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J Heine

Publications and source records attributed to J Heine.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Rationale and management of perioperative atrial fibrillation].

Atrial fibrillation is the most common clinically relevant arrhythmia. Anesthesiologists will be faced with atrial fibrillation of new or undetermined onset at their preoperative evaluation of patients as well as during intra- and post operative care. Because of fast electrophysical and structural remodeling, atrial fibrillation tends to persist and reoccur after successful conversion with increasing time of duration. Therefore, atrial fibrillation with an onset of less than 48 hours should be attempt to convert as soon as diagnostic work up has been made and possible causes have been corrected. New developments of electrophysiological and pharmacological treatment have improved the short term success rate of cardioversion. Further developments might give even more specific treatment options for the individual patient. In contrast, for treatment of chronic atrial fibrillation rate control therapy and thromboembolic prophylaxes seems to be more advisable with a lower risk of drug side effects and stroke. Anticoagulation should be initiated not later than 48 hours after the onset of atrial fibrillation. Finally, the development of implantable devices for the treatment of atrial fibrillation seem to be a promising therapeutic option for patients in end-stage heart diseases.

Atrial Fibrillation↗
PubMed2003

[New pathways and current concepts in intensive care medicine--a summary of important articles of the last month].

One of the most outstanding critical care concepts of the last month is the definition of 5 therapy strategies by the Society of Critical Care for treatment of patients in septic shock. These strategies are: Low tidal volume of 6 ml/kg(-1) body weight in patients with ARDS, early goal-directed therapy, activated protein C therapy, moderate-dose corticosteroids, and tight control of blood sugar. Following further review of the main critical care medicine related journals for strategies to reduce mortality, the non-invasive ventilation is worthwhile mentioning. Moreover, this review summarizes articles on the topics of: Low-dose dopamine does not prevent acute renal insufficiency, increase of mortality is not related to albumin infusion, subglottic suctioning prevents early onset of ventilator associated pneumonia, prone position in ARDS patients has no influence on mortality, the safest site for central venous catheterization, and pulmonary-artery catheter directed therapy has no influence on mortality of high-risk surgical patients.

English Abstract↗
PubMed2003

Ensemble averaging and multiple statistical testing of EMG activities of cyclically repeated body motions. A tool for muscle function analysis in experimental and clinical orthopaedics.

Coupled with suitable computerized signal recording and processing methods surface electromyography can be a powerful tool for the analysis of muscle activity in specific body movements. It can be used for this purpose in experimental and in clinical diagnostic orthopaedics as well as in physiotherapy. We describe in this paper a motion analysis system comprising this feature. It has been employed for the diagnosis of the basic angular kinematics and muscle function in human gait and other cyclically repeatable movements of the human locomotive system. Changes in the temporal characteristics of the movements and the muscle activity due to changed physical or experimental conditions can be systematically investigated this way. Such changes can be the result of surgical and/or conservative orthopaedic therapy, a long term physiotherapeutic program, or modified walking conditions as in experimental orthopaedics. They are displayed and validated by signal ensemble averaging and subsequent multiple statistical testing (e.g. by a suitably adapted Bonferroni criterion). The efficiency of the system is demonstrated by an exemplary gait analysis of selected kinematic and muscular effects caused by an experimental simulation of a leg length inequality.

Algorithms↗
PubMed2003

Lack of toxic side effects in neutrophils following hyperbaric oxygen.

Conflicting data have been reported about the impact of repeated HBO2 exposure on the production of superoxide radicals during the neutrophil respiratory burst (RB) and on phagocytosis. In this study we wanted to see if exposure to hyperoxia would affect human neutrophil RB and phagocytosis. Short- and long-term effects after single or repetitive HBO2 exposure of 2.5 atmospheres absolute over a period of 90 min were studied in 40 healthy volunteers. The RB was measured by the intracellular oxidation of dihydrorhodamine after induction by Escherichia coli (E. coli), or priming with recombinant tumour necrosis factor alpha (TNF-alpha), followed by N-formyl-methionyl-leucyl-phenylalanine (fMLP) stimulation. The phagocytic activity was determined by the intake of FITC-labelled opsonized E. coli. No differences could be found between RB and phagocytic activity before and after HBO2 therapy, regardless of short- or long-term exposure. These findings indicate that exposure to hyperoxia does not impair these two important functions of the human innate host defense.

Adolescent↗
PubMed2002

[High energy extracorporeal shockwave therapy (ESWT) in pseudarthrosis].

The gold standard for treatment of pseudarthrosis is operation with osteosynthesis and grafting. More than 10 years ago, extracorporeal shock wave therapy (ESWT) was additionally introduced as a noninvasive and low-risk treatment for pseudarthrosis. The aim of our prospective study was to analyze the treatment effect in a homogeneous group of patients and to develop prognostic factors. Forty-three consecutive patients were included in this study. All patients had been operated on for trauma or undergone selective osteotomy and had developed pseudarthrosis that persisted for 9 months. All patients received high-energy ESWT (0.6 mJ/mm2) with 3000 impulses (Siemens Osteostar) in one session under regional anesthesia. To differentiate active from inactive pseudarthrosis, a bone scintigraphy was compulsory. Clinical and radiological follow-ups were done at 4-week intervals starting 8 weeks after ESWT for 9 months. Cortical bridging was found in 31 of 43 (72.1%) pseudarthroses at 4.0 +/- 0.6 months after ESWT. Of 31 (80.6%) successfully treated patients, 25 had a positive scintigraphy compared to 4 of 12 (33.3%) treatment failures. Of 35 (82.9%) patients with a positive bone scintigraphy, 29 had bony healing compared to 2 of 8 (25%) patients with a negative bone scintigraphy. Six of these eight patients smoked more than 20 cigarettes a day. ESWT is still a clinically experimental treatment method. The absence of complications justifies its use for pseudarthrosis treatment. Further controlled studies are mandatory.

Adolescent↗
PubMed2002

[Effects of Repetitive Exposure to Hyperbaric Oxygen (HBO) on Leukocyte Function].

OBJECTIVE: Despite favourable clinical data on the successful use of hyperbaric oxygen (HBO), only limited investigations have been carried out to date regarding the influence of hyperoxia on leukocyte function. In a murine model, CD4+ T-cell population remained unchanged after repeated HBO exposure, however CD8+ cells were found to be increased. The aim of this study was to investigate whether repetitive exposure to hyperoxia would affect human monocyte and lymphocyte function. METHODS: Methods: After Ethics Committee approval the effects of elevated partial oxygen pressure were studied in the course of a ten-day HBO therapy (2.5 atmospheres absolute over a daily period of 90 min). Monocytes and lymphocytes of 30 patients with acute hearing loss were determined by flow cytometry before, throughout and after HBO therapy using monoclonal antibodies to CD3, CD4, CD8, CD14, CD25, CD45 and HLA-DR. Statistical analysis was made by ANOVA (analysis of variance). RESULTS: The relative percentage of CD3+, CD4+, CD8+, CD25+, CD14+, and HLA-DR+ cells remained unchanged during the course of and after HBO therapy. CONCLUSIONS: We conclude that repetitive exposure to hyperoxia does not influence human monocyte and lymphocyte functions in contrast to experimental data.

Adult↗
PubMed2002

[Influence of a bolus injection of thiopental and propofol on the expression density of P-selectin and fibrinogen receptors on the surface of human platelets ex vivo].

OBJECTIVE: Exposure of platelets to anaesthetic agents may alter their functional characteristics and in patients undergoing surgery or long-term sedation this may be clinically relevant. We investigated the influence of thiopentone and propofol on the expression of platelet membrane P-selectin, fibrinogen receptor, and leukocyte-platelet aggregates ex vivo. METHODS: In patients undergoing surgery blood samples were taken from a peripheral vein cannula before induction of anaesthesia with propofol (3.0 mg kg (-1) BW) or thiopentone (7.0 mg kg (-1) BW) and five minutes later (n = 11 in each group). Surface expression of the fibrinogen receptor complex (GP Ib/IIIa), P-selectin, and the percentage of leukocyte-platelet aggregates were measured by flow cytometry after stimulation via the ADP or thrombin receptor pathway. RESULTS: There was no significant difference in the expression of gpIIb/IIIa, P-selectin, and percentage of leukocyte-platelet aggregates in the thiopentone and propofol group after induction of anaesthesia. CONCLUSIONS: In clinically relevant concentrations thiopentone and propofol did not influence the surface expression density of fibrinogen receptors, P-selectin molecules, and the percentage of leukocyte-platelet aggregates ex vivo.

Anesthetics, Intravenous↗
PubMed2002

[Kinematic changes after bicondylar resurfacing knee arthroplasty].

AIM: Knee joint motion appears as a hinge movement around the flexion - extension axis. But corresponding to the rolling-sliding-mechanism and alternative models of knee joint kinematics an instant center pathway must be expected. Objective of the study was the comparison of this pathway when assessed in the sagittal plane in patients with preoperative varus or valgus deformity. METHOD: A total of 40 patients either with varus or valgus deformity (20 in each group) were examined before and 6 months after implantation of PFC(R)-SIGMA prostheses. Apart from the influence of knee joint deformity (35 degrees varus to 24 degrees valgus), a so called soft tissue ratio was investigated. Therefore the relation of thigh and femur as well as lower limb and tibia diameters was calculated and combined in one value. The examination by means of photogrammetry consisted of a standardized chair with passive knee joint movement (90 degrees to 0 degrees flexion) supported by an electric motor. The position of defined skin markers was assessed by digital camara with online transmission to PC. The instant center pathway was then evaluated applying the Reuleaux-technique based on the changes of skin marker positions. RESULTS: Results showed a dependence of the course and dimension of the instant center pathway on the extent of soft tissue ratio as well as knee joint deformity. Small values of the ratio (W = 2.9) were represented by round or oval courses of the pathway whereas increasing ratios (W = 4.0) led to triangular and slightly increased dimensions of the courses. Varus deformitywas primarily combined with an increase of the pathways dimension and in contrast, valgus deformity showed decreased pathways. In each case, dimension normalized after prostheses implantation. CONCLUSION: The instant center pathway of knee joint motion showed for both patient groups characteristic phenomen. They were clearly combined with constitutional and clinical features of each patient.

Aged↗
PubMed2001

[3-dimensional biomechanical study of a new flexible lumbar intervertebral disk implant].

The aim of this study was to determine the significance of a new artificial nucleus implant for lumbar discs (polymethyl siloxane polymer, DR-PMSO) with special regard to the biomechanical properties of the spinal motion segment. The lumbar segments L1/L2 and L4/L5 were harvested from six calf cadavers. The segments were fixed on a special device mounted on a three-dimensional testing machine. Physiological load with a maximum of 7 Nm was applied in flexion/extension, right and left lateral bending, and right and left torsion. The movement of the measuring point (center of L1 and L4) was registered along three axes (sagittal, frontal, and vertical). Three cycles of measurements were performed on all specimens: (1) intact segment, (2) segment after nucleotomy, and (3) segment with PMSO. There was a statistically significant (p = 0.0313) increase in segmental mobility in all directions after nucleotomy with an increased mobility of the segment up to 30% for rotation and 50% for translation. After introduction of the PMSO implant, segmental mobility for all movement directions was restored with no statistically significant difference from the intact situation before nucleotomy. The disc material was found to be noncytotoxic according to current ISO 10993 standards.

Animals↗
PubMed2001

General anesthesia for interventional neuroradiology: propofol versus isoflurane.

STUDY OBJECTIVE: To compare recovery of psychomotor and cognitive ability after isoflurane and propofol-based general anesthesia. DESIGN: Prospective, blinded interventional study. SETTING: University hospital. PATIENTS: 24 ASA physical status I and II patients undergoing embolization procedures for intracranial vascular lesions. INTERVENTIONS: Isoflurane anesthesia or propofol anesthesia was given to patients. MEASUREMENTS: Awakening time; early recovery (5 minutes, 15 minutes, 30 minutes) was assessed using orientation and Steward tests; medium recovery (30 minutes, 60 minutes, 120 minutes) was tested using Controlled World Association (COWAT) and Digit Span tests; late recovery (4 hours, 24 hours) was assessed using a Verbal Learning and Memory Test and three subtests of a computerized attention test battery. MAIN RESULTS: Awakening time and early recovery of motor and respiratory function did not differ between groups. The propofol group scored worse in COWAT and Digit Span tests up to 60 minutes after anesthesia. Both groups showed an impairment of higher cognitive functions up to 24 hours after anesthesia. CONCLUSIONS: Both isoflurane- and propofol-based anesthesia allow early extubation and recovery of basic psychomotor functions. More sophisticated tests show a decline of cognitive functions up to 24 hours after isoflurane- as well as propofol-based anesthesia. Because both anesthetics show similar recovery of psychomotor functions after long duration anesthesia, other factors such as subjective well-being and costs may be considered when deciding between these two anesthetics.

Adolescent↗
PubMed2001

Effects of different preparations of propofol, diazepam, and etomidate on human neutrophils in vitro.

BACKGROUND: Intravenous anaesthetics and sedatives can influence polymorphonuclear cell (PMN) functions. Some of the drugs for sedation and anaesthesia have been alternatively dissolved in lipid solutions containing medium (MCT) and/or long chain (LCT) triglycerides. The in vitro effects of two different diazepam (benzyl-alcohol, LCT/MCT), etomidate (propylene-glycol, LCT/MCT), and propofol (LCT, LCT/MCT) preparations on respiratory burst (RB) and phagocytosis of human PMNs were studied. METHODS: Diazepam (2, 20 microg ml(-1)), etomidate (0.5, 5 microg ml(-1)), and propofol (6, 60 microg ml(-1)) were investigated in clinical and 10-fold concentrations with flow cytometric assays. The RB was measured with the fluorescent dye rhodamine after induction with Escherichia coli or formyl-methionyl-leucylphenylalanine (FMLP) following priming with tumour necrosis factor alpha (TNF-alpha). Phagocytosis of PMNs was carried out in whole blood after incubation with fluorescein-labelled E. coli. RESULTS: LCT-propofol at 60 microg ml(-1) reduced the percentage of PMNs with RB activity after induction with E. coli (52.8+/-20.4) and TNF-alpha/FMLP (10.8+/-5.1)) as well as the percentage of phagocytosing PMNs (48.9+/-19.5) in contrast to LCT/MCT-propofol, which augmented all parameters (85.4+/-10.1, 50.3+/-12.7, 66.5+/-12.5). Also the higher concentrations of LCT/MCT-diluted etomidate and diazepam increased the percentage of RB positive PMNs compared to the alternative compositions. The percentage of phagocytosing PMNs was less reduced with 20 microg ml(-1) LCT/MCT-diazepam (85.2+/-6.9) than with the same concentration of benzyl-alcohol diluted diazepam (68.8+/-12.2) compared to the control. CONCLUSION: The in vitro effects of diazepam, etomidate, and propofol are dependent on the solvent applied. The tested LCT/MCT preparations reduce the inhibitory effects on the bacterial killing capacity of PMNs found after incubation with propyleneglycol, benzyl-alcohol, or LCT preparations, respectively.

Anesthetics, Intravenous↗
PubMed2001

Effects of colloidal resuscitation fluids on the neutrophil respiratory burst.

BACKGROUND: Experimental studies have revealed that gelatin and HES produce increased neutrophil respiratory burst activity. It was investigated whether 3-percent gelatin (MW 35,000) and three types of 6-percent HES (MW 70,000; degree of substitution, 0.5; 200,000/0.5; 450,000/0.7) preparations can influence superoxide anion production during respiratory burst under clinical conditions. STUDY DESIGN AND METHODS: Blood samples were obtained from 40 patients before and 1 hour after the infusion, before anesthesia and surgical treatment. After stimulation with bacteria (Escherichia coli), the respiratory burst was measured by oxidation of nonfluorescent dihydrorhodamine 123 to the fluorescent rhodamine 123 by the use of flow cytometry. RESULTS: Respiratory burst activity decreased significantly (p = 0.004) from the baseline (60.0 +/- 6.5%) to 1 hour after the administration of the low-molecular-weight HES preparation (55.0 +/- 6.8%). No significant differences in respiratory burst activity could be found after the administration of gelatin or medium-molecular-weight or high- molecular-weight HES solution. CONCLUSION: The investigated administration of gelatin and medium- and high-molecular-weight HES preparations did not influence respiratory burst activity under clinical conditions. However, the neutrophil respiratory burst was impaired after the administration of low-molecular-weight HES. Neutrophil respiratory burst activity may vary according to the type of colloidal plasma substitutes administered.

Adult↗
PubMed2001

Using intranasal midazolam spray to prevent claustrophobia induced by MR imaging.

OBJECTIVE: Up to 37% of patients undergoing MR imaging examinations experience moderate to severe levels of anxiety that necessitate the termination of the procedure in 5-10% of patients. Although the clinical use of MR imaging has increased, effective procedures to handle claustrophobia are lacking. We evaluated the effectiveness of intranasally administered midazolam spray in preventing claustrophobic responses of patients undergoing MR imaging. SUBJECTS AND METHODS: Fifty-four patients scheduled for MR imaging were included in this prospective study. Anxiety and sedation of patients were evaluated before drug administration, immediately before MR imaging, and at the end of the procedure. The Spielberger State-Trait Anxiety Inventory, the visual analogue scale of anxiety, and a five-point sedation scale were used. Half the patients received intranasal spray applications of 4 mg midazolam, whereas the other patients received a placebo, in a randomized, double-blind study design (six sprayings of 0.5% midazolam solution or NaCl 0.9%, respectively). The intensity of the sensation of burning of the nasal mucosa was rated by patients using a three-point scale (no, slight, or strong burning). The quality of scan images was evaluated by a radiologist using a five-point scale (0 = extremely poor, 5 = excellent). RESULTS: No cancellations occurred with patients who received midazolam, whereas four of 27 patients receiving placebo panicked and terminated the scanning procedure. The initial anxiety and sedation scores did not differ between the groups. Patients who received midazolam spray were more sedated and less anxious immediately before entering the MR scanner and reported a more intense slight transient burning of the nasal mucosa than those in the placebo group. The quality of the MR image was higher in the midazolam group. CONCLUSION: A sizeable reduction in MR imaging-related anxiety and improved MR image quality were seen with patients who received intranasal midazolam spray. With the exception of transient burning of the nasal mucosa, no adverse effects were reported. This simple and safe method is useful in sedating patients for MR imaging and other minor procedures.

Administration, Intranasal↗
PubMed2000

Preoperative chemotherapy and pelvic radiation for tethered or fixed rectal cancer: a phase II dose escalation study.

PURPOSE: To study the impact of preoperative radiation dose escalation and postoperative adjuvant chemotherapy on the outcome of tethered and fixed rectal carcinoma. METHODS AND MATERIALS: We have treated 156 patients with 3 consecutive preoperative chemoradiation protocols with escalating treatment intensity. Schedule 1 consisted of 40 Gy radiation with concurrent 5-fluorouracil (5-FU) infusion and mitomycin C. Schedule 2 used a sandwich design with preoperative (40 Gy) and postoperative (18 Gy) radiation with concomitant 5-FU infusion, leucovorin, and mitomycin C. In schedule 3, the preoperative radiation dose was increased to 50 Gy and adjuvant 5-FU/leucovorin chemotherapy was added following surgery. There were 54, 27, and 75 patients treated in schedules 1, 2, and 3, respectively. RESULTS: The resectability was 91% for schedule 1 and 100% for both schedules 2 and 3. A dose-response relationship was observed between the radiation dose and the tumor downstaging and local control. The pathological complete response (T0N0M0) rates for schedules 1, 2, and 3 were 4%, 15%, and 25%, respectively. The respective rates of tumor downstaging were 41%, 33%, and 68%, respectively. The 5-year local relapse-free rates were 67% for schedule 1 (40 Gy), 96% for schedule 2 (58 Gy), and 92% for schedule 3 (50 Gy) (p = 0.0011). The addition of postoperative chemotherapy appeared to improve both the survival and the relapse-free survival. The 5-year survival was increased from 52% to 84% (p = 0.0004) and the 5-year progression-free survival was improved from 48% to 74% (p = 0.0008). CONCLUSION: Preoperative 5-FU infusion, leucovorin, mitomycin C, and 50-Gy pelvic radiation, followed by postoperative bolus 5-FU/leucovorin chemotherapy, appeared to be an effective treatment for tethered/fixed rectal cancers. However, its therapeutic efficacy could only be validated in randomized studies.

Adult↗
PubMed2000

[Occult fracture of ossified Achilles tendon without associated rupture of the tendon].

Ossification of the Achilles tendon is the result of a traumatic, hypoxic injury of the tendon. The usually asymptomatic ossification has a clinical importance only in case of a new trauma. We report about a patient with an isolated fracture of the ossification without an accompanying rupture of the Achilles tendon. Because of the radiologically "occult" fracture the diagnosis could only be verified by MRI. With a conservative treatment without resection of the ossification we could reach painless recovery.

Achilles Tendon↗
PubMed2000

Endoluminal grafting of abdominal aortic aneurysms: experience with the Talent endoluminal stent graft.

The aim of this study was to evaluate the Talent endoluminal stent graft (TESG) in treating abdominal aortic aneurysms (AAA). The TESG is a polyester-covered nitinol endograft (proximal diameters 20-38 mm and iliac limb diameters 8-22 mm). Twenty-two men were treated with the TESG via bilateral femoral arteriotomies. Pre-implantation, coil embolization of various vessels arising from the aneurysm was performed in 6 patients. Plain radiographs and spiral CT angiograms (CTA) were carried out at 7 days, 3, 6, and 12 months following TESG implantation or re-intervention. Median aortic and iliac diameters were 27 mm (range 20-34 mm) and 14 mm (range 10-19 mm). The corresponding graft diameters were 30 mm (range 24-38 mm) and 14 mm (range 12-20 mm). No patient was rejected purely on the basis of too large aortic or iliac diameters. Eight patients required custom-made grafts. Graft implantation was successful in all patients. There were no blood transfusions, distal embolic episodes, or conversions to open surgery. Re-intervention was necessary in 1 patient. Complications included one fatal myocardial infarction, one inguinal hematoma, and two superficial wound infections. The aneurysm thrombosed completely following implantation in 14 patients and at 3 or 6 months in 4 other patients. One patient with endoleak is awaiting his 3-month control and 2 patients show tiny endoleaks but reduction of aneurysm size. The mean aneurysm size decreased significantly from 58 +/- 10 to 53 +/- 13 mm (p < 0.0005). Due to the large sizes available and the option of custom-made grafts, the TESG helps widen the spectrum of patients who can be treated with endoluminal grafting. The treatment is associated with a significant reduction in aneurysm size.

Aged↗