Biomedical subjects

H Ulmer

Publications and source records attributed to H Ulmer.

At least 73 records · Page 4Linked to original sources

PubMed1999

Spatial analysis of Percutaneous Transluminal Coronary Angioplasty (PTCA) in Austria.

STUDY OBJECTIVES: To investigate the geographical distribution of Percutaneous Transluminal Coronary Angioplasty (PTCA) and morbidity for coronary heart disease, angina pectoris and myocardial infarction by spatial analysis of the standardized morbidity rates (SMR) on district level. To identify clusters by Moran's I Statistic and the Regional Spatial Autocorrelation Coefficient (RSAC) of Munasinghe and Morris. To investigate demand factor morbidity and supply factor health care infrastructure on the district level as reasons for geographical disparity. To describe characteristics of the cluster population and intervention centres. STUDY DESIGN: Retrospective record linkage study. SETTING: All hospitals and cardiological centres in Austria (n = 150) which performed the Minimum Basic Data Set (MBDS). PATIENTS: All Austrian residents who were diagnosed for myocardial infarction, coronary heart disease or angina pectoris in 1995 (n = 87,174). MEASUREMENTS AND MAIN RESULTS: One 'positive' PTCA cluster (all SMRs > or =0.96) and one 'negative' PTCA cluster (all SMRs < or =0.59) were identified. They differed significantly in morbidity rate, intervention rate and available cardiological beds. The tendency to inverse relation between PTCA utilization and morbidity in the 'negative' cluster supported the thesis of 'inverse care law'. Austrianwide no significant correlation was found between the SMR of PTCA-application and both demand factor and supply factors. Nevertheless, differences between the clusters concerning number and capacity of intervention centres and density of specialists pointed to supply factors as reasons for geographical disparity. The ongoing trend of steady expansion of existing intervention centres and establishment of new ones will reduce the extent of geographical variation in future.

Angioplasty, Balloon, Coronary↗

PubMed1999

Pulmonary Aspergillus colonization in humans and its impact on management of critically ill patients.

Samples of lung tissues were obtained and analysed for Aspergillus carriage in 56 patients undergoing thoracic surgical intervention and 18 people who had an unexpected death. Out of 74 samples, 46 (63%) had evidence of pulmonary fungal colonization. The surgery population had a rate of 62% of fungal growth. Aspergillus was present in 39%. The autopsy population had a rate of 61% of fungal colonization. Aspergillus was present in 41%. In these cases eradication of fungal spores residing in the lung prior to aggressive chemotherapy and prevention of further spore uptake during hospitalization is indispensable in preventing pulmonary aspergillosis.

Aspergillosis↗

PubMed1999

Quantitative analysis of masseter and temporalis EMGs: a comparison of anterior guided versus balanced occlusal concepts in patients wearing complete dentures.

The lack of easily measurable, objective physiological activity parameters of the masseter and temporalis muscle during jaw movements in humans has led to the consideration to revise data of surface electromyographies (EMGs) by applying a computerized quantification method. The aim of this follow-up analysis was to get quantitative data out of EMG-records of an earlier study. These records were obtained with two different splints, splint 1 providing an anterior front-canine guidance and splint 2 providing bilateral balanced occlusion. Utilizing a computer aided integration method led to numeric results which statistically proves the prediction of the previous investigation. Applying the integration method, the EMG raw signal was transformed into area-values which enabled a statistical work up of the data. Wilcoxon test statistics shows a significant (P<0.05) lower muscle activity in patients wearing dentures providing anterior front-canine guidance compared to those with balanced occlusion. It is concluded that the neuromuscular activity of the elevator muscles is highly reproducible and that the neuromuscular function is similar in edentulous subjects to that found in people with natural teeth. Furthermore, the study statistically proves earlier visual data that all those subjects, whose muscle activities were observed with anterior guidance (splint 1) compared to bilateral balanced occlusion (splint 2) showed significantly lower values with regard to subjects wearing splint 2.

Centric Relation↗

PubMed1999

Consequences of acute normovolaemic haemodilution on haemostasis during major orthopaedic surgery.

Acute preoperative normovolaemic haemodilution (NHD) is an accepted tool for reducing allogeneic blood transfusion requirements during surgery. At present, little is known of its impact on haemostasis. We have investigated the consequences of NHD on haemostasis by comparing conventional global tests (prothrombin time (PT), activated partial thromboplastin time (aPTT) with more specific measures of coagulation (prothrombin fragment 1 + 2 (F 1 + 2), thrombin-antithrombin III complex (TAT) and fibrinolysis (D-dimer (DD), plasmin-alpha 2-antiplasmin complex (PAP)). Blood samples were collected from two groups (NHD and controls) undergoing elective spinal surgery or pelvic osteotomy until day 3 after operation. The conventional global tests remained within normal limits: there were no significant differences between groups. Although surgery induced significant increases in the more specific measures of coagulation and fibrinolysis, there were no differences between NHD and control patients. Major orthopaedic surgery strongly activates coagulation and fibrinolysis. As the degree of these alterations was similar in haemodiluted and control patients, we suggest that acute preoperative normovolaemic haemodilution itself does not appear to be associated with greater perioperative disturbances in haemostasis.

Adult↗

PubMed1999

[Changes of renal blood flow during organ-associated foot reflexology measured by color Doppler sonography].

Using colour Doppler sonography blood flow changes of the right kidney during foot reflexology were determined in a placebo-controlled, double-blind, randomised study. 32 healthy young adults (17 women, 15 men) were randomly assigned to the verum or placebo group. The verum group received foot reflexology at zones corresponding to the right kidney, the placebo group was treated on other foot zones. Before, during and after foot reflexology the blood flow of three vessels of the right kidney was measured using colour Doppler sonography. Systolic peak velocity and end diastolic peak velocity were measured in cm/s, and the resistive index, a parameter of the vascular resistance, was calculated. The resistive index in the verum group showed a highly significant decrease (p </= 0.001) during and an increase (p = 0.001) after foot reflexology. There was no difference between men and women and no difference between smokers and non-smokers. Verum and placebo group significantly differed concerning alterations of the resistive index both between the measuring points before versus during foot reflexology (p = 0.002) and those during versus after foot reflexology (p = 0.031). The significant decrease of the resistive index during foot reflexology in the verum group indicates a decrease of flow resistance in renal vessels and an increase of renal blood flow. These findings support the hypothesis that organ-associated foot reflexology is effective in changing renal blood flow during therapy.

Adult↗

PubMed1999

Effects of morbidity, age, gender and region on percutaneous transluminal coronary angioplasty (PTCA) utilisation.

OBJECTIVES: To investigate changes in the use of PTCA application in respect to morbidity, gender, region and age, and to investigate the morbidity as related to geographical variation. STUDY DESIGN: Retrospective record linkage study. SETTING: All hospitals and cardiological centres (n = 156) which performed the Minimum Basic Data Set (MBDS). PATIENTS: All Austrian residents who were diagnosed for myocardial infarction, coronary heart disease or angina pectoris in 1993-1995 (1993: n = 73.077; 1994: n = 80.173; 1995: n = 84.896). MEASUREMENTS AND MAIN RESULTS: The intervention rate (IR = PTCA/indication) increased from 0.03-0.04 (33%) between 1993 and 1995 with differences in genders (males: 24%, females: 27.7%) and regions (Vorarlberg: -7.5%, Burgenland: 65.3%). Male morbidity started to increase at about 60 y and female morbidity at about 70 y. Morbidity as a demand factor did not correlate with PTCA application. The intervention rate was significantly lower for females in Austria in general (P < 0.001) as it was in every Federal State (P < 0.001). This pattern was constant during 1993-1995 with the highest difference in Salzburg and the lowest in Styria. Austrian men were about three times more likely to have received PTCA application than women (crude Odds Ratio = 2.8, 95% CI = 2.6-3, P-value < 0.001). Logistic regression modelling revealed age as main confounder (adjusted Odds Ratio = 1.36, 95% CI = 1.31-1.42, P < 0.001). The > or = 5% intervention rate peak was between 30-75 y for males and between 30-65 y for females whereas morbidity of > or = 1% started for males at about 50 y and for females at about 60 y. Marked geographical differences of the intervention rate were observed (Upper Austria, Salzburg IR = 0.07, Styria IR = 0.02) but could not be explained by the demand factor morbidity (Pearson's correlation coefficients 1993: 0.039, P = 0.71; 1994: 0.155, P = 0.133; 1995: 0.087, P = 0.399). CONCLUSIONS: The highest intervention rates were in the age groups with the lowest morbidity. Women received significantly fewer interventions than men by age and region. The demographic strata with lowest use rate were women aged 64 y and more. Marked geographical differences of PTCA application were stated but could not be explained by the demand factor morbidity. Further studies on supply factors as well as on economic and social factors are needed in order to develop public health strategies to guarantee equal utilisation rates for the whole Austrian population.

Adult↗

PubMed1998

Prediction of recovery from post-traumatic vegetative state with cerebral magnetic-resonance imaging.

BACKGROUND: The early post-traumatic vegetative state (VS) is compatible with recovery. Various clinical and laboratory tests have failed to predict recovery so we assessed the value of cerebral magnetic-resonance imaging (MRI) in prediction of recovery. METHODS: 80 adult patients in post-traumatic VS had cerebral MRI between 6 weeks and 8 weeks after injury. MRIs were reviewed by three neuroradiologists for the number, sizes, and location of brain lesions. Three neurologists assessed the patients at the time of MRI and at 2 months, 3 months, 6 months, 9 months, and 12 months after injury using the Glasgow Outcome Scale. FINDINGS: At 12 months, 38 patients had recovered while 42 patients remained in the VS. The demographic characteristics and causes and severity of injury were similar in patients in persistent VS (PVS) and those who recovered (NPVS). An average of 6.1 different brain areas were injured in patients in PVS compared with 4.6 areas in patients who had NPVS. Patients in PVS revealed a significantly higher frequency of corpus callosum, corona radiata, and dorsolateral brainstem injuries than did patients who recovered. Logistic regression analysis showed that corpus callosum and dorsolateral brainstem injuries were predictive of non-recovery. The adjusted odds ratios for non-recovery of patients with a corpus callosum lesion and dorsolateral brainstem injury were 213.8 (95% CI 14.2-3213.3), and 6.9 (11-42.9), respectively. In contrast, clinical characteristics, such as initial score on the Glasgow Coma Scale, age, and pupillary abnormalities failed to predict recovery. INTERPRETATION: Cerebral MRI findings in the subacute stage after head injury can predict the outcome of the post-traumatic VS. Corpus callosum and dorsolateral brainstem lesions are highly significant in predicting non-recovery.

Adult↗

PubMed1998

[Coping with anger and the premenstrual syndrome].

OBJECTIVE: Investigations in recent years confirm the importance of "anger coping-behaviour" for women suffering from different diseases such as migraine, high blood pressure and coronary heart disease. The hypothesis for this investigation was that "anger-in" coping (anger-suppression) is a possible causal factor in the premenstrual syndrome. METHODS: Data analysis was undertaken on 38 patients (average age 32 years) fulfilling the inclusion criteria. The Menstrual Distress Questionnaire (MDQ) was used for measuring the intensity of premenstrual symptoms. As a result of a cluster analysis of MDQ scores, the 38 patients were divided into 3 subgroups (group 1: mild symptoms, n = 16; group 2: moderate symptoms, n = 10; groups 3: severe symptoms, n = 12). The 3 groups were compared by using different questionnaires regarding the variables anger, attitudes to menarche and menstrual bleeding, anxiety and depression. Additionally, sociodemographic data were obtained and a daily record taken for 2 days premenstrually and 5 day postmenstrually of subjective replies to a standardized protocol. RESULTS: Contrary to our expectations the results showed no significant differences for "anger coping" between the 3 subgroups. Increased daily stress (professional and familial double load) statistically significantly influenced the intensity of premenstrual symptoms. Additional significant factors were a general tendency towards somatization disorder, a negative attitude toward menarche and menstrual bleeding, as well as a tendency to depressive mood in patients with severe premenstrual symptoms. CONCLUSION: Emotional disorders (anger, anxiety) showed less influence on the premenstrual syndrome in the investigated women than daily stress and medical anamnesis.

Adaptation, Psychological↗

PubMed1998

[German language version and validation of the Edinburgh postnatal depression scale].

BACKGROUND AND OBJECTIVE: There is no valid method in the German literature for assessing postpartum depressive disorders. This study was undertaken to translate into German, validate and test the reliability of the Edinburgh postnatal depression scale (EPDS). PATIENTS AND METHODS: Randomly selected women after childbirth (n = 110) underwent (on the fourth postpartum day) a semistructured interview after first having answered the translated EPDS questionnaire. The diagnosis of depressive disorder was made according to the the criteria for psychological disorders in the ICD-10. For validation the results of the EPDS were compared with the clinical diagnosis of depression. The calculation of sensitivity, specificity and positive prognostic value was related to the respective EPDS results. In addition the EPDS data were analyses as to their reliability. RESULTS: The average age of the tested women was 28.6 years; 72% were married and 45% were primiparae. For an EPDS total score threshold value of 9.5 the sensitivity was 0.96, the specificity 1.0, and a positive prognostic value of 1.0. In the reliability analysis for EPDS the Guttmann split-half reliability was 0.82 and the alpha-coefficient 0.81. CONCLUSIONS: The German version of the EPDS with ten questions is an "application friendly" as well as proven to be a valid and reliable method for supporting the diagnosis of postpartum depressive disorder. It is suitable for both clinical and research use.

Adult↗

PubMed1998

Free and total bupivacaine plasma concentrations after continuous epidural anaesthesia in infants and children.

We measured free and total venous bupivacaine plasma concentrations in fourteen infants and children aged 6 days (2800 g) to 9 years (27 kg) undergoing epidural anaesthesia. An initial bolus of 0.5 ml.kg-1 bupivacaine 0.25% was followed by a continuous infusion administered one h after bolus over a period of seven h (first hour 0.25 ml.kg-1.h-1 0.25%; then reduced to 0.125%). Although total bupivacaine plasma concentrations were within acceptable limits (< 1.5 micrograms.ml-1), four of the seven infants showed adverse reactions. Maximum plasma concentrations of free bupivacaine were significantly higher in infants (P < 0.05) than in older children. We conclude that toxicity may be underestimated when only measuring total bupivacaine concentrations. In young infants the bupivacaine dose administered for continuous epidural anaesthesia should be further lowered below recommended concentrations and the patients closely observed for possible adverse reactions.

Anesthesia, Epidural↗

PubMed1998

Permanent junctional re-entry tachycardia. A multicentre long-term follow-up study in infants, children and young adults.

AIMS: Permanent junctional re-entry tachycardia is a relatively uncommon form of re-entry tachycardia with antegrade conduction occurring through the atrioventricular node and retrograde conduction over an accessory pathway usually located in the postero-septal region. It was the aim of the study to investigate the course of permanent junctional re-entry tachycardia with particular regard to the effectiveness of pharmacological treatment and ablation procedures; evaluation was performed with respect to the patient's symptoms, tachycardia rate, frequency of the tachycardia and left ventricular function. METHODS AND RESULTS: The long-term follow-up of 32 patients with permanent junctional re-entry tachycardia was evaluated. The first presentation with supraventricular tachycardia occurred between the 27th week of gestation and 27 years. The tachycardia rate ranged from 100 to 250 beats.min-1. During Holter-ECG, permanent junctional re-entry tachycardia was documented as present for over 50% of the time in 24 h in 22 patients (69%). Left ventricular performance was impaired in nine patients (28%) due to a tachycardia-related cardiomyopathy. Symptoms or signs of heart failure were mild to moderate in eight and severe in four patients; 20 patients showed no clinical impairment. Follow-up time was 1 to 31 (mean 10) years; current age of the patients ranged from 1.5 months to 35 (mean = 15 x 3) years. Four patients needed no therapy because of the infrequency of permanent junctional re-entry tachycardia episodes. Twenty-five patients initially received antiarrhythmic drugs, which were effective or partially effective in 14 (56%). Eight of them are still on medical therapy; in five treatment was discontinued because of absence of symptoms. Eleven patients had ablation of the accessory pathway during follow-up, three underwent ablation as a primary procedure. CONCLUSION: Permanent junctional re-entry tachycardia in our experience is an arrhythmia with a large variety of clinical symptoms. Patients with a slow tachycardia rate and infrequent episodes of tachycardia may never develop symptoms and therefore do not need any therapy. Patients with frequent permanent junctional re-entry tachycardia, a fast tachycardia rate and impaired left ventricular function need effective therapy. In infancy and early childhood medical therapy is recommended as a first option, whereas in older and symptomatic patients catheter ablation is an effective and safe procedure.

Adolescent↗

PubMed1998

Tolerance of N-chlorotaurine, an endogenous antimicrobial agent, in the rabbit and human eye--a phase I clinical study.

N-chlorotaurine (NCT), an essential weak oxidative N-chloro compound produced by stimulated human leukocytes, shows bactericidal, fungicidal, virucidal and vermicidal efficacy. A double-blind, randomized and placebo controlled study was done to evaluate the tolerance of the aqueous NCT solution by application to rabbit and human conjunctiva. In six rabbits treated with 1% and 3% NCT regimen for nine days no ocular and behaviour changes could be observed. In a pilot study with two volunteers, treatment with 2.8% NCT for five days caused a self-limited conjunctival injection of one subject, while 1% NCT was well tolerated. Subsequently, eight healthy volunteers participated in a phase I clinical study. One percent NCT was applied for five days and was well tolerated by all subjects except for minimal eye burning after the application. Because of these positive results, usage of the antimicrobial agent NCT in ophthalmology is suggested.

Adult↗

PubMed1998

[Prevalence of depressive disorders in early puerperium].

OBJECTIVE: The aims of this investigation were to detect the prevalence and influencing factors of early postpartal depressive disorders in a large hospital sample. METHODS: By means of an interview we acquired information on sociodemographic data, physical and psychiatric anamnesis, obstetric and psychological variables. The German version of the Edinburgh Postnatal Depression Scale (EPDS) served to determine the depressive disorder of our patients. The interview was carried out on 1,250 women at the maternity ward 5 days after delivery. RESULTS: According to the results of the German validation of the EPDS, 254 (20.3%) women at the maternity ward had an at least mild depressive disorder. A comparison between nondepressed women (n = 996, 79.7%) and depressed women (n = 254, 20.3%) revealed the following risk factors for the development of an early postpartal depressive disorder: higher subjective burden of childbirth, higher trait anxiety, poorer couple compatibility, lower job satisfaction and lower social status. Of all the obstetric variables previous abortions, elevated pregnancy risks, low weight of the newborn at delivery and cesarean section were of significant influence. CONCLUSIONS: Early postpartal depressive disorder appears in 20% of all women 5 days after delivery. According to previous studies this group seems to be at highest risk for developing a later postpartum depression. Considering the psychosocial and obstetric risk factors, preventive psychotherapeutic interventions at the maternity ward are indicated.

Adult↗

PubMed1997

[Follow-up studies of routine health screening in Vorarlberg 1986-1994].

In this longitudinal study we observed a sample of people who participated in the general health screening program in Vorarlberg between 1986 and 1994. The aim was to analyse the changes in the parameters, body-mass index, diastolic and systolic blood pressure, blood glucose, cholesterol, gamma-GT and triglycerides of 1205 women and 718 men over this period. Using the baseline values recorded in 1986 as reference the sample was divided into groups with normal, slightly increased and highly increased values for the parameters. On average, the risk factors of people with highly increased baseline values decreased on both a short-term (1986-1988), and a long-term basis (1986-1994). The only exception was the body-mass index, which showed a slight reduction in the first two years and a slight increase in the long run. The normal baseline values rose in all the variables within the period of observation. Sex differences must be considered with regard to body-mass index, cholesterol and triglycerides, age differences are significant with regard to body-mass index, systolic blood pressure and cholesterol. The results of the study point to the usefulness of regular participation in general health screening programs. They show, in particular, that the risk factors for civilization-induced diseases diminish visibly in the group of highly endangered people.

Adult↗

PubMed1997

The effect of recombinant human erythropoietin on circulating hematopoietic progenitor cells in anemic premature infants.

In vitro and animal studies suggest that high concentrations of recombinant human erythropoietin (rHuEPO) might divert multipotent progenitors into erythroid maturation at the expense of granulocyte production. We determined whether changes of number and lineage commitment of peripheral blood progenitor cells occur in premature infants during therapy with rHuEPO. Thirty preterm infants were randomly assigned either to receive 300 IU of eopoetin alpha s.c. per kilogram body weight three times a week for four weeks or to a control group. At study entry and after two weeks of treatment the numbers of circulating BFU-E, granulocyte-macrophage colony-forming units (CFU-GM) and granulocyte-erythrocyte-macrophage-megakaryocyte CFU (CFU-GEMM) were analyzed by semisolid culture technique, CD34+ cells and early myeloid CD34+CD45RA- progenitors by flow cytometry. As compared with the control group, rHuEPO treatment did not exert any significant modulatory effect on numbers of CFU-GM, nor was there a significant change in numbers of BFU-E, CFU-GEMM, total-CFU, percentage of CD34+ or CD34+CD45RA- cells. Mean neutrophil count was not significantly reduced at any period during the study. Compared with the control group, the infants receiving rHuEPO had higher hematocrit values (p = 0.003) and absolute reticulocyte counts (p < 0.001). The median cumulative volume of blood transfused per kilogram per day was 0.86 ml (first quartile 0.5 ml; third quartile 1.1 ml) in the control group and 0 ml (first quartile 0 ml; third quartile 0.47 ml) in the rHuEPO group (p = 0.038). We conclude using a relatively high dose of rHuEPO in premature infants, no significant in vivo effect on circulating peripheral blood progenitor or neutrophil count could be detected.

Anemia↗

PubMed1997

[Hospitalization of young women after selected cardiovascular and thromboembolic incidents in Austria 1993 and 1994].

The aim of this study is to describe the hospitalization and regional distribution of selected cardiovascular and thrombo-embolic events (cardiac infarction, cerebral strokes, deep vein thromboses, pulmonary embolism) of young women in Austria in the years 1993 and 1994, and to collect basic epidemiologic data for the study of the side effects of oral contraceptives. The calculated hospitalization rates are based on the Austrian hospitals' discharge records of 1993 and 1994. The persons concerned are women aged between 15 and 44 who live in Austria. The results of the study reveal that--in 1993--of the above mentioned group 51 out of 100,000 inhabitants were hospitalized because of the selected cardiovascular and thromboembolic events: 4/100,000 had a cardiac infarction, 5/100,000 had a stroke, 17/100,000 had a pulmonary embolism, and 27/100,000 suffered a deep vein thrombosis. In 1994 the counted cases per 100,000 inhabitants were 48, out of which 4/100,000 where cardiac infarcts, 5/100,000 strokes, 16/100,000 pulmonary embolism, and 25/100,000 deep vein thromboses.

Adolescent↗

PubMed1997

External stabilization of long-segment tracheobronchomalacia guided by intraoperative bronchoscopy.

BACKGROUND: Symptomatic obstruction of long-segment tracheal or bronchial portions either related to congenital instability or secondary to vascular compression are rare malformations, which remain difficult to manage. A method of external tracheal or bronchial stabilization is described. METHODS: From July 1992 to April 1995, 7 children (age range, 4 months to 4 years; mean age, 19 months) and 1 adult (age, 46 years) were operated on for severe respiratory insufficiency. In 4 cases of congenital tracheal instability, 2 children had associated type IIIb esophageal atresia. Both children with esophageal atresia had previous operations (two and three times, respectively): 1 child had aortopexy and division of a patent ductus arteriosus and another child had distal tracheal resection elsewhere, both without relief of malacia. All children were intubated and ventilated since birth for 11 to 15 months. Secondary tracheobronchomalacia due to vascular compression was seen in 4 patients caused by double aortic arch (n = 2) and persisting ligamentum arteriosum after previous ligation of a patent ductus arteriosus (n = 2), with 1 child ventilated thereafter for 5 months. Operation was performed with the aid of extracorporeal circulation in all patients but 1, and consisted of transection of vascular rings and persistent ligamentum Botalli (n = 5), closure of multiple ventricular septal defects (n = 1) and extensive mobilization of the tracheobronchial tree as well as the great arteries. External stabilization of the severely dysplastic distal trachea (n = 6) or left main bronchus (n = 2) was achieved by suspending the malacic segment within an oversized and longitudinally opened ring-reinforced polytetrafluoroethylene prosthesis. Multiple plegeted sutures were placed extramucosally to the dysplastic tracheal wall and the dyskinetic pars membranacea, as well as to the polytetrafluoroethylene prosthesis in a radial orientation. Guided by simultaneous video-assisted bronchoscopy, reexpansion of the collapsed segments was achieved by gentle traction on the sutures while tying. RESULTS: Stenosis-free tracheobronchial reexpansion was achieved in all patients, as seen on repeated bronchoscopies during hospitalization and thereafter. All patients were extubated within 1 to 12 days after the operation. There was one late death, unrelated to the procedure, in a 31-month-old child 20 months after the operation. All other patients are free of stridor and in excellent clinical condition 21 to 54 months (mean, 38 months) thereafter. CONCLUSIONS: The presented method of bronchoscopically guided external tracheobronchial suspension within a ring-reinforced polytetrafluoroethylene prosthesis immediately relieves severe malacia of the trachea or main bronchi in infants as well as adults without necessitating resection. Midterm preliminary data suggest that growth potential of the affected segment exists within the oversized polytetrafluoroethylene prosthesis.

Abnormalities, Multiple↗

PubMed1997

Spinal cord protection using hypothermic cardiocirculatory arrest in extended repair of recoarctation and persistent hypoplastic aortic arch.

OBJECTIVE: In recurrent coarctation collateral circulation may not be sufficient to maintain adequate perfusion of the lower body during the period of surgical repair. Different techniques such as interposition of a Gott-shunt, use of left heart bypass or hypothermic cardiocirculatory arrest are used to prevent spinal cord injury. METHODS: Twenty-eight operations for recurrent coarctation were performed in 26 patients following end-to-end anastomosis (58%), patch plasty (21%), subclavian flap aortoplasty (14%) and graft interposition (7%). Associated cardiac defects were present in 77% of the patients. Eleven patients who had adequate (> 50 mmHg) distal perfusion pressure during a test occlusion were operated on using simple cross-clamping (group I, mean age 8.5 +/- 3.8 years). In group I, end-to-end anastomosis was performed in nine patients and graft interposition in two patients. In 17 cases (including two patients from group I) with insufficient collateral circulation and with persistent hypoplasia of the arch, hypothermic cardiocirculatory arrest was used (group II, mean age 12.8 +/- 9.6 years). In group II end-to-end anastomosis was performed in three patients and graft interposition in 14 patients. Mean bypass-time was 116 +/- 36 min and arrest-time 33 +/- 16 min. Hypothermic cardiocirculatory arrest was begun when nasopharyngeal temperature was below 20 degrees C, corresponding to a rectal temperature of 24 +/- 3 degrees C. RESULTS: Hypothermic cardiocirculatory arrest allowed open reconstruction of the arch and/or complete or partial replacement of the arch and the coarctation segment. In-hospital mortality was 0 and 5.9% in group I and II, respectively. The one patient who died in group II had simultaneous correction of an anomalous pulmonary venous connection and death was unrelated to the method of coarctation repair. Reversible laryngeal nerve paresis was observed in two patients in group II, no other neurologic complications were observed in either group. Postoperative gradients over the repair site were less than 20 mmHg by Doppler-echocardiography. Two patients of group I had to have a second, early reoperation because of stenosis at the anastomotic site. Reconstruction of the distal aortic arch was then performed during hypothermic cardiocirculatory arrest. CONCLUSIONS: The use of hypothermic cardiocirculatory arrest in this special indication is a safe method which allows open reconstruction of the coarctation site and the aortic arch and protection of the spinal cord. The need for early reoperation because of inadequate repair may be reduced.

Anastomosis, Surgical↗