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LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION IN NONCOMPACTION CARDIOMYOPATHY: IS AN AGGRESSIVE SURGICAL APPROACH MANDATORY FOR EVENT FREE SURVIVAL? Chest 2019. [DOI: 10.1016/j.chest.2019.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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REAL LIFE EARLY EXPERIENCE WITH THE AVALUS AORTIC BIOPROSTHESIS. Chest 2019. [DOI: 10.1016/j.chest.2019.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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The Direct Flow Medical Prosthesis as a Sutureless Device for Valve Replacement in Aortic Valve Regurgitation: A Feasibility Study. Thorac Cardiovasc Surg 2018. [DOI: 10.1055/s-0038-1628061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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HBO Therapy in Patients with Neurological Deficits after Cardiac Surgeries. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sinus Venosus Defect and Partial Anomalous Pulmonary Venous Connection: Effect of Surgical Strategies on Sinus Node Function and Potential Obstruction of the Superior Vena Cava. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Pediatric Minimal Extracorporal Circulation - First Clinial Experience Using a Newly Established Closed Mini-Bypass Circuit as Perfusion Technique for Pediatric Cardiac Surgery. Thorac Cardiovasc Surg 2015. [DOI: 10.1055/s-0035-1544586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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7
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Sutureless aortic valve replacement via anterolateral minithoracotomy. Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1367325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Sutureless aortic valve implantation in isolated fashion and combined cardiovascular procedures. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Minimally-invasive implantation of sutureless aortic valve prosthesis. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Aneurysma. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1310661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Analysis of risk factors for neurological dysfunction in patients with acute aortic dissection type A: data from the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 2012; 42:557-65. [DOI: 10.1093/ejcts/ezs025] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Sutureless aortic valve implantation – experience in over 70 patients. Thorac Cardiovasc Surg 2012. [DOI: 10.1055/s-0031-1297906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Abstract
Acute respiratory distress syndrome (ARDS) still represents a serious problem in clinical routine and is associated with a high mortality. Several concepts are known for special treatment, but, in some instances, the application of an extracorporeal membrane oxygenation (ECMO) is necessary for both the improvement of oxygenation and the elimination of carbon dioxide (CO(2)). One basic aspect in lung protective ventilation in this context is alveolar recruitment, which can be achieved by different approaches, such as "the open lung concept", according to Lachmann, or by additional kinetic therapy. The most exposed feature of this entity is 'prone', which may be quite challenging in patients requiring extracorporeal support or organ replacement therapy under ongoing critical illness. We report two outstanding cases of prone under conditions of a veno-venous ECMO therapy which improved significantly under this position. Furthermore, we reflect critically possible risk factors and adverse events of such procedures and afford a current view from the literature.
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German Registry for Acute Aortic Dissection Type A (GERAADA) - New Software Design, Parameters and Their Definitions. Thorac Cardiovasc Surg 2011; 59:69-77. [DOI: 10.1055/s-0030-1250748] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Use of stentless xenograft as bioroot in the absence of aortic disease: experience of 139 patients. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Differences in management and outcomes between young and elderly patients with acute aortic dissection type A: Results from the German Registry for Acute Aortic Dissection type A (GERAADA). Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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17
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The „fourfold ECMO man“: Cardiosurgical treatment of a severe ARDS due to Herpes simplex pneumonia. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Risk factors for new postoperative neurological disorders in patients with acute aortic dissection type A - data from the German Registry for Acute Aortic Dissection type A (GERAADA). Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Transaortic catheter based aortic valve replacement via anterolateral minithoracotomy for patients with limited peripheral vascular access and larger aortic annulus. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1269007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Influence of operative strategy for Debakey Type I Aortic Dissection-Analysis of the GERAADA Registry. Thorac Cardiovasc Surg 2011. [DOI: 10.1055/s-0030-1268927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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German Registry for Acute Aortic Dissection Type A (GERAADA) – Lessons Learned from the Registry. Thorac Cardiovasc Surg 2010; 58:154-8. [DOI: 10.1055/s-0029-1240806] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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22
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Aortic root surgery in acute aortic dissection type-A – new insights from GERAADA (German Registry for Acute Aortic Dissection type-A) after three years. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1247027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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German Registry for Acute Aortic Dissections type-A (GERAADA) – trends after three years. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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24
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Cardiac surgery in nonagenarians-pushing the boundary one further decade. Thorac Cardiovasc Surg 2010. [DOI: 10.1055/s-0029-1246692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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25
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Deutsches Register für akute Aortendissektion Typ A (GERAADA). ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2009. [DOI: 10.1007/s00398-009-0733-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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26
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The stentless bioroot for treatment of complex aortic valve-ascending aortic pathologies: Experience of 400 patients. Thorac Cardiovasc Surg 2009. [DOI: 10.1055/s-0029-1191407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Zur Kinetik des unteren Harntraktes nach Radikaloperation und Strahlentherapie des Kollumkarzinoms. Geburtshilfe Frauenheilkd 2008; 43:116-22. [PMID: 6551292 DOI: 10.1055/s-2008-1037071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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28
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Operatives Konzept zur Therapie der weiblichen Streßinkontinenz. Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1058227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Funktionelle Störungen des unteren Harntraktes nach Radikaloperation des Kollumkarzinoms. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1036981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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30
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The stentless bioroot: A valuable alternative in acute endocarditis of the aortic valve – early and midterm results. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Aortic root surgery in the elderly: Operative risks and midterm results. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1038040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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Frozen elephant trunk Implantation in Verbindung mit einem Aortenbogenersatz als einzeitiger Eingriff zur Therapie einer Stanford-A-Dissektion. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2007. [DOI: 10.1007/s00398-007-0573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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33
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Long term survival of dialysis patients independent of type of prosthetic valve substitute. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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34
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Stentless full root aortic valve replacement is as safe as stented xenograft implantation. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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35
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Frozen elephant trunk technique for radical single step treatment of aortic type A dissections. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Beating heart valve surgery as possible alternative for high risk patients. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-922320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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The role of stentless valves in aortic surgery. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-922329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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38
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Coronary artery bypass grafting and moderate mitral regurgitation. Thorac Cardiovasc Surg 2005. [DOI: 10.1055/s-2005-922393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Minimally invasive direct coronary artery bypass grafting: a systematic review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2004; 45:255-64. [PMID: 15179338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
AIM Recently minimally invasive direct coronary artery bypass grafting (MIDCAB) has become an interesting alternative to conventional coronary artery bypass grafting, especially in patients with a high-grade left anterior descending coronary artery (LAD) stenosis unsuitable for balloon angioplasty. Although MIDCAB offers several advantages such as the avoidance of sternotomy and cardiopulmonary bypass, concerns have been raised about the technical accuracy of the anastomoses that can be performed on a beating heart. Therefore, clinical and angiographic outcomes after MIDCAB are the subject of current controversy. METHODS A literature search for all published outcome studies of MIDCAB grafting was performed for the period from January 1995 through April 2003. Sixteen articles were enrolled in this review. The data presented in the studies was analysed with regard to clinical outcome and angiographic results. RESULTS Early mortality ranged from 0% to 4.9% and late mortality (>30 days after MIDCAB) ranged from 0.3% to 12.6%. Infarct rates (non-fatal myocardial infarction) ranged between 0% and 3.1%. Intra- and postoperative complications (wound infections, reoperation for management of bleeding, arrhythmias, stroke, etc.) occurred in 1.6-40%. The conversion rate to sternotomy/cardiopulmonary bypass ranged between 0% and 6.2%. Reinterventions due to graft failure were necessary in up to 8.9% of patients (surgical revision or percutaneous transluminal coronary angioplasty, PTCA). Short-term and mid-term angiographic outcomes are given in Table I. CONCLUSION Clinical outcomes and immediate graft patency after MIDCAB are acceptable. However, long-term follow-up results and further randomized prospective clinical trials comparing this new technique with standard revascularization procedures are needed.
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Determinants of short- and midterm outcome following the modified Bentall procedure. Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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[Atypical organ-oriented effects of so-called ovulation inhibitors following bilateral nephrectomy, as well as unusual endometrial changes during long-term acyclic therapy for chronic myelosis]. ZEITSCHRIFT FUR GEBURTSHILFE UND GYNAKOLOGIE 2002; 168:268-86. [PMID: 12156326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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[Women and the severely handicapped... Reflections on the negotiations about appointments to a chair]. GYNAKOLOGISCH-GEBURTSHILFLICHE RUNDSCHAU 2000; 38:177-9. [PMID: 10325521 DOI: 10.1159/000022262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Berufungsverhandlungen sind Tabuthemen. Nach einem 27jährigen Ordinariat und 4jährigem Dekanat stelle ich mich einigen Fragen aus zugegeben subjektiver und eingeschränkt österreichischer Sicht: Wählen wir die Besten oder entscheiden oftmals Lobbies jenseits der persönlichen Verantwortlichkeit der Kommissionsmitglieder? Lässt deren grosse Zahl und ihre Kompetenz eine Leistungsbeurteilung zu? Steht der Impactfaktor oder die klinische Rundumerfahrung im Vordergrund? Besteht Chancengleichheit für Kollegen mit onkologischem oder geburtshilflichem Tiefgang? Hat die Einrichtung von Arbeitskreisen für Gleichbehandlungsfragen für Kandidatinnen etwas gebracht?
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[Developments in surgical gynecology]. GYNAKOLOGISCH-GEBURTSHILFLICHE RUNDSCHAU 2000; 38:180-7. [PMID: 10325522 DOI: 10.1159/000022263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This farewell lecture presents an overview of the development of operative gynecology on the basis of oncological surgery, removal of the uterus with or without pelvic floor reconstruction as well as corrective surgery of the uterovaginal canal. Without doubt the significance of endoscopic surgery, especially involving the adnexa and the cavum uteri, has increased. Uterus extirpation should remain in the domain of the vaginal approach. An experienced 'vaginalist' has has hardly any need for parasocpic assistance which should influence the renaissa lance of the vaginal method. Emphasis should be put on vaginal reconstruction of the affected pelvic floor in the course of incontinence surgery. Thanks to new diagnostic means malformations of the uterus can be detected more frequently, and it appears essential to develop and improve these methods further if one is to prevent laparoscopic polypragmatism. The author's opinion about the insufficient surgical experience and training in medical specialist education will be discussed.
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Multiple blue nevi of the vagina. A case report. THE JOURNAL OF REPRODUCTIVE MEDICINE 2000; 45:42-4. [PMID: 10664947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Melanotic lesions of the vagina are very rare; clinically, most are suspected to be malignant melanomas. Occasional benign cases, however, require differential diagnostic consideration. We report a case of multiple (benign) blue nevi of the vagina. CASE A 51-year-old woman presented with bluish black macules irregularly distributed throughout the vagina. Biopsies revealed pigmented cells in the dermis that proved to be melanocytes. The patient received no therapy. The lesions remained unchanged in the follow-up period. CONCLUSION Multiple blue nevi could be a differential diagnosis for malignant melanoma of the vagina. Our patient showed no malignant transformation over a 29-year period. Therapy for blue nevi in the vagina does not require complete excision.
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Abstract
OBJECTIVES In the surgical treatment of cervical carcinoma the conservation of ovaries in premenopausal women is a common procedure. To date, however, there have been no controlled studies to prove that the risk of recurrence or death from disease is not elevated among women who do not undergo oophorectomy. STUDY DESIGN We performed a matched pairs analysis according to the tumor volume, comparing the outcomes of patients with in situ conservation of >/=1 ovary with those of control subjects who underwent bilateral oophorectomy. From among 658 patients, 150 pairs with International Federation of Gynecology and Obstetrics stage I disease were matched. Kaplan-Meier survival curves were compared with the log rank test. RESULTS Among patients who retained their ovaries 5- and 10-year overall survival rates were 98% and 96%, respectively, versus 97% and 97% for the oophorectomy control group. The corresponding figures for progression-free survival were 95% and 94%, respectively, versus 97% and 93%. Outcomes were equal with sufficient power to detect a 10% difference. Three of 214 patients with conservation of ovaries (1.3%) subsequently required oophorectomy, all because of benign ovarian diseases. CONCLUSIONS Our results confirm that ovarian conservation is safe in International Federation of Gynecology and Obstetrics stage I disease and that the occurrence of subsequent complications in ovaries retained in situ is rare.
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Abstract
OBJECTIVE Continuous perfusion of the coronary arteries with beta-blocker (esmolol)-enriched normothermic blood during cardiac surgery has been suggested as an alternative technique for myocardial protection. The aim of the present study was to compare the beta-blocker technique to Buckberg's blood cardioplegia during coronary artery bypass grafting (CABG). METHODS Sixty patients with coronary artery disease were randomly assigned to either the esmolol group (ES, n = 30) or the blood cardioplegia group (BC, n = 30). During aortic crossclamp ES patients received continuous normothermic coronary perfusion with esmolol-enriched blood. Hearts of the BC group were protected by antegrade cold blood cardioplegia according to Buckberg. We measured left ventricular (LV) contractility using TEE (fractional area of contraction, FAC) and hemodynamic parameters prior to cannulation for cardiopulmonary bypass (CPB), after decannulation, and 4 h postoperatively. Myocardial lactate release was measured prior to aortic cross-clamp, during cross-clamp, and after decannulation. LV biopsies for determination of heat-shock protein (HSP-70), actin pattern and intercellular adhesion-molecule (ICAM-I) as indicators for structural changes were collected prior CPB, at the end of the aortic cross-clamp period, and prior to weaning off CPB. RESULTS There was no significant difference between both groups with respect to grafts and cross-clamp time. ES hearts did not release lactate during cross-clamp. In contrast, BC hearts released significant amounts of lactate. Post CPB FAC and hemodynamics under similar inotropic stimulation showed no difference between groups, whereas at 4 h post CPB measurements showed slightly better values in the ES group: cardiac index: ES: 2.9+/-0.1 (SEM) versus BC: 2.6+/-0.1 L/min per m2 (P < 0.05); FAC: ES: 55+/-3 versus BC: 48+/-3% (P < 0.05). HSP-70 and actin pattern showed no difference between groups; however, ICAM-I showed a significantly higher degree of structural changes in BC hearts: 18+/-2 versus ES: 11+/-1% (P < 0.05). CONCLUSION Our data demonstrate that application of the beta-blocker technique during routine CABG was associated with slightly better functional recovery and less structural myocardial alteration as compared with intermittent cold blood cardioplegia, however, both techniques provided equivalent myocardial protection in terms of patient outcome. Future studies are required to investigate if myocardial ischemia minimization by use of the beta-blocker technique may be beneficial in compromized hearts.
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Single coronary artery bypass grafting--a comparison between minimally invasive 'off pump' techniques and conventional procedures. Eur J Cardiothorac Surg 1998; 14 Suppl 1:S7-12. [PMID: 9814785 DOI: 10.1016/s1010-7940(98)00097-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE At present, few studies directly comparing minimally invasive and conventional coronary artery bypass grafting are available. The aim of the present study was to evaluate the clinical outcome of the two techniques. METHODS We retrospectively compared our first consecutive 20 patients undergoing minimally invasive coronary artery single bypass grafting on the beating heart (group I) with 23 consecutive patients receiving single coronary artery bypass via sternotomy using cardiopulmonary bypass and cardioplegia (group II). The procedures were performed during the period from Jan 1, 1994 to Feb 20, 1997. There were no significant differences in demographic data. RESULTS Statistically significant differences were found concerning total operative time (172.6 min in group I and 149.6 min in group II P = 0.0009) and myocardial ischemic time (23.7 min local coronary occlusion time in group I and 17.6 min aortic cross-clamp time in group II P = 0.03. Patients treated minimally invasive received significantly fewer blood transfusions (25.0% vs. 69.6% P = 0.0035) and were discharged significantly earlier from the hospital (admission rate on the fifth postoperative day 68.4% in group I vs. 100.0% in group II P = 0.0004). CONCLUSION We conclude that minimally invasive coronary artery bypass grafting on the beating heart in comparison to conventional single coronary artery bypass grafting during the learning curve requires longer operative times but can reduce blood transfusion requirements and hospital stay.
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Different intracellular compartmentations of cardiac troponins and myosin heavy chains: a causal connection to their different early release after myocardial damage. Clin Chem 1998; 44:1912-8. [PMID: 9732976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
We investigated the net myocardial release of creatine kinase isoenzyme MB (CKMB), myoglobin, cardiac troponin T (cTnT), cardiac troponin I (cTnI), and cardiac beta-type myosin heavy chain (beta-MHC) into the coronary circulation after cardioplegic cardiac arrest in humans. Cardiac markers were measured in paired arterial, central venous, and coronary sinus blood in 19 patients undergoing elective coronary artery bypass grafting (CABG) before aortic cross-clamping and 1, 5, 10, and 20 min after aortic declamping. cTnT and cTnI were released into the coronary sinus in parallel to each other and almost simultaneously to myoglobin and CKMB within 20 min of reperfusion. In contrast, no beta-MHC was released in the same patients during the study period. The average soluble cTnT and cTnI pools in right atrial appendages of 11 patients with right atrial and right ventricular pressures within reference values were comparable and were approximately 8% of total myocardial troponin content. The soluble beta-MHC pool was <0.1% in all patients. Our results demonstrate the impact of the different intracellular compartmention of regulatory and contractile proteins on their early release from damaged myocardium.
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Abstract
PURPOSE The clinical impact of endogenous cytokines supplied with deterministic properties in the generation of either T helper (Th)1 -type or Th2-type immune response was investigated in patients with ovarian cancer. Whereas interleukin (IL)- 12 initiates the differentiation of naive Th0 cells toward Th1 phenotype, IL-4 and IL-10 mediate the development of Th2-type immunity. PATIENTS AND METHODS Cytokines were determined before treatment by means of enzyme-linked immunosorbent assay (ELISA) in ascites fluid and serum of 76 patients with ovarian cancer. Cytokine levels were compared with each other and with standard clinicopathologic parameters. A stepwise logistic regression was calculated to rule out interdependence in the associations of the various variables. Survival analyses were performed with the Kaplan-Meier method and differences in survival were examined according to Mantel and Breslow. Cox proportional hazards analysis was used to identify independent prognostic factors. RESULTS Whereas IL-10 and IL-12 were detectable in all ascites-fluid samples, IL-4 was measurable in only 43% of the specimens. With the exception of neopterin, macrophage colony-stimulating factor (M-CSF), and IL-4, determined cytokine levels were significantly elevated in ascites fluid compared with serum (P < .01). In univariate analyses, high ascitic-fluid concentrations of either neopterin, tumor necrosis factor-alpha (TNF-alpha), or IL-12 were associated with poor disease-free (P < .005) and overall (P < .01) survival. Multivariate Cox regression analysis showed ascitic-fluid IL-12 levels to be the only immunologic variable that retained independent prognostic significance (P < .03 for disease-free and P < .01 for overall survival), together with residual disease, Fédération Internationale de Gynécologie et d'Obstétrique (FIGO)-stage, and patient age. CONCLUSION In ovarian cancer, high ascitic-fluid IL-12 levels, which may indicate a local Th1-generated immune response, are associated with disease progression.
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