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Börgermann J, Friedrich I, Flohé S, Spillner J, Majetschak M, Kuss O, Sablotzki A, Feldt T, Reidemeister JC, Schade FU. Tumor necrosis factor-alpha production in whole blood after cardiopulmonary bypass: downregulation caused by circulating cytokine-inhibitory activities. J Thorac Cardiovasc Surg 2002; 124:608-17. [PMID: 12202878 DOI: 10.1067/mtc.2002.122300] [Citation(s) in RCA: 24] [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: 11/22/2022]
Abstract
OBJECTIVES Cardiopulmonary bypass is associated with the release of proinflammatory cytokines (tumor necrosis factor alpha, interleukin 1beta, interleukin 6, and interleukin 8) and anti-inflammatory cytokines (interleukin 10 and transforming growth factor beta(1)). On the one hand this cytokine release is related to the postoperative systemic inflammatory response syndrome, and on the other hand it is related to deterioration of the immune system, for example in monocyte or polymorphonuclear neutrophil function, leading to an increased susceptibility to infections. To gain further insight into the alterations of immune cell reactivity and possible regulatory mechanisms, we studied lipopolysaccharide-induced tumor necrosis factor alpha synthesis in whole blood from cardiac surgical patients. METHODS Fifteen patients undergoing elective heart surgery with cardiopulmonary bypass were included in the study. Ex vivo lipopolysaccharide-induced tumor necrosis factor alpha synthesis was measured in a whole blood assay before, during, and after bypass. Corresponding tumor necrosis factor alpha messenger RNA levels were determined by semiquantitative reverse transcriptase-polymerase chain reaction. In addition, the influence of patient serum on whole blood responsiveness and its relationship to anti-inflammatory cytokines were evaluated in vitro. RESULTS Tumor necrosis factor alpha synthesis was significantly reduced after 30 minutes of cardiopulmonary bypass and showed the lowest values at the end of bypass (mean +/- SD 0.109 +/- 0.105 ng/10(6) white blood cells after 30 minutes of bypass and 0.050 +/- 0.065 ng/10(6) white blood cells at the end of bypass, vs 0.450 +/- 0.159 ng/10(6) white blood cells preoperatively, P <.001). As a further indication of reduced cytokine biosynthesis, diminished messenger RNA levels for tumor necrosis factor alpha were detected. Serum withdrawn from patients at the end of cardiopulmonary bypass reduced tumor necrosis factor alpha synthesis in heterologous blood from healthy volunteers highly significantly to 39.93% +/- 23.18% relative to control serum (P =.005) and preoperatively drawn serum (P =.024). This effect was dose dependent and was not specific for lipopolysaccharide-induced tumor necrosis factor alpha synthesis. Anesthesia and heparin administration did not influence tumor necrosis factor alpha production significantly. Ex vivo tumor necrosis factor alpha synthesis was negatively related to interleukin 10 serum levels, positively but weakly related to interleukin 4, and was not related to transforming growth factor beta(1) (Spearman correlation coefficients -0.565, P <.001, 0.362, P <.001, and -0.062, P =.460, respectively). However, interleukin 10 levels in patient serum after cardiopulmonary bypass were 300-fold below the quantities needed for half-maximal inhibition of tumor necrosis factor alpha synthesis in vitro. Moreover, the inhibitory activity could not be removed by immune absorption of interleukin 10. CONCLUSIONS These results suggest that during cardiac operations cytokine-inhibitory serum activities are released or newly formed. These activities could not be explained by the actions of interleukins 4 and 10 or transforming growth factor beta(1). Although their exact nature remains undetermined, these substances may contribute to the diminished immune cell functions after cardiopulmonary bypass and thus need further characterization.
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Affiliation(s)
- J Börgermann
- Department of Cardiac and Thoracic Surgery, Martin-Luther-University Halle-Wittenberg, Halle/Saale, and the Department of Surgery, Clinical Research Group Shock & MOF, University Hospital of Essen, Essen, Germany.
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Friedrich I, Spillner J, Lu EX, Bartling B, Barnscheid M, Sablotzki A, Schade U, Reidemeister JC, Silber RE, Gunther A, Borgermann J. Ischemic pre-conditioning of 5 minutes but not of 10 minutes improves lung function after warm ischemia in a canine model. J Heart Lung Transplant 2001; 20:985-95. [PMID: 11557194 DOI: 10.1016/s1053-2498(01)00290-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [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: 10/27/2022] Open
Abstract
BACKGROUND Protection from reperfusion injury by ischemic pre-conditioning (IPC) before prolonged ischemia has been proven for the heart and the liver. We now assess the efficacy of IPC to protect lungs from reperfusion injury. METHODS Eighteen foxhounds (25 to 30 kg) were anesthetized, intubated, and ventilated with a fraction of inspired oxygen of 0.3 at a volume-controlled mode to maintain arterial pCO2 of 30 to 40 mm Hg. After left thoracotomy, we performed warm ischemia for 3 hours by clamping the left hilus, and followed with 8 hours of reperfusion (control, n = 6). In the treated groups, IPC was performed either for 5 minutes followed by 15-minute reperfusion (n = 6, IPC-5), or by 2 successive cycles of 10-minute ischemia, followed by 10-minute reperfusion (n = 6, IPC-10) before prior to the 3-hours warm-ischemia period. Pulmonary compliance and gas exchange were determined separately for each lung, and we recorded pulmonary and systemic hemodynamics. We performed bronchoalveolar lavage (BAL) at the end of the experiment and determined total protein concentration as well as tumor necrosis factor alpha (TNF-alpha) mRNA expression in cell-free supernatant and in BAL cells, respectively. We also assessed the wet/dry ratio of the lung. RESULTS In the controls, on reperfusion, we encountered a progressive deterioration of gas exchange, especially of the reperfused left lung, which we could largely avoid using the IPC-5 protocol. Similarly, pulmonary compliance steadily declined but was much better in the ICP-5 group. Parallel to the improvement of gas exchange and lung mechanics, we found less total alveolar protein content and TNF-alpha mRNA expression in BAL cells in the IPC-5 than in the controls. However, we did not find IPC-10 to be paralleled by a significant improvement of lung function. Neither IPC-5 nor IPC-10 influenced the pulmonary vascular resistance index or the fluid accumulation in the lung. CONCLUSION The major finding of the present study was that 5 minutes of IPC improved lung function after 3 hours of warm ischemia of the lung.
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Affiliation(s)
- I Friedrich
- Cardiothoracic Surgery, Martin Luther University, Halle, Germany.
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3
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Abstract
Mediastinal infection is a feared complication observed after 0.4%-5% of cardiac operations. Even today the mortality remains as high as 20%-40%. We discuss the aetiology, mechanisms, prevention, diagnosis, and medical management. The staging system for mediastinal wound infections developed at a joint conference of German cardiac surgical centres is presented. The use of parenteral polyvalent immunoglobulins is also discussed.
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Affiliation(s)
- G Marggraf
- The Department of Thoracic and Cardiovascular Surgery, University of Essen, Germany.
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Reidemeister JC, Wolfhard U. [Changes in heart surgical strategies: a word of caution]. Z Kardiol 1999; 88:179-84. [PMID: 10355068 DOI: 10.1007/s003920050274] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The introduction of minimally invasive coronary artery bypass surgery has expanded the technical armementarium for operative treatment of coronary artery disease. Minimal access surgery using partial sternotomy or anterior intercostal minimal thoracotomy can be combined with videoscopic techniques or port-access-methods. Either atrio-aortal cannulation, femoro-femoral or jugular-femoral connections to the pump are possible for extracorporal circulation (ECC). Even endoluminar occlusion of the aorta and application of cardioplegia into the aortic root can be considered and applied. Extracorporal circulation has developed into a safe standardized method. As far as pathophysiology is concerned, the decision to use ECC or not is of much more importance than the grade of invasiveness. Fundamentally we therefore need to distinguish between minimally invasive methods with and without ECC. Video-assisted coronary surgery in hearts under hypothermia and fibrillation with ECC is also recommended occasionally. Minimally invasive coronary artery procedures on beating hearts without ECC have to be done in a stabilized and bloodless operative field to allow the construction of high standard anastomoses between bypass grafts and coronary arteries. In practice, silicon occluders, epicardial and myocardial suture occlusion and fixation, mechanical stabilization devices, and pharmacologic induction of bradycardia are used. In principle a skilled surgeon should be familiar with all these methods to select the most suitable solution for the special clinical problem. A final judgement about each method is not possible up to now. High patients numbers have to be recruited in the groups and subgroups due to low mortality (1%) and morbidity (5%), otherwise statistical significance of the results cannot be gained.
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Affiliation(s)
- J C Reidemeister
- Abteilung für Thorax- und Kardiovaskuläre Chirurgie, Zentrum für Chirurgie Med. Einrichtungen der Universität-Gesamthochschule Essen.
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Christiansen S, Geiger A, Splittgerber FH, Reidemeister JC. Aortocoronary Vein Bypass in a Patient with Type II Heparin-Associated Thrombopenia: A Case Report. Int J Angiol 1998; 7:268-70. [PMID: 9585467 DOI: 10.1007/bf01617410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Two types of heparin-associated thrombopenia (HAT) can be distinguished. Patients with type II HAT (HAT II) present a particularly difficult management problem when they require full anticoagulation. There is no consensus about the proper anticoagulation management for patients with HAT II who have to undergo cardiopulmonary bypass (CPB). We present a HAT II patient who underwent successful aortocoronary saphenous vein grafting. Sodium-danaparoid (SD) was used for anticoagulation. The anti-factor Xa level was kept below the values reported in the literature for patients undergoing CPB. We did not observe any fibrin formation during the time of CPB or any severe postoperative hemorrhage, which is frequently described in the literature. We discuss the management of our patient with SD intra- and postoperatively.
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Affiliation(s)
- S Christiansen
- Department of Thoracic, Cardiac, and Vascular Surgery, Münster University Medical School Medical Center, Münster, Germany
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6
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Christiansen S, Renzing K, Hirche H, Reidemeister JC. [Measurement of the humidity of inspired air in ventilated patients with various humidifer systems]. Anasthesiol Intensivmed Notfallmed Schmerzther 1998; 33:300-5. [PMID: 9645289 DOI: 10.1055/s-2007-994253] [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] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Humidification of inspired gas in artificially ventilated patients positively influences mucociliary function and secretolysis. We performed this study to examine the properties of heat and moisture exchangers in comparison with hot water humidifiers and dry artificial ventilation. METHODS We measured inspired humidity with a special sensor in 41 patients after coronary artery bypass grafting with cardiopulmonary bypass. Three Heat and Moisture Exchangers (HME) and a hot water humidifier were used to humidity the inspired gas of artificially ventilated patients. Humidity measurements were compared. RESULTS Hot water humidifiers produced the highest humidification (average of 38.4 mg/l, 37-43 mg/l); lowest humidification was produced by dry artificial ventilation (average of 8.7 mg/l, 6-11 mg/l). Heat and moisture exchangers (HME) produced humidity between 24 and 36 mg/l. Highest humidification was produced by HME hygrobac s (average of 32.2 mg/l, 31-36 mg/l) and hygrovent s (average of 31.4 mg/l, 29-35 mg/l); lowest humidification was produced by HME hygroster (average of 28.6 mg/l, 24-31 mg/l). Multifactorial analysis shows a significant impact of the humidification method on the humidity of inspired gas. The multiple comparison procedure (Tukey) shows significant differences (alpha = 0.05) between all humidification techniques on inspired gas except the heat and moisture exchangers hygrobac s and hygrovent s. CONCLUSIONS Hygrobac s and hygrovent s may be an alternative to hot water humidifiers. Further clinical studies of HMEs and hot water humidifiers will be necessary to evaluate the influence of inspired gas humidity on the outcome of artificially ventilated patients.
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Affiliation(s)
- S Christiansen
- Abteilung für Thorax- und Kardiovaskuläre Chirurgie, Universität Essen
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Christiansen S, Geiger A, Splittgerber FH, Reidemeister JC. Coronary artery bypass grafting in a patient with type II heparin associated thrombopenia. Cardiovasc Surg 1998; 6:90-3. [PMID: 9546852 DOI: 10.1016/s0967-2109(97)00114-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Two types of heparin-associated thrombopenia can be distinguished. Patients with the type II condition present a particularly difficult management problem when they require full anticoagulation. There is no consensus about the proper anticoagulation management for type II patients who have to undergo cardiopulmonary bypass. The case is reported of a type II heparin-associated thrombopenia patient who underwent successful aortocoronary saphenous vein grafting. Sodium-danaparoid was used for anticoagulation. The anti-factor Xa level was kept below the value reported in the literature for patients undergoing cardiopulmonary bypass. No fibrin formation was observed during the time of cardiopulmonary bypass, nor was any severe postoperative haemorrhage seen, as is frequently described in the literature.
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Affiliation(s)
- S Christiansen
- Department of Thoracic, Cardiac and Vascular Surgery, University of Münster, Germany
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Christiansen S, Claus M, Philipp T, Reidemeister JC. Cardiac surgery in patients with end-stage renal failure. Clin Nephrol 1997; 48:246-52. [PMID: 9352160] [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
End-stage renal failure is commonly considered a significant factor for an increased risk after coronary artery bypass grafting. This holds true for patients who have received a kidney transplant (NTX group) as well as for patients who require chronic hemodialysis (HD group). To assess the risk in our population we performed a retrospective analysis of 22 patients with end-stage renal failure (HD group: 17, NTX group: 5) who underwent cardiac surgery. The perioperative course was compared to a normal population. In addition to standard data we assessed the following factors: renal failure etiology, risk factors, concurrent diseases, duration of renal failure, function of renal graft, ECG (paying special attention to signs of previous myocardial infarctions and rhythm disorders), results of cardiac catheterization and coronary angiography, NYHA class and urgency of operative intervention. Complications and mortality were the main measures of the perioperative course. We analyzed the hospital charts retrospectively and requested the patients' physicians to complete a questionnaire about the patient's present condition. All HD group patients were dialyzed on the day before surgery. The first postoperative HD was performed for hyperkalemia or signs of volume overload (pulmonary capillary wedge pressure > 20 mmHg) when signs of pulmonary function deterioration were seen. HD was successful in treating these conditions. 3 of the 17 patients on HD expired postoperatively, 4 died within 3 years, all of unrelated diseases. Mortality and morbidity was 0% in the NTX group. In one NTX patient who required intermittent HD preoperatively because of poor renal graft function, renal function improved postoperatively, presumably secondary to better renal perfusion, and he did not require HD after his cardiac surgery. By surgical intervention the NYHA class of all patients improved (by 1.6 on the average) as well as their quality of life. Because of these good short- and long-term results and relatively low operative risk we support an approach of prompt work-up and surgical intervention when necessary in HD and NTX patients.
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Affiliation(s)
- S Christiansen
- Department of Thoracic and Cardiovascular Surgery, Essen University Medical School Medical Center, Germany
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Christiansen S, Splittgerber FH, Marggraf G, Claus M, Philipp T, Zerkowski HR, Reidemeister JC. Results of cardiac operations in five kidney transplant patients. Thorac Cardiovasc Surg 1997; 45:75-7. [PMID: 9175223 DOI: 10.1055/s-2007-1013691] [Citation(s) in RCA: 8] [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: 02/04/2023]
Abstract
Because of the paucity of literature reports about cardiac operations in renal-transplant patients we performed a retrospective study encompassing all such patients operated upon in our institution in 1993 and 1994. During this time 5 renal transplant patients underwent cardiac surgical procedures between 1 and 9 years after transplantation: in 4 patients coronary artery bypass grafting (CABG) was carried out and in one patient aortic valve replacement. We analyzed pre-, peri-, and postoperative data. Late results were obtained by questionnaire from the patients' primary physicians. Short- and long-term results were excellent. Mortality was 0%. At late follow-up (8-23 months) all patients were in NYHA class II or better. Postoperatively all patients experienced a clear improvement of their cardiac symptoms. None of the transplanted kidneys deteriorated. One patient who had to undergo intermittent hemodialysis preoperatively improved so much that she did not require any dialysis postoperatively. Although the total number of patients in this study is limited we believe it can be stated that renal transplant patients can undergo cardiac operations with generally good results.
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Affiliation(s)
- S Christiansen
- Department of Thoracic and Cardiovascular Surgery, Essen University Medical School, Germany
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10
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Wolfhard U, Splittgerber FH, Gocke P, Reidemeister JC. Bilateral inferior vena cava with azygos continuation but without congenital heart disease complicates routine venous cannulation for cardiopulmonary bypass in an adult. Thorac Cardiovasc Surg 1997; 45:40-2. [PMID: 9089975 DOI: 10.1055/s-2007-1013683] [Citation(s) in RCA: 9] [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: 02/04/2023]
Abstract
Attempted venous cannulation with a dual-stage cannula for cardiopulmonary bypass in routine coronary revascularization led to the discovery of an abnormal inferior vena cava in a 65-year-old patient. The operative and postoperative course of the patient were not affected by the inferior caval anomaly. The detailed infradiaphragmatic venous anatomy was elucidated later by MRI and showed bilateral inferior caval veins with azygos continuation. Although this malformation of the inferior cava is rare in adults, the occurrence should be known. Quick recognition and handling should be achieved if detected during cannulation for cardiopulmonary bypass.
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Affiliation(s)
- U Wolfhard
- Department of Thoracic- and Cardiovascular Surgery, University of Essen School of Medicine, Germany
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11
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Hellinger A, Piotrowski J, Konerding MA, Burchard WG, Doetsch N, Peitgen K, Erhard J, Reidemeister JC. Impact of particulate contamination in crystalloid cardioplegic solutions: studies by scanning and transmission electron microscopy. Thorac Cardiovasc Surg 1997; 45:20-6. [PMID: 9089970 DOI: 10.1055/s-2007-1013678] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 02/04/2023]
Abstract
The amount of particulate matter present in Bretschneider's cardioplegic solution (HTK) was assessed by laser-mediated particle counting. Permissible levels of contaminant particles with a distribution of diameters between 0.2 and 20 microns were found. A significant further increase in the particle count was observed when the fluid was administered for clinical use, which resulted in the additional release of particles from, for example, the infusion kit, which included an in-line filter with pores of 270 microns. Filtration of the HTK solution by a terminal inline filter (0.2 micron) significantly reduced the number of particles. In order to determine the chemical composition and the potential hazards of the particulate material we used scanning electron microscopy in combination with energy dispersive X-ray analysis and transmission electron microscopy to examine specimens taken from heart tissue obtained from Göttinger minipigs after cardioplegia and from humans undergoing mitral valve replacement after cardioplegia and reperfusion. Particles of various diameters were found either to be plugging coronary capillaries, to be adherent to the endothelial layer, or to be engulfed by polymorphonuclear (PMN) granulocytes, which appeared to be activated. Some of the PMN granulocytes were apparent in the endothelial layer. It is recommended, therefore, that a terminal in-line filter (0.2 micron) should be routinely used.
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Affiliation(s)
- A Hellinger
- Department of General Surgery, Essen University, Germany
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12
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Glattki GP, Baumgart D, Leischik R, Knocks M, Görge G, Haude M, Reidemeister JC, Erbel R. [Right atrial, non-hereditary myxoma as differential diagnosis in increasing dyspnea. Echocardiography diagnosis]. Med Klin (Munich) 1996; 91:509-514. [PMID: 8965749] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- G P Glattki
- Abteilung für Kardiologie, Medizinische Klinik und Poliklinik, Universitätsklinik der Universität-Gesamthochschule Essen
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13
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Günnicker M, Brinkmann M, Donovan TJ, Freund U, Schieffer M, Reidemeister JC. The efficacy of amrinone or adrenaline on low cardiac output following cardiopulmonary bypass in patients with coronary artery disease undergoing preoperative beta-blockade. Thorac Cardiovasc Surg 1995; 43:153-60. [PMID: 7570567 DOI: 10.1055/s-2007-1013790] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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: 01/26/2023]
Abstract
We examined 20 patients undergoing coronary bypass grafting for coronary artery disease with NYHA classifications of II and III who had been treated with beta-blocking agents. Patients were randomised for administration of either adrenaline (0.1 microgram/kg/min) or amrinone (bolus 1 mg/kg, continuous infusion of 5-10 micrograms/kg/min), if following cardiopulmonary bypass their cardiac index was < 2.4 L/min/m2 with normal peripheral resistance and normal or increased right- or left-ventricular filling pressures. Over a period of 1 hour, the hemodynamic parameters mean arterial pressure (MAP), cardiac index (CI), heart rate (HR), coronary perfusion pressure (CPP), total peripheral resistance (TPR), as well as the pressure-work index (PWI) were registered or calculated. By means of a coronary sinus catheter myocardial arterio-venous oxygen content difference (AVDO2cor), myocardial blood flow (MBF), using the thermodilution method, and myocardial oxygen consumption (MVO2) could be measured or calculated. Simultaneously, arterial and myocardial lactate concentrations and, using the arterio-venous lactate ratio, myocardial lactate extraction or production were quantified. Using a transseptal approach, the left-ventricular pressure curve was measured and used to differentiate for myocardial contractility (dp/dtmax). Following induction of anesthesia and after cardiopulmonary bypass, plasma levels of the used beta-blocking agent were determined. Both substances caused a significant increase in myocardial contractility, with adrenaline showing a more potent effect than amrinone. Both substances caused a significant increase in CI with a mild increase in HR. Amrinone caused a significant drop in TPR, while MAP remained practically constant.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Günnicker
- Institute of Anaesthesiology, University Hospital Essen, Germany
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14
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Zerkowski HR, Günnicker M, Marggraf G, Reidemeister JC. [Concept for therapy of heart failure in heart surgery]. Z Kardiol 1994; 83 Suppl 2:55-61. [PMID: 8091825] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Perioperative deterioration of the circulatory performance of patients undergoing heart surgery ranges from transitory impairment in cardiac output by deterioration of the compensation range of the oxygen transport system to manifest circulatory failure without previous myocardial damage and the acute decompensation of pre-existing chronic heart failure. On the basis of the current state of knowledge in this field, a concept for rational staged treatment should be based on the different myocardial beta-adrenoceptor conditions related to the type and stage of the individual underlying heart disease and on adrenoceptor subtype specific properties of positive inotropic drugs. 1. The therapy of perioperative "circulatory" insufficiency after extra-corporal circulation consists of the use of drugs to adapt the performance of the oxygen transport system to increased overall oxygen demand. Simultaneous volume loading (by CVP) and positive inotropic support with dobutamine are the best means of treating this (normally transitory) dysregulation. 2. In the case of manifest severe circulatory insufficiency (low cardiac output syndrome), sepsis or acute heart failure (e.g., following acute myocardial infarction), the use of a pulmonary artery catheter for determining perioperative cardiac output and resistance is essential. In such cases, positive inotropic therapy is based on catecholamines of medium (dobutamine) to high (adrenaline) efficacy, because it can be assumed that the beta-adrenoceptor pattern will remain normal with regular functioning and regulation of the (remaining) myocardium up to the onset of acute heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H R Zerkowski
- Abteilung für Thorax- und Kardiovaskuläre Chirurgie, Universitätsklinikum Essen
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15
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Abstract
Lung transplantation has been successfully used in the treatment of patients with end-stage pulmonary disease and adequate cardiac function. We report about a 32-year-old man with pulmonary alveolar microlithiasis who underwent sequential bilateral lung transplantation. Preoperative hemodynamic studies revealed severe pulmonary hypertension; the right ventricular ejection fraction was 0.27. Eighteen months postoperatively, he continues to do well with normalized pulmonary and cardiac function and without clinical or histopathologic signs of graft rejection.
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Affiliation(s)
- G Stamatis
- Center for Pneumology and Thoracic Surgery, Ruhrlandklinik, Essen, Germany
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16
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Abstract
OBJECTIVE The aim was to investigate transient outward currents (I(to)) in single myocytes isolated from human heart muscle specimens which were obtained either from patients in terminal heart failure receiving a transplant or from multiorgan donors whose hearts were not suitable for transplantation. METHODS Using the whole cell patch clamp technique, depolarisation dependent I(to) was investigated in these myocytes, and its electrophysiological characteristics compared to I(to) of rat myocytes. RESULTS I(to) was observed in ventricular myocytes isolated from failing and non-failing human hearts. The current density of I(to) was similar in cells from failing and non-failing hearts [at +60 mV: 7.9(SEM 1.0) pA.pF-1, n = 9, and 8.7(1.2) pA.pF-1, n = 8, respectively], but smaller in human than in normal rat myocytes, ie, 8.2(0.7) pA.pF-1 (n = 17) v 19.9(2.8) pA.pF-1 (n = 12, six hearts), respectively. Half maximum activation was found at more positive potentials in human than in rat cells, at +21.2(2.0) v +6.4(1.3) mV. In human myocytes, the fraction of non-inactivating outward current at the end of 300 ms long clamp steps was smaller than in rat cells, ie, 22(5%) of peak I(to) in human (n = 17) and 39(5%) in rat cells (n = 12). The potential of half maximum steady state inactivation of rapidly inactivating I(to) in the presence of 0.1 mM Cd2+ was -21.4(0.7) mV in human (n = 15, five hearts), and -35.3(1.0) mV in rat cells (n = 12, six hearts). The late component of outward current showed no potential dependent inactivation in human cells, but underwent steady state inactivation at all potentials positive to -100 mV in rat myocytes. At -100 mV, recovery of I(to) from inactivation took place with a similar time constant, ie, 18(2) ms (n = 7), 24(2) ms (n = 6), and 25(2) ms (n = 4) in cells from three failing and two non-failing human hearts, and from two normal rat hearts, respectively. CONCLUSIONS In a limited number of cells, I(to) in human ventricular myocytes shows no dramatic differences between cells derived from failing and non-failing hearts. The characteristics of I(to) in human cells were similar though not identical to I(to) in rat heart cells. This current may be a potential target for antiarrhythmic drug action.
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Affiliation(s)
- E Wettwer
- Pharmakologisches Institut, University of Essen, Germany
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Zerkowski HR, Knocks M, Konerding MA, Doetsch N, Roth G, Hakim K, Reidemeister JC. Endothelial damage of the venous graft in CABG. Influence of solutions used for storage and rinsing on endothelial function. Eur J Cardiothorac Surg 1993; 7:376-82. [PMID: 8373622 DOI: 10.1016/1010-7940(93)90070-r] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [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: 01/30/2023] Open
Abstract
A significant proportion of early graft occlusions after aortocoronary revascularization using autologous saphenous vein grafts (SVG) are due to mechanical and/or metabolic or biochemical endothelial lesions. The morphological examination of the endothelium, usually carried out using light microscopy or by various types of scanning electron microscopy (SEM), does not give any indication of the functioning of the endothelium (E). Functionally intact E is capable of producing endothelium-derived relaxing factor (EDRF); a practicable in vitro test is the relaxation of pre-contracted vein segments (VS) in response to acetylcholine (ACh) application. To study the effect of the solution used to rinse and store the SVG between removal and implantation on the functional characteristics of the E, we performed in vitro tests on macroscopically intact VS removed from the saphenous vein of 30 male patients who underwent elective CABG surgery. Isolated VS rings were incubated for 60 min in heparinized whole blood (HWB), Bretschneider's cardioplegic solution (HTK), human albumin solution (HAS), or Ringer's solution (RS) and compared with the results obtained immediately after the removal of untreated control samples (C) taken from the same patients. After equilibration in carbogen aerated Krebs-Henseleit solution and precontraction by 3 x 10(-7) M noradrenaline (NE), relaxation induced by 10(-6) M ACh was measured. Only the samples stored in HWB (13.4 +/- 0.4 mN) showed similar maximal contractions with NE to those in the control group (14.4 +/- 0.5 mN), i.e. all those segments which showed both contractions with NE and relaxation with ACh.(ABSTRACT TRUNCATED AT 250 WORDS)
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Zerkowski HR, Günnicker M, Freund U, Dieterich HA, Dressler HT, Doetsch N, Schieffer M, Hakim-Meibodi K, Lockhart JD, Reidemeister JC. Low-output syndrome after heart surgery: is a monotherapy with phosphodiesterase-III inhibitors feasible? A comparative study of amrinone and enoximone. Thorac Cardiovasc Surg 1992; 40:371-7. [PMID: 1290186 DOI: 10.1055/s-2007-1020183] [Citation(s) in RCA: 9] [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: 12/26/2022]
Abstract
In order to determine whether the primary use of a phosphodiesterase-III (PDE) inhibitor as monotherapy for severe cardiac low-output states (LOS) is in fact practicable, we investigated the haemodynamic effects of amrinone and enoximone in a prospective randomized study. After elective CABG, AVR, or MVR, patients with cardiac LOS were given amrinone (n = 10) or enoximone (n = 9). Following bolus saturation (1.0-2.0 mg/kg [XA = 1.4] or 0.5-1 mg/kg [XE = 0.9] in total), a dose of 5-10 microgram/kg/min was given by infusion. The standard monitoring program included discontinuous haemodynamic measurements (Swan-Ganz) over a maximum time period of 48 hours, arterial and venous blood-gas analyses, and clinical chemistry. The preoperative clinical and haemodynamic status of the enoximone (E) group (55% CABG patients; MPAP 27 +/- 2.5 mmHg, PCWP 20 +/- 2.9 mmHg, PVR 201 +/- 35 dyn.s.cm-5) was considerably worse than that of the amrinone (A) group (70% CABG patients; MPAP 23 +/- 2.3 mmHg, PCWP 16 +/- 3.5 mmHg, PVR 153 +/- 28 dyn.s.cm-5). Both PDE inhibitor preparations led to a significant increase in cardiac index (from 1.9 +/- 0.1 to 2.5 +/- 0.12 L/min/m2 (A) and from 1.98 +/- 0.1 to 2.6 +/- 0.18 L/min/m2 (E) within 30 minutes, accompanied by a simultaneous decrease in filling pressures and vascular resistances. For up to 2 hours, 3/10 (A) and 2/9 (E) patients required additional positive inotropic support with adrenaline. There were no significant differences between the two groups at any time.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- H R Zerkowski
- Department of Thoracic and Cardiovascular Surgery, University Hospital, Essen, Germany
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Zerkowski HR, Doetsch N, Hellinger A, Reidemeister JC. [The concept of lung and heart-lung preservation within the scope of multiple organ procurement]. Langenbecks Arch Chir 1991; 376:102-7. [PMID: 1905376 DOI: 10.1007/bf01263467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Preservation of the lung is still one of the most challenging problems, because due to limited procurement time not all organs available can be used. The most common procurement technique is flush perfusion of the pulmonary artery system. Alternative methods in clinical use are either the autologous working heart-lung preparation or donor core-cooling (DCC). The own concept presented here, modified to the special demands of multi-organ-procurement, combines DCC and interstitial equilibration adapted to intracellular ion concentration. DCC is induced by extracorporeal circulation (ECC) using a transportable heart lung machine including a highly effective cooling system: cooling circuit based on two parallel heat exchangers with ice-water cooling produced by a high-pressure overflow of a low-temperature ice block (-40 degrees C). While cooling by ECC stepwise hemodilution is achieved by priming volume and incorporation of the cardioplegic solution (Bretschneider-HTK). The aim of equilibration is to lower the extracellular levels of sodium and calcium, and to increase the level of potassium. Additionally, the buffer capacity of donor blood is increased by the incorporated histidine-buffer system (alpha-stat). To avoid donor organ edema the time of ECC should be as short as possible. Using our system donor organ temperatures below 10 degrees C are reached within less than 30 min. In addition to ECC, lung surface cooling is achieved by external overflow with cold arterial blood (internal mammary artery). Besides lung preservation the main advantage of this concept is the profound precooling of all visceral organs before their individual flush perfusion.
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Affiliation(s)
- H R Zerkowski
- Abteilung für Thorax- und kardiovaskuläre Chirurgie, Universitätsklinikum Essen, Bundesrepublik Deutschland
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Wurm K, Walz M, Donhuijsen K, Reidemeister JC. [The vena cava superior syndrome in sarcoidosis]. Radiologe 1988; 28:424-8. [PMID: 3186977] [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: 01/04/2023]
Abstract
We report the first observation of clinical manifestations of vena cava superior syndrome (VCSS) associated with sarcoidosis. Twenty-four years after the first signs of the disease had been noted, mediastinal lymphomas penetrating the wall of the vena cava superior caused complete obstruction. It is most unusual for the vessel wall to be destroyed in this way, which explains why VCSS is often missed in sarcoidosis. The obstructed vessel was resected and successfully replaced by a Gore-Tex prosthesis. The importance of VCSS for the differential diagnosis is pointed out. Two further peculiarities are the simultaneous occurrence of elevated intraocular pressure and VCSS, and the familial incidence.
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Affiliation(s)
- K Wurm
- Fachkliniken Sonnenhof, Höchenschwand, Universitätsklinikum Essen
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Zerkowski HR, Doetsch N, Schax M, Wolfhard U, Reidemeister JC. [Surgical treatment of multiple congenital thoracic aorta stenoses using a transpericardial aorto-aortic prosthesis bypass]. Thorac Cardiovasc Surg 1988; 36:57-60. [PMID: 3376092 DOI: 10.1055/s-2007-1020046] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- H R Zerkowski
- Dept. of Thoracic and Cardiovascular Surgery, University Clinic, University of Essen, FRG
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Brodde OE, Schüler S, Kretsch R, Brinkmann M, Borst HG, Hetzer R, Reidemeister JC, Warnecke H, Zerkowski HR. Regional distribution of beta-adrenoceptors in the human heart: coexistence of functional beta 1- and beta 2-adrenoceptors in both atria and ventricles in severe congestive cardiomyopathy. J Cardiovasc Pharmacol 1986; 8:1235-42. [PMID: 2434752 DOI: 10.1097/00005344-198611000-00021] [Citation(s) in RCA: 136] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We evaluated the amount of beta 1- and beta 2-adrenoceptors in human right and left atrium as well as in right and left ventricular wall obtained from heart transplant recipients who suffered from end-stage congestive cardiomyopathy. The total number of myocardial beta-adrenoceptors was assessed with the nonsubtype selective beta-adrenoceptor radioligand (-)[125I]iodocyanopindolol (ICYP); concomitantly, the number of beta 1-adrenoceptors was determined with the selective beta 1-adrenoceptor radioligand (-)[3H]bisoprolol. The number of beta 2-adrenoceptors was calculated by subtracting (-)[3H]bisoprolol binding sites from ICYP binding sites. With this technique, a beta 1/beta 2-ratio of approximately 65/35% for both atria and of approximately 75/25% for both ventricles was found. Identical results were obtained when the beta 1/beta 2-ratio was calculated indirectly by nonlinear regression analysis of competition curves of the selective beta 1-adrenoceptor antagonist bisoprolol and the selective beta 2-adrenoceptor antagonist ICI 118,551 with ICYP binding. In addition, on atria and on ventricles, adenylate cyclase was activated by norepinephrine (presumably by beta 1- and beta 2-adrenoceptor stimulation) and by procaterol (by beta 2-adrenoceptor stimulation). It is concluded that in the human heart functional beta 1- and beta 2-adrenoceptors coexist on both atria and both ventricles. In end-stage congestive cardiomyopathy, there appears to be a selective down-regulation of cardiac beta 1-adrenoceptors, whereas beta 2-adrenoceptors are obviously not affected. This may explain the beneficial effects of beta 2-adrenoceptor agonists in severe heart failure.
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Brodde OE, Kretsch R, Ikezono K, Zerkowski HR, Reidemeister JC. Human beta-adrenoceptors: relation of myocardial and lymphocyte beta-adrenoceptor density. Science 1986; 231:1584-5. [PMID: 3006250 DOI: 10.1126/science.3006250] [Citation(s) in RCA: 149] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In human right atria obtained from 21 patients during open-heart surgery, beta-adrenoceptor density [assessed by iodine-125-labeled (-)-cyanopindolol binding] and responsiveness (positive inotropic responses to isoprenaline) were linearly related to the beta-adrenoceptor density in the corresponding circulating lymphocytes. This direct relation of human myocardial and lymphocyte beta-adrenoceptor alterations, therefore, makes it possible to monitor drug- or disease-induced beta-adrenoceptor changes in tissues not easily accessible in humans.
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Zerkowski HR, Ikezono K, Rohm N, Reidemeister JC, Brodde OE. Human myocardial beta-adrenoceptors: demonstration of both beta 1- and beta 2-adrenoceptors mediating contractile responses to beta-agonists on the isolated right atrium. Naunyn Schmiedebergs Arch Pharmacol 1986; 332:142-7. [PMID: 2871495 DOI: 10.1007/bf00511404] [Citation(s) in RCA: 64] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
On the isolated electrically driven muscle strip of human right atrial appendages the beta-adrenoceptor subtypes mediating the positive inotropic effects of isoprenaline, dobutamine and procaterol were characterized using the beta 1-selective antagonist bisoprolol and the beta 2-selective antagonist ICI 118,551. The three agonists induced concentration-dependent increases in force of contraction with an order of potency: procaterol (pD2-value: 8.03) greater than isoprenaline (pD2-value: 7.73) greater than dobutamine (pD2-value: 5.44). In saturating concentrations all three agonists produced the same maximum of developed tension. ICI 118,551 (10(-9)--10(-7) mol/l) and bisoprolol (10(-9)--10(-7) mol/l) were nearly equipotent in antagonizing the positive inotropic effects of isoprenaline and dobutamine. However, the slopes of the Schild-plots for both antagonists against both agonists were significantly less than 1.0 indicating interaction with beta 1- and beta 2-adrenoceptors. On the other hand, ICI 118,551 (10(-10)--10(-8) mol/l) was approximately 100 times more potent than bisoprolol (10(-8)--10(-6) mol/l) in antagonizing the positive inotropic effect of the highly selective beta 2-agonist procaterol. In addition, the slopes of the Schild-plots for antagonism of ICI 118,551 and bisoprolol against procaterol were not significantly different from unity indicating interaction with a homogeneous class of beta-adrenoceptors. The pA2-value for ICI 118,551 was 9.49, for bisoprolol it amounted to 6.99.(ABSTRACT TRUNCATED AT 250 WORDS)
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Serdarevic M, Löhr E, Reidemeister JC. [Superior vena cava syndrome--clinical aspects, etiology and case reports]. Radiologe 1984; 24:286-92. [PMID: 6473762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The so-called superior-Cava Syndrome is caused by obstructions by centrally localized tumors by thrombosis or by inflammations of the mediastinum. In cases of tumorous infiltration a graft can be inserted. The different phenomena of thrombosis caused by nutritial catheters and pace makers are of clinical importance. Acute thrombosis of the brachio-cervical veins and the Vena Cava can be treated successfully by means of thrombolysis. Besides CT bilateral brachial phlebography communicates optimal information concerning localization of vascular obstruction and collateral circuits.
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Abstract
This is a report on a rare case of acquired stenosis of the descending thoracic aorta resulting from an extreme posttuberculotic gibbous formation. The unusual anatomical relationship precluded conventional alleviation of the stenosis which was bridged ultimately with a graft producing a satisfactory functional result.
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Brodde OE, Karad K, Zerkowski HR, Rohm N, Reidemeister JC. Coexistence of beta 1- and beta 2-adrenoceptors in human right atrium. Direct identification by (+/-)-[125I]iodocyanopindolol binding. Circ Res 1983; 53:752-8. [PMID: 6139182 DOI: 10.1161/01.res.53.6.752] [Citation(s) in RCA: 98] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The highly specific beta-adrenoceptor radioligand, (+/-)-[125I]iodocyanopindolol, has been used to subclassify beta-adrenoceptors in membranes from human right atrial appendage obtained during open heart surgery. Binding of (+/-)-[125I]iodocyanopindolol was saturable (Bmax = 86.4 +/- 7.4 fmol (+/-)-[125I]iodocyanopindolol bound/mg protein, n = 4), of high affinity (KD = 53 +/- 6 pM, n = 4), rapid, reversible, and stereospecific. The relative potencies of isoprenaline, adrenaline, and noradrenaline for inhibition of (+/-)-[125I]iodocyanopindolol binding and activation of adenylate cyclase were 1:10:10, indicating a population composed mainly of beta 1-adrenoceptors. Inhibition of (+/-)-[125I]iodocyanopindolol binding by beta 1- (practolol, metoprolol, betaxolol) and beta 2- (IPS 339, ICI 118,551, zinterol, procaterol) selective drugs, however, resulted in biphasic displacement curves with slope factors (nH, pseudo Hill coefficients) significantly less than 1.0. Nonlinear regression analysis of these curves revealed a beta 1: beta 2 ratio of 80:20 in human right atrial appendage. Nonselective beta-adrenergic drugs (propranolol, isoprenaline, and adrenaline), on the contrary, inhibited binding with monophasic displacement curves and nH = 1.0. Binding of agonists to the beta-adrenoceptors in human right atrial appendage seems to be regulated by guanyl nucleotides. In the absence of GTP, isoprenaline binds to high and low affinity state of the beta-adrenoceptors. GTP (10(-4) M) converts this heterogeneous binding into a homogeneous one of low affinity. It is concluded that, in human right atria, beta 1- and beta 2-adrenoceptors coexist; however, beta 1-adrenoceptors predominate. The physiological function of beta 2-adrenoceptors in human right atrium remains to be elucidated.
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Stoermer J, Hentrich F, Galal O, Reidemeister JC, Doetsch K. [Left coronary artery originating from the pulmonary artery as a syndrome found in infancy, childhood and adulthood]. Monatsschr Kinderheilkd 1983; 131:775-8. [PMID: 6664345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The cases of two patients with Bland-White-Garland-Syndrome are reported. A 13 year old girl had been operated during infancy (ligation of the left coronary artery at its origin from the pulmonary artery) and showed reopening of the ligation with marked collateral circulation between the right and left coronary artery. She was operated again, successfully. A second critically ill patient with a typical pattern of anterolateral infarction in his ECG recovered so well that only five years later he was readmitted; then he showed the adult-type ECG with good collateral circulation between the right and left coronary artery. He underwent an equally successful operation. In both cases there is good evidence for the development of a sufficient collateral circulation after ligation of the coronary artery to pulmonary artery connection. Spontaneous formation of anastomoses between the right and left coronary artery enables even infants with this anomaly to survive. These findings confirm the suggestion that the "infancy-type" and "adult-type" of the Bland-White-Garland-Syndrome represent only different stages of the same disease.
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Hentrich F, Schramm G, Galal O, Stoermer J, Reidemeister JC. [Congenital aneurysms of the left atrium with intact pericardium--value of diagnostic methods for recognition, prognosis and therapy]. Z Kardiol 1983; 72:548-52. [PMID: 6636936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
An intrapericardial aneurysm of the left atrial appendage in a 7-year-old girl is reported. Review of the 36 cases described up to now reveals that there is no specific age for this disease. It is therefore questioned whether this defect is really congenital in origin. Systemic embolism and serious rhythm disturbances are the most common complications; the younger the patient, the less likely they are to occur. Systemic embolism has only been described in the case of aneurysms located at the left atrial appendage, not in aneurysms of other parts of the left atrial wall. The risk of the development of rhythm disorders, however, is independent of the location within the left atrium. Clinical findings (including ECG) are nonspecific. Cardiomegaly and unusual configuration of the heart are constantly found, but are not pathognomonic. The diagnosis is usually confirmed by angiocardiography. Operation seems always to be indicated if complications are to be avoided. Operative deaths or complications during the follow-up after operation are not described. Nothing is known about the etiology of the disease.
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Zerkowski HR, Rohm N, Reidemeister JC. [New treatment concept of tumor-caused chylothorax using fibrin glue. A clinical case report]. Chirurg 1983; 54:335-7. [PMID: 6603339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Hanke J, Doetsch N, Zerkowski HR, Reidemeister JC, Schramm G. [Primary cardiac tumours: diagnosis and surgical treatment (author's transl)]. Dtsch Med Wochenschr 1982; 107:55-9. [PMID: 7056151 DOI: 10.1055/s-2008-1069871] [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: 01/23/2023]
Abstract
A teratoma of the cardiac skeleton, a rhabdomyoma of the right ventricle and an intramural fibroma in the left ventricle were observed in three children, aged eight weeks, eight months and eight years, respectively. Atrial myxoma was found in a 42-year-old and a 49-year-old patient. History and symptoms showed no particular common features in the various patients, merely signs of flow obstruction in four of the five patients. Amongst specific cardiological diagnostic methods only angiocardiography was reliable in the demonstration of intra- or paracardiac space-occupying lesions. All five patients were successfully operated on under cardiopulmonary bypass. The surgical technique varied according to localisation, extent of the tumour and its site in relation to essential cardiac structures. Follow-up examination indicated that the patients were free of symptoms and recurrence.
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Abstract
A new method for correction of right ventricular flow tract obstruction is described. The method combines the advantages of patch-plasty-procedure and external valved conduit by conduit integration into the right ventricular and pulmonary arterial wall. Good results had been achieved in 3 cases (2 cases of Fallot's tetralogy and one case of double outlet right ventricle).
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Blümchen G, Barthel W, van den Bergh K, Bierck G, Brandt D, Scharf-Bornhofen E, Reidemeister JC. [Social fate (return to work) after coronary heart surgery and/or aneurysmectomy (author's transl)]. Z Kardiol 1980; 69:632-8. [PMID: 6971020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The "return to work"-rate of 4 groups of patients with myocardial infarction (MI) is evaluated (all coronary angiography): Group 1: 314 patients after aorto-coronary bypass operation: mean age 50.5 years. Time after infarction 28 months, after surgery 18 months. The social fate of 52% were not yet decided. 20% got pension, 25% returned to work. Group 2: 86 patients after conservative treatment of myocardial infarction: mean age 42 years. Time after MI 18 months. The social fate of 21% was not yet decided, 41% got pension, 36% returned to work. Patients with one-vessel disease returned to work in 52%, with two-vessel disease in 20% and with three-vessel disease in 12.5%. Group 3: 24 patients after aneurysmectomy: mean age 47 years. Time after infarction 28 months, time after operation 11 months. Social fate of 8 out of 24 patients was not yet decided, 7 out of 24 got pension, 5 out of 24 returned to work. Group 4: 27 patients with conservatively treated left ventricular aneurysm: mean age 43 years. Time after infarction 42 months. The social fate of 2 out of 27 patients was not yet decided, 14 out of 27 got pension, and 8 out of 27 returned to work. Exercise-tolerance is no good indicator for the work status 18 months after myocardial infarction, 18 months after aorto-coronary bypass, 18 months after aneurysmectomy and 42 months after conservative treatment of left ventricular aneurysm. Selection of patients (all were examined by coronary angiography because of limitation by angina pectoris in daily life activities) may be partly responsible for the poor long-term work status. But more important seems to be the "tied social network". Decision for "return to work" or "pension" should be made 6 months after MI or after operation.
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Wagner J, Schümann HJ, Knorr A, Rohm N, Reidemeister JC. Stimulation by adrenaline and dopamine but not by noradrenaline of myocardial alpha-adrenoceptors mediating positive inotropic effects in human atrial preparations. Naunyn Schmiedebergs Arch Pharmacol 1980; 312:99-102. [PMID: 6248799 DOI: 10.1007/bf00502581] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In isolated electrically driven right auricular strips of human hearts (1 Hz at 37 degrees C) the ability of the endogenous catecholamines noradrenaline, adrenaline, and dopamine to mediate positive inotropic effects by stimulation of myocardial alpha-adrenoceptors was investigated. 1. The concentration-response curve for the positive inotropic effect of noradrenaline was shifted to the right by pindolol, 10(-8)M, whereas the additional blockade by phentolamine, 3 x 10(-6)M, was without further effect; therefore, the positive inotropic effect of noradrenaline is mediated by beta-adrenoceptors only. 2. In contrast, the positive inotropic effects of adrenaline as well as of dopamine are caused by stimulation of both, beta- and alpha-adrenoceptors. 3. These results are discussed with respect to the possible physiological and pathophysiological function of myocardial alpha-adrenoceptors.
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Blümchen G, Heid HP, Scharf-Bornhofen E, Reidemeister JC. [Longterm prognosis of 27 patients with left ventricular aneurysm and conservative treatment (author's transl)]. Z Kardiol 1978; 67:736-48. [PMID: 726553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The results of a follow-up study (mean 42 months after infarction) of 27 patients with conservatively treated left ventricular aneurysms showed: 1. 3/27 patients died of sudden death. Only one of these three could be predicted (ventricular fibrillation during exercise). 2. 3/24 remaining patients developed congestive heart failure. This could be predicted in one patient because of global hypocinesia of the left ventricle. 3. The exercise tolerance (Swan-Ganz) of the remaining 21 patients decreased from approximately 100 to 70 watts. Thus, all patients were able to lead an almost normal live. 4. Therefore conservative treatment of left ventricular aneurysms in most cases is the method of choice, since high surgical mortality, financial burdens of the society and man power has also to be considered. 5. The development of complications which would lead to aneurysmectomy (sudden death, life threatening arrhythmias, embolisation, congestive heart failure) cannot be foreseen from history, non-invasive and invasive data. 6. The close "patient to physician-contact" (risk-factors, medication) may have influenced the relatively good long-term prognosis of this group.
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36
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Luboldt W, Fiedler H, Reidemeister JC, Schotte JF. [Autologous transfusions of frozen blood in heart surgery]. Dtsch Med Wochenschr 1978; 103:1413-2. [PMID: 679857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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37
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Reidemeister JC. [Surgical cardiac emergency interventions]. Monatsschr Kinderheilkd (1902) 1978; 126:306-8. [PMID: 651920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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38
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Schümann HJ, Wagner J, Knorr A, Reidemeister JC, Sadony V, Schramm G. Demonstration in human atrial preparations of alpha-adrenoceptors mediating positive inotropic effects. Naunyn Schmiedebergs Arch Pharmacol 1978; 302:333-6. [PMID: 208010 DOI: 10.1007/bf00508304] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In isolated, electrically driven right auricular strips of the human heart the inotropic effect of phenylephrine was studied. 1. First, the influence of the driving rate on the tension developed (i.e., the frequency-force relationship) was determined by stimulation of the preparations at 0.1, 0.5, 1, 2 and 3 HZ. The force of contraction was lowest at a stimulation rate of 0.1 HZ (36.9 g/g dry weight). The maximally developed force of contraction observed at frequencies of 0.5, 1 and 2 HZ amounted to about 200 g/g dry weight. The values did not significantly differ from each other. 2. The negative log of the EC50 (-log EC50) for the positive inotropic effect of phenylephrine determined at a frequency of 0.5 and 1.0 HZ amounted to 5.28 +/- 0.08 and 5.34 +/- 0.11, respectively. The alpha-adrenolytic drug phentolamine (3 x 10(-6) M) diminished significantly the -log EC50 to 5.01 +/- 0.04 and 4.89 +/- 0.10, respectively. 3. At a frequency of 1 HZ a shift of the concentration-response curve to the right was observed after treatment with the beta-adrenolytic drug pindolol (3 x 10(-8) M); the -log EC50 of phenylephrine decreased significantly to 4.08 +/- 0.07. 4. From these results it is concluded that alpha-adrenoceptors are present in human atria; they mediate positive inotropic effects and are stimulated by phenylephrine.
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Löhr E, Timmermann J, Reidemeister JC, Popitz G. Metabolic action and cellular structure of the myocardium during coronary angiography. Cardiovasc Radiol 1978; 1:15-20. [PMID: 743699 DOI: 10.1007/bf02551968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Experimental perfusion of coronary arteries of guinea pig heart with contrast media causes various changes in electrolyte metabolism, depending on the chemical structures of the administered contrast media. These electrolyte changes are related to the tolerance of the myocardium to the contrast agents. Electron microscopic sections of human myocardium after coronary perfusion with Urografin-76 reveal that no alterations of subcellular structure occur.
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Luboldt W, Helmig L, Satter P, Reidemeister JC. [Chances of reducing the formation of immune antibodies after massive transfusions in open heart surgery (author's transl)]. Thoraxchir Vask Chir 1975; 23:546-51. [PMID: 814653 DOI: 10.1055/s-0028-1097026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Children, young people and women at the age of possible maternity form the majority of patients operated by extracorporal circulation. A longterm planning of these operations should also have donor in call, who are compatible with the patients' Rh groups and Kell antigens. Having practiced such a selection of donors we succeeded in reducing the formation of immune antibodies. 6 out of 330 patients had antibodies, but 4 had been sensibilized before operation. In the case of the other 2 it would not be excluded that they might have been immunized a long time ago. We emphasize the importance of hemodilution, strict indication of every postoperative therapy with red cells and the autologous transfusion.
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Helmig L, Reidemeister JC, Gleichmann U, Hager W, Rosenkranz KA. [1-Year-results of anuloplastisy (Carpentier-technic) in 7 patients (author's transl)]. Thoraxchir Vask Chir 1975; 23:484-8. [PMID: 1081771 DOI: 10.1055/s-0028-1097014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Of 7 patients who had Carpentier anuloplasty, two had very good, two had good and two had unsatisfactory results in postoperative cardiac catheterization one year after operation. One patient died of acute hepatitis. Reasons for the poor results are false indications and inadequate operative technic. These results show that the Carpentier-technic can well be recommended for critical use in carefully selected patients with mitral insufficiency.
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Helmig L, Reidemeister JC. [Clinical experience with a seamless myocardial screw-in electrode (author's transl)]. Thoraxchir Vask Chir 1974; 22:652-4. [PMID: 4548979 DOI: 10.1055/s-0028-1102847] [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] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Rumpf P, Schelbert H, Reidemeister JC, Bircks W. [Aneurysms and fistulas of the Valsalva sinus]. Z Kardiol 1974; 63:177-93. [PMID: 4408566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Reidemeister JC, Isselhard W, Hasselkus W, Olbrisch R, Müller U, Stock W. [Myocardial recovery following heart arrest caused by extracellular sodium and calcium withdrawal and by procaine administration]. Basic Res Cardiol 1973; 68:21-38. [PMID: 4710224 DOI: 10.1007/bf01907654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Reidemeister JC, Marx E, Schulte HD, Kreuzer H, Gleichmann U, Schorn A. [Preliminary experiences with isotope pacemakers]. Thoraxchir Vask Chir 1972; 20:435-40. [PMID: 4539573 DOI: 10.1055/s-0028-1099038] [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] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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46
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Reidemeister JC. [Development of extracorporeal circulation and current status of its utilization]. Chirurg 1971; 42:202-8. [PMID: 5574108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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47
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Reidemeister JC, Schramm G, Gehl H, Heberer G. [Clinical experiences in Bretschneider's cardioplegia]. Thoraxchir Vask Chir 1971; 19:104-18. [PMID: 5280347 DOI: 10.1055/s-0028-1099104] [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] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Reidemeister JC, Gehl H, Schramm G, Mennicken U. [Correction of total anomalous pulmonary vein drainage using the heart-lung machine in infants and small children]. Thoraxchir Vask Chir 1970; 18:386-9. [PMID: 5275532 DOI: 10.1055/s-0028-1099238] [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] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Heberer G, Reidemeister JC, Rau G, Huismans BD. [Aortic arch replacement in leutic aneurysm]. Chirurg 1969; 40:174-9. [PMID: 5353990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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