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Biomedical subjects

U Losert

Publications and source records attributed to U Losert.

At least 73 records · Page 4Linked to original sources
PubMed1990

A method for constricting large veins for use in arterial vascular reconstruction.

A satisfactory biologic graft can be created if dilated, but otherwise unusable veins are wrapped with a constrictive mesh tube. The purpose of this study was to determine whether a resorbable constrictive tube creates an appropriately sized vascular graft by induction of neoarterial wall growth. In 8 sheep a 5 cm segment of the carotid artery was resected and the external jugular vein inserted as a tubular graft. The vein was either wrapped with a polydioxanon (PDS) reinforced polyglactin (Vicryl) mesh (n = 4), a Vicryl mesh (n = 4), or a Dacron mesh tube (n = 3) to achieve a diameter reduction to 7 mm. Or the vein was used without reinforcement (n = 3). At angiography after 6 months the unreinforced veins had a diameter of 19 mm (range 15-22). The Vicryl reinforced veins measured 9.4 (8.5-10) mm, but 3 of 4 developed aneurysmatic dilatations at sites of valve sinuses with a mean diameter of 19 (15-21) mm. PDS reinforced veins measured 7.4 mm (7.1-7.9). Two of 4 had minor aneurysms of 13 and 16 mm. The two remaining PDS reinforced grafts were indistinguishable from the native artery. Dacron tubes reduced the vein size reliably to 7.6 (7.5-7.9) mm, but showed narrowing at the proximal anastomoses (PDS 7.2 +/- 0.4, Dacron 6.1 +/- 0.4, p = 0.016). PDS wrapping reduced maximal graft diameter to 10.9 +/- 4 mm as compared to that of the native vein, 18.7 +/- 3.5 (p less than 0.05). Resorbable meshes can reduce the diameter of a venous graft by strengthening the vessel wall.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

Effect of cardiac tamponade on plasma concentrations of atrial natriuretic peptide (ANP) in calves.

To study the effect of cardiac tamponade on plasma concentrations of atrial natriuretic peptide (ANP) female calves received an infusion of 450 ml of 0.9% saline into the pericardial space. This was accompanied by a parallel rise in both, right atrial pressure (from 4.5 +/- 2.6 mm Hg to 14.1 +/- 3.8 mm Hg (p less than 0.01] and in intrapericardial pressure (from 0.4 +/- 2.0 mm Hg to 12.9 +/- 3.9 mm Hg (p less than 0.01] and a fall in cardiac output from 11.4 +/- 1.9 l/min to 8.5 +/- 2.4 l/min (p less than 0.01). Plasma concentrations of ANP remained unchanged in 7 of 9 experiments. During these seven experiments plasma concentrations of renin and aldosterone increased from 0.65 +/- 0.27 X 10 E-4 GU/ml to 1.04 +/- 0.43 X 10 E-4 GU/ml (p less than 0.01) and from 2.7 +/- 0.9 ng/dl to 11.4 +/- 6.1 ng/dl (p less than 0.01), respectively. On two occasions, which were characterized by an excessive fall in cardiac output (to less than 40% of initial values) cardiac tamponade was followed by an extensive rise in the plasma concentrations of ANP, renin and aldosterone. These results indicate that an increase in intra-atrial pressure per se is not the decisive factor in the control of ANP secretion. Since atrial transmural pressure does not change during cardiac tamponade ANP concentrations are, as a rule, unaltered by that condition. An increase in plasma ANP is seen only during preshock hemodynamic conditions possibly due to a reduced intra-atrial volume.

Aldosterone↗
PubMed1989

Clinical total artificial heart bridging: Viennese strategy and experiences.

Worldwide the clinical use of total artificial hearts (TAH) for bridging the time until heart transplantation (HTX) has become part of HTX programs. At our clinic, TAH bridging has been performed in five deteriorating HTX candidates since 1986. Four patients suffered from dilative CMP and one patient from a large anterior wall infarction. Three times the ellipsoid heart and twice the Berlin TAH were implanted. After TAH implantation, the conditions of all patients improved. The accompanying dysfunctions of kidneys and other vital organs, which were due to cardiogenic shock, could be restored in the three patients who underwent subsequent HTX. Bridging periods lasted from 9 to 13 days. Two patients, however, could not be transplanted because of infection. Although three patients could be bridged until transplantation and were in good clinical conditions, the longest survival following two-stage HTX was 40 days. In the future, complications like infection, bleeding, and transplant rejection have to be prevented to improve the long-term results of Viennese TAH bridging.

Aged↗
PubMed1989

Control of the total artificial heart: new aspects in human versus animal experience.

Control strategies for total artificial heart application have generally been based on experience with healthy animals. Human patients in a bad state of health who have impaired organ functions and who are subjected to intensive care procedures can develop atypical hemodynamic behavior. In these patients, both unstable and hyperstable behavior of the vascular resistance were observed. Therefore, regulation of cardiac output (CO) by pressure parameters only was avoided and CO was adjusted to obtain an appropriate O2-utilization (O2U). Intending to keep the O2U within ranges of 20-25%, we obtained cardiac indexes between 3.3 and 4.4 L/m2/min (CO 6-8 L/min), which is higher than other cardiac indexes reported. A CO of 10.5 L/min was even necessary to obtain an O2U of 30% in a septic patient. This strategy caused a stable driving management and led to a rapid hemodynamic stabilization and general improvement of the patients' condition. Results indicate that it is also very important to monitor metabolic parameters for appropriate driver adjustment as well, especially in the early postoperative phase, and that O2-U is a sensitive and useful parameter for this purpose.

Animals↗
PubMed1989

Hemodynamic effects of mexiletine and disopyramide after cardioplegic arrest.

To study the hemodynamic side effects of mexiletine and disopyramide when administered before cardioplegic arrest 15 dogs underwent sham cardiac surgery with a 90-min period of aortic cross-clamping. 5 dogs served as control, 5 were given 8 mg/kg/day mexiletine and another five 11 mg/kg/day disopyramide for 1 week before surgery. On the day of surgery a continuous infusion was started. After reperfusion treated animals exceeded their preischemic blood pressure and regained their preoperative cardiac output. Compared to control animals left ventricular work was higher in the treated animals after reperfusion. The two tested type I antiarrhythmics tend to add to myocardial protection when given before cardioplegic arrest and do not exhibit negative inotropic side effects.

Animals↗
PubMed1987

Total artificial heart bridging: a temporary support for deteriorating heart transplantation-candidates--methods and results.

Since 1975 at the 2. Dept. of Surgery, University of Vienna, Austria, artificial circulation devices and artificial hearts have been constructed and in experimental use. We started a clinical heart transplantation (HTX) program in 1984, and up to now more than 40 HTXs have been performed. Since May 1986, 3 patients--all suffering from end stage dilatative cardiomyopathy--received total artificial heart (TAH) as a temporary support until HTX was possible. Two of them were transplanted after 9 and 10 days. The third patient, who additionally suffered from a postinfarctial lung abscess and had to undergo an indispensable lobectomy contemporary with TAH implantation, could not be transplanted due to an incurable infection, which he died of after 22 days on TAH. The temporary TAH implantation proved to be a valuable measure preventing life-threatening circulatory deterioration. After restoration of a sufficient circulation by the implanted system, the patients' general conditions improved and the concomitant dysfunctions of kidneys, brain, and other vital organs, due to cardiogenic shock, could be rectified in those two patients, who underwent transplantation. Thromboembolic complications were observed only in the third patient, who developed a small infarction in the anterior lobe of the left hemisphere caused by cerebral embolism after 3 weeks of TAH pumping. The use of TAH is liable to severe, even lethal, complications. At present it should be used only as a last resort. If a donor heart is not available, this measure can be a real chance to save the patient's life.

Adult↗
PubMed1987

[The esophageal tracheal Combitube (ETC): animal experiment results with a new emergency tube].

Prompt and effective ventilation, essential for patients with cardiopulmonary arrest, may be provided by a new airway for emergency resuscitation. The "Esophageal Tracheal Combitube (ETC)" offers endotracheal or esophageal obturator ventilation according to choice. Ventilation is therefore always possible after blind intubation. Experimental studies in dogs showed encouraging results during oesophageal placement of the ETC; blood gas analyses and cardiovascular parameters, in particular, were comparable to conventional endotracheal ventilation. Satisfying results were achieved during routine surgical operations in humans. We intend to use the ETC as a device for emergency cardiopulmonary resuscitation in humans. It is especially suitable for medical personnel not trained in endotracheal intubation. The ETC has been conceived to bridge the gap of the prehospital phase.

Animals↗
PubMed1986

Influence of long-term low direct current on rat ischiadic nerves.

The effects of a low direct current on peripheral nerves and electrodes on the ischiadic nerve were investigated, and a constant direct current was applied for various time periods. Afterwards clinicophysiological tests and histological evaluations were performed. The muscles of 55 rats could be stimulated by external stimulation during the follow-up examinations, but 90% of all animals showed microscopically visible nerve tissue alterations which might have been caused by mechanical rather than electrolytic factors.

Animals↗
PubMed1985

Organisation of experimental thrombosis by blood cells. Evidence of the transformation of mononuclear cells into myofibroblasts and endothelial cells.

To clarify whether thrombus organisation was carried out by local cell activity or by elements of the circulating blood we developed an artificial prosthesis, made of an impermeable polyurethane material with an athrombogenic surface but with a central part consisting of a DACRON velour ring which was thrombogenic. We implanted these devices into the aorta of 10 sheep. In these animals, organisation of the central thrombus by local aortic cells could be excluded. After varying periods of time (2-84 days), the device was removed and the organized thrombus investigated by light and electron microscopy. From our investigations the organisation process with the development of mesenchymal cellular elements proceeded in 3 steps: The activation of the mononuclear macrophage system, the appearance of myofibroblastic cells and endothelial formation. The activation of the mononuclear macrophage system is probably induced by chemospecific products of metabolism arising from aging thrombotic material. Apart from mononuclear elements such as monocytes, macrophages, and giant cells we observed fibroblast-like and myofibroblast-like cells. The matrix contained collagen. Endothelium developed on the surface of the organizing thrombus. The final stage was characterized by the formation of a pseudovessel wall, which followed the pattern of the vascular model. Our findings support the hypothesis that a thrombus may be organized by cells derived from the circulating blood.

Animals↗
PubMed1984

Reduction of infarct size induced by pressure-controlled intermittent coronary sinus occlusion.

The effect of pressure-controlled intermittent coronary sinus (CS) occlusion on myocardial infarction (MI) size was evaluated. A device for this purpose was developed that consisted of a balloon catheter and pump system that produced controlled, intermittent occlusion of the CS and used CS pressure as a feedback to determine the duration of occlusion. It was hypothesized that proper selection of occlusion and non-occlusion times would both facilitate improved retrograde flow to ischemic areas and allow for more complete venous washout of metabolites. In 13 treated dogs and 12 control dogs before treatment, myocardium at risk of MI was estimated by injection of technetium-labeled microspheres. Intermittent CS occlusion was then begun, 15 minutes after coronary artery occlusion, and continued until termination of the experiment 6 hours later. Postmortem determination of infarct size was performed using the triphenyltetrazolium chloride staining technique. Intermittent CS occlusion begun 15 minutes after coronary artery occlusion and continued for 6 hours resulted in a 45% average reduction in MI size (p less than 0.001). During CS occlusion, the sinus systolic mean pressure increased from 10 to 44 mm Hg, while the distal coronary artery mean pressure increased by an average of 36% (from 22 to 30 mm Hg, p less than 0.05). These results suggest intermittent occlusion may be an effective treatment for evolving MI. This therapy, used alone or combined with other therapies (e.g., administration of pharmacologic agents), appears to have great clinical potential.

Animals↗
PubMed1984

The use of 123I-labeled heptadecanoic acid (HDA) as metabolic tracer: preliminary report.

The feasibility of using 123I-heptadecanoic acid (HDA) as a metabolic tracer was studied. Different administration routes of HDA were compared. An intracoronary bolus injection was given to calves (n = 3), and an intravenous injection was given to patients (n = 4). In addition, we examined the influence of 4-h halothane anesthesia in calves and in patients the impact of an insulin (1.5 IU/kg) + glucose (1.5 g/kg) infusion on the myocardial kinetics of HDA. Data were accumulated with a scintillation probe in calves (t = 50 min) and a gamma camera in patients (t = 70 min). In calves after an intracoronary bolus injection of HDA the myocardial time-activity curve could be described by two exponentials. The mean elimination half-time of the initial phase (ta 1/2) was 7.3 min and that of the second phase (tb 1/2) was 35 min. The ratio of the size of the initial and second component at to was 0.93. Halothane anesthesia prolonged the elimination half-times and reduced the component ratio. The biphasic behavior of the myocardial time-activity curve was maintained in patients after intravenous administration of HDA under basal conditions (initial ta 1/2 = 8.4 min). However, during infusion of insulin + glucose the decline in the myocardial activity was prolonged and monoexponential. This data shows that insulin glucose, interfering with fatty acid metabolism, influences the myocardial washout of HDA, and thus support its use as a metabolic tracer.

Animals↗
PubMed1982

Myocardial perfusion evaluated by contrast echocardiography. A preliminary report.

The usefulness of contrast echocardiography for demonstration of myocardial perfusion was studied on six mongrel dogs. Two contrast agents tested were: (1) 0.9 percent saline solution, and (2) CO2-enriched saline solution (containing 0.2 ml CO2/10 ml). Only the latter solution produced an elucidation of the myocardium and allowed an estimation of the distribution and flow velocity of the contrast agent, which was characterized using the following three parameters: (1) transmural flow time (0.13 +/- 0.02 s x +/- SEM); (2) circumferential flow time (1.43 +/- 0.31 s); and (3) persistence time (42.0 +/- 4.3 s). There were no serious side effects on hemodynamics or heart rhythm. Thus, contrast echocardiography offers the possibility of detecting and quantitating myocardial perfusion.

Animals↗