Search PubMed⌕ Search

Biomedical subjects

M Wimmer

Publications and source records attributed to M Wimmer.

At least 19 recordsLinked to original sources
PubMed1995

Erythropoietin, erythropoesis and iron status in children after major surgical stress.

UNLABELLED: The aim of our study was to evaluate bone marrow stimulation and bone marrow response to post-operative anaemia in children after open heart surgery. In 16 children (age 5.7 +/- 0.9 years, weight 20.1 +/- 3.2 kg) serum erythropoietin, haematocrit, reticulocyte count, ferritin, transferrin saturation and C-reactive protein were assessed perioperatively after cardiopulmonary bypass for surgical repair of atrial septal defect. Erythropoietin increased seven fold from 14 +/- 6.2 (7-30) to 80 +/- 49 (20-171) mU/ml (P < 0.05) and the reticulocyte count a 1.7-fold from 11.1 +/- 3.1 (6-19) to 18.4 +/- 5.9 (10-31) / 1000 (P < 0.05). Transferrin saturation was inversely correlated to C-reactive protein. CONCLUSION: These findings suggest adequate bone marrow stimulation but an inadequate bone marrow response during the immediate perioperative period, caused by inhibition of erythropoesis by acute postoperative inflammation in children after open heart surgery.

Acute-Phase Reaction↗
PubMed1994

[Balloon dilatation of postoperative and congenital aortic isthmus stenoses].

From July 1987 to December 1992, 52 patients underwent balloon-angioplasty of aortic coarctation at three units of pediatric cardiology in Austria (Graz = 35 patients, Innsbruck = 15 patients, and Vienna = 2 patients). 35 patients had postoperative and 17 had native coarctation. Mean age at intervention was 7 10/12 years with 2 patients under 1 year and 5 patients over 18 years old. The mean relation balloon diameter-coarctation diameter was 2.6 +/- 0.9. The blood pressure gradient between upper and lower extremities decreased from a mean of 44 +/- 16 mm Hg to 15 +/- 13 mm Hg (p < 0.0001). The diameter of the stenosed segment was increased from 5 +/- 3 mm to 8.5 +/- 3.5 mm (p < 0.0001). Native coarctation showed a significantly better result in respect to decrease of the gradient (36 +/- 12 mm Hg) than did postoperative coarctations (25 +/- 19 mm Hg) (p < 0.03). 13 patients did not respond adequately to angioplasty. 10 patients out of this group had tubular narrowings and belonged to the group of postoperative coarctations, whereas localized stenoses in native coarctations gave the best results. Localized wall irregularities were found in 4 patients with native coarctation. Balloon angioplasty of postoperative and native coarctations in childhood and adolescence is a secure and effective means of treatment and should be considered as therapy of first choice. The best results can be found in the group of the circumscript type of stenoses in native coarctation, whereas long and tubular stenoses in the group of postoperative coarctations give less satisfying results.

Adolescent↗
PubMed1994

[Comparison of surgical techniques and various suture materials for correction of aortic isthmus stenosis].

UNLABELLED: Clinical examination and Doppler ultrasound were performed in 31 children after repair of coarctation of the aorta. Median postoperative follow-up period was 4.5 years. The aim of our study was a comparison of different operation techniques and suture materials. In 16 infants subclavian flap repair had been performed using polydioxanone absorbable sutures (PDS) in 8 cases and polypropylene (Prolene) sutures in the other 8 cases. Resection and end-to-end repair had been carried out in 8 infants using PDS and in 7 using Prolene sutures. Doppler-echocardiographically derived gradients across the reconstructed aorta were significantly lower in infants operated with the subclavian flap technique (p < 0.05). The length of the arm on the side of the subclavian flap operation was shorter (median 1.2 cm), but there were no signs of ischaemic complications. Using PDS sutures the aortic arch and the aortic isthmus were each morphologically significantly wider in both operation techniques. Noninvasive two-dimensional echocardiography demonstrated good anatomical repair and no anastomotic aneurysm formation after aortic repair using polydioxanone. CONCLUSION: Regarding the doppler-echocardiographically derived gradients in the anastomotic region this intermediate follow-up study reveals better results using the subclavian flap technique; absorbable polydioxanone sutures favour normal growth of the anastomotic site without vascular complications.

Anastomosis, Surgical↗
PubMed1993

The acinar heterotopy of phosphoenolpyruvate carboxykinase activity in rat liver under the influence of the oestrous cycle.

The acinar localization of phosphoenolpyruvate carboxykinase was investigated in livers from untreated female rats during the 4-day oestrous cycle. The results were correlated with plasma levels of insulin, glucagon and oestrogens. Total activity was highest in dioestrus and lowest in metoestrus. The highest activities were present in the periportal zone and decreased continuously towards the perivenous zone in all four phases of the cycle. This general pattern was modified under the influence of the cycle. The periportal-perivenous gradient was subject to cycle dependent changes, being steepest in proestrus. In addition to oestrogens the concentrations of plasma insulin also varied during the female cycle. Insulin was highest in oestrus and lowest in proestrus. Glucagon showed only minor variations. Oestrogen concentrations increased continuously from low values in oestrus to high values in proestrus. These changes were directly related to the changes in the slope of the activity gradient.

Animals↗
PubMed1993

Quantitative EEG before and after open heart surgery in children. A significant decrease in the beta and alpha 2 bands postoperatively.

Quantitative EEGs of 30 patients undergoing open heart surgery were investigated before, 6 days, 11 days and 44 days after operation. The study was conducted in order to investigate whether quantitative EEGs can show postoperative changes in children after open heart surgery. In 28 children, no new neurological signs of cerebral involvement were seen postoperatively. The most striking feature in these children was a significant decrease in the beta and the alpha 2 bands 6 and 11 days postoperatively. The pattern in the delta band was dominated by an increase 6 days postoperatively. Except for a slight decrease in alpha 2 waves, all variables were restored to preoperative values at 44 days after the operation. We found a significant decrease in plasma sodium and chloride after surgery but children with no or slight declines (1-3 mmol/l) also showed increased slow activity postoperatively. Therefore we conclude that an organic brain syndrome, although usually mild and transient, is a general phenomenon after open heart surgery.

Adolescent↗
PubMed1993

Anomalous origin of the left coronary artery: a review of surgical management in 13 patients.

Over the last decades, surgical management of anomalous left coronary artery originating from the pulmonary artery (ALCAPA) has seen a considerable evolution. Between 1965 and 1992, 13 children with age at operation ranging between 2 months and 11 years (mean 23 months) underwent one of 5 different surgical procedures: ligation (n = 3), direct aortic reimplantation (n = 7), subclavian (n = 1) or internal mammary (n = 1) artery anastomosis, or modified aortic implantation (Vigneswaran-procedure, n = 1). There were 3 early and one late deaths resulting in an overall mortality of 30.7%. Mortality was 66.7% in the ligation group, and 20% in the revascularization group (28.6% in the subgroup with direct aortic implantation). The one late death occurred 6 months after ligation. Follow-up ranges between 3 months and 21 years, mean 7.3 years. All but one survivors are in NYHA functional class I. Following operative correction, there was clear improvement in left ventricular performance. Our data give reason to suggest ALCAPA to be more frequent than considered so far. Early surgery is recommended in all patients with ALCAPA, regardless of age or symptomatic status. Reestablishment of a two-coronary system is considered the procedure of choice. All survivors require long-term follow-up controls of early recognition of residual or progressive cardiac problems.

Austria↗
PubMed1992

Long-term hemodynamic effects of nifedipine on congenital heart disease with Eisenmenger's mechanism in children.

The hemodynamic effect of long-term nifedipine medication was studied in 10 children, 3-12 years of age, five with ventricular septal defect and five with complete atrioventricular septal defect; all had Eisenmenger's reaction, seven also had Down's syndrome. They underwent heart catheterization prior to and during 1-4 years of nifedipine therapy. Fick's principle was used to calculate the ratio of pulmonary arterial pressure to aortic pressure (PAP/PAO), the ratio of pulmonary flow to aortic flow (QP/QS), as well as the ratio of pulmonary vascular resistance to aortic vascular resistance (RP/RS). In the seven children under 8.8 years, nifedipine caused a significant drop in PAP/PAO (p less than 0.004), a slight increase in arterial O2 saturation, a significant increase in QP/QS (p less than 0.02), and a decrease in RP/RS (p less than 0.02). The nifedipine effect was age related. On nifedipine, breathing oxygen resulted in, independent of age, a significant increase in QP/QS (p less than 0.003) and a significant decrease in PAP/PAO (p less than 0.04) and in RP/RS (p less than 0.003). Direct O2 consumption measurements before and during oxygen breathing in six patients demonstrated no significant change in RP, RS, QP, or QS indices. Nifedipine had a relaxing effect on the pulmonary vascular bed, especially in the younger child with Eisenmenger's mechanism. On nifedipine therapy, O2 produced a more complex hemodynamic reaction that was not restricted to the pulmonary circulation alone.

Child↗
PubMed1991

Two-dimensional and Doppler echocardiographic follow-up after the arterial switch operation for transposition of the great arteries.

An echocardiographic follow-up examination was performed in 20 children who underwent an arterial switch operation from November 1984 to October 1990. The age at the time of operation ranged from 1 to 54 days, the weight ranged from 2.5 to 4.5 kg body weight. The time interval from the day of operation and the examination ranged from 3 to 74 months. M-mode echocardiography showed hypokinetic left ventricular function in 6 patients (30%). Abnormal segmental left ventricular wall motions were found in 6/16 patients (37.5%). Doppler echocardiographic examination at the site of the pulmonary anastomosis revealed an instantaneous gradient less than 20 mmHg in 9 patients (45%), a gradient between 20 and 60 mmHg in 9 patients (45) and a gradient greater than 60 mmHg in two patients (10%). The location of the stenosis was just below the bifurcation in 17 patients (85%) and seemed to be related to stretching of the pulmonary trunk during the Lecompte maneuver. One patient (5%) had a supravalvular aortic stenosis with a gradient of 43 mmHg. Color-flow mapping revealed mild aortic regurgitation in 8 patients (40%) but moderate regurgitation in one patient (5%). Three patients (15%) showed mild mitral regurgitation, all of them also had hypokinetic left ventricular function.

Child, Preschool↗
PubMed1991

[Heart transplantation in childhood].

This report presents 5 children, in whom a heart transplantation was performed at the II. Chirurgische Universitätsklinik of Vienna. At the time of transplantation the age of the children was 2, 3, 6, 10, and 14 years. The preoperative diagnosis was dilative cardiomyopathy in two patients, hypertrophic cardiomyopathy, right ventricular decompensation after atrial repair of TGA and a tumor of the heart in the other patients. Three children are alive and well. One child suffered from severe postoperative complications and 1 child died because of rejection of the heart. Indication, follow-up, complications of the therapy and the position of heart transplantation in children are discussed.

Adolescent↗
PubMed1990

Changes in the acinar activity patterns of phosphoenolpyruvate carboxykinase in livers of male and female rats upon feeding a high protein and a high fat diet.

Phosphoenolpyruvate carboxykinase (PEPCK) activity was investigated in relation to its localization within the liver acinus of male and female rats after feeding either a high protein diet (77%) or a high fat diet (52%). Both diets led to sex-dependent changes in activity and acinar distribution patterns. In male rats high protein diet provoked a shift in the acinar activity pattern towards the perivenous parts of the acinus without increase in average activity. Yet in the livers of females the activity was increased in all parts of the acinus, but to a greater extent in the perivenous parts of the acinus. Feeding a high fat diet increased PEPCK activity in males and to an even greater extent in females. In both sexes the increase was greater in the perivenous zone when compared to the changes within the periportal zone. The results are discussed in relation to changes in the concentrations of glucoregulatory hormones.

Animals↗
PubMed1990

The development of the acinar heterotopic pattern of phosphoenolpyruvate carboxykinase activity in the newborn rat.

The postnatal appearance of phosphoenolpyruvate carboxykinase activity (PEPCK) and acinar heterotopy was investigated in newborn rats aged 2 h, 12 h, 24 h and 3 days, as well as in juvenile rats aged 25 days. The livers showed an almost homogeneous distribution of activity along the sinusoidal length at the beginning of extrauterine life where energy needs are greatest. Compared to rats aged 2 h, the PEPCK activity was higher in the livers from rats aged 12 h. The increase in activity was most pronounced in the intermediary zone. After 24 h of extrauterine life the activity decreased again creating a homogeneous acinar activity pattern. By day 3 activity had increased in the periportal zone, while decreasing in the perivenous zone, resulting in a periportal to perivenous gradient. By day 25 total activity had reached highest values both in males and females, due to a relatively high perivenous activity. The more prominent acinar gradient corresponded approximately to the one seen in adult animals.

Aging↗
PubMed1990

Enzyme activity patterns of phosphoenolpyruvate carboxykinase, pyruvate kinase, glucose-6-phosphate-dehydrogenase and malic enzyme in human liver.

The distribution patterns of the enzyme activities of phosphoenolpyruvate carboxykinase, pyruvate kinase, glucose-6-phosphate-dehydrogenase and malic enzyme were determined in the liver acini of men and women by microquantitative means. The activity of PEPCK was higher in men compared to the activity in women. In both sexes no heterotopic distribution pattern was observed. PK activity of men was higher, but in both sexes no heterotopic distribution was detectable. G6PDH and ME showed relatively low activity. The distribution of G6PDH and ME activity was to some extent different in men and women. Yet their heterotopic patterns were not particularly distinct.

Female↗
PubMed1990

Angiotensin converting enzyme activity in children with congenital heart disease.

Serum angiotensin converting enzyme (ACE) activity was determined in 46 children with congenital heart disease with normal and abnormal lung perfusion: (1) congenital heart disease with normal pulmonary blood flow (12 patients); (2) congenital heart disease with increased pulmonary blood flow (18 patients); (3) congenital heart disease with decreased pulmonary blood flow (16 patients). There was no significant difference in serum ACE activity between the three groups. In group 2 serum ACE activity had a tendency to correlate inversely with both mean pulmonary arterial pressure (r = -0.43; P less than or equal to 0.05) and pulmonary vascular resistance (r = -0.48; P = 0.05). No further correlations between serum ACE activity and age, serum electrolytes, creatinine nor other haemodynamic data could be established.

Adolescent↗
PubMed1990

The effects of acetylsalicylic acid on phosphoenolpyruvate carboxykinase activity and acinar heterotopy in livers from juvenile and adult rats.

Male and female juvenile as well as adult rats were treated with acetylsalicylic acid in order to examine the effect of the drug on over-all activity and activity distribution of phosphoenolpyruvate carboxykinase (PEPCK) in the liver acinus. Upon administration of acetylsalicylic acid PEPCK activity increased in juvenile males and adult females, but was reduced in juvenile females and adult males. The periportal-perivenous activity gradient along the sinusoidal length, which is flatter in untreated juvenile rats compared to the livers of adult rats, was distinctly steepened by acetylsalicylic acid treatment. Acetylsalicylic acid did not affect the gradient in adult rats.

Aging↗
PubMed1990

The heterotopic effects of insulin and glucagon on the acinar activity pattern of phosphoenolpyruvate carboxykinase in male and female rat liver.

The effects of the administration of insulin and glucagon on the intraacinar heterotopy of phosphoenolpyruvate carboxykinase (PEPCK) were investigated in male and female rat liver. Insulin did not noticeably influence PEPCK activity or its acinar distribution, either in males or in females. But it affected the activities of glucose-6-phosphate dehydrogenase and malic enzyme. Glucagon in supraphysiological concentrations led to an induction of PEPCK activity. Despite high glucagon concentration along the whole sinusoidal length, the inducing effect of glucagon was most pronounced in the periportal and intermediary parts of the acinus; thus indicating that there is no direct interrelationship between local glucagon concentration and PEPCK activity. In both experiments blood glucose levels were kept fairly constant.

Animals↗
PubMed1990

Experience with long-term nifedipine therapy in paediatric cardiological patients.

Clinical experience with long-term nifedipine treatment in 23 patients aged between 1 1/12 and 14 8/12 years is reported. The cardiopulmonary diseases comprised primary pulmonary diseases with pulmonary hypertension (n = 4), congenital heart defects with intracardiac shunts and pulmonary hypertension which either were inoperable as a result of an Eisenmenger reaction (n = 7) or presented a high surgical risk (n = 5), or defects in which pulmonary hypertension did not regress despite corrective (n = 1) or palliative surgery (n = 3), and congenital defects without pulmonary hypertension (n = 3). Subjective improvement with an increase in physical performance was clearly observed in 15 cases. Echocardiography and cardiac catheter examinations showed no progression of the pulmonary arterial diseases, except in 1 patient with severe primary pulmonary hypertension and an 11-year observation period with nifedipine treatment during the last 4 years. No complications occurred during the 4 corrective operations. A patient aged 14 8/12 years with the Down syndrome and atrioventricular septal defect developed easily controllable heart failure during 7-day administration of nifedipine without additional cardiotherapy. 4 children initially suffered from flushed face and scalp, in one case with headache; 2 children reported fatigue. Long-term treatment with nifedipine should begin with strict 7-day supervision in hospital and possibly additional digitalization. Success of the treatment was determined by an improved quality of life in patients with primary pulmonary hypertension and inoperable defects, and by a reduced perioperative risk and postoperative regression of pulmonary hypertension in patients with operable defects.

Adolescent↗
PubMed1989

[Secondary immunopathogenesis in myocarditis, diseases of the heart muscles and infarct-associated arrhythmia in childhood and adulthood].

In histologically proven or clinically diagnosed perimyocarditis in children and adults alterations in cellular and humoral effector mechanisms are demonstrable: OKIaI-positive B- or activated T-lymphocytes are increased in the peripheral blood, whereas natural killer cell activity is reduced. Antibodies are directed to the membranes of isolated human atrial myocytes and, to a lesser extent with lesser specificity, to endothelial cells and to the extracellular matrix. AMLAs are of diagnostic relevance if they belong to the IgM class, indicating a recent humoral immune stimulation and, if they fix complement, indicating a functional property which is complement associated lysis of target cells. Immunohistological studies demonstrate fixation of immunoglobulins to the autologous biopsy specimens, which are diagnostic only if they also belong to the IgM class and fix complement. In acute rhythm disturbances in the context of a recent "common cold", similar humoral immune reactions can be found in children, which are compatible with a secondary immunopathogenesis after viral illness involving the myocardium.

Adult↗