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Biomedical subjects

P Stelzer

Publications and source records attributed to P Stelzer.

27 records · Page 2Linked to original sources

Pulmonary autograft: an American experience.

Pulmonary valve autograft replacement of the aortic valve has been performed in nine patients in an effort to duplicate in the United States the experience of Sir Donald Ross in London. Four male and five female patients ranging in age from seven to thirty-four years have been operated on for indications of aortic stenosis in six and aortic regurgitation in three. Three patients had associated procedures performed concomitantly. All patients survived the surgery and were clinically improved, however, one patient did require reoperation for progressive aortic insufficiency. Specific indications, results, and technical considerations are discussed and illustrated.

Adolescent↗

Inappropriate ventricular blanking in a DDI pacemaker.

The DDI mode is a new pacing mode with potential advantages over DVI pacing. We describe anomalous post R wave ventricular pacing due to the presence of inappropriate ventricular blanking periods in a pacemaker programmed to the DDI mode. Although no adverse consequences were seen in our patients, potentially dangerous R-on-T pacing could occur, particularly if long atrioventricular delays are programmed. A method for eliminating this pacing anomaly is described. Patients programmed to the DDI mode with the pacemaker model described should be evaluated for post R wave ventricular pacing and corrective measures should be taken.

Aged↗

Differential inhibition by aspirin of vascular and platelet prostaglandin synthesis in atherosclerotic patients.

We studied the ability of a single oral dose of aspirin to inhibit prostacyclin synthesis by human arterial and venous tissue and to inhibit thromboxane A2 synthesis by platelets in 70 patients who were undergoing aortocoronary bypass. A dose of 40, 80, or 325 mg of aspirin was administered 12 to 16 hours before surgery. The generation of thromboxane in serum--which provides an estimate of platelet thromboxane production--was reduced from the control value by 77, 95, and 99 per cent after single doses of 40, 80, and 325 mg of aspirin, respectively. By contrast, prostacyclin production in aortic tissue that was removed at operation was reduced by only 35, 38, and 75 per cent, respectively, in response to these doses. Production of prostacyclin in saphenous-vein tissue (not tested after 40 mg of aspirin) fell only slightly and not significantly after 80 mg but was reduced by 85 per cent after 325 mg. These findings indicate that a low dose of aspirin (40 to 80 mg) can largely inhibit platelet aggregation and thromboxane synthesis but has much less effect on prostacyclin production in arterial and venous endothelium.

Administration, Oral↗

[Liver hemangioma--an angiographic contribution to the differential diagnosis of sonographic lesions (author's transl)].

Small liver hemangiomas are displayed as echogenic as well as sonolucent patterns on ultrasonic scans. Differentiation from malignomas is difficult and responsible, hepatomas and solitary metastases being possible. By partial liver resection the malignant diseases can be treated successfully. Therefore an accurate diagnosis is to be aimed at. Of all the methods only angiography can ensure a certain amount of clarity. This is possible under the following circumstances: The cavernomas must be of a certain size. They must not withdraw from evidence due to large avascular areas which can result from thrombosis, fibrosis or necrosis. Moreover a superselective filling of the hepatic artery is claimed but not always possible. If the portal vein is opacified it conceals the radiologically typical image of the cavernoma. Under these circumstances only few moments of the late arterial and the hepatovenous phases remain to detect the hemangioma in the seriogram.

Adult↗

[The post-traumatic biliary cyst (author's transl)].

The case report communicated here illustrates a late complication subsequent to an emergency operation for liver rupture. This complication may result from ligating a branch of the hepatic artery to stop bleeding. If the necessary second operation is omitted for any reason, the hepatic sequester can develop into an abscess or biliary cyst. It is to be expected that these late complications will occur more frequently in future owing to a probable increase in the incidence of the so-called blunt abdominal traumas. The reason for this is, on the one hand, the growing number of traffic accidents and, on the other hand, the increasing use of safety seat belts which tend to promote the occurrence of ruptures of the liver as part of the blunt abdominal traumas. However, we must emphasize that it is the use of safety seat belts only which ensures the traffic victims' chance of survival.

Abdominal Injuries↗

Tumors of the chest wall.

Primary tumors of the chest wall are uncommon but should be considered in the evaluation of patients with persistent chest wall pain or the presence of a chest wall mass, especially when this is near the costal cartilages. Special radiographic techniques may help to define the diagnostic possibilities and the extent of local involvement. Since at least half of the primary rib tumors and virtually all of the sternal tumors are malignant, these problems demand prompt investigation, accurate tissue diagnosis, and, usually, generous surgical excision. With appropriate attention to skin, soft tissue, and skeletal involvement, resection of major chest wall tumors can be done safely, and there are a variety of reconstructive techniques available to deal with the resulting defects. Radiotherapy has little role in the treatment of chest wall tumors except for the myeloproliferative disorders and possibly some cases of Ewing's sarcoma. Chemotherapy has similarly been ineffective for the cartilaginous tumors but shows some promise in the multidisciplinary approach to osteogenic sarcoma. Surgical resection, however, remains the mainstay for the treatment of most tumors of the chest wall. Even in instances of recurrent disease there are many whose long-term survival has been achieved by multiple operative procedures.

Chondroma↗

Routine myocardial revascularization with the radial artery: a multicenter experience.

BACKGROUND: Current literature documents use of the radial artery (RA) for myocardial revascularization only as an alternative conduit in cases where the saphenous veins have been previously harvested or are unsuitable for use. Large-scale routine clinical use of the RA as the conduit of choice has not been reported. METHODS: This prospective study evaluated the harvest of the RA from 933 patients and the subsequent use of the conduit as a preferred coronary artery bypass graft second only to the left internal thoracic artery in 930 of these patients. RESULTS: Unilateral RA harvest was performed in 786 patients and 147 patients had bilateral RA harvest. A total of 1080 RAs were harvested; 214 (19.8%) originated from the dominant forearm. There was a mean of 3.30+/-0.93 grafts per patient of which 2.43+/-0.83 were arterial grafts. The mean number of RA grafts was 1.43+/-0.53. Operative mortality was 2.3% with none due to the RA graft(s). There was no ischemia nor motor dysfunction in the operated hands. Thirty-two (3.4%) patients experienced transient thenar dysesthesia that resolved in 1 day to 6 weeks. CONCLUSIONS: Our results demonstrate that routine total or near total arterial myocardial revascularization may be achieved safely and effectively with the use of one or both RAs in conjunction with the internal thoracic artery.

Adolescent↗

[The prevention of injuries in greyhounds].

The analysis of 154 greyhound injuries shows a significant lower incidence of injuries in the case of proper preparing for the race. The prevention of injuries was carried out during the whole training-season. These optimally prepared dogs showed a better race performance and were able to take part in more races.

Animals↗