Rupture of gastroepiploic-coronary bypass graft due to cardiopulmonary resuscitation.
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Arteries↗
Biomedical subjects
J Vogt
Publications and source records attributed to J Vogt.
Plasma arginine and citrulline kinetics in adults given adequate and arginine-free diets.
The fluxes of arginine and citrulline through plasma and the rate of conversion of labeled citrulline to arginine were estimated in two pilot studies (with a total of six adult subjects) and in a dietary study with five healthy young men. These latter subjects received an L-amino acid-based diet that was arginine-rich or arginine-free each for 6 days prior to conduct, on day 7, of an 8-hr (first 3 hr, fast; final 5 hr, fed) primed continuous intravenous infusion protocol using L-[guanidino-13C]arginine, L-[5,5-2H2]citrulline, and L-[5,5,5-2H3]leucine, as tracers. A pilot study indicated that citrulline flux was about 20% higher (P < 0.05) when determined with [ureido-13C]citrulline compared with [2H2]citrulline, indicating recycling of the latter tracer. Mean citrulline fluxes were about 8-11 mumol.kg-1.hr-1 for the various metabolic/diet groups and did not differ significantly between fast and fed states or arginine-rich and arginine-free periods. Arginine fluxes (mean +/- SD) were 60.2 +/- 5.4 and 73.3 +/- 13.9 mumol.kg-1.hr-1 for fast and fed states during the arginine-rich period, respectively, and were significantly lowered (P < 0.05), by 20-40%, during the arginine-free period, especially for the fed state, where this was due largely to reduced entry of dietary arginine into plasma. The conversion of plasma citrulline to arginine approximated 5.5 mumol.kg-1.hr-1 for the various groups and also was unaffected by arginine intake. Thus, endogenous arginine synthesis is not markedly responsive to acute alterations in arginine intake in healthy adults. We propose that arginine homeostasis is achieved largely via modulating arginine intake and/or the net rate of arginine degradation.
Adult↗
Splanchnic metabolism of dietary arginine in relation to nitric oxide synthesis in normal adult man.
Urinary nitrate (NO3) is the stable end product of nitric oxide, which is formed, in turn, from a guanidino nitrogen of arginine. We have conducted two experiments, each in four healthy adult men receiving a low nitrate diet for 7-10 days, to investigate the in vivo conversion of arginine to nitrate. In the first study [guanidino-15N2, 5,5-2H2]arginine was given on day 7 via a primed continuous intravenous infusion for 8 h. In the second study, the labeled arginine was given for 8 h by the intragastric route on day 7 and by the intravenous route on day 10. Measurement of 15NO3 output in urine collected for 24 h beginning at the time of the arginine tracer infusion revealed a more extensive transfer of 15N when the arginine tracer was given intragastricly. From the comparative labeling of 15NO3 after administration of the tracer arginine via the intragastric and intravenous routes, we estimate that 16% +/- 2% of the daily production of nitrate arises from the metabolism of dietary arginine that is taken up during its "first pass" in the splanchnic region. Hence, nitric oxide production occurs, to a measurable extent, in this area in healthy subjects, raising the question as to how various pathophysiological states might alter the relations between exogenous and endogenous sources of arginine as precursors of NO. and the relative contributions made by various organs to whole body (NO.) NO3 formation. These results also raise important questions about the use of nitric oxide synthase inhibitors in animal and human studies.
Adult↗
Williams-Beuren syndrome: a 30-year follow-up of natural and postoperative course.
One hundred and four patients with Williams-Beuren syndrome were investigated from 1958 to 1992. Follow-up ranged from 1 to 32 years (mean 13), during which time 10 patients died and 17 were lost to follow-up. Seventy-six patients were in NYHA classes I and II and one was in class III. When first investigated, blood pressure was raised in 82% of the patients; at the latest evaluation 52% suffered from high blood pressure. Right heart catheterization was performed in 100 patients and repeated in 19; left heart catheterization was performed in 85 patients and repeated in 21. Right ventricular pressure ranged from 20 to 140 mmHg (mean 45), the mean pressure decreased from 66 mmHg to 50 mmHg (P < 0.006), the average value of the 19 patients in whom the measurements were repeated. The supravalvular aortic gradients ranged from 0 to 110 mmHg (mean 27), and the mean value of the 21 patients with repeated catheterization increased from 13 to 27 mmHg (P < 0.03). Twenty-nine patients underwent operative repair, two patients died peri-operatively. Pre-operative aortic gradients ranged from 40 to 110 mmHg (mean 76), postoperative gradients from 0 to 90 mmHg (mean 15). Forty-one adult patients were reevaluated. Doppler investigation revealed mild aortic insufficiency in eight patients and severe mitral regurgitation in one. In 32 patients, bicycle exercise testing was normal.
Abnormalities, Multiple↗
Pulmonary artery origin of the left coronary artery: diagnosis by transoesophageal echocardiography in infancy.
In two infants the anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was detected prospectively by transoesophageal echocardiography (TEE). Colour flow mapping and pulsed Doppler ultrasound revealed a predominant right-to-left shunt from the pulmonary artery to the left coronary artery. These findings were confirmed by angiography. Transthoracic echocardiography (TTE) failed to show the anomalous origin of the left coronary artery or any abnormal pulmonary flow pattern. TEE may be useful in the diagnosis of ALCAPA in selected cases, when TTE is inconclusive.
Coronary Vessel Anomalies↗
Effects of xylitol on carbohydrate and protein metabolism after trauma and during sepsis.
INTRODUCTION: Total parenteral nutrition (TPN) after trauma and during sepsis has two major goals. One is the reduction of increased protein catabolism, the second is to avoid hyperglycemia and enhanced hepatic gluconeogenesis. Glucose and xylitol differ in their utilization rates after trauma and during sepsis. Whole-body glucose utilization is reduced during such states, while the utilization of xylitol is more than doubled. In order to investigate whether these differences are associated with beneficial effects on hepatic glucose production and protein sparing, we conducted two animal and two clinical studies. METHODS: For the analysis of glucose and protein turnover radioactive and stable isotope techniques were applied. In burned rats primed constant infusions of 6-[3H]-glucose, 1-[14C]-alanine, 3-[14C]-alanine and U-[14C]-acetate were used to determine whole body glucose turnover, gluconeogenesis from C3-precursors and alanine flux. In septic rats nitrogen balance was calculated after determination of 24-hour-urine nitrogen content measured by micro-Kjeldahl digestion. 24-hour urinary 3-methyl-histidine excretion was analysed by amino acid autoanalyser. In human studies hepatic glucose production and urea synthesis rates were measured using primed continuous infusions of [6,6-d2]-glucose and [2-N15]-urea, respectively. RESULTS: In the first trauma model we demonstrated that hypocaloric xylitol in contrast to glucose significantly reduced hepatic glucose production and gluconeogenesis from C3-carbons. In the septic rat exchange of glucose calories by xylitol in a proportion of 1:1 was associated with a significantly ameliorated nitrogen retention and lower 3-methyl-histidine excretion. In two studies on surgical intensive care patients we were able to confirm these nitrogen sparing properties of xylitol. Hepatic glucose production and urea synthesis rates were significantly reduced during xylitol infusion after trauma, whereas equicaloric glucose had no effects. In septic patients xylitol led to significant lower lactate concentrations and gluconeogenesis rates than isocaloric glucose. DISCUSSION: In animal as well as in human studies hypocaloric xylitol and the mixture of glucose/xylitol (1:1) were more efficient in preserving body protein than glucose alone. Hepatic gluconeogenesis was significantly reduced when compared to isocaloric glucose. During the acute phase after trauma we therefore recommend a carbohydrate supplementation of 3 g/kg BW/d by xylitol. During long-term TPN a glucose/xylitol mixture (1:1) in a dosage of 6 g/kg BW/d is recommended together with amino acids and, if necessary, lipids.
Animals↗
[Acute pericardial tamponade after percutaneous transluminal coronary angioplasty (PTCA). A rare life threatening complication].
Cardiac tamponade following coronary perforation is a rare complication in conventional balloon angioplasty. In a series of 8000 dilatations we observed this complication after PTCA in 2 female patients (0.25/1000). In both cases cardiac tamponade occurred 2 h after PTCA of small, in 1 case calcified, coronary arteries during monitoring on the coronary care unit. By immediate percutaneous pericardiocentesis and subsequent drainage by a pigtail catheter we could manage the complication. One patient suffered an acute myocardial infarction 3 days after PTCA because of a subacute occlusion of the perforated vessel.
Aged↗
[Recanalization of occluded coronary arteries using the Magnum system].
Recanalization procedures with the "Magnum" system were undertaken in 137 patients (113 men, 24 women; mean age 57.1 +/- 8.1 years) with complete occlusion of a coronary artery. The system consists of a 0.021 inch guidewire with a flexible 1 mm diameter olive tip, a double-lumen probing catheter and a Magnarail balloon catheter. Chronic coronary artery occlusion of maximally 3 months was present in 51 patients (37%), for over 3 months in 52 (38%), while the duration of occlusion was unknown in 18 (13%). An acute coronary occlusion was successfully recanalized in 7 patients (5%), while in 9 (7%) it was accomplished when it had occurred during or shortly after a percutaneous coronary artery angioplasty (PCTA). The occlusion was successfully passed in 87 patients (64%); in 15 of them recanalization with another system had failed. The highest success rates were obtained with an acute occlusion (5 of 7; 71%), occlusion of 3 months' duration or less (39 of 51; 76%), and occlusion during PTCA (8 of 9; 89%). The success rates were lower for occlusions over 3 months' duration (25 of 52; 48%; P < 0.05) and of unknown duration (10 of 18; 56%; n.s.). Recanalization after failed recanalization was successfully accomplished by rotation-angioplasty (n = 2) or a standard system (n = 4).--These results indicate that the Magnum system is suitable for recanalizing chronic or acute coronary occlusion. But cardiologists should be capable of using several systems to increase the chances of successful recanalization.
Adult↗
[The percutaneous extraction of an embolized Pudenz-Heyer catheter fragment from the pulmonary artery].
A ventriculoatrial shunt had been placed 3 years previously in a now 17-year-old boy because of obstructive hydrocephalus of unknown cause. He presented with symptoms of elevated cerebrospinal fluid pressure and computed tomography demonstrated a dilated ventricular system. The chest X-ray film revealed a break in the shunt catheter at the level of the right clavicle with embolization of its 13 cm long distal part into the main stem and right branch of the pulmonary artery. The fragment was retrieved without complication with a percutaneously and transvenously introduced basket catheter. Centrally embolized catheter fragments should be removed as soon as possible. The percutaneous route is well tolerated by and of low risk for the patient. It should always be attempted before any surgical intervention.
Adolescent↗
Myocardial ischemia and left-ventricular function after ligation of left coronary artery (Bland-White-Garland syndrome): a long-term follow-up.
Left-ventricular function and myocardial perfusion were studied in 8 patients for between 3 and 21 years (mean 16 years) after ligation of the anomalous left coronary artery from the pulmonary artery. While only one patient complained of exercise-dependent stenocardia, 4 patients had abnormal ST-segments in the exercise ECG and all patients showed myocardial ischemia at exercise scintigraphy. At rest, the ejection fraction of the left ventricle was within normal range in all patients. In 5 patients, it failed to increase adequately under exercise conditions, reflecting impaired ventricular function. These results confirm the advantages of surgical procedures establishing a 2-coronary system.
Adolescent↗
Therapy for acute vascular complications in percutaneous transluminal coronary angioplasty with the autoperfusion balloon catheter.
Prolonged dilatation with an autoperfusion balloon catheter (APBC) (High-Flow-CPC-Mainz (Schneider) in 23 cases and Stack Perfusion (ACS) in 50 cases) was carried out in 73 patients (60 men, 13 women, mean age 59.3 +/- 8.8 years) with acute vascular complications occurring during PTCA (25 occlusive dissections (34%), five thrombotic occlusions (7%), 42 non-occlusive dissections (58%) and one non-occlusive thrombus with reduction of flow (1%)) in order to avoid stent implantation or emergency bypass surgery. On average 1.5 +/- 0.8 inflations were carried out per patient with a mean maximum inflation time of 14.1 +/- 8.4 min and a mean total inflation time of 16.8 +/- 12.3 min. In 61 patients (83.5%), the vascular complication could be controlled successfully with APBC, but in 12 APBC was not successful. Eight patients (11%) had emergency surgery. A stent was implanted in three patients (4.1%), and one suffered an acute myocardial infarction. Out of the 61 patients with positive result after prolonged dilatation, the hospital phase was uncomplicated in 53 (86.9%), five (8.2%) suffered an infarct with a maximum rise in CK of 350 U.l-1, two with multivessel disease had elective operations and one was dilated a second time because of a subacute reocclusion. Our experience indicates that when an acute vascular complication occurs, prolonged dilatation with an APBC is good interventional therapy avoiding stent implantation or emergency bypass surgery. However, new techniques cannot always replace surgery so an emergency bypass operation may still be necessary.
Adult↗
Neurokinin receptors and mucosal ion transport in porcine jejunum.
Neurokinin (NK) peptides such as substance P (SP) may modulate epithelial ion transport in the small intestine. The present study was undertaken to examine the pharmacological mechanisms by which SP and its endogenous homologs NKA and NKB affect active electrolyte transport in the mucosa of porcine jejunum. Neurokinins and NK agonist analogs increased short circuit current, a measure of active ion transport, across sheets of jejunal mucosa-submucosa with the order of potency: SP greater than [beta-Ala8]NKA4-10 greater than or equal to [Sar9,Met(O2)11]SP greater than NKA = Arg-NKB greater than NKB after their addition to the serosal aspect of tissues (SP EC50 = 11 nM). Epithelial responses to SP or NKA underwent rapid autotachyphylaxis and unidirectional cross-tachyphylaxis after repeated peptide administration. The neuronal conduction blocker tetrodotoxin significantly reduced NK efficacy. SP activity was significantly reduced in tissues pretreated with the muscarinic cholinoceptor blocker atropine or the eicosanoid synthesis inhibitor eicosa-5,8,11,14-tetraynoic acid. NK peptides increased contractility in longitudinally oriented strips of jejunal smooth muscle with an order of potency: [Sar9,Met(O2)11]SP greater than SP greater than Arg-NKB = [beta-Ala8]NKA4-10 greater than or equal to NKB = NKA (SP EC50 = 11 nM). SP-induced contractions were reduced by 70 to 80% in tissues pretreated with atropine or the neuronal Ca++ channel blocker, omega-conotoxin. [125I]Bolton-Hunter-substance P (BHSP) bound specifically to a single population of sites in slide-mounted sections of mucosa-submucosa and smooth muscle with Kd = 0.3 and 0.1 nM and Bmax = 18 and 31 fmol/mg protein, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
[Spontaneous renal artery dissection].
The clinical clues of sudden arterial hypertension, acute pain in the side, proteinuria, hematuria, abdominal bruits and renal failure are suspicious for spontaneous dissection of the renal arteries, even in the absence of one or more of the above-mentioned symptoms. To confirm the diagnosis and to provide appropriate therapy, immediate renal arteriography is mandatory, otherwise acute loss of renal tissue may occur. We report on one patient with spontaneous dissection of the renal arteries.
Aortic Dissection↗
Incontinentia pigmenti (Bloch-Sulzberger syndrome). A case report.
Incontinentia pigmenti is a rare genodermatosis with multiple manifestations affecting the skeletal, ocular, dental, and other tissues. More than 95% of reported cases occur in females, and more than 60% of reported cases involve some dental abnormality. A brief review of the literature and a case in a 7-year-old girl with the disease are presented.
Anodontia↗
Aneurysm of the distal aortic arch in a five-year-old patient.
Surgical repair of a distal aortic arch aneurysm in a 5-year-old boy with coarctation is presented. No synthetic material was incorporated thus allowing future growth of the anastomosis.
Anastomosis, Surgical↗
[EEG, CCT and MRT in patients after mild and moderate craniocerebral trauma. A study of 102 patients].
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Adult↗
[Percutaneous transluminal coronary angioplasty (PTCA) in unstable angina pectoris: results and complications with reference to a new classification].
Percutaneous transluminal coronary angioplasty (PTCA) of patients with unstable angina pectoris is an established therapy, although the rate of major complications (death, myocardial infarction, emergency coronary artery bypass operation) is higher than in patients with stable angina. This study analyzes the results of PTCA in 168 patients (136 men, 32 women, mean age 60.6 +/- 9.6 years) treated between January 1989 and June 1990 for unstable angina pectoris. Unstable angina was classified according to the criteria proposed by Braunwald in 1989. PTCA was successful in 141 patients (83.9%) and failed in 27 patients (16.1%). No patient died. One patient (0.6%) suffered an acute myocardial infarction related to PTCA. After failed PTCA 16 patients (9.5%) underwent emergency coronary artery bypass grafting (CABG), 10 patients had no complication. In patients of unstable angina class III (angina at rest within the last 48 h before PTCA) emergency CABG was needed in 20.3% compared to 3.6% (p less than 0.01) in patients with unstable angina class II (last attack of angina at rest more than 48 h before PTCA). Also 30% of patients with unstable angina within 2 weeks after myocardial infarction (clinical subgroup C) needed emergency CABG after failed PTCA as compared to only 6.9% (p less than 0.01) of patients with primary unstable angina pectoris without previous infarction (clinical subgroup B). The highest frequency (66.6%/6 of 9 patients) of emergency CABG was observed in patients with class III and subgroup C. We conclude that the classification of unstable angina pectoris proposed by Braunwald might be helpful to identify patients with risk in PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Multivessel PTCA as an alternative to bypass operation: effect of complete revascularization on long-term follow-up].
In this study we examine the influence of the initial grade of revascularisation on clinical follow-up in patients with multivessel PTCA instead of CABG. Between I/85 and VII/89 multivessel PTCA was performed in 231 patients (202 m, 29 w; age 57 +/- 9 years). 71% of the patients had 2-vessel disease (VD), 14% 3-VD. 15% had angioplasty of one major and at least one important side branch. Clinical follow-up was achieved by a questionnaire 19.8 +/- 10.1 months after PTCA. 473 of 508 (93.1%) treated stenoses were successfully (residual stenosis less than 50%). 198 patients (86%) had successful angioplasty of all treated lesions. 31 patients (13%) had failed PTCA of one stenosis, 1 patient of both treated lesions. 1 patient underwent emergency CABG. A complete revascularisation (group A) - no residual stenosis greater than 50% in any coronary artery - was achieved in 164 patients (71%). 65 patients (28%) had incomplete revascularisation [group B]. 206 patients (89.1%) had clinical follow-up by questionnaire, 144 patients in group A (87.8%) and 60 patients in group B (92.3%) [n.s.]. 3 patients had died by noncardiac reasons (two in group A and one in group B), 1 patient of group A by cardiac reason. 70% in group A and 68% in group B had continuous clinical improvement (n.s.). Total amount of cardiac events (PTCA, CABG, cardiac death, MI) showed no significance between both groups - 35 (24%) vs 23 (38%). Patients in group B had more CABG (12% vs 3%) and angioplasty of further lesions (7% vs 1%) [p less than 0.05] during follow-up. We conclude multivessel PTCA shows good primary results with low risk.(ABSTRACT TRUNCATED AT 250 WORDS)
Angina Pectoris↗