A human stomach cell type transcriptome atlas.

BACKGROUND: The identification of cell type-specific genes and their modification under different conditions is central to our understanding of human health and disease. The stomach, a hollow organ in the upper gastrointestinal tract, provides an acidic environment that contributes to microbial defence and facilitates the activity of secreted digestive enzymes to process food and nutrients into chyme. In contrast to other sections of the gastrointestinal tract, detailed descriptions of cell type gene enrichment profiles in the stomach are absent from the major single-cell sequencing-based atlases. RESULTS: Here, we use an integrative correlation analysis method to predict human stomach cell type transcriptome signatures using unfractionated stomach RNAseq data from 359 individuals. We profile parietal, chief, gastric mucous, gastric enteroendocrine, mitotic, endothelial, fibroblast, macrophage, neutrophil, T-cell, and plasma cells, identifying over 1600 cell type-enriched genes. CONCLUSIONS: We uncover the cell type expression profile of several non-coding genes strongly associated with the progression of gastric cancer and, using a sex-based subset analysis, uncover a panel of male-only chief cell-enriched genes. This study provides a roadmap to further understand human stomach biology.

Linear repair versus ventricular reconstruction for treatment of left ventricular aneurysm: a 10-year experience.

OBJECTIVE: To describe a 10-year experience with surgical treatment of left ventricular aneurysm and compare the results of linear repair and ventricular reconstruction. DESIGN: A retrospective data analysis. SETTING: Department of cardiothoracic surgery. PATIENTS: All patients treated with concurrent coronary artery bypass revascularization and surgical repair of ventricular aneurysm from 1985 to 1995. METHODS: Patients underwent either linear repair after aneurysmectomy (group A; n=51) or reconstruction of the left ventricle using a patch (group B, n=10). Preoperative patient characteristics and postoperative mortality and symptomatic results in the two groups were compared with chi(2) and paired "t"-tests. RESULTS: The early mortality rates were 9.8% overall, 7.8%, in group A, and 20% in group B. During a mean follow-up of 58 months, the late mortality rates were 34.5%, 38.2%, and 12.5%. In comparison to patients in group A, those in group B had higher preoperative rates of seriously impaired left ventricular ejection fraction (p=0.01) and pathologic left ventricular end-diastolic pressure (p=0.03) and a prolonged operative aortic cross-clamp time (p=0.04). Early mortality in group B may have been influenced by the initially impaired hemodynamic function and the cross-clamp time. In the longterm, patients in group B had more symptomatic improvement than those in group A (p=0.02). CONCLUSIONS: Ventricular function in patients with left ventricular aneurysm improved after ventricular reconstruction using a patch. Further experience with this procedure should improve postoperative survival and long-term prognosis.

[Primary hemangiosarcoma of the heart]. / Primäres Hämangiosarkom des Herzens.

Primary cardiac sarcomas are malignant neoplasmas of mesenchymal cells. Angiosarcomas, unlike all other primary cardiac sarcomas, are typically found in the right atrium. We present the case of a 52-year-old patient in whom through echocardiography, computed tomography and angiography the precise diagnosis and extent of the tumor was revealed. Surgical treatment consisted of excision of the tumor with right atrium patch-plasty under cardiopulmonary bypass. Despite the successful operation the patient died 6 months later because of metastasis. Very early and precise diagnosis is essential to improve patient survival and prevent the development of metastases.

[Surgical treatment of acute pericardial tamponade in an infestation of the heart by Echinococcus]. / Chirurgische Behandlung der akuten Perikardtamponade bei Echinokokkusbefall des Herzens.

HISTORY AND CLINICAL FINDINGS: A 56-year-old turkish patient, previously in good health, was admitted because of pain suggesting myocardial infarction. Physical examination of the heart, lungs and abdomen was unremarkable. INVESTIGATIONS AND DIAGNOSIS: The concentrations of myocardium-specific enzymes were not elevated and the ECG showed no signs of ischaemia. Echocardiography and magnetic resonance imaging ruled out acute aortic dissection, but demonstrated a round cystic space-occupying mass over the anterior wall of the heart. Hydatid cyst was suspected from the imaging results and the patient's origin from area endemic for Echinococcus. The diagnosis was confirmed by a titre of 1:6,400 (normal: 1: < 100) for Echinococcus antibodies. TREATMENT AND COURSE: Albendazole administration was initiated. Planned elective surgical removal of the hysatid cyst had to be performed urgently because of acute pericardial tamponade. Cyst rupture was suspected but an actually undamaged cyst was subtotally removed under cardiopulmonary bypass. The postoperative course was uneventful and albendazole treatment was continued. CONCLUSION: Because of the high incidence of fatal complications urgent surgical removal under cardiopulmonary bypass is the treatment of choice for hydatid cyst involving the heart. Perioperative albendazole administration is also essential.

[Clinical, anatomical-pathological and therapeutic correlates of benign intracavitary heart tumors]. / Klinische, anatomopathologische und therapeutische Korrelate benigner intrakavitärer Herztumoren.

Benign intracavitary cardiac tumors lead to "malignant" complications, so early diagnosis and adequate treatment are of vital importance. Our investigation summarizes a 10-year experience after surgical treatment of 29 patients suffering from benign intracavitary cardiac tumors. The postoperative histological examination revealed a myxoma in 27 cases; in 2 cases a papillary fibroelastoma was diagnosed. The main symptom in 19 patients was dyspnea. In 8 cases an embolic event occurred. All patients underwent extirpation of the tumor. Early mortality was 10%, while late mortality was 4%. The treatment of choice of benign intracavitary cardiac tumors is extirpation, which, due to unpredictable embolic complications, is to be carried out immediately should the tumor have a lobulated tuberous surface. In such cases the descriptive function of echocardiography is of considerable importance.

[The quadri-cusp aortic valve: a congenital defect, responsible for pathologic changes?]. / Die quadricuspide Aortenklappe: Ein angeborenes Vitium, das pathologische Veränderungen hervorruft?

We report on a 61-year-old patient with considerable insufficiency of a quadricuspid aortic valve and coronary three vessel disease. The congenital quadricuspid aortic valve has become symptomatic due to the development of (post-endocarditic) insufficiency only in the advanced stage of life. It was treated by replacement of the aortic valve and bypass myocardial revascularization. The physiopathology of quadricuspid aortic valve will be discussed.

[Quality assurance in heart surgery in Germany. Development, current status and outlook]. / Qualitätssicherung in der Herzchirurgie in Deutschland. Entwicklung, gegenwärtiger Stand und Ausblick.

In a multicenter pilot study and with the support of the German Federal Ministry of Research and Technology, a commission of the German Association for Thoracic, Cardiac and Vascular Surgery developed a procedure for cardiosurgical quality assurance. After concluding the pilot phase, the data were reduced for general practicability to the essential characteristics and now comprise 205 items. After a cooperation contract between funding agents, the German Hospital Association, The German Federal Hospital Association and the German Association for Thoracic, Cardiac and Vascular Surgery, The Federal Working Group on Cardiosurgical Quality Assurance was founded. Under supervision of a federal board, the practical work is performed in a project office, which works closely together with a board of cardio-surgeons. The quality assurance comprises almost all cardiac surgery performed on adults. The data collected in the hospitals are drawn by the office into comparative statistics that allow judgement of the quality.

Aortic valve debridement by ultrasonic surgical aspirator in degenerative, aortic valve stenosis: follow-up with Doppler echocardiography.

OBJECTIVE: Recently there has been an emphasis on reconstructing diseases native valves as an alternative to prosthetic valve replacement. Whereas; the surgical repair of aortic valve stenosis has been always problematic. This study was performed to estimate the clinical results after aortic valve debridement using ultrasonic energy. METHODS: Between 1990-1994 26 patients underwent ultrasonic aortic valve decalcification. There were 15 females and 11 males, the age was in average 74 years. As a concomitant diagnosis 88% patients (23) had mostly mild, aortic valve insufficiency, 16 (61%) had coronary artery disease and 11 (42%) had mild mitral valve incompetence. All of the patients were operated with cardiopulmonary bypass using moderate hypothermia, cardioplegical arrest and topical cooling for myocardial protection. The calcifications were removed tangentially using Cavitron Ultrasonic Surgical Aspirator. (CUSA), CAVITRON, USA. Leaflet perforation and/or unsatisfactory valve closure have been indications for aortic valve replacement. RESULTS: Two operative death (8%) have occurred and six patients have died in the further course (follow-up mean 17 months ranging from 4 to 61 months). Postoperative Doppler-Echocardiography results taken directly after surgery and then again 17 months later (n = 18) showed a decrease of peak and mean gradients across the aortic valve three and two times respectively (p < 0.001). 17 months after debridement we observed a mild rise in both gradients (by peak gradient p < 0.05). Directly postoperative, the aortic valve area increased doubly and decreased 17 months later slight, but it was still statistically significant in comparison with our preoperative data (p < 0.001). Follow-up echocardiography demonstrated late onset of moderate aortic valve insufficiency in 6 patients. The classification of New York Heart Association was improved in 13 (72%) survivors after 17 months. CONCLUSIONS: Ultrasonic debridement of aortic valve stenosis allows precise and energy-controlled removal of calcium, increased doubly the valve area and decreased of peak and mean gradients statistically significant. The advantages of preserving the native aortic valve in elderly patients are relative good arguments; although a longer follow-up is necessary to establish this procedure.

Paradoxical embolism in the presence of right-to-left shunt due to tricuspid occlusion.

The case of a 33-year-old woman suffering from a paradoxical peripheral embolism in the presence of a right-to-left shunt at the level of an ostium secundum defect is presented. A functional stenosis of the tricuspid valve due to obstruction through a thrombotic atrial mass was found to be responsible for the right-to-left shunt. Treatment consisted of peripheral embolectomy, removal of the atrial mass, and closure of the atrial septum defect.

Composite graft (Medtronic-Hall) replacement of the ascending aorta and aortic valve in aortic aneurysms: what is adequate follow-up?

Between 1987 and 1994, 39 patients underwent 41 replacements (2 reoperations) of the aortic valve and ascending aorta by composite grafts with mechanical valves. One patient had annuloaortic ectasia, one had a sinus of valsalva aneurysm, 13 patients had a Debakey type I acute dissection, 10 had a Debakey type II acute dissection including two Marfan patients, and 14 had atherosclerotic aneurysms. 6 patients (15%) died within a postoperative period of 30 days. The mean follow-up time was 40 months (1-82 months). Twenty-six patients were restudied by clinical examinations and computed tomography of the chest (CT). Two patients required emergency reoperation due to disruption of the proximal aortic anastomosis and right coronary anastomosis. Both patients had been diagnosed to have Marfan disease. Anastomotic dehiscence of composite grafts has a potentially high risk of lethal complications. In follow-up examination computed tomography was performed as a simple and accurate method to detect complications such as pseudoaneurysms, but up to now did not give the indications for reoperation. We suggest that complications may occur not only in the early postoperative period so that regular CT-scan control studies (every 6 to 12 months) should be performed in all patients who undergo composite graft replacement.

Efficacy of aprotinin in different doses and autologous blood transfusions in cardiac surgery.

A study was undertaken to compare the two doses of aprotinin and the amount of autologous blood transfused in order to determine the optimal dose of this inhibitor for use in cardiac surgery. A total of 120 patients undergoing elective cardiac surgery from November 1990 to April 1992 took part in this randomized double-blind study. Two groups of 60 patients were treated. Patients in the high-dose group were given the dose of aprotinin recommended by the Hammersmith group (6 million kallikrein inactivator units), the other 60 (the low-dose group) received half the dose. Blood loss from thoracic drains in the postoperative period showed a statistically significant difference between the two groups between 6 and 12 h (a mean loss of 69 ml in the high-dose group versus 109.5 ml in the low dose, P = 0.003). The overall postoperative drainage losses were very similar (537.2 ml in the high-dose group versus 610.9 ml in the low dose). The blood and clotting markers did not differentiate between the high- and low-dose patients. In combination with autologous blood transfusions, a low dose of aprotinin appears as efficient in reducing postoperative blood loss as the high-dose regimen.

Therapy and results of surgery: requiring infarction complications. An 8-year experience.

Among myocardial infarction (MI) secondary complications requiring surgical intervention, the primary sequel is the left ventricular aneurysm (LVA), as a matter of fact, the ventricle septum rupture (VSR) and the moderate to severe ischemic mitral valve regurgitation (IMR) are common as secondary or third follow ones. Between June 1985 and June 1993 in our department, we performed 6418 operations with the support of the heart-lung-machine. This number includes 74 (1.15%) operations of MI complications; 38 interventions because of LVA, 18 operations because of IMR and 18 surgical corrections of VSR. In the great majority of cases a myocardial revascularization was performed simultaneously. Preoperatively the distribution of the whole patient population according to the functional NYHA classification was as follows: NYHA class I: 0, class II: 0, class III: 36 (48.6%), class IV: 27 patients (36.5%) and cardiogenic shock: 11 patients (14.9%). LVA surgery consists in aneurysmectomy and linear closure or endoventricular patch reconstruction, VSR was closed with synthetic patch material and the correction of IMR was performed mainly through partial resection and replacement with a prosthetic valve. Our early mortality was 13.1% for the LVA, 38.8% for the VSR and 11.1% for the IMR patient population, which was congruent with the rates quoted in current literature. The patient follow-up was done within a period of 6 to 90 months after discharge and the available results are very good. Late mortality was 15%. The actuarial survival rat after 7 years was 85% for the LVA, 82% for the VSR and 87% for the IMR patient population.(ABSTRACT TRUNCATED AT 250 WORDS)

The use of intra-aortic balloon pump after surgical treatment of DeBakey type I dissecting aneurysm of the aorta.

The case is reported of a sixty-four-year-old patient with DeBakey type I aortic dissection in whom postoperative extensive intra-aortic balloon pumping was applied. Surgical repair involved replacing the ascending aorta with a Medtronic Hall valved conduit. After surgery severe low-output syndrome occurred. Despite the use of high-dose inotropic drugs the patient could not be hemodynamically stabilized. An intra-aortic balloon pump was finally applied as a therapeutical last resort. Within three days, under counterpulsation, the patient reached a stable hemodynamic condition. After twenty-one days in the intensive care unit, he could be transferred to a normal ward. The patient was discharged on the fifty-fourth postoperative day. During counterpulsation there were no balloon- or catheter-induced complications. Follow-up at five months showed the patient in good general health: echocardiography did not identify any lesions of the thoracic aorta which could be linked to counter-pulsation. It is concluded that the postoperative use of intra-aortic balloon pump in the event of DeBakey type I dissecting aneurysm of the aorta, and adversely affected patient hemodynamics, is a justifiable therapeutical alternative.

[Can administration of trasylol in reduced Hammersmith dosage with simultaneous transfusion of autologous blood meet the requirements of open heart surgery?]. / Kann die Gabe von Trasylol in einer verringerten Hammersmith-Dosierung bei gleichzeitiger Applikation von Eigenblutspenden den Ansprüchen der offenen Herzchirurgie entsprechen?

PROBLEM: The general positive effect of the proteinase inhibitor trasylol on blood loss and transfusion demand in cardiac surgery has been demonstrated in several placebo-controlled studies. Given the possibility of cardiac and renal side effects associated with a high dose of trasylol (Hammersmith dosage: 6 x 10(6) kallikrein inactivator units KIU), the question of a dose reduction was raised. METHODS: Being designed as a randomized double-blind comparative group study, the investigation included 120 patients with elective primary cardiac surgery from November 1990 to April 1992. One characteristic aspect of this study was the combined administration of trasylol and autologous blood transfusions. To compare the efficacy and safety of different doses of trasylol, two groups, each with 60 patients, were created: the former with the full Hammersmith dose (high dose group = HD group), the latter with half of the Hammersmith dose (los dose group = LD group). A placebo group had to be excluded for ethical reasons. RESULTS: The trasylol plasma levels showed a good dose correlation for the complete interval. The intra-operative bleeding tendency, as judged by the surgeons in charge, did not show any statistical significant difference between the HD group and the LD group. As to the post-operative blood loss via thoracic drainage, the early collection periods did not show any difference between both study groups. Starting at 6 hours post-operatively, the drainage losses showed a tendency towards lower volumes in the HD group. This difference was statistically significant for the time period "6-12 hours post-operatively". The analysis of the post-operative complications did not show any difference. SUMMARY: In this study with a high percentage of autologous blood transfusions, a lower dose of trasylol seemed to be nearly as effective as a full Hammersmith dose. However, such a reduced dose did not demonstrate any advantage regarding the complication rate in comparison with the conventional high dose.

[Emergency management of type A aortic dissection in the acute rupture phase with pericardial tamponade]. / Notfallmässige Versorgung einer Aortendissektion Typ A im Stadium der akuten Ruptur mit Perikardtamponade.

A case of successful operative repair of a previously unknown aortic dissection type A after intrapericardial rupture is presented. Under resuscitative measures an inferior pericardiotomy was done, followed by sternotomy to control bleeding under then stabilized circulation. Without detailed diagnostic evaluation, immediate operation with resection of the aneurysm and supracoronary prosthesis interposition was carried out. The diagnostic methods and problems, the differential diagnosis, and comparable cases from the literature are discussed.

Brachial plexus injury after cardiac surgery. The role of internal mammary artery preparation: a prospective study on 1000 consecutive patients.

Brachial plexus injury is a typical complication after median sternotomy. A prospective study was performed on 1000 consecutive patients to determine whether preventive actions, including lower position and least possible opening of the sternal retractor, help to reduce the complication rate. Twenty-seven patients were observed with postoperative brachial plexus injury. Nerve conduction measurements and electromyography were performed. Patients without preparation of the internal mammary artery had a complication rate of less than 1%, whereas the complication rate of those patients with preparation of the internal mammary artery was as high as 10.6%. The main symptoms were continuous pain and motor and sensory disturbances. Most frequent were lesions corresponding to the roots C8-T1. Six patients had Horner's syndrome; three had ptosis only with no other signs of Horner's syndrome. Symptoms persisted in eight patients more than 3 months after the operation, and one patient still had intractable pain. Increasing use of internal mammary artery grafts in coronary artery bypass demands measures to protect the brachial plexus.

Frequency of trisomy 21 in Germany before and after the Chernobyl accident.

For Berlin (West) the rate of trisomy 21 among newborn and all prenatally diagnosed cases can be almost completely recorded, including the maternal age distribution. During the 9-year-period from 1980 and 1988 the average number of trisomy 21 per month was about 2, following a Poisson distribution. A significant increase (P less than 0.01) was observed in January 1987, exactly 9 months after the Chernobyl accident. In a supraregional study based on greater than 30,000 prenatal diagnoses performed in 1986, no significant effect could be observed. However, the highest rates of trisomy 21 were observed in the more heavily contaminated, southern part of Germany. The majority of these fetuses were conceived during the period of greatest radioactive exposure. The data are discussed with respect to the effect of low-dose radiation around the time of conception on the induction of non-disjunction in man.

Multicentric quality assurance in cardiac surgery. QUADRA study of the German Society for Thoracic and Cardiovascular Surgery (QUADRA: quality data retrospective analysis).

A method for initiating quality assurance in cardiac surgery was developed multicentrically by a commission of the German Society for Thoracic and Cardiovascular Surgery (QUADRA Study). To appraise the quality of cardiosurgical action, variables were compiled from the preoperative, intraoperative, and postoperative treatment course. The data collection was carried out at the same time as treatment. On the basis of unicentric data profiles, multicentric hospital profiles, and problem profiles, a quality comparison could be carried out and the variability of cardiosurgical action which may occasion interventions could be identified. A reduction of perioperative blood consumption during the study period could be observed in four out of five hospitals as the first result. The data collection also revealed epidemiological features. On average, women were older than men at the time of the heart-valve and coronary operations. To ensure data validity and the organization of quality assurance, a documentation assistant and a specially trained physician are necessary at every cardiovascular surgery center. The multicentric external comparison is indispensable and must be carried out by means of a central data collection, for which intrumental and staff capacities are also to be provided. With modern methods of data processing, an additional and new approach to the improvement of quality in cardiac surgery can thus be made.

Development and application of a quality assurance information system in cardiac surgery (QUADRA study).

Preventive measures for quality in cadiac surgery which are based on electronic data processing initially have to overcome a variety of obstacles. Some of the most serious encountered are the need for more extensive but more precise and correct documentation, the definition of quality and the identification of parameters to assess it, fears that means to check everything and everybody are being installed, and finding ways to found the measures. The measures have two aims at least: ensuring a broad general standard of treatment which every patient can expect, and supporting efforts at a continuous improvement of treatment methods and thus of the results. These aims dictate that any measures instituted have to be of a permanent nature: they cannot be reached in the long term by a simple supplementary activity such as a research project. On the contrary, a complete integration in the general hospital routine and in the standard documentation and information processes is necessary. As these today still are not usually based on clinical progress reports which are formally suitable for data processing, reorganisation to achieve this is a prerequisite for successful quality assurance. This means, however, that those responsible for quality must help in the reorganisation.