Showing papers by "Peter Feindt published in 1994"

Device for assisting cardiac function

Abstract: Disclosed is a device for assisting cardiac function having the following atures: at least one half-shell is provided, the interior and exterior contours of which are designed in such a manner that it can be inserted into the human thorax in such a manner that it at least partially surrounds the heart with the exception of the arteries leading to and away from the heart, in or at the half-shell respectively half-shells is situated at least one filling chamber which can be inflated with gas and is propped by the shell, a control unit controls a pneumatic drive which fills and empties the individual filling chambers in such a manner that said filling chambers press at least on the left ventricle synchronously with cardiac activity in such a manner that blood is pressed into the aorta.

The pectoral muscle flaps in the treatment of bronchial stump fistula following pneumonectomy.

Abstract: Between 1975 and June 1992, pneumonectomy was performed in 594 patients, of whom 33 (5.6%) developed bronchopleural fistulae postoperatively. Until 1989 25 cases were reoperated: 5 patients were treated by thoracoplasty primarily, 20 by repair of the stump with sutures and by covering the stump with pericardial tissue or intercostal muscle, of whom 10 suffered from empyema. In 5/20 patients (25%) chronic fistulae developed making further interventions necessary. Since 1989 seven patients with bronchial stump fistulae have been reoperated with a delay of less than 12 h after diagnosis. Surgery consisted of reclosure of the stump with sutures in five patients. In addition, every patient was treated with the intrathoracic transposition of a petiolated ipsilateral pectoral muscle graft, which was the only treatment in two patients. Neither recurrence of the bronchopleural fistula nor empyema was seen in this group of patients (0%). We conclude that bronchial stump fistulae in patients after pneumonectomy can be treated successfully by the use of pectoral muscle flaps either combined with a closure of the leak using sutures or as the only measure. The method proved to be simple, safe and without major impairment of the patient. In combination with early reintervention, postpneumonectomy empyema including a disfiguring thoracoplasty can thereby often be avoided.

Is there a phase of hypercoagulability when aprotinin is used in cardiac surgery

Abstract: To determine a possible phase of hypercoagulability after the use of high-dose aprotinin, a prospective randomized double-blind study was performed. Twenty patients undergoing aortocoronary bypass surgery were investigated, a placebo group P (n = 10) was compared to an aprotinin group A (n = 10). Examining parameters of thrombin activation and fibrinolysis, we found during extracorporeal circulation--under continuous aprotinin infusion--a significant inhibition of thrombin activation and fibrinolysis in the aprotinin group (thrombin-antithrombin-III-complexes: 95 +/- 23 micrograms/l, d-dimers: 448 +/- 60 ng/ml, plasminogen activity: 33 +/- 3%, plasminogen activator inhibitor: 98 +/- 14 U/ml) compared to the placebo group (thrombin-antithrombin-III-complexes: 143 +/- 13 micrograms/l, d-dimers: 2755 +/- 430 ng/ml, plasminogen activity: 125 +/- 15%, plasminogen activator inhibitor: 10 +/- 4 U/ml). In contrast, after stopping the aprotinin infusion--from the end of extracorporeal circulation until the morning of the first postoperative day--strong thrombin activation took place in the aprotinin group (d-dimers increased from 472 +/- 90 to 1607 +/- 140 ng/ml), while in the placebo group a decrease could be registered. At this time, the fibrinolysis was still reduced in the aprotinin group (plasminogen activity: 48 +/- 6% vs 85 +/- 16% in the placebo group). In conclusion, interference with the thrombohemorrhagic balance induces hypercoagulability after the use of high-dose aprotinin, with elevated levels of thrombin-antithrombin-III-complexes, d-dimers, and plasminogen and a decreased level of plasminogen activator inhibitor. In our opinion, it is necessary to prevent this counter-regulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Squamous cell carcinoma of the lung: does the nm23 gene expression correlate to the tumor stage?

Abstract: We examined the nm23 gene activity in 30 human squamous cell carcinomas of the lung using the Northern blot analysis. Matched healthy lung tissue was available from 10 patients. 26 tumor samples were obtained after resection treatment between 1986 and 1990, 4 additional samples of advanced stages from autopsy. We found a significant increase of nm23 expression towards advanced stages of squamous cell carcinoma (IIIa vs. I: p < 0.015, IV vs. II: p < 0.043, IV vs. I: p < 0.043). Furthermore in stage I and II, poorly differentiated squamous cell carcinomas contained significantly more nm23 mRNA than did moderately differentiated ones (p < 0.027). We could also demonstrate an inverse correlation between the levels of nm23 mRNA and disease-free survival after resection treatment (p < 0.016, chi 2-test for trend). Thus the nm23-gene activity correlates to the tumor stage and the grade of differentiation of the squamous cell carcinoma of the lung, and is therefore of prognostic relevance. It might be possible to describe the biological behaviour of the individual tumor more accurately by the additional measurement of the nm23 mRNA.

Mitral valve replacement with preservation of the subvalvular structures where possible: an echocardiographic and clinical comparison with cases where preservation was not possible. Surgical technique and early postoperative course.

Abstract: Mitral valve replacement (MVR) is still associated with a relatively high mortality. To prove the benefits of chordal preservation at mitral valve replacement, we investigated its effects in a series of 65 consecutive MVR patients. Of those patients, in 42 preservation of the mitral subvalvular structures was possible whereas in the other 23 they had to be excised. Both groups showed no differences in age, sex, preoperative NYHA class, and valve pathology. Intra- and postoperative management was similar in both groups. The surgical techniques employed are described and the early postoperative course of both groups are analysed. Clinical, electrocardiographic and echocardiographic investigations, measuring left-atrial and -ventricular diameters, right-ventricular diameters and left-ventricular length, demonstrated that whereas beneficial effects were evident in both groups, the amount of benefits was higher in patients with chordal preservation. Chordal preservation also provided less arrhythmias than chordal resection.

Device for supporting the functioning of the heart

Abstract: Described is a device for supporting the functioning of the heart, the device having the following features: at least one housing (2) whose internal and external shape is such that it can be inserted in the human rib cage so that it at least partly surrounds the heart (1) with the exception of the vessels leading to and away from the heart; located in the housing(s) (2) is at least one chamber (4) which can be inflated by gas and which presses against the walls of the cavity; a control unit controls a pneumatic drive which fills and empties the individual chambers (4) in such a way that the chambers (4) press, in synchrony with the action of the heart, on at least the left ventricle of the heart so that blood is pressed into the aorta.

Vorrichtung zur unterstützung der herzfunktion

Abstract: Beschrieben wird eine Vorrichtung zur Unterstutzung der Herzfunktion mit folgenden Merkmalen: es ist mindestens eine Schale (2) vorgesehen, deren Innen- und Aussenkontur derart ausgebildet sind, das sie in den menschlichen Brustkorb derart eingesetzt werden kann, das sie das Herz (1) mit Ausnahme der zum Herz fuhrenden und vom Herz weg fuhrenden Adern mindestens teilweise umschliesst; in der bzw. den Schalen (2) befindet sich mindestens eine Fullkammer (4), die sich mit Gas aufblasen lassen und die sich am Hohlkorper abstutzen; eine Steuereinheit steuert einen pneumatischen Antrieb, der die einzelnen Kammern (4) fullt und entleert, derart, das die Fullkammern (4) synchron zur Herztatigkeit zumindest auf die linke Herzkammer druckt, so das Blut in die Korperschlagader gedruckt wird.