Intracellular pH measurement during cardiac arrest in ventricular myocardium by Bretschneider's cardioplegic solution HTK and St. Thomas Hospital solution with and without procaine.

Intracellular pH (pHi) has been measured in human or cat ventricular muscle during 60, 120 and 180 minutes of cardiac arrest by Bretschneider's cardioplegic solution HTK or St. Thomas solution with and without procaine. In 319 control measurements in modified Tyrode's solution pHi (mean, S.

[Compression syndrome of the upper thoracic outlet (thoracic outlet syndrome)--report on a 13-year-old girl].

The thoracic-outlet-syndrome, a symptom complex consisting of arterial, venous and neural disorders of the upper extremity, is caused by compression of the neurovascular structures between the clavicle and the first rib. Other reasons are congenital abnormalities like a cervical rib, an abnormal first rib, acquired anatomic lesions like fractures and traumata or functional factors. The younger-and middle-age groups are most commonly involved.

[Stress tolerance following traumas of the thorax and great vessels].

After clinical investigation the most important diagnostic procedure is the simple chest X-ray in upright position. In case of hemothorax or pneumothorax the insertion of a large chest tube in the third of fourth intercostal space is necessary. Patients with traumatic flail chest and paradoxical respiration need first of all immediate intubation and artificial respiration, afterwards operative stabilization is beneficial in selected patients.

[Surgical treatment of aortic isthmus stenosis in adults].

The report refers to a group of 34 adult patients. End-to-end anastomosis was performed in 15 cases, interposition or bypass of prostheses in 13 cases and plastic operations in 6 cases. The surgical mortality rate came up to 2.

Prolonged safe ischemic cardiac arrest using hypothermic Bretschneider cardioplegia combined with topical cardiac cooling. Clinical experience with cardiac arrest of up to 180 minutes in a few borderline cases.

Out of 494 patients operated upon using Bretschneider cardioplegia, 8 complicated surgical procedures (3 cases of single or double valve replacement combined with coronary bypass grafting, 2 cases of double valve replacement, 2 cases of multiple coronary bypass procedures and one case of aortic valve replacement with replacement of the ascending aorta) required a mean aortic cross-clamp time of 164 minutes. Four patients had a single infusion, and 4 other patients 2 or more infusions, of cold cardioplegic solution. With the aid of topical cooling, the myocardial temperature was reduced to a mean value of 12.

[Surgical treatment of the flail chest (author's transl)].

Six patients with traumatic flail chest underwent surgical stabilization using a procedure introduced by Brunner, Hoffmeister and Koncz (2). Compared with internal stabilization by intermittend positive pressure respiration (IPPR), there are some advantages: Time of artificial respiration is shortened, early mobilization is possible, nursing is easier. The procedure is simple to do and is indicated in those patients, in whom longterm artificial respiration is not necessary for other reasons.

[Cardioplegia according to Bretschneider for valve replacement: clinical experiences and electronmicroscopical results (author's transl)].

We report about clinical experiences with the cardioplegia according to Bretschneider combined with deep selective hypothermia of the heart in 44 patients. Before, during and after cardioplegia we made biopsies from the left ventricle of 6 patients for electronmicroscopical examinations. Besides the mitochondrial changes already known we saw a break-down of the nexuses.