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Mair H, Fowler N, Papatzanaki ME, Sudhakar P, Maldonado RS. Novel missense WFS1 variant causing autosomal dominant atypical Wolfram syndrome. Ophthalmic Genet 2022; 43:567-572. [PMID: 35450504 DOI: 10.1080/13816810.2022.2068038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/02/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND In contrast to the classic autosomal recessive Wolfram syndrome, Wolfram-like syndrome (WLS) is an autosomal dominant disease caused by heterozygous variants in the WFS1 gene. Here, we present deep phenotyping of a mother and son with a WFS1 variant NM_006005.3:c.2508 G > T, p. (Lys836Asn) detected with next-generation sequencing, which is novel at the nucleotide level. In this Greek family, the proband and mother had sensorineural hearing loss and mild non-progressive vision loss with optic nerve atrophy. An initial optic atrophy panel that did not test for WFS1 was unremarkable, but a broader inherited retinal dystrophy panel found the WFS1 variant. CONCLUSION This study highlights the importance of including WFS1 sequencing in the evaluation of optic nerve atrophy to discover syndromic conditions.
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Affiliation(s)
- Hailey Mair
- Department of Ophthalmology and Visual Sciences-Ophthalmic Genetics Service, University of Kentucky, Lexington, Kentucky, USA
| | - Nicholas Fowler
- Department of Ophthalmology and Visual Sciences-Ophthalmic Genetics Service, University of Kentucky, Lexington, Kentucky, USA
| | | | - Padmaja Sudhakar
- Department of Ophthalmology and Visual Sciences-Ophthalmic Genetics Service, University of Kentucky, Lexington, Kentucky, USA
- Department of Neurology, University of Kentucky, Lexington, Kentucky, USA
| | - Ramiro S Maldonado
- Department of Ophthalmology and Visual Sciences-Ophthalmic Genetics Service, University of Kentucky, Lexington, Kentucky, USA
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Mair H, Kenney NA, Uhl TL, Ullery LR, Hosey RG. Effect of Pitching Restrictions and Mound Distance on Youth Baseball Pitch Counts. Orthop J Sports Med 2022; 10:23259671221110547. [PMID: 35859649 PMCID: PMC9289911 DOI: 10.1177/23259671221110547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Studies have shown that higher pitch counts are directly related to a greater
incidence of elbow and shoulder pain among youth baseball pitchers. Purpose/Hypothesis: The purpose of this study was to examine the effect of different pitching
restriction rules on the number of pitches thrown in youth baseball leagues.
We hypothesized that more pitches would be thrown in leagues with inning
restrictions versus leagues with pitch count restrictions as well as in
leagues with a longer mound distance (from pitching mound to home
plate). Study Design: Cohort study; Level of evidence, 2. Methods: Pitch count data were collected for 2 consecutive years over a 10-week season
from 3 different leagues of 9- to 12-year-old baseball players in a single
city. The Eastern league had a pitch count restriction and 46-ft (14.02-m)
mound distance. The Southeastern and South leagues’ pitching restrictions
were based on innings per week. The Southeastern league had a 50-ft
(15.24-m) mound distance, while the South league had a 46-ft mound distance.
Comparisons of total seasonal pitches thrown were made of the 3
highest-volume pitchers on each team. League averages for each value were
then compared utilizing analysis of variance with Bonferroni post hoc
analysis. The number of pitchers in each league who threw >600 pitches
per season was compared using the chi-square test. Results: No significant difference in seasonal pitch counts or innings pitched was
noted between the Eastern and South leagues, which differed only in their
pitching restrictions. The Southeastern league, with a longer mound
distance, was found to have higher seasonal pitch counts per thrower (598 ±
195 pitches) than the South league (463 ± 198 pitches) for the 3
highest-volume throwers for each team (P = .004). The
Southeastern league also had a significantly larger number of pitchers who
threw >600 pitches per season (33 vs 20 for Eastern and 13 for South;
P = .009). Conclusion: There was no significant difference in seasonal pitch counts when the leagues
in this study differed based on pitching restrictions. However, the league
with a greater mound distance (Southeastern) had higher seasonal pitch
counts for the highest-volume throwers. Pitching restrictions based on pitch
counts, as opposed to innings, may be advisable.
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Affiliation(s)
- Hailey Mair
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | | | - Timothy L Uhl
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - L Robert Ullery
- University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Robert G Hosey
- University of Kentucky Medical Center, Lexington, Kentucky, USA
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Velmurugan S, Mair H, Yin G, Despa F, Despa S. Inhibition of sodium glucose cotransporter 1 reduces arrhythmogenesis in diabetic rats. Biophys J 2022. [DOI: 10.1016/j.bpj.2021.11.1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Schramm R, Schuba B, Mair H, Sodian R, Hagl C, Greif M, Lange P, Kupatt C, Schmitz C. Can EuroSCORE predict operative mortality of Transcatheter Aortic Valve Implantation (TAVI)? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mair H, Schramm R, Sodian R, Hagl C, Greif M, Lange P, Kupatt C, Schmitz C. Previous cardic surgery does not increase mortality of Transcatheter Aortic Valve Implantation (TAVI). Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mair H, Güthoff S, Sodian R, Schmitz C. Impact of valve type on long-term results after combined repair of aortic aneurysm and the aortic valve –45 years experiance. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Mair H, Sodian R, Lange P, Kupatt C, Schmitz C. Transcatheter aortic valve implantation (TAVI) in patients after previous heart surgery. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Brenner P, Zelger T, Kainzinger S, Sodian R, Überfuhr P, Mair H, Reichart B, Schmitz C. Prolonged extracorporeal membrane oxygenation (ECMO) in 231 patients after different indications with low cardiac output – a single-center experience. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Mair H, Sodian R, Schmitz C. The Lower End Sternal Split (LESS) Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) approach: A safe and less invasive option for beating heart revascularization – long-term-results. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Mair H, Güthoff S, Vogt F, Sodian R, Schmitz C. Thromboprophylaxis after Fontan procedure – long term results. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lamm P, Pfannebecker P, Mair H, Juchem G, Kilian E, Kilger E, Beiras A, Reichart B. Survival after aortocoronary bypass operations in patients with poor left ventricular function depends on the surgical protocol. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sodian R, Rassoulian D, Mair H, Kaczmarek I, Reichart B, Daebritz S. Design and fabrication of three – dimensional scaffolds for tissue engineering of human heart valves. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Daebritz S, Mair H, Sachweh J, Aigner V, Kaczmarek I, Überfuhr P, Lamm P, Reichart B. Gender differences in outcome after surgical coronary artery revascularisation without the use of extracorporeal circulation. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Mair H, Reichart B, Kaczmarek I, Juchem G, Überfuhr P, Lamm P, Daebritz S. Long-term anticoagulation self-testing after mechanical heart valve replacement. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Däbritz SH, Schmoeckel M, Kaczmarek I, Mair H, Roemer U, Essig J, Loeff M, Groetzner J, Christ F, Reichart B. ABO incompatible heart transplantation in infants. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mair H, Däbritz SH, Kaczmarek I, Oberhoffer M, Lamm P, Überfuhr P, Kreuzer E, Reichart B. Long-term results of surgical treatment of the aorta – 30 years experience. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mair H, Däbritz SH, Juchem G, Kaczmarek I, Schmoeckel M, Fichter M, Reichart B, Lamm P. Long term results in cardiac resynchronization therapy for heart failure – over 5 years experience. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sachweh JS, Tiete AR, Groetzner J, Gulbins H, Mair H, Muehler EG, Messmer BJ, Däbritz SH. Left-sided mechanical heart valve replacement in pediatric patients. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Oberhoffer M, Weis M, Eifert S, Kaczmarek I, Mair H, Schmoeckel M, Reichart B, Vicol C. Prospective randomized study of preoperative intraaortic balloon counterpulsation in high-risk coronary artery bypass grafting patients. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Gödje O, Gallmeier U, Schelian M, Grünewald M, Mair H. Coagulation factor XIII reduces postoperative bleeding after coronary surgery with extracorporeal circulation. Thorac Cardiovasc Surg 2006; 54:26-33. [PMID: 16485185 DOI: 10.1055/s-2005-872853] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND One cause of diffuse bleeding after cardiac operations may be a low plasma concentration of coagulation Factor XIII, which is essential for coagulation but is not covered by standard coagulation monitoring. PATIENTS AND METHODS In a prospective, randomized, double blinded study, 2500 units, 1250 units, and a placebo were administered in groups of 25 patients each, immediately after administration of protamine. Postoperative amount of blood loss and blood transfusion was recorded. RESULTS Patients were not statistically different with respect to the course of plasma levels of Factor XIII until administration of the study drug. In all groups Factor XIII fell from preoperative normal values to subnormal values after extracorporeal circulation. After administration of the study drug, Factor XIII increased to 71 %, 85 %, 103 % in the placebo, 1250 units, and 2500 units group, respectively, and these differences were statistically significant ( p < 0.05). Postoperative blood loss was lowest in the 2500 units group and highest in the placebo group, however this was not significantly different. There was also no significant difference in the amount of blood transfusion. After differentiating all patients according to their post medication Factor XIII level into two groups with levels of < 70 % and > or = 70 %, postoperative blood loss was found to be significantly higher in the < 70 % group as was the amount of blood transfusions. CONCLUSIONS Factor XIII administration reduces postoperative blood loss and the extent of blood transfusion after coronary surgery, however administration is only helpful if plasma levels are below the normal value. Measurement of plasma levels is recommended before Factor XIII substitution.
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Affiliation(s)
- O Gödje
- Department of Cardiac Surgery, University Hospital, University of Ulm, Ulm, Germany
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Mair H, Sachweh J, Pohl S, Überfuhr P, Kreuzer E, Reichart B, Däbritz S. Self-management of anticoagulation therapy after mechanical heart valve replacement -10 years experience of a single center. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-862073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Däbritz S, Sachweh J, Gulbins H, Klaus T, Mair H, Reichart B. Durability of bioprosthetic aortic valves with regard to patient related factors and valve size. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-862026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Right atrial thrombosis during chemotherapy is commonly treated conservatively. We describe a minimally invasive surgical procedure to remove a right atrial thrombus in a patient with a history of recurrent lung embolism. Surgery was performed through a mini-thoracotomy without cardiopulmonary bypass during occlusion of both caval veins. Recovery was uneventful.
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Affiliation(s)
- C Vicol
- Herzchirurgische Klinik, Klinikum Grosshadern der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 München, Germany.
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Mair H, Sachweh J, Roemer U, Daebritz S, Reichart B. Stable and event-free anticoagulation with INR self-determination after fontan palliation. Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schuetz A, Schulze CJ, Sarvanakis KK, Mair H, Plazer H, Kilger E, Reichart B, Wildhirt SM. Surgical treatment of permanent atrial fibrillation using microwave energy ablation: a prospective randomized clinical trial. Eur J Cardiothorac Surg 2004; 24:475-80; discussion 480. [PMID: 14500062 DOI: 10.1016/s1010-7940(03)00377-4] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Radiofrequency or the use of microwave energy in combination with atrial size reduction during open heart surgery have been reported to be effective in up to 75% in the treatment of permanent atrial fibrillation. However, no data from prospective randomized trials using microwave energy are available. METHODS Forty-three patients with permanent atrial fibrillation undergoing open-heart surgery were randomly stratified into treatment group receiving microwave ablation and atrial size reduction (n=24) or control group (n=19). Patients in either group were treated with amiodarone or sotalol for 3 months if sinus rhythm or any atrioventricular rhythm was successfully restored. Follow-up time points were at 3, 6 and 12 month after surgery. RESULTS In the treatment group 22 out of 24 patients (91,7%) were successfully converted to sinus rhythm by using intraoperative microwave ablation therapy whereas only six out of 19 (31.5%) patients converted to sinus rhythm directly after surgery. At 12-month follow-up there were still a significantly higher percentage of patients in the treatment group free from atrial fibrillation when compared to control (80 vs. 33.3%, P=0.036). CONCLUSION The preliminary data from this first prospectively randomized trial indicate that microwave ablation combined with atrial size reduction is a safe and highly efficient treatment in permanent atrial fibrillation.
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Affiliation(s)
- A Schuetz
- Department of Cardiac Surgery, Heart Center Augustinum, Ludwig-Maximillians University, Wolkerweg 16, D-81375 Munich, Germany
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Wildhirt SM, Schulze C, Schulz C, Egi K, Brenner P, Mair H, Schütz A, Reichart B. Reduction of systemic and cardiac adhesion molecule expression after off-pump versus conventional coronary artery bypass grafting. Shock 2002; 16 Suppl 1:55-9. [PMID: 11770035 DOI: 10.1097/00024382-200116001-00011] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cardiopulmonary bypass (CPB) and operative trauma are associated with increased expression of proinflammatory mediators. We determined the relative contribution of CPB on activation of cytokines and adhesion molecules in patients undergoing coronary revascularization by comparing them with patients receiving off-pump coronary artery bypass grafting (OPCAB). Twenty-six patients were assigned to either the OPCAB procedure using a suction device and regular sternotomy (n = 13), or were treated conventionally using extracorporeal circulation, blood cardioplegia, and hypothermic arrest (29 degrees C-31 degrees C; n = 13). Systemic levels of TNF-alpha and the soluble adhesion molecules P-selectin and intracellular adhesion molecule 1 (ICAM-1) were assayed. Immunohistochemistry was used to account for cardiac-specific expression of adhesion molecules in interventricular endomyocardial sections. Both systemic and endomyocardial expression of adhesion molecules were lower in the OPCAB group. Coronary revascularization with CPB resulted in a significant higher expression of TNF-alpha, which was associated with P-selectin and ICAM-1 expression. This was accompanied with higher catecholamine requirement in the CPB group in the early postoperative period. Despite comparable surgical trauma, the OPCAB procedure without the use of CPB and cardioplegic arrest significantly reduces systemic and cardiac adhesion molecule expression and catecholamine requirement. Since the clinical course in the early postoperative period was comparable, larger trials are required to select the appropriate patient who benefits most from one or the other treatment regime.
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Affiliation(s)
- S M Wildhirt
- Department of Cardiac Surgery, Ludwig-Maximilians University, Munich, Germany
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Block M, Stange-Budumlu O, Mair H, Schütz A, Götz A. [Only for limited indications. Biventricular pacemaker improves severe heart failure]. MMW Fortschr Med 2001; 143:45-7. [PMID: 11481917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
In patients with congestive heart disease in whom left ventricular dilatation is associated with severely disordered contraction due to delayed ventricular conduction, a new form of treatment not requiring drugs is currently becoming established--biventricular pacing. Via an implanted electrode, biventricular stimulation accelerates conduction in the left ventricle and resynchronizes its contraction. Patients being considered for such therapy must have stable stage III disease (NYHA classification) under optimal medication, and a left bundle branch block with a QRS of at least 150 ms. Definitive recommendations with regard to indications will be possible only when current randomized mortality studies have been concluded.
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Affiliation(s)
- M Block
- Abt. für Kardiologie, Stiftsklinik Augustinum, München
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Abstract
BACKGROUND The present study compared redo coronary artery bypass grafting (Re-OPCAB) techniques with conventional redo coronary artery bypass grafting (Re-CABG) with particular focus on myocardial damage and clinical outcome parameters. METHODS Redo OPCAB (Re-OPCAB) was performed on 20 consecutive patients (15 males, mean age 63.2 +/- 9.3 years) using either the anterolateral approach for minimally invasive direct coronary artery bypass (n = 4) or the Octopus technique with regular sternotomy (n = 16). The Re-CABG group consisted of 20 consecutive patients (18 males, mean age 67.1 +/- 6.6 years). Groups did not differ in the number of atherosclerotic risk factors, or left ventricular, renal or liver function. RESULTS Duration of surgery, number of bypass grafts and amount of transfused red blood cells did not differ significantly between both groups. Requirement of epinephrine (mg/h) within the first 24 h was lower in the Re-OPCAB group (Re-OPCAB: 0.14 +/- 0.22 vs. CABG: 0.88 +/- 0.97; p<0.01). In addition, CKMB levels at 24 h after operation were lower in the Re-OPCAB group (Re-OPCAB: 10.0 +/- 10.1 vs. Re-CABG: 38.7 +/- 28.1 U/l, p<0.001). There were no acute myocardial infarctions or deaths in the perioperative period. In the CABG group, there was a longer time period to extubation (hours) (Re-OPCAB: 9.8 +/- 3.9 vs. Re-CABG: 28.7 +/- 25.5; p<0.001), and the length of ICU stay was significantly prolonged (OPCAB: 1.3 +/- 0.5 versus Re-CABG: 4.4 +/- 8.7; p<0.001). The graft patency rate at follow-up was 95% in the Re-OPCAB group. CONCLUSION Re-OPCAB results in decreased cardiac specific enzyme release, reduced requirement of inotropes and comparable clinical outcome in the early postoperative period. It is an appropriate alternative to conventional Re-CABG in selected patients awaiting reoperation for myocardial revascularization. Larger prospective and randomized trials are required to select the appropriate patient who benefits most from one or the other treatment regime.
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Affiliation(s)
- A Schütz
- Department of Cardiac Surgery, Herzklinik am Augustinum, München, Germany.
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Schütz A, Mair H, Wildhirt SM, Reichart B. [Minimally invasive procedures in heart surgery. How does it work and who profits?]. MMW Fortschr Med 2001; 143:34-6. [PMID: 11268737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The leading minimally invasive procedures employed in coronary surgery are minimally invasive direct coronary arterial bypass surgery (MIDCAB) and the Octopus system. These interventions are performed on the beating heart and require no extracorporeal circulation (ECC), thus avoiding the side effects, such as pulmonary or neurological complications, associated with ECC. In surgery on the mitral or aortic valve, the procedures are carried out via small incisions in the non-beating heart, and endovascular bypass systems (e.g. Port-Access) are sometimes needed for EEC. The advantages of small incisions are a reduction in the risk of infection, shorter hospital stay and, in particular, improved cosmesis. A disadvantage is the longer operating time. Only careful patients selection guarantees successful surgery.
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Affiliation(s)
- A Schütz
- Leiter der Herzklinik am Augustinum der Ludwig-Maximilians-Universität München.
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Gödje O, Lamm P, Adelhard K, Schütz A, Kilger E, Götz A, Lange T, Mair H, Reichart B. Surgical versus medical care for postoperative cardiac surgical patients at the general ward. Eur J Cardiothorac Surg 1999; 16:222-7. [PMID: 10485425 DOI: 10.1016/s1010-7940(99)00203-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To shorten hospital stay after cardiac surgery, several risk factors have been defined to identify patients who can be discharged early. These risk factors are dependant on the patient; no studies exist on the influence of the treating physician himself on postoperative patient stay. METHODS In a university affiliated cardiac surgical clinic we investigated patients who were postoperatively treated either on medical wards with no cardiac surgeon's presence or on a cardiac surgical ward; at both types of wards physicians had several years experience with cardiac surgical patients. Taking several risk factors for postoperative morbidity into account, postoperative length of stay and incidence of wound healing complications have been compared. RESULTS Within a 3-month period, 84 patients were treated at the cardiac surgical ward, 102 patients at the medical wards. Risk factors for postoperative morbidity were present in 87% of patients, statistically independent of postoperative wards. Although demographic data and median ICU-stay of both patient groups was comparable, the median post-ICU stay was 9 days at the surgical and 13 days at the medical wards (P < 0.0001). Incidence of wound healing complication was higher (19.6%) at the medical wards than at the surgical ward (10.7%), without reaching statistical significance. CONCLUSION As patients at the respective wards were statistically not different, the difference in post-ICU stay, infection and costs must depend on the treating physicians. As a consequence, postoperative care for cardiac surgical patients in all cases should include direct cardiac surgical participation.
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Affiliation(s)
- O Gödje
- Department of Cardiac Surgery of the Ludwig-Maximilians-University of Munich at Augustinum, Germany.
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Gödje O, Peyerl M, Seebauer T, Lamm P, Mair H, Reichart B. Central venous pressure, pulmonary capillary wedge pressure and intrathoracic blood volumes as preload indicators in cardiac surgery patients. Eur J Cardiothorac Surg 1998; 13:533-9; discussion 539-40. [PMID: 9663534 DOI: 10.1016/s1010-7940(98)00063-3] [Citation(s) in RCA: 167] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Monitoring of cardiac preload is mainly performed by measurement of central venous and pulmonary capillary wedge pressure in combination with assessment of cardiac output, applying the pulmonary arterial thermal dilution technique. However, the filling pressures are negatively influenced by mechanical ventilation and the pulmonary artery catheter is criticized because of its inherent risks. Measurement of right atria, right ventricular, global end diastolic and intrathoracic blood volume index by arterial thermal dye dilution utilizing the COLD-system may represent an alternative. METHODS In 30 CABG patients with an uncomplicated postoperative course the mentioned parameters were measured 1, 3, 6, 12 and 24 h postoperatively to prove their qualification as preload indicators: As patients received no inotropic support, changes of cardiac index and stroke volume index must correlate to changes of presumably preload indicating parameters. RESULTS When arterial and pulmonary arterial thermal dilution were compared, no differences were found; the correlation coefficient being 0.96, the bias 0.16 l/min per m2 (2.4%) and coefficients of variation did not exceed 7%. Changes of central venous pressure, capillary wedge pressure, right atrial end diastolic volume index and right ventricular end diastolic volume index did not correlate at all to changes of cardiac and stroke volume index (coefficients ranged from -0.01 to 0.28). In contrast, intrathoracic and global end diastolic blood volume indices with coefficients from 0.76 to 0.87, did show a good correlation to cardiac and stroke volume index. CONCLUSION Central venous pressure, capillary wedge pressure, right atrial and right ventricular end diastolic volumes are no suitable preload parameters in cardiac surgery intensive care, compared to intrathoracic and global end diastolic blood volumes. The latter show a higher clinical value and can be obtained by less invasive methods, as no pulmonary artery catheter is required.
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Affiliation(s)
- O Gödje
- Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-Universität München, Munich, Germany.
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Detter C, Mair H, Klein HG, Georgescu C, Welz A, Reichart B. Long-term prognosis of surgically-treated aortic aneurysms and dissections in patients with and without Marfan syndrome. Eur J Cardiothorac Surg 1998; 13:416-23. [PMID: 9641341 DOI: 10.1016/s1010-7940(98)00043-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Aortic aneurysms and dissections are the leading causes of premature death in Marfan syndrome (MfS). This study aims to compare long-term results of surgically treated aortic aneurysms and dissections in patients with and without MfS in respect to early and late prognosis. METHODS From March 1975 to August 1994, 33 patients with classic MfS (group A, age 34.2 +/- 9 years) and 298 patients with non-fibrillinopathic aortic disease (group B, age 54 +/- 13 years) underwent aortic surgery. Acute dissections occurred in 57.6 (A) versus 37.9% (B). A total of 54.6% of patients in group A were treated with a composite graft versus 16.4% in B. The aortic arch and the descending aorta was replaced in 30.4% of MfS patients and 24.9% of patients without MfS. RESULTS We observed 7 (25.0%, A) versus 35 (14.2%, B) late deaths among the 28 (A) versus 247 (B) early survivors. In 5 patients (17.9%) of A and 8 patients (3.2%) of B, late death was caused by redissection or recurrent aneurysm (P < 0.001). Long-term survival after 5, 10 and 15 years in group A was 82 +/- 7, 60 +/- 11 and 30 +/- 22%, and 75 +/- 3, 69 +/- 3 and 64 +/- 4% in group B. A total of 22 reoperations were performed in 11 MfS patients, 17 reoperations were due to recurrent aortic diseases. Three of the 8 patients underwent reoperation after Wheat procedure because of sinus valsalva aneurysm. None of the patients with composite graft replacement needed reoperation in this segment, but 3 patients suffered from redissection at the proximal aortic arch. In group B, reoperations were significantly less frequent (10.7%) compared to MfS patients (66.7%; P < 0.001). CONCLUSIONS Surgical treatment of aortic disease in MfS patients is associated with a high risk of redissection and recurrent aneurysm. If the ascending aorta needs to be replaced, we recommend the composite graft technique and a more aggressive approach to reduce the frequency of distal reoperations. In order to reduce the high reoperation rate in MfS patients, frequent clinical follow-up may contribute to improve life expectancy in MfS patients.
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Affiliation(s)
- C Detter
- Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilian-University, Munich, Germany
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Grau U, Klein HG, Detter C, Mair H, Welz A, Seidel D, Reichart B. A novel mutation in the neonatal region of the fibrillin (FBN)1 gene associated with a classical phenotype of Marfan syndrome (MfS). Mutations in brief no. 163. Online. Hum Mutat 1998; 12:137. [PMID: 10694921 DOI: 10.1002/(sici)1098-1004(1998)12:2%3c137::aid-humu14%3e3.0.co;2-p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Marfan Syndrome (MfS) is an autosomal dominant inherited connective tissue disorder with variable phenotypic expression of cardiovascular, skeletal and ocular manifestations. Cardiovascular complications, such as aortic aneurysm and dissection drastically reduce life expectancy of individuals with MfS, whereas preventive surgery substantially improves the prognosis of these patients. A number of mutations in the fibrillin 1 (FBN1) gene associated with MfS have been identified to date, demonstrating considerable molecular heterogeneity. One region, however, located around exon 24, exhibits a striking clustering of mutations, which are associated with a severe, socalled neonatal form of MfS. Here we report the first mutation (G2950A) in exon 24 of the neonatal region of the FBN1 gene, associated with a classic MfS phenotype. The mutation leads to the subsitution of valin by isoleucin (V984I), both uncharged amino acids, which only differ in a single methyl group. This defect was identified in a proband with cardiovascular manifestations of MfS by SSCP analysis of PCR-amplified genomic DNA, direct PCR sequencing and RFLP analysis. The substitution was neither detected in the unaffected 4-year old daughter of the proband, nor in 3 of his healthy family members nor in 108 allels from control individuals, suggesting that this mutation is causative for MfS in the patient. Since no other family member of the proband is affected by MfS, the defect described is sporadic. In summary, we identified a novel defect in exon 24 of the neonatal region of the FBN1 gene in a patient with a classic phenotype of MfS, suggesting that conservative substitutions in this region may lead to a less severe phenotype of the disease. This finding further demonstrates the remarkable phenotypic heterogeneity associated with FBN1 mutations and stresses the significance of modifying genes and individual alterations in protein function for the pheontypic expression of the disease.
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Affiliation(s)
- U Grau
- Department of Cardiovascular Surgery, Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, D-81366 München, Germany
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Meiser BM, Uberfuhr P, Fuchs A, Schulze C, Nollert G, Mair H, Martin S, Pfeiffer M, Reichenspurner H, Kreuzer E, Reichart B. Tacrolimus: a superior agent to OKT3 for treating cases of persistent rejection after intrathoracic transplantation. J Heart Lung Transplant 1997; 16:795-800. [PMID: 9286771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Acute myocardial rejection refractory to treatment still contributes significantly to patient death after intrathoracic transplantation. A historical series of 25 patients who received OKT3 (5 mg/day for 10 days) was compared with our current experience with 14 patients treated with tacrolimus (0.1 mg/kg/day targeting whole blood concentrations of 13 to 18 ng/ml): all 39 patients having persistent rejection unresponsive to treatment at the time of conversion. Mean periods of follow-up were 842.9 days and 342.6 days, respectively. Actuarial 1-year patient survival rates were 64.0% and 76.2% for the OKT3 and tacrolimus treatment groups, with most of the deaths in the OKT3 group occurring early (p = 0.064). Causes of death for patients receiving OKT3 included acute rejection (n = 5), infection (n = 3), carcinoma (n = 2), multiorgan failure (n = 1) and graft vessel disease (n = 1). The two deaths in the tacrolimus treatment group were the result of infections. Eighty percent of patients treated with OKT3 subsequently experienced further rejection episodes, in many cases necessitating methotrexate therapy. In contrast, only one patient (7.1%) from the tacrolimus group was diagnosed with rejection after conversion (p < 0.001). In conclusion, when compared with OKT3 therapy, a switch in baseline immunosuppression from cyclosporine to tacrolimus seems to be markedly more effective, as well as being safe for the treatment of persistent acute rejection.
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Affiliation(s)
- B M Meiser
- Department of Cardiac Surgery, University of Munich, Grosshadern Medical Center, Germany
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Meiser BM, Uberfuhr P, Schulze C, Fuchs A, Mair H, Reichenspurner H, Kreuzer E, Reichart B. Tacrolimus (FK506) proves superior to OKT3 for treating episodes of persistent rejection following intrathoracic transplantation. Transplant Proc 1997; 29:605-6. [PMID: 9123150 DOI: 10.1016/s0041-1345(96)00321-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- B M Meiser
- Department of Cardiac Surgery, University of Munich, Grosshadern Medical Center, Germany
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Gödje O, Fischlein T, Adelhard K, Mair H, Reichart B. 25 years follow-up of patients after replacement of the aortic valve with a Smeloff-Cutter prosthesis. Thorac Cardiovasc Surg 1996; 44:234-8. [PMID: 8948550 DOI: 10.1055/s-2007-1012026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Thirty years ago the Smeloff-Cutter double-caged ball prosthesis was developed for aortic valve replacement. Between 1967 and 1977 a total of 46 patients admitted to the University Hospital Munich underwent an isolated aortic valve replacement with the Smeloff-Cutter prosthesis. Postoperatively all patients received anticoagulation treatment with phenprocoumon (Marcumar). A retrospective follow-up of 95.6% of patients, representing 842 patient years, was completed. The corresponding actuarial survival rates after 10, 20, and 25 years were 69.1%, 47.4%, and 31.4%. The actuarial freedom rates from either valve-related complications, reoperations, or death were 72.9%, 47.4%, and 20.3%. Thromboembolism occurred in 1.41% per patient year, bleeding in 1.90%. The rates of valvular dysfunction, reoperation, and endocarditis were 1.16%, 1.16%, and 0.2% per patient-year. Today, of the surviving patients 81% are in NYHA Class I or II, 19% in NYHA Class III. No surviving patient deteriorated over the reported time in his or her functional NYHA classification. After 25 years the Smeloff-Cutter valve has proved to be a reliable prosthesis for aortic valve replacement and-together with the Starr-Edwards prosthesis-it has set a standard in longterm durability by which all other valve designs will have to be measured.
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Affiliation(s)
- O Gödje
- Department of Cardiac Surgery, University Hospital Grosshadern, Ludwig-Maximilians-University, Munich, Germany
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Meiser BM, Wenke K, Thiery J, Brandl U, Mair H, Kur F, Detter C, Uberfuhr P, Kreuzer E, Seidel D. Prevention and treatment of graft vessel disease after heart transplantation. Transplant Proc 1995; 27:1931-5. [PMID: 7792841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- B M Meiser
- Department of Cardiac Surgery and Clinical Chemistry, Ludwig-Maximilians-University Munich, Grosshadern Medical Center, Germany
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Hart JC, Howells CH, Mair H, Gann PG, Mitchell ER. A programme for collaborative influenza surveillance. A report of a working group of the Public Health Laboratory Service. J Hyg (Lond) 1975; 75:1-6. [PMID: 1056966 PMCID: PMC2130235 DOI: 10.1017/s002217240004701x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A surveillance programme is described which is intended to assess the effects of influenza virus infections on communities at large by collating influenza virus isolations and consultations for respiratory infections from general practices with new claims for sickness benefit and deaths from all causes. Particular importance is attached to relating virus isolations to symptomatic respiratory disease seen in practices of known age and sex structure.
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Mair H. Community mental health services. Public Health 1972; 86:73-8. [PMID: 4262949 DOI: 10.1016/s0033-3506(72)80005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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