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Biomedical subjects

B Eber

Publications and source records attributed to B Eber.

At least 127 records · Page 7Linked to original sources

[Hypertension and hemorheology].

A number of epidemiologic studies have provided evidence for an increased blood viscosity in hypertensive patients. Increased viscosity could result either from hemoconcentration, thus constituting a secondary phenomenon, or, alternatively, result directly from increased intracellular calcium concentrations in erythrocytes. The latter would augment the aggregating potential of these cellular blood compounds. This currently hypothetic view remains to be elucidated. Enhanced viscosity, however, may result in increased peripheral resistance and lead to hypertensive complications. The evaluation of antihypertensive therapy should therefore take possible effects upon blood viscosity into account.

Antihypertensive Agents↗

[What are the therapeutic consequences of evaluating hypertensive patients with 24-hour blood pressure monitors and blood pressure self-measurement?].

Arterial hypertension is an important risk factor for excessive cardiovascular morbidity and mortality due to its high prevalence of about 20% in the adult population. Causal readings, which have been obtained for diagnosis and control of treatment in hypertension are of limited value. They are not reproducable due to physiologic variability of blood pressure, which causes a rise of blood pressure, if a straining situation (e.g. in doctor's office) occurs (white-coat-hypertension). Furthermore, no correlation between causal readings and signs of endorgan-damage (EOD) such as left ventricular hypertrophy (LVH) can be observed. Especially the development of LVH comprises an independent risk factor and worsens prognosis. Results of ambulatory monitoring and self-measurement of blood pressure are reproducable and show an excellent correlation to EOD. Both methods are able to exclude white-coat-hypertension. Furthermore, ambulatory blood pressure monitoring allows to obtain blood pressure values during sleep, which may give further information concerning secondary hypertension, EOD and prognosis. Self measurement of blood pressure reinforces compliance of the patient and gives the possibility of self-titration and long-term control of antihypertensive drug treatment. The non-consensus concerning normal values is one limitation of both methods, but the cut-off level of office blood pressure recordings appears arbitrary, too. For optimal concomittance of hypertensives both methods have to reach more importance for diagnosis, evaluation of prognosis as well as treatment control.

Adult↗

[Thrombolytic therapy of acute myocardial infarct in advanced age (based on 2 case reports)].

The introduction of thrombolysis has reduced the mortality of acute myocardial infarction (MI) by 25%. Large-scale studies have revealed that especially patients over 65 benefit from this therapy. Nevertheless, many centers apply an age limit for thrombolytic therapy due to the higher risk of stroke or bleeding in elderly patients. In 1993 181 patients suffering from acute MI were admitted to the intensive care unit of the University Clinic of Internal Medicine, Graz, and 54 (29.4%) of them were treated with fibrinolytic drugs. In this paper we report on the successful thrombolytic management of acute MI in two male patients (87 and 88 years old) who were treated with 100 mg recombinant tissue-type plasminogen activator complex. As a sign of successful reperfusion a rapid increase in plasma creatinine kinase levels and fast amelioration of the ischemia-related ECG changes were observed. In the follow-up examination after four months the first patients showed only minimal exertional dyspnea and was otherwise well. The second patient died one month after MI following a laparotomy for ileus. We draw the conclusion that patients of advanced age also benefit from thrombolytic treatment of acute myocardial infarction, but the indications and contraindications have to be carefully observed.

Aged↗

[Recent molecular and pharmacologic aspects of ACE inhibitors].

ACE-Inhibitors are well established in the treatment of hypertension and heart failure. Other indications, that are under discussion, are coronary artery disease, renal failure and diabetes mellitus. The mechanism of action of ACE-Inhibitors is not only the reduction of angiotensin II and accumulation of bradykinin but also an increase of the action potential of the heart muscle, increase in glucose uptake in skeletal muscle, inhibition of platelet aggregation and opening of the K-ATP-channels.

Angiotensin II↗

Giant cyst of the liver with complete resolution following blunt trauma to the abdomen.

Here we report on a 78-year old female who was admitted to a local hospital with unspecific abdominal complaints. Sonography showed a solitary liver cyst 30 cm in diameter confirmed by computed tomography. At that time the patient refused any intervention. Thus, neither needle puncture nor operation were carried out. Approximately three years later patient was reexamined following a fall with blunt trauma to the chest and abdomen. Ultrasound examination now indicated complete disappearance of the cyst and this was confirmed by computed tomography. To our knowledge disappearance of such a large cyst following a blunt trauma has not been previously documented by CT imaging.

Abdominal Injuries↗

[Dilated cardiomyopathy--diagnosis and conservative therapy].

Diagnosis of dilated cardiomyopathy (IDC) is a diagnosis of exclusion. Physical examination of the patient, non-invasive tests and invasive tests have to be done to exclude secondary dilated cardiomyopathies. Treatment can be divided into baseline therapy, established treatment, e.g. ACE-inhibitors, digitalis and diuretics and optional treatment including betablocker, anticoagulation and an natural course of IDC for an individual patient is not clear although there are several prognostic parameters for this disease.

Angiotensin-Converting Enzyme Inhibitors↗

Cyclic phenomena in early myocardial infarction.

It has been shown by a number of authors that early myocardial infarction constitutes a dynamic process of cyclic oscillation between coronary occlusion and spontaneous coronary reopening. Infarct-markers, such as ST-segment elevation, serum-creatine kinase isoenzyme MB, the atrionatriuretic peptide (ANP) and serum-myoglobin (Mb) exhibit cyclic behaviour pattern during early AMI and thus reflect episodes of intermittent, spontaneous reperfusion. The latter have recently been verified by angiography. The mechanism underlying the phenomena seen in early myocardial infarction is likely to be based on a constant vasoconstrictive stimulus, deriving from aggregating platelets. The vasoconstriction subsequent to platelet aggregation produces an initial episode of myocardial ischemia. This episode is followed by a hypoxia of the artery wall. Reactive coronary dilation secondary to ischemia is than promoted by the release of vasoactive by-products of anaerobic glycolysis as well as changes in the open propability of certain transmembrane ion channels. Thereafter, the initial coronary occlusion is interrupted by transient vasodilation. A wave of reperfusion follows and leads to reoxygenation and wash-out of ischemia-induced vasodilative components as well as biochemical markers. The vasoconstrictive forces then take over again. This results in repeated waves of reperfusion. A number of arguments in favour of this concepts are discussed in this paper.

Atrial Natriuretic Factor↗

Relationship between heart rate threshold, lactate turn point and myocardial function.

We examined the relationship between heart rate threshold (HRT), lactate turn point (LTP) and myocardial function expressed as left ventricular ejection fraction (LVEF) determined by radionuclide ventriculography. Two groups of subjects (G I: N = 8; G II: N = 7) with and without a deflection of heart rate performance curve (HRPC) underwent sitting cycle ergometry. HRT (G I), aerobic threshold (AeT; G I, G II), and LTP (G I, G II) were determined by means of linear regression break point analysis. Also, a break point in LVEF performance curve (LVEFBP) was obtained. Power output at HRT and at LTP was not significantly different between G I and G II (272.5 +/- 38.7 W; 294.3 +/- 20.6 W). Power output at LVEFBP (G I: 182.6 +/- 31.7 W; G II: 211.8 +/- 21.5 W) was not significantly different to power output at LTP (G I: 194.2 +/- 32.7 W; G II: 215.2 +/- 24.4 W) and HRT (G I: 193.0 +/- 38.2 W). Significant differences (p < 0.05) could only be found between G I and G II for heart rate (HR) at LTP (G I: 163.5 +/- 5.8 b.min-1; G II: 154.4 +/- 6.7 b.min-1) and LVEF at the end of the load (LVEFend) (G I: 77.9 +/- 2.9%; G II: 71.3 +/- 7.0%). The drop of LVEF at LVEFBP was significantly related to LTP in all cases. The present data suggest that the noninvasive determination of anaerobic threshold by means of heart rate curve analysis is not always possible due to different response of myocardial function and heart rate to graded cycle ergometer exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Assessment of cerebrovascular risk profiles in healthy persons: definition of research goals and the Austrian Stroke Prevention Study (ASPS).

The advent of new laboratory methods and noninvasive imaging modalities has extended the diagnostic possibilities in normal individuals. This article elaborates the new options for the assessment of stroke risk offered by these techniques. In this context we present the Austrian Stroke Prevention Study, which is the first prospective long-term investigation of normals that includes Doppler sonography, magnetic resonance imaging and single photon emission computed tomography. The design, utility and limitations of this study are discussed.

Aged↗

Autoantibodies to oxidized low density lipoproteins in restenosis following coronary angioplasty.

Oxidized low density lipoproteins (oLDL) play an important role in the pathogenesis of atherosclerosis. Recently, elevated oLDL autoantibodies in serum were shown in patients with severe peripheral atherosclerosis. To evaluate their role in restenosis after percutaneous transluminal coronary angioplasty (PTCA), oLDL autoantibodies were determined in a randomly selected series of 48 males following successful PTCA. Follow-up angiography as well as blood sampling were done 12 months after PTCA; restenosis was defined as > or = 50% reduction in diameter of the coronary artery. Twenty-six patients (mean age: 56 years) showed restenosis (Restenosis Group), whereas 22 (mean age: 53 years) had open vessels (Patent Vessel Group). Both groups did not differ in age, past medical history, fibrinogen and lipid profile as well as in initial angiographic findings. Oxidized LDL autoantibodies were 13 +/- 21 U in the Restenosis Group and 6 +/- 4 U in the Patent Vessel Group, showing no significant difference. Six of 26 patients in the Restenosis Group and 3 of 22 in the Patent Vessel Group (NS) had elevated oLDL autoantibody levels (> or = 10 U). Thus, although there is a trend to elevated oLDL autoantibodies in males with restenosis of coronary arteries, oLDL cannot serve as a strong marker for stenosis following PTCA.

Adult↗

Long-term outcome and prognostic factors in dilated cardiomyopathy. Preliminary results.

UNLABELLED: To investigate long-term follow-up and identify prognostic factors in patients with dilated cardiomyopathy (DCM) the authors investigated 167 consecutive patients on an outpatient basis. All patients underwent left- and right-heart catheterization; follow-up comprised clinical and echocardiographic investigations. RESULTS: After a mean follow-up period of ninety-three +/- thirty-six months 82 patients (49%; 71 men, 11 women, mean age fifty-five +/- eleven years) were alive. 29 of them (27 men, 2 women, mean age fifty-two +/- nine) showed normal left ventricular ejection fraction (LVEF) after a mean follow-up period of one hundred four +/- forty months. The remaining 53 patients (44 men, 9 women, mean age fifty-six +/- eleven) revealed LVEF similar to that of the first examination. Eighty-five patients died (51%; 73 men, 12 women). Causes of death were the following: progressive heart failure, 24; sudden death, 23; stroke, 3; pulmonary embolism, 2; noncardiac death, 4; unknown causes, 29. The median period from the onset of first symptoms until definite diagnosis was two months in patients with stable conditions, three months in those with normalization of LVEF and twenty-four months in those who died, respectively (P < 0.01). At the time of diagnosis, patients with stable outcome had a mean LVEF (LVEF 1) of 37%, those who returned to normal had 40% (ns). Patients who died had a mean LVEF 1 of 32% and therefore differed significantly from both groups of survivors (P < 0.001). Left ventricular end-diastolic pressure (LVEDP) at the time of diagnosis was highest in patients who died (22 mmHg) and therefore differed significantly from both groups of survivors (normalization: 16 mmHg, stable patients: 18 mmHg, P < 0.001). CONCLUSIONS: According to their results, time until diagnosis, LVEF, and LVEDP are prognostic indicators. No difference was noted between the groups concerning etiology, medical treatment, or functional classification according to the New York Heart Association.

Adult↗

The Mattis Dementia Rating Scale: normative data from 1,001 healthy volunteers.

We administered the Mattis Dementia Rating Scale (MDRS) to 1,001 healthy volunteers, aged 50 to 80 years, randomly selected from our community. Multivariate regression analysis revealed educational level (p = 0.000004) and age (p = 0.00001), but no other sociodemographic or risk factors for stroke, to be significantly associated with the MDRS score. The age- and education-specific lowest quintile cutoff scores ranged from 140 in subjects aged 50 to 59 years with at least college experience to 130 in subjects aged 70 to 80 years with only 4 to 9 years of schooling. These percentile distributions obtained for decades of age and different levels of education should be useful reference values for clinicians and investigators when applying the MDRS to assess cognitive functioning.

Aged↗

[ECG of the athlete's heart].

The athlete's heart is characterized by eccentric hypertrophy of all cardiac cavities and there is a close connection to increased tone of the vagal system. As a consequence, not only arrhythmias are observed in the ECG of healthy athletes, but also changes in the QRS complex and in the ST-T-segment. Left ventricular hypertrophy is diagnosed in ECG by a positive Sokolow-Lyon index. The frequent finding of a right ventricular conduction delay is possibly due to hypertrophy of the myocardium in the apex of the right ventricle. The causes of various T wave changes are generally unclear and await further diagnostic clarification. In cases when normalization of the T-wave deviation is observed under stress, such changes are of functional nature. Echocardiography is indicated in any case to establish the heart's size and function; hypertrophic cardiomyopathy has to be excluded. Frequent cardiac dysrhythmias found in athletes are sinus bradycardia and sinus arrhythmia, less often escape rhythms are seen. A arrhythmia more often found in athletes is the respiration-dependent simple atrioventricular dissociation. Also, escape rhythms are observed in some cases with ventricular origin. Finally, a pronounced vagotonia can lead to a prolonged conduction time; AV-blocks of all degrees of severity are observed in athletes. The functional character of these arrhythmias can be easily demonstrated by their disappearance under stress.

Arrhythmias, Cardiac↗

[First aid measures by lay persons in cardiovascular arrest].

The efficiency of first aid resuscitation is affirmed by many publications. In a questionnaire of the division of Cardiology of the Department of Internal Medicine, Graz and the Styrian Heart Patient Society distributed during the course of the Graz spring fair 1993 the population was approached as to first aid in cardiac arrest. 550 subjects responded to answer this circular for assessment dividing the population statistically in 4 different age groups showing differences among male and female and country and city dwellers. It has been shown that general first aid resuscitation has been known sufficiently, whereas special cardiorespiratory procedures (such as artificial respiration or cardiac massage) were unknown to most.

Adolescent↗