Stefan Wirtz

Fat elimination from autologous blood

Bowl-based autotransfusion devices reduce the amount of fat found in shed blood, but cannot completely eliminate fat particles. When fat is seen on the surface of the processed blood, this blood should be filtered with a leukocyte removal filter before retransfusion.

Crossing atrial thrombus in a patient with recurrent pulmonary embolism.

ObjectivesTo report the detection of a thrombus entrapped in a patent foramen ovale by echocardiography in a patient with recurrent pulmonary embolism. DesignCase report. SettingIntensive care unit of a university hospital. PatientA 62-yr-old man with initial deep venous thrombosis and recurrent minor pulmonary embolism followed by a severe embolic event with transitory hemiparesis 10 days after prostatectomy. InterventionSystemic anticoagulation, surgical removal of a crossing atrial thrombus, closure of a patent foramen ovale, and venous thrombectomy. Measurements and Main ResultsTransesophageal echocardiography revealed a large thrombus entrapped in a patent foramen ovale with portions in all four heart chambers. Intraoperatively, a 19-cm-long thrombus, shaped like the pelvic veins, was found. The patient was successfully weaned from cardiopulmonary bypass, requiring temporary positive inotropic support because of right ventricular dysfunction. Within 24 hrs of the operation, the patient was discharged to the intermediate care unit. ConclusionsRecurrent pulmonary embolism can potentially result in paradoxic embolism in patients with a patent foramen ovale. In such patients, it may be crucial to monitor right ventricular function and exclude right-to-left shunts by transesophageal echocardiography, regardless of clinical symptoms. The patent foramen ovale should be closed. This case emphasizes an important indication for transesophageal echocardiography in critically ill patients.

Effective systolic orifice area of the aortic valve: implications for Doppler echocardiographic cardiac output determinations

Background:  Substantial research using echocardiography has established that stroke volume (SV) or cardiac output (CO) can be measured non‐invasively at the level of the aortic valve (AV) with high accuracy. Stroke volume is the product of the velocity time integral occurring at the sampling site and the effective systolic AV orifice area (AVOAeff). Nevertheless, a generally accepted method for the determination of AVOAeff is still lacking.

Tumorerkrankungen nach Herztransplantation

Up to 30% of patients with an organ transplantation develop precancerous lesions and malignant tumors, especially of the skin. All 241 patients who underwent heart transplantation from 1990 to 2000 were evaluated with regard to the development of neoplasias. Those alive in September 1999 were referred for a standardized dermatological exam (n=156) which detected malignancy in 28 patients being transplanted for 4.98 years on average. The skin was the organ most frequently involved (64%, n=18). 18% (n=5) of tumors were found in the urinary and genital tract, 7% (n=2) each in the respiratory and gastrointestinal tract, and 4% (n=1 ) in the breasts. The average age of patients who developed tumors was significantly higher as compared to the overall mean age (59.5±5 vs 49.8±14.7 years, p=0.00027). There was no correlation between development of malignancy and HLA matching, immunosuppressive drugs used, dosage and serum levels of immunosuppressive medication, and episodes of transplant rejection. Our study shows that the risk to develop tumors is at least doubled after heart transplantation. Due to the high incidence of skin tumors, transplant patients should undergo dermatological examinations on a regular basis. Bis zu 30% der organtransplantierten Patienten entwickeln Präkanzerosen und maligne Tumoren, insbesondere der Haut. Alle Patienten (n=241), die sich zwischen 1990 und 2000 einer Herztransplantation unterzogen, wurden hinsichtlich Tumorerkrankungen evaluiert; alle im September 1999 noch lebenden Patienten wurden dermatologisch untersucht (n=156). Innerhalb des Nachbeobachtungszeitraums von durchschnittlich 4,98 Jahren traten bei 28 Patienten maligne Tumoren auf, die Haut war mit 64% (n=18) am häufigsten betroffen. 18% (n=5) der Tumoren fanden sich im Urogenitaltrakt, 7% (n=2) im Bronchialsystem, 7% (n=2) im Gastrointestinaltrakt sowie 4% (n=1) Mammakarzinome. Im Vergleich mit dem Gesamtkollektiv aller transplantierten Patienten, die kein Tumorleiden entwickelten, zeigte sich, dass die Tumorpatienten älter waren (59,5±5 Jahre vs. 49,8±14,7 Jahre, p=0,00027). Die HLA-Kompatibilität, die Induktionsbehandlung sowie die Art, Dosis und Höhe der Serumspiegel der verwendeten Immunsuppressiva und die Häufigkeit der Abstoßungsbehandlungen schienen keinen Einfluss zu haben (p=n.s.). Unsere Untersuchungen zeigen, dass das Tumorrisiko nach Herztransplantation mindestens verdoppelt ist. Aufgrund der hohen Inzidenz von Hauttumoren sollte insbesondere ein regelmäßiges dermatologisches Screening durchgeführt werden.

Tumorerkrankungen nach Herztransplantation@@@Malignomas following heart transplantation

Up to 30% of patients with an organ transplantation develop precancerous lesions and malignant tumors, especially of the skin. All 241 patients who underwent heart transplantation from 1990 to 2000 were evaluated with regard to the development of neoplasias. Those alive in September 1999 were referred for a standardized dermatological exam (n=156) which detected malignancy in 28 patients being transplanted for 4.98 years on average. The skin was the organ most frequently involved (64%, n=18). 18% (n=5) of tumors were found in the urinary and genital tract, 7% (n=2) each in the respiratory and gastrointestinal tract, and 4% (n=1 ) in the breasts. The average age of patients who developed tumors was significantly higher as compared to the overall mean age (59.5±5 vs 49.8±14.7 years, p=0.00027). There was no correlation between development of malignancy and HLA matching, immunosuppressive drugs used, dosage and serum levels of immunosuppressive medication, and episodes of transplant rejection. Our study shows that the risk to develop tumors is at least doubled after heart transplantation. Due to the high incidence of skin tumors, transplant patients should undergo dermatological examinations on a regular basis. Bis zu 30% der organtransplantierten Patienten entwickeln Präkanzerosen und maligne Tumoren, insbesondere der Haut. Alle Patienten (n=241), die sich zwischen 1990 und 2000 einer Herztransplantation unterzogen, wurden hinsichtlich Tumorerkrankungen evaluiert; alle im September 1999 noch lebenden Patienten wurden dermatologisch untersucht (n=156). Innerhalb des Nachbeobachtungszeitraums von durchschnittlich 4,98 Jahren traten bei 28 Patienten maligne Tumoren auf, die Haut war mit 64% (n=18) am häufigsten betroffen. 18% (n=5) der Tumoren fanden sich im Urogenitaltrakt, 7% (n=2) im Bronchialsystem, 7% (n=2) im Gastrointestinaltrakt sowie 4% (n=1) Mammakarzinome. Im Vergleich mit dem Gesamtkollektiv aller transplantierten Patienten, die kein Tumorleiden entwickelten, zeigte sich, dass die Tumorpatienten älter waren (59,5±5 Jahre vs. 49,8±14,7 Jahre, p=0,00027). Die HLA-Kompatibilität, die Induktionsbehandlung sowie die Art, Dosis und Höhe der Serumspiegel der verwendeten Immunsuppressiva und die Häufigkeit der Abstoßungsbehandlungen schienen keinen Einfluss zu haben (p=n.s.). Unsere Untersuchungen zeigen, dass das Tumorrisiko nach Herztransplantation mindestens verdoppelt ist. Aufgrund der hohen Inzidenz von Hauttumoren sollte insbesondere ein regelmäßiges dermatologisches Screening durchgeführt werden.