to serum levels, sensitivity and specificity were 0.872 and 0.815, respectively. The positive predictive value was 0.41 and the negative predictive value was 0.977. We found similar results in urine levels.

Acute Disease↗
PubMedDate not supplied

Noninvasive assessment of acute rejection after orthotopic heart transplantation: value of changes in cardiac volume and cardiothoracic ratio.

Since 1984, 47 orthotopic heart transplantations (HTX) were carried out in 45 patients. In 29 long-term survivors cardiac volume as well as cardiothoracic ratio were measured during their routine follow-up. These two parameters of cardiac size were evaluated from posterior-anterior (pa) and lateral chest x-rays by using conventional technics. Changes of these parameters were correlated to the histological grading of endomyocardial biopsies (EMB). Increases of cardiac volume of more than 10 percent or 100 ml compared with the last measurement and simultaneous increases of cardiothoracic ratio of more than 2 percent were assumed to represent rejection equivalents. Sensitivity and specificity were 0.759 and 0.969, respectively. Predictive values of a positive or negative test for the presence or absence of disease came to 0.815 and 0.957.

Cardiac Volume↗