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Biomedical subjects

P Kalmar

Publications and source records attributed to P Kalmar.

At least 37 records · Page 2Linked to original sources
PubMed1990

Multicentric quality assurance in cardiac surgery. QUADRA study of the German Society for Thoracic and Cardiovascular Surgery (QUADRA: quality data retrospective analysis).

A method for initiating quality assurance in cardiac surgery was developed multicentrically by a commission of the German Society for Thoracic and Cardiovascular Surgery (QUADRA Study). To appraise the quality of cardiosurgical action, variables were compiled from the preoperative, intraoperative, and postoperative treatment course. The data collection was carried out at the same time as treatment. On the basis of unicentric data profiles, multicentric hospital profiles, and problem profiles, a quality comparison could be carried out and the variability of cardiosurgical action which may occasion interventions could be identified. A reduction of perioperative blood consumption during the study period could be observed in four out of five hospitals as the first result. The data collection also revealed epidemiological features. On average, women were older than men at the time of the heart-valve and coronary operations. To ensure data validity and the organization of quality assurance, a documentation assistant and a specially trained physician are necessary at every cardiovascular surgery center. The multicentric external comparison is indispensable and must be carried out by means of a central data collection, for which intrumental and staff capacities are also to be provided. With modern methods of data processing, an additional and new approach to the improvement of quality in cardiac surgery can thus be made.

Blood Transfusion↗
PubMed1990

[Dissecting aneurysm of the thoracic aorta. Diagnosis--surgical management--results].

From 1980 to 1989, 84 patients underwent surgery for dissection of thoracic aortic aneurysms. According to the DeBakey classification there were 23 dissections of type I, 35 of type II and 26 of type III. Magnetic resonance imaging and combined transesophageal and transthoracic echocardiography are highly sensitive and specific methods for diagnosis and followup of aortic dissection. 10% of the patients had to undergo surgery again during the first 5 years. The 5-year-survival rate was 56.1% and the 10-year rate was 40.1%.

Adult↗
PubMed1990

[Central nervous system risk factors in heart surgery].

Serious complications involving the central nervous system in the course of cardiac surgical procedures have become rare. Nevertheless, CNS dysfunctions still are observed in a considerable number of patients, exceeding by far the number of those at risk from preoperative neurological hazards. The influence of extracorporeal circulation performance and hypothermia on the physiology of cerebral autoregulation, as well as microembolization events seem to be crucial factors in this context. The resulting regional or global posthypoxic changes in brain metabolism may lead to the manifestation of various neurologic and psychiatric disorders in the postoperative course. These often minor disturbances of CNS function can only be detected regularly and diagnosed correctly in a prospective way by consulting specialists in neurology, psychiatry and psychology, as performed at the Department of Thoracic- and Cardiovascular Surgery of the University Hospital in Hamburg since 1974, and currently in use an international multicenter study. We found postoperative neurological abnormalities in more than 50% of our patients. While irreversible brain damage occurred in only 0.5% of cases, about twothird exhibited transient symptoms that were no longer apparent after 8-10 days postoperatively. Obvious psychopathological symptoms were noted in 10% of cases after surgery, and minor, likewise transient, psychiatric disturbances were seen in up to 50% of patients; 20% suffered from long-lasting psychic problems. The subjective complaints in these cases exceeded the results of objective assessments to a remarkable amount. The discussion focuses on a critical valuation of clinical and supplementary examination techniques and on the potential pathophysiologic mechanisms induced by extracorporal circulation.

Brain Damage, Chronic↗
PubMed1989

[Disorders of fascicular conduction following coronary surgery: etiology and clinical relevance].

Seventy-one consecutive patients undergoing coronary artery bypass grafting (CABG) were studied prospectively. New fascicular conduction defects (FCD) were evident in 51 patients (72%) 1 h after cardioplegic cardiac arrest, in 40 patients (56%) after 2 h, in 29 patients (41%) on the first postoperative day, and in 14 patients (20%) on the seventh postoperative day. Right bundle branch block was the most common type of FCD, followed by left anterior hemiblock. FCD were related to longer aortic cross-clamp time, higher age (p less than 0.025), frequency of wall motion abnormalities (p = 0.033), the number of diseased (p = 0.007) and bypassed vessels (p less than 0.0005), a greater intra- (p = 0.018) and postoperative (p = 0.017) demand for catecholamines, a more complicated postoperative course (p = 0.005), and a longer stay in the intensive care unit (p less than 0.01). Ischemic damage to the conduction system during cardioplegic cardiac arrest appears to be the most likely explanation for new FCD after CABG. Severe coronary heart disease contributes to their development. Hence, adequate myocardial preservation is of crucial importance. FCD are associated with increased perioperative morbidity, according to other studies, also with poorer long-term prognosis, especially in case of a left bundle branch block. In this subset a closer follow-up may be indicated.

Arrhythmias, Cardiac↗
PubMed1988

Increase in myocardial Gi-proteins in heart failure.

The contractile response and myocardial content of Gi-proteins were examined in cardiac preparations from explanted hearts of four different patients with end-stage heart failure. Three patients had idiopathic dilated cardiomyopathy and one patient had inflammatory heart disease. Preparations from patients with idiopathic dilated cardiomyopathy showed reduced contractile response to the cAMP-increasing agent isoprenaline and an increase in myocardial Gi-proteins, compared with preparations from non-failing hearts. Therefore it is conceivable that an increase in myocardial Gi-proteins is causally related to heart failure due to idiopathic dilated cardiomyopathy. In the preparation from the patient with inflammatory heart disease the contractile response to isoprenaline was not reduced and likewise content of Gi-proteins was not changed.

Cardiomyopathy, Dilated↗
PubMed1988

'Head and heart'--neurological and psychological reactions to open heart surgery.

Neurological and psychological reactions to open-heart surgery are widely underestimated phenomena and occur in a much higher incidence than one might expect. When analyzed retrospectively, up to 3.8% of patients who underwent cardiac surgery at the Hamburg University Hospital exhibited these reactions, whereas 35%-50% presented with symptoms and signs of perioperative CNS dysfunctions in prospective studies at our department. About the same percentages are detected in prospective studies of the patients' perioperative psychopathology, stating that a great number of cardiac patients exceed the normal range of anxious, tense, and depressive moods in this setting. The consequences of these findings for the patients' quality of life and the impact for the perioperative management of patients undergoing open-heart surgery are discussed. The current prospective studies, preliminary results of which are presented here, are part of an international interdisciplinary study, initiated to bring more light into the complicated relations between ECC-assisted cardiac surgery, anaesthesiology, neurology and psychology.

Adaptation, Psychological↗
PubMed1987

[Intracoronary thrombus in patients with unstable angina pectoris].

Intracoronary thrombi were found in 20 of 52 patients (38%) who had coronary angiography because of treatment-resistant unstable angina. Unrelated to the angiographic finding, eight patients (15%) sustained a myocardial infarction, and two died during their hospital stay. Only one patient (5%) with and six patients (19%) without intracoronary thrombi were stabilized and discharged from hospital. The remaining patients either had an aortocoronary bypass (n = 31) or transluminal balloon angioplasty (n = 13). These findings underline the importance of intracoronary thrombus formation in the pathogenesis of treatment-resistant unstable angina.

Adrenergic beta-Antagonists↗
PubMed1984

[Arterial digital subtraction angiography for demonstrating aortocoronary venous bypasses].

We examined the patency of aortocoronary venous bypasses in 51 patients during the early postoperative phase by using non-selective contrast injection into the aorta with digital subtraction angiography. In all patients it was possible to evaluate the degree of patency by this method. The accuracy and value of this examination, as compared with other invasive and non-invasive methods, is discussed.

Adult↗
PubMed1984

Intracoronary thallium 201 scintigraphy as an immediate predictor of salvaged myocardium following intracoronary lysis.

Since February of 1980, 157 patients who had had symptoms of acute myocardial infarction for less than 3 hours underwent intracoronary lysis. Forty-six patients required early aorta-coronary revascularization. However, operation was believed to be indicated only when intracoronary lysis was successful and myocardium was salvaged. Since left ventricular angiography proved unreliable in assessing the viability of the myocardium in the acute stage, starting in March of 1981 we obtained intracoronary thallium 201 scintiscans in 23 patients before and after intracoronary lysis. Patients in whom there was a significant reduction (greater than 50%) in the initial 201Th defect (n = 12) were considered ideal candidates for operation (Group 3). Patients with poor or unimproved 201Th uptake after successful intracoronary lysis (n = 6) were treated medically (Group 2), as were patients in whom intracoronary lysis was unsuccessful (n = 5, Group 1). In order to validate this new approach, we compared the change in the regional wall motion of the "infarcted area," as shown in the early and follow-up left ventricular angiograms in all three groups. In the acute stage, the mean regional ejection fraction was 19.9% in Group 1, 19.1% in Group 2, and 20.1% in Group 3. Only in Group 3 was there a significant increase in regional ejection fraction to a mean of 51%. The mean ejection fraction obtained at follow-up in Groups 1 and 2 was 16.5% and 17.3%, respectively. From our findings, we conclude that 201Th scintigraphy is a valuable predictor of the salvageability of myocardium immediately following intracoronary lysis. To date, it has been the most valuable tool in assessing those patients suitable for early coronary revascularization.

Coronary Vessels↗
PubMed1983

[Demonstration of neo-intima in PTFE-prostheses after venous replacement in dogs].

Because of the danger of thrombosis, venous replacement by prostheses is a yet clinically unsolved problem. We tested the PTFE-prosthesis at the positions of vena cava inferior and iliac veins in dogs. Already eight weeks after operation, the inner surface of the prosthesis was covered by a thin neo-intima, which by light microscopy, scanning and transmission electron microscopy was shown to contain a basal membrane and endothelial cells. This continuous layer may be responsible for the observed low rate of thrombosis. These findings suggest that the PTFE-prosthesis may offer advantages for venous replacement in patients.

Animals↗
PubMed1983

Transesophageal two-dimensional echocardiography in the diagnosis of cor triatriatum in the adult.

Two adult patients with left ventricular inflow obstruction are presented. Conventional two-dimensional echocardiography had failed to yield a definite diagnosis, whereas transesophageal two-dimensional echocardiography clearly documented a membraneous echo structure within the left atrium, diagnostic of cor triatriatum. On the basis of the transesophageal echocardiographic findings, left heart catheterization and angiocardiography were not performed and both patients successfully underwent cardiac surgery.

Adult↗
PubMed1983

Alteration in thyroid hormone concentration during and after coronary bypass operation.

The effect of a surgical stress on serum TSH, T4, free T4, T3, rT3 and TBG was measured before, during and after a coronary bypass operation. Precautions were taken to age, sex, pre-operative nutritional state, anamnestic illness, pre- and post-operative medication. Compared to the pre-operative period TSH increased during operation and normalized at the first post-operative day, while only minor alterations for total and free serum T4 were observed. T3 and rT3 declined at the start of extracorporal circulation, T3 remained reduced during the post-operative period, while rT3 reached its pre-operative value at the first post-operative day. It is concluded that the coronary bypass operation evokes a rapid decline in T3, which is not normalized by the TSH induced response of the thyroid gland, while the post-operative period is characterized by a "low T3 state". The clinical relevance of this finding is discussed with respect to the cardiovascular and the nutritional state of the patients in the post-operative period.

Adult↗