Search PubMed⌕ Search

Biomedical subjects

P Satter

Publications and source records attributed to P Satter.

At least 55 records · Page 3Linked to original sources
PubMed1989

Avoiding reperfusion injury after limb revascularization: experimental observations and recommendations for clinical application.

This study tests the hypothesis that reperfusion injury is the principal cause of limb loss after acute arterial occlusion and that this injury is avoidable. Of 61 isolated hindlimbs amputated at the level of the hip joint, 17 were controls (group I), 5 were perfused without ischemia to establish the validity of the model (group II), and 15 underwent 4 hours of ischemia at room temperature without reperfusion (group III). Acute embolectomy was simulated in 24 limbs after 4 hours of ischemia; 12 were reperfused with standard Krebs-Henseleit solution at 100 mm Hg (group IV), and 12 were reperfused under controlled conditions (i.e., 37 degrees C, 50 mm Hg) with substrate-enriched modified reperfusate (group V). Leg volume, water content, contractile function, and high-energy phosphate content were assessed and data were expressed as mean +/- SD. Four hours of ischemia caused a profound fall in adenosine triphosphate content (4.0 vs 26.0 mmol/L/gm of protein, p less than or equal to 0.001). Uncontrolled reperfusion resulted in severe reperfusion injury; massive edema developed (83% vs 75%, p less than or equal to 0.01), leg volume increased markedly (21.5% above control, p less than or equal to 0.001), and no contractile function followed electrical stimulation. In contrast, controlled reperfusion resulted in normal water content (76.9% vs 75.0%, NS) and minimal change of leg volume (5.5% +/- 5% of control, NS), replenished adenosine triphosphate completely (24.2 vs 26.4 mmol/L/gm of protein, NS), and restored immediate contractile function in all limbs (24.3% +/- 14% of control). This study shows that 4 hours of room-temperature ischemia (18 degrees C) does not produce irreversible damage of the rat hindlimb because the reperfusion injury that follows uncontrolled reperfusion can be avoided. Immediate recovery of contractile function can be restored if the conditions of reperfusion are controlled by gentle reperfusion pressure (50 mm Hg) at 37 degrees C and if a modified substrate-enriched, hyperosmotic, alkalotic, low-Ca++ reperfusate is administered.

Adenine Nucleotides↗
PubMed1989

[Can the progression of coronary heart disease be modified by calcium antagonists?].

Experimental atherosclerosis in animals preferentially induced by cholesterol-rich food can be successfully suppressed by calcium channel blocking agents such as verapamil, nifedipin, nicardipin, and diltiazem. The question whether calcium channel blockers can favorably influence atherosclerosis in humans remains a matter of debate. A few observational investigations in the past showed positive results of calcium channel blocker therapy in patients with angiographically proven coronary artery disease (CAD). At present three prospective randomized clinical trials are under way (INTACT-study, FIPS-study, study from the Montreal Heart Institute). Target variable is the severity of coronary atherosclerosis assessed by angiography both at entry into the study and after 2-3 years of treatment. 445 patients after coronary bypass surgery were included in the FIPS study (Frankfurt Isoptin Progression Study) and were randomly allocated to either verapamil 120 mg t.i.d. or placebo treatment. Extent of coronary atherosclerosis, assessed by repeat angiography 1 and 3 years after randomization, is expressed by scores with separate evaluation of non-bypassed vessels, segments distal to the peripheral bypass insertion, bypassed segments and grafts. The 1-year follow-up was completed for 162 patients (Group A = 80 patients; group B = 82 patients). There was a homogeneous distribution in both groups for all clinical variables, graft patency rates (76%/75%), and the incidence of clinical events (myocardial infarct, need for cardiac surgery or PTCA, cardiac death: 5%). The overall progression of atherosclerosis in the first year after bypass surgery was small. Thus, the question of whether calcium channel blockers can retard progression of coronary atherosclerosis cannot be answered before completion of the aforementioned trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[Thoracoscopy in the treatment of bronchial asthma].

The indications, complications and results obtained in asthma bronchiale are described on the basis of 132 thoracal vagotomies according to Kux. The operation was found to be effective in 60% of the patients, without however being able to compare them by means of control examination conducted with a comparative group.

Asthma↗
PubMed1988

[Coronary revascularization with the internal thoracic artery. Angiographic controls in 86 patients].

Among a cohort of 454 consecutive patients who had undergone coronary revascularization with the internal mammary artery (from November 1984 to October 1987), postoperative angiography was performed in 86 (18.9%) (77 males and 9 females, aged 33-74 years; median age 56 years). The interval between operation and angiography ranged from one week to 26 months (median 47 weeks). The mean patency rate for the internal mammary artery grafts was 83.7% (72 of 86 grafts), the patency rate having increased from 71% in 1984/85 to 92% in 1987. In the same cohort the patency rate of venous grafts was 64.5% (78 of 121 aortocoronary venous grafts). Many asymptomatic patients refused follow-up angiography; the patency rate is therefore likely to have been higher for the entire cohort. The high patency rate and good long-term results for internal mammary artery grafts support the view that this type of graft is preferable to others for coronary revascularization.

Adult↗
PubMed1988

[Transfemoral closure of the duct of Botallo. Acute and long-term results].

A persistent ductus arteriosus was occluded with an Ivalon plug via a catheter delivery system, introduced through the femoral artery, in 38 patients, aged 11-72 years (mean 39). The mean diameter of the ductus was 4.5 +/- 1.2 (2-9) mm, mean pulmonary artery pressure 30/12 (15/5-70/27) mm Hg. In two patients the plug became dislocated after two and seven weeks, respectively, without serious consequences. In all others the occlusion was successful and permanent. There were only a few complications and none was serious. During a follow-up period of up to four years there were no instances of recanalization or further plug dislocation.

Adolescent↗
PubMed1988

[Long-term results of transluminal valvuloplasty in calcified aortic valve stenosis].

Transluminal valvuloplasty (TVP) was attempted in 11 patients, aged 38-82 years, with calcified aortic valve stenosis (AS). The transvalvular systolic pressure gradient was reduced from a mean of 91 +/- 28 to 44 +/-30 mm Hg. Two patients had needed an emergency with decompensated AS in cardiogenic shock, died during the operation, another died of the consequences of an endocarditis. One patient had an inadequate TVP: a renewed TVP was subsequently performed at another hospital, followed by an operation for severe aortic regurgitation produced by the second TVP. In four patients left-heart catheterization 3-12 months post-dilation demonstrated considerable restenosis. One patient was significantly improved clinically (but no angiography had as yet been performed) four months after the TVP. Doppler echocardiography in this patient, too, demonstrated renewed increase in transvalvular pressure gradient. The results demonstrate that, because of the high rate of recurrence, TVP is at present only rarely indicated for calcified AS.

Adult↗
PubMed1988

[Leiomyosarcoma of the pulmonary artery--report of 2 cases from clinic practice and review of the literature].

Sarcoma of the pulmonary artery is a rare tumor. Only 81 cases are reported in the international literature. Leiomyosarcoma of the pulmonary artery is seen in 17% of these tumors. Most of them are not recognized during life but accidentally found at autopsy. So primary leiomyosarcoma of the pulmonary artery is a very rare tumor. We report about two new clinical cases and give a review of the literature.

Adult↗
PubMed1988

Late results of prosthetic valve replacement for aortic regurgitation and the prognostic significance of the end-diastolic and regurgitated blood volumes.

Between January 1975 and December 1985 214 patients underwent prosthetic aortic valve replacement for isolated aortic regurgitation. Patient follow-up averaged 5.4 years after the operation (range 0.7-10.7 years). Preoperative staging showed 9 patients to be in NYHA stage II, 111 patients in stage III, and 94 patients in stage IV. At follow-up 3 patients complained of increased fatigue, 9 patients remained stable and 167 patients had improved. 103 of these patients were free of symptoms under stress, i.e. NYHA stage I. The hospital mortality was 3.7% (8/214 patients). An additional 26 patients died within an average of 2.8 years. The cumulative 5-year survival rate was 85%; the 10-year survival rate was 81.5%. 10 patients underwent a second operation within an average of 3.4 years. The correlation between the end-diastolic volume and the regurgitated blood volume has prognostic significance. 25 patients with appropriate enlargement of the left ventricle showed a significant decrease of the end-diastolic volume and the roentgenographic heart volume combined with an increase of ejection fraction. None of these 25 patients died from cardiac complications. A control group of 9 patients with myocardial damage showed no significant change in the above parameters. 4 patients in the control group died. We conclude that the relationship of regurgitated blood volume and the left ventricular end-diastolic volume is of prognostic significance for patients with chronic aortic regurgitation presenting with minimal symptoms.

Adult↗
PubMed1988

Studies of the tissue reaction induced by transvenous pacemaker electrodes. I. Microscopic examination of the extent of connective tissue around the electrode tip in the human right ventricle.

The purpose of this study was to investigate the extent of connective tissue of the human right ventricle induced by cardiac pacing electrodes. Between January 1984 and July 1987, 34 consecutive patients with VVI-pacing systems were autopsied in the Department of Pathology at the University of Frankfurt/M. The surrounding tissue of these 34 electrodes (17 Siemens Elema 412 S, five Medtronic 6957, one Medtronic 6959, one Medtronic 4011, three Biotronik D2K, three Biotronik K 10, two Osypka FY 62, one Biotronik N, and one Siemens Elema 588) in the right ventricle were investigated histologically. The tissue was stained with Giemsa and the thickness of the connective tissue layer was measured. Stimulation threshold data at various times were known in four of eight screw-in electrodes, in seven of 17 vitreous carbon electrodes and in two of seven smooth surface electrodes. Electrode surface area, implantation time, age of the patient and cause of death were comparable for all three electrode groups. However, a significant difference was found in the extent of connective tissue between the porous surface and screw-in electrodes (128 +/- 55 vs 397 +/- 269 micron, P less than or equal to 0.01) and porous surface and smooth surface electrodes (128 +/- 55 vs 307 +/- 117 micron, P less than or equal to 0.01). No relation (r = 0.106) was found between the duration of implantation and the extent of connective tissue for the vitreous carbon electrodes (Siemens Elema 412 S).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

[Detection of calcium in mitral valve diseases using computer-assisted 2-dimensional echocardiography].

In order to detect mitral valve calcification, 31 consecutive patients were examined using two-dimensional echocardiography 1 day before mitral valve replacement. Calcifications of the valve were diagnosed by digital image control (grey-scale manipulation using S-curve and reject control). After the operation, the excised valves were X-rayed to determine the degree of calcification. Calcifications of the mitral valve were found by echocardiography with a sensitivity of 89.5%, a specificity of 91.7% and a predictive accuracy of 90.3%. The degree of calcification, however, was underestimated in 47%. The results show that the described grey-scale manipulations are a reliable method of detecting calcifications of the mitral valve by echocardiography. This enables the preoperative identification of those patients who are suitable for mitral valve commissurotomy.

Calcinosis↗
PubMed1987

[Coarctation of the abdominal aorta. Experiences with transluminal angioplasty].

Balloon dilatation was performed transfemorally in three patients suffering from coarctation of the abdominal aorta. In two cases the pressure gradient could be reduced markedly from 85 to 55 and from 72 to 32 mm Hg, respectively. At follow-up angiography 3 months later the gradient was reduced further to 12 and 5 mm Hg, respectively. One women patient who had previously been handicapped by claudication intermittens, was free from complaints after balloon dilatation, whereas the other women patient with suprarenal stenosis of the aorta and renal hypertension was normotensive subsequent to balloon dilatation. In the third (male) patient who had already been operated on earlier because of stenosis of the aortic isthmus, dilatation was unsuccessful even if a very high balloon pressure was applied. These experiences support the view--in agreement with other authors--that balloon dilatation in coarctation of the abdominal aorta is a method of low invasiveness that should be attempted before surgery is performed.

Adult↗
PubMed1987

Mortality trends in cases of elective and emergency aorto-coronary bypass after percutaneous transluminal coronary angioplasty.

Between October 1977 and March 1986 82 emergency and 113 elective revascularizations (aorta-coronary bypass = ACB) were performed after complicated or unsuccessful PTCA (n = 1633). Mortality in emergency ACB was 10.9%, in elective surgery 1.2%. If permanent transmural ischemia after complicated PTCA is present, mortality was high (12.6%) and postoperative infarction rate 70%. In intermittent ischemia mortality was 5.1% and total recovery of the myocardium was 94%. Mortality in emergency ACB after PTCA was directly related to the number of diseased vessels. In single vessel disease mortality was 3.5%, in multiple vessels disease 28%.

Adult↗
PubMed1987

Improvement of myocardial function after global hypoxia by protection of the inner mitochondrial membrane.

In the present study the hypothesis is tested that hypoxia causes morphological damage to the inner mitochondrial membrane and that this damage can be reversed by modification of the reoxygenated perfusate. Using the working rat heart model, hearts in group I (n = 40) were subjected to a 30 min normothermic, normoxic phase and a 90 min hypoxic phase, followed by 60 min reoxygenation. Hearts in group II (n = 32) were also subjected to a 30 min normoxic and a 90 min hypoxic phase. However, after 30 min of reoxygenation 1.5 mmol/l 2-mercaptopropionylglycine (MPG) was injected in the reoxygenated solution in order to test its ability to improve mitochondrial function. Mitochondrial function was assessed by measuring oxygen uptake (ST3), ST4, respiratory control index (RCI), ADP/O and oxidative phosphorylation rate (OPR). In addition mechanical function (heart rate, aortic and coronary flow, cardiac output, stroke volume) was monitored along with ultrastructural parameters. 90 min of hypoxia caused a deterioration of all parameters with persistent impairment in hemodynamic, morphologic and biochemical functions after 60 min of reoxygenation (group I). The role of the ATP-synthetases in the pathogenesis of oxygen-paradox is discussed. In contrast, the MPG-enriched reoxygenated solution (group II) improved hemodynamics, ultrastructure and mitochondrial function significantly (alpha = 0.05). It is concluded from these data that the ATP-synthetases are damaged during oxygen-deficiency and that MPG may be a useful drug for protecting the inner mitochondrial membranes during reoxygenation.

Adenosine Diphosphate↗
PubMed1987

[Imaging of aortocoronary bypasses with intravenous digital subtraction angiography].

We examined 24 patients with 52 coronary bypass grafts, an average of 18 months after their respective operations. During the course of 1 week, a coronary angiography and a digital subtraction angiography (DSA) incorporating an intravenous injection of contrast medium were performed. Conventional coronary angiograms showed 40 bypasses as being open, ten as being occluded, and two could not be displayed at all. With the aid of digital angiography, 50 out of 52 bypasses could be classified as either open or occluded. In 44 out of 52 bypasses, DSA and coronary angiogram results were identical. Using DSA, three out of ten angiographically occluded bypasses were falsely diagnosed as being open and three out of 40 open bypasses as occluded. Two bypasses could not be interpreted due to poor picture quality. In the diagnosis "open bypass" the degree of both sensitivity and specificity subsequently amounted to 92.5%, and 70% in the diagnosis "occluded bypass". The distal part of the bypasses, as well as the proximal and distal part of the anastomoses, could not be evaluated for the most part. Furthermore, on account of the comparatively inferior quality of the pictures, detection of bypass stenosis is not reliable using digital subtraction angiography. Intravenous digital subtraction angiography may therefore serve as a screening method in the evaluation of coronary bypass grafts.

Coronary Angiography↗