Influence of incremental preoperative risk factors on the perioperative outcome of patients undergoing emergency versus urgent coronary artery bypass grafting

A retrospective analysis of 127 patients with impending myocardial infarction undergoing coronary artery bypass grafting was performed to evaluate incremental risk factors associated with perioperative mortality and morbidity. Fifty-four patients (group 1) were operated upon as emergencies within 24 h and 73 patients underwent urgent coronary revascularization within a mean of 3.4 days (group II) after admission. The incidence of non-transmural myocardial infarctions (NTMI), haemodynamic parameters, the number of diseased vessels and the incidence of a preceding percutaneous coronary dilatation (PTCA) were not statistically different between the groups. The overall perioperative mortality was 8.7% (16.7% group I, 2.7% group II). Major non-fatal complications were frequent in the surviving collective including low cardiac output in 14 patients (12.1%) and transmural or subendocardial perioperative infarction in 12 patients (10.3%). Perioperative mortality was associated with reduced left ventricular myocardial function (P less than 0.001), operation within 24 hr after onset of anginal symptoms (P less than 0.001) or subendocardial infarction (P less than 0.025) in the 4 weeks before operation. Perioperative mortality was independent of the degree of coronary stenosis, number of distal anastomoses or performance of a coronary endarterectomy. Of the patients, 90.5% (87.5% of group I and 92.3% of group II) included in a mean follow-up of 16.8 months (range 5-27 months) were graded into Canadian Heart Functional Class I. Successful coronary surgery for acute myocardial ischaemia results in excellent late functional recovery. The major risk factors for fatal perioperative outcome are reduced left ventricular function and the necessity of every early surgical intervention.     

Implementation of a palliative care team in an Austrian university hospital

Implementation of hospital-based palliative care team is a new subject in German-speaking areas, especially in university hospitals. Our Section of Palliative Care was subsequently built up to a 12-bed palliative care unit, a home-based, and a hospital-based palliative care team. Analysis of the implementation strategies, development of the working profile, and documentation of the hospital-based palliative care team were done. During the first 2 years, quality and number of inquiries for palliative care increased significantly. In our opinion, a high degree of expertise, involvement of the nursing staff, and personal contact play a key role for a successful implementation of a palliative care team in a large university hospital.     

Determination of deoxymyoglobin changes during graded myocardial ischemia: An in Vivo 1H NMR spectroscopy study

¹H NMR spectroscopy was used to detect the proximal histidyl N_δ, proton signal of deoxymyoglobin from canine hearts in vivo during graded myocardial ischemia. The NMR signal intensity provided an indicator of intracellular oxygenation in myocardium. The relationship between the myocardial blood flow and the deoxymyoglobin concentration was successfully measured during resting, partial, and complete coronary artery occlusion conditions. The results demonstrate the feasibility to detect deoxymyoglobin using a ¹H NMR spectroscopy technique in living hearts for the first time and the possibility to use this technique for investigating myocardial oxidative metabolism nondestructively and repetitively.     

Mediastinal lymph node staging with transesophageal echography in cancer of the lung

Transesophageal echography (TEE) was used prospectively to study mediastinal lymph node enlargement in 23 patients with cancer of the lung. The findings were validated blindly by comparison with computed tomography (CT, n = 23) and pathological N classification after curative surgery (n = 9). Lymph nodes larger than 1 cm were defined as pathologically enlarged. In the upper mediastinum, 22% (8 vs 36), in the lower mediastinum including the subaortic region 112% (37 vs 33) and in the hilar region 67% (6 vs 9) of enlarged lymph nodes diagnosed by CT were detected by TEE. A pathological study in 9 patients demonstrated true positive findings in 2 vs 1, true negatives in 4 vs 5, false positives in 3 vs 2 and false negatives in 0 vs 1 comparing TEE with CT. From these preliminary data, we conclude that TEE, although still experimental, is equal or superior to CT in detecting enlarged nodes in the lower mediastinum, specifically in the aortopulmonary window but clearly inferior in the upper mediastinum and the hilar region. Additional information on central tumors and infiltration of the heart or great vessels can be clarified. In addition, data on hemodynamics and cardiac status can be obtained. TEE seems to be a promising tool in the preoperative staging of lung cancer.     

Zur Theorie der Diurese

Ohne ZusammenfassungWir gebrauchen hier den Ausdruck Diurese einfach für Harnausscheidung, während sich das Wort in der Literatur häufig für Harnausscheidung nach Belastung oder nach Gebrauch eines Diureticums, manchmal sogar nur für negative Wasserbilanzen verwandt findet. Unter Wasserdiurese verstehen wir die Wasserausscheidung nach Wasserzufuhr, nicht wie manche Autoren, eine Partialfunktion der Niere.Die Versuche wurden in der Medizinischen Poliklinik Bonn, im Medizinischen Laboratorium der Mayoklinik und im Institut of experimental medicine, Mayo-Foundation Rochester Minnesota USA. ausgeführt.     

Biologische Aktivität vollsynthetischer Insulinpräparate

Zusammenfassung Vollsynthetisches Schafinsulin erwies sich, gemessen am Gasaustausch des epididymalen Fettgewebes der Ratte, als biologisch aktiv. Die Wirksamkeit betrug etwa 0,1% des natürlichen Schafinsulins. Die geringere Ausbeute im Vergleich zu Voruntersuchungen anderer Autoren ist auf Denaturierungserscheinungen des unreinen Präparates durch längere Lagerung zurückzuführen.Ein zweites vollsynthetisches Schafinsulin, das in einem modifizierten Syntheseverfahren gewonnen wurde, war biologisch unwirksam.

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Summary Synthetic sheep insulin showed biological activity as maesured by gas-exchange of epididymal fat tissue of rats. The activity amounted to the range of 0.1% compared with natural sheep insulin. This level is lower than that found by other authors in previous experiments. Probably the difference is caused by loss of activity for the impure, alkaline preparation was partial destroyed during the storage of 8 to 11 weeks. A second synthetic insulin prepared by a modified chemical procedure showed no biological activity.

     

Preliminary experience with the catheter dilatation of coronary artery stenoses (author's transl)]

The method of percutaneous transluminal coronary angioplasty (PTCA) may in selected cases dramatically improve myocardial blood supply. Seven attempts were made between September and December 1978 at the Gollwitzer-Meier Institute of Cardiology; three dilatations were unsuccessful, two were moderately successful and two highly successful. The problems as to methodology and selection of patients submitted to this procedure are discussed.     

Zum Krankheitsbild der tuberösen Sklerose

Zusammenfassung Es wird über sechs Patienten berichtet, die an tuberöser Sklerose erkrankt sind. Bei fünf Patienten wurden Veränderungen am Augenhintergrund gefunden, die sehr verschiedenartig waren. Die Beobachtung dieser Veränderungen ergab einige neue Gesichtspunkte für die Möglichkeit der Entwicklung der Netzhauttumoren. An einem Auge konnte eine Heilung durch Lichtcoagulation erreicht werden. Vier Patienten, die an einer symptomatischen Epilepsie litten, wiesen Wesensveränderungen, Intelligenzdefekte und Verhaltensauffälligkeiten auf, die in erster Linie dem bekannten organischen Psychosyndrom der Epileptiker entsprachen. Außerdem konnten sekundäre, psychoreaktive Verhaltensstörungen festgestellt werden.