[Gas gangrene as a manifestation of endogenous Clostridium septicum infection]. / Gasbrand als Manifestation einer endogenen Clostridium-septicum-Infektion.

Endogenous, nontraumatic clostridial myonecrosis has a frequent association with colon carcinoma, leukemia, diabetes mellitus, and drug-induced immunosuppression. We present two cases of Clostridium septicum myonecrosis. An 18-year-old girl developed severe abdominal pain on day 7 after hospitalization for cytostatic treatment of acute lymphoblastic leukemia. Blood cultures yielded Clostridium septicum and histopathological exam of muscle tissue showed extended myonecrosis. Eventually the patient recovered with antibiotics and surgical therapy. A 72-year-old diabetic woman was treated as an outpatient with an intramuscular injection of steroidal antiphlogistics for "acute lumbar disc disease". The next morning persistence of hip pain and discoloration of the right thigh caused hospitalization under the suspected diagnosis "fracture of the neck of the femur". Clostridium septicum was cultured from intraoperatively taken swabs. At autopsy, in addition to the gangrene, there was an adenocarcinoma of the cecum, which had not been diagnosed during life.

Considerations and problems in the development of the mini-spindle pump.

The premise for the development of the mini-spindle pump, planned as an implantable device for assisted circulation, was to transport 4 L of water/min in mock circulation with a speed of 12-15,000 rpm against an afterload of 90 mm Hg. After calculations, the resulting first prototype had a spindle rotor with 3 threads (outer diameter, 18 mm; inner diameter, 6.2 mm; length, 45 mm) in a U-shaped housing, driven by an electric motor with a cooling system. In mock circulation, this pump moved 7.8 L of water/min at 18,000 rpm. To avoid animal experiments, its influence on the blood was tested in a Maxima oxygenator. The device circulated 4.2 L of blood/min with the same speed. Because of its high traumatic hemolysis rate (> 250 mg% of free hemoglobin after 7 h of pumping), the rotor was modified, first without effect at 2.5 threads and then at 4 threads. In addition, in this third prototype, the flow direction was reversed. This prototype was more effective (4.3 L of blood/min at 12,000 rpm in the oxygenator) and the hemolysis rate, after a pumping duration of 8 h, could only be reduced to 180 mg% of free hemoglobin. As a result, a fourth prototype was developed (i.e., the U-shape of the housing was abandoned). This device functioned better than the third prototype (4.5 L of blood/min at 12,000 rpm in the oxygenator), but the blood trauma increased (220 mg% of free hemoglobin after 7 h of pumping).(ABSTRACT TRUNCATED AT 250 WORDS)

Long-term efficacy of physiologic dual-chamber pacing in the treatment of end-stage idiopathic dilated cardiomyopathy.

The long-term efficacy of physiologic dual-chamber (DDD) pacing in the treatment of end-stage idiopathic dilated cardiomyopathy was evaluated in a longitudinal study of up to 5 years in 17 patients. The considerable clinical improvement achieved after implantation of a pacemaker programmed for DDD pacing at an atrioventricular delay of 100 ms was maintained throughout the follow-up period or until death and was associated with a consistent decrease in New York Heart Association class and an increase in left ventricular ejection fraction. Cardiothoracic ratio, heart rate and echocardiographic dimensions progressively decreased, and systolic and diastolic blood pressures increased. Median survival time was 22 months. During follow-up, 4 patients received donor hearts, 9 had a sudden death at home without defined cause or after a thromboembolic event, and 1 died from adenocarcinoma. Three patients survived the follow-up. No patient needed rehospitalization owing to a worsening of heart failure after pacemaker implantation. An interruption of pacing in DDD mode for 2 to 4 hours was followed within the first months by a marked decrease in left ventricular ejection fraction and an increase in cardiothoracic ratio and echocardiographic dimensions, but this response consistently decreased during follow-up. The data indicate that DDD pacing can be recommended as a useful tool in the long-term treatment of end-stage idiopathic dilated cardiomyopathy, with progressive improvement in cardiac function and a reduction of the dilatation of the left ventricle.

[Multiple liver abscesses in chronic granulomatosis]. / Multiple Leberabszesse bei chronischer Granulomatose.

We report on a case of a three year old boy, suffering from chronic granulomatosis disease, which led to repeated bacterial infections and finally to multiple liver abscesses. Diagnosis was based on the nitroblue-tetrazolium-test and histology. Antibiotic therapy over many weeks was not successful in spite of an adequate choice of medication against staphylococcal microorganisms and of good intracellular penetration, applicated parenterally. Only treatment by chloramphenicol after previous surgical drainage of the abscesses led to a dramatic clinical improvement and regression of the liver abscesses. The subsequent chemoprophylaxis with trimethoprim/sulfamethoxazole for at lest two years left the patient without clinical symptoms.

Usefulness of physiologic dual-chamber pacing in drug-resistant idiopathic dilated cardiomyopathy.

The beneficial effects of physiologic dual-chamber (DDD) pacing in the treatment of end-stage idiopathic dilated cardiomyopathy were evaluated in 16 patients in whom conventional drug therapy had failed. Candidates for cardiac transplantation as well as patients not accepted for transplantation participated. During DDD pacing at an atrioventricular delay of 100 ms, left ventricular ejection fraction increased from 16.0 +/- 8.4 to 25.6 +/- 8.6% (p less than 0.001) accompanied by a striking improvement in clinical symptoms, such as severe dyspnea at rest and pulmonary edema. The New York Heart Association class decreased from 3.6 +/- 0.4 to 2.1 +/- 0.5 (p less than 0.001). The decrease in cardiothoracic ratio from 0.60 +/- 0.06 to 0.56 +/- 0.05 (p less than 0.001) coincided with a decrease in left atrial and right ventricular echocardiographic dimensions, indicating a decrease in preload. Systolic blood pressure increased from 108 +/- 29 to 126 +/- 21 mm Hg (p less than 0.01) and diastolic blood pressure from 67 +/- 15 to 80 +/- 11 mm Hg (p less than 0.01). Normalization of heart rate was achieved. No major complications developed as a consequence of DDD pacing. All patients could be discharged from the hospital within 3 weeks after pacemaker implantation and return to a relatively normal life. Within 1 year after onset of DDD pacing only 4 of the patients died (from either sudden death or stroke). DDD pacing could represent an alternative approach to the management of chronic heart failure due to dilated cardiomyopathy, especially for heart transplant candidates and patients who are not accepted for cardiac transplantation, but no longer respond to drug therapy.

[Congenital epigastric-umbilical arteriovenous fistula. Contribution on a rare clinical picture]. / Die angeborene epigastrisch-umbilicale AV-Fistel. Ein Beitrag zu einem seltenen Krankheitsbild.

A congenital arteriovenous fistula involving the inferior epigastric arteries and the umbilical vein, simulating a congestive heart failure, occurred in a newborn infant. The embryology of this condition is explained. The involved vessels were ligated and excised. The diagnostic and surgical problems of this rare type of fistula are discussed.

[Acute implantation technique of the ellipsoid heart for clinical left ventricular assistance (author's transl)]. / Akute Einsatzform des Ellipsoidherzens zur klinisch assistierten Zirkulation.

The results of the first clinical trials of left ventricular assist devices are not encouraging. The only indication at present is in patients with cardiac failure after cardiac operations. The acute type of ellipsoid heart described in this paper-displays a canulation technique where the inflow canula inserted in the left ventricular cavity via the left atrium and the outflow canula is directly connected to the aortic canula of the cardiopulmonary bypass. The haemodynamic response shows the efficacy of this system. The circulation can be maintained in severe cardiac failure, as well as in ventricular fibrillation and cardiac arrest. On the basis of data obtained in experiments on 7 female calves this system is considered worthy of clinical trial.

[Severe hemolytic anemia after mitral valvuloplasty]. / Schwere hämolytische Anämie nach Raffplastik der Mitralklappe.

A patient with mitral insufficiency is described who developed severe hemolytic anemia six months after mitral valvuloplasty. Various laboratory tests suggested that the cause of the hemolysis was mechanical. A second heart operation was therefore performed which revealed intact valve function. In view of the mechanical cause of hemolysis a bioprosthesis was implanted but the patient died shortly after this operation. Since similar cases are not found in the literature the authors invite discussion of the course in this case.

[Estimation of myocardial damage after open-heart surgery by CK isoencymes (author's transl)]. / Zur Diagnostik des Myokardzellunterganges nach offener Herzchirurgie durch CK-Isoenzyme.

After 12 cases of open-heart surgery serum activities of CK and CKMB have been registrated. To make a more exact statement about myocardial damage the portion of CKMB out of the CK-activity has been evaluated by the way of a mathematic programm. The results verify the statement that after aortic valve replacement the CKMB portion is higher than the average, and that after intraoperative complications the highest CKMB portions have been reached. No myocardial infarction occurred.

[Drainage-dependent continence disorder after deep resection of the anterior rectum]. / Drainageabhängige Kontinenzstörung nach tiefer vorderer Rectumresektion.

Anorectal continence following low anterior resection in 37 controlled patients from the University Hospitals of Innsbruck, Department of Surgery, in the years 1970 to 1974 is described. Of these 37 patients, 10% were partially incontinent for from 18 to 24 months. It is pointed out that the partial incontinence of these patients is due to the extensive perirectal-perianal drainage. The low anterior resection can be called continence-saving, if a too extensive perirectal-perianal drainage is avoided and the criteria of the operation are considered.