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Biomedical subjects

B Maisch

Publications and source records attributed to B Maisch.

At least 253 records · Page 14Linked to original sources
PubMed1991

Safety of transesophageal echocardiography. A multicenter survey of 10,419 examinations.

BACKGROUND: During the past few years, transesophageal echocardiography (TEE) has been increasingly used in clinical cardiology; data concerning the practicability and safety of the technique, however, are rare. METHODS AND RESULTS: This report analyzes the experience of 15 European centers performing TEE studies for at least 1 year. At the time of this survey, 10,419 TEE examinations had been attempted or performed in these institutions. These TEE examinations were carried out by 54 physicians, 53.7% of whom had been trained in endoscopic techniques. Within the same time period, 160,431 precordial echocardiographic examinations were performed in the 15 institutions; the ratio between TEE and transthoracic studies averaged 9.03 +/- 6.4% (range of the 15 centers, 1.4-23.6%). Of the 10,419 patients, 9,240 (88.7%) were conscious inpatients or outpatients at the time of the TEE examination; the vast majority of the conscious patients did not receive intravenous sedation before TEE. In 201 cases (1.9%), insertion of the TEE probe was unsuccessfully attempted because of a lack of patient cooperation and/or operator experience (98.5%) or because of anatomical reasons (1.5%). In 90 of 10,218 TEE studies (0.88%) with successful probe insertion, the examination had to be interrupted because of the patient's intolerance of the echoscope (65 cases); because of pulmonary (eight cases), cardiac (eight cases), or bleeding complications (two cases); or for other reasons (seven cases). One of the bleeding complications resulted from a malignant lung tumor with esophageal infiltration and was fatal (mortality rate, 0.0098%). CONCLUSIONS: This multicenter survey documents that TEE studies are associated with an acceptable low risk when used by experienced operators under proper safety conditions.

Data Collection↗
PubMed1990

Immunological features in a case of hypereosinophilic syndrome and myocarditis.

The clinical and immunological follow-up of a 38-year-old female patient with hypereosinophilic syndrome and classical cardiac involvement, but without demonstrable degranulation of eosinophils and lacking binding of a specific antibody for activated eosinophils, is presented. Instead, the patient demonstrated all the immunological features of autoreactive myocarditis: cytolytic, complement-fixing antimyolemmal antibodies and increased concentrations of circulating immune complexes were present over 3 years.

Adult↗
PubMed1990

Endomyocardial biopsy in infants and children: experience in 60 patients.

In 60 children, aged between 1 month and 22 years (median 3.54 years) and with a body weight of 3-67 kg (median 12.6 kg), transvascular endomyocardial biopsy (EMB) was performed from the right (35 children) or left ventricle (30 children). The specimens were investigated by light and electron microscopy. There were three indications for biopsy: (1) poorly functioning, dilated left ventricle (seven patients with endocardial fibroelastosis, 16 with dilated cardiomyopathy, six from healing/healed or chronic myocarditis); (2) unexplained left ventricular hypertrophy (10 with hypertrophic cardiomyopathy, four with secondary hypertrophy, three with storage diseases); (3) to answer certain questions in eight children (four with hypoxic and two with cytoxic myocardial damage). Retrospectively, there were five nonindicated biopsies. There were no serious complications. Biopsies were diagnostic in 11.7% of cases, helpful in 71.7%, and of no help in 16.6%. Thus even in childhood endomyocardial biopsy is a diagnostic tool which can add useful information on the etiology or pathogenesis of an underlying myocardial disease.

Adolescent↗
PubMed1990

Immunology of cardiac tumors.

Whereas abundant literature is available on mechanisms imposed by neoplastic diseases on the immune system, only few details are known about immunological parameters of autoreactive mechanisms directed against the heart. This report will focus on cardiac autoreactivity in patients with endomyocardial types of cardiac tumors (e.g. atrial myxomas), Hodgkin's disease, and with neoplastic pericardial effusion. In patients with atrial myxomas antimyolemmal antibodies were significantly increased when compared to non-cardiac controls. Antisarcolemmal antibodies were positive in 100% of trivalent immunoglobulin binding. Antiendothelial antibodies of the IgG type could be found in 86% of patients with atrial myxoma. Circulating immune complexes were present in 6 out of 7 patients. In 107 patients with Hodgkin's disease without pericarditis the presence of antimyolemmal antibodies was lower than in healthy controls. The incidence of antimyolemmal antibodies in 10 patients with pericarditis lymphogranulomatosa was 10%, whereas in postradiation pericarditis 8 of 15 patients demonstrated antimyolemmal antibodies. Antiendothelial antibodies were positive in 7 out of 15 patients. The number of patient lymphocytes available for functional assays is yet too small to permit further conclusions on cellular autoreactive mechanisms in Hodgkin's disease. Antimyocardial antibodies were found both in the serum and in the effusions at least in lower titers in all patients. With regard to in-vitro analysis it can not be excluded that a balance between protective and cytolytic antibodies keeps a normal mean of antibody-mediated cytolysis. Analysing the first line of defense, the natural killer cell activity was found significantly increased in neoplastic pericardial effusions, whereas peripheral blood and pericardial effusion showed no lymphocytotoxicity with isolated myocardial cells.

Adult↗
PubMed1990

Atrial natriuretic peptide levels reflect hemodynamic changes under pacemaker stimulation.

Pacemaker stimulation influences plasma levels of atrial natriuretic peptide (ANP). This study evaluated in individuals without impaired myocardial function whether a consecutive increase of pacing rates results in reduced alteration of plasma ANP levels mirroring a putative decrease of atrial contribution to cardiac output. In nine resting patients with DDD pacemakers, absolute and relative ANP plasma levels were determined under DDD (175 msec AV delay) and VVI pacing at a pacing rate of 72, 82, 92, and 113 beats/min. When pacing rates were consecutively increased, higher plasma ANP concentrations were measured. However, the differences in relative ANP levels were nearly identical. Therefore, it seems likely that the atrial contribution to cardiac output at high pacing rates is less important than at lower frequencies, at least when the overall myocardial function is not impaired.

Aged↗
PubMed1990

Symptoms, cardiovascular risk profile and spontaneous ECG in paced patients: a five-year follow-up study.

UNLABELLED: Only few data are available about the course of symptoms, cardiac diseases, and spontaneous rhythm in pacemaker patients. Therefore, we followed the course of 308 paced patients (age 72 +/- 11 years) with a mean implantation time of 63 +/- 45 months. RESULTS: The symptom triad of syncope, dizziness, and dyspnea improved remarkably in 93% of patients. Thirty-nine percent suffered from coronary heart disease. The risk factors of hypertension (47%), nicotine (37%), and diabetes mellitus (25%) were found significantly more often than in a normal population with the same age and sex profile. In VVI paced patients with sick sinus syndrome (SSS, n = 67) atrial fibrillation (AF) occurred significantly more often (42%) than in patients with AV block (n = 80, 23%, P less than 0.05). Only one out of 41 DDD paced patients showed AF at follow-up. VVI stimulation seems to favor AF due to retrograde conduction in SSS. Only 3% of patients with SSS developed second- or third-degree AV block. Therefore, atrial pacing is preferable in most patients with SSS.

Aged↗
PubMed1990

Lethal myocarditis with atrioventricular block and ventricular tachycardia--a case report.

This case report details the acute clinical course and the follow-up of a 42-year-old woman with active recurring myocarditis, the main electrical features of which were atrioventricular block and ventricular tachycardia. It also focuses on immunohistological and serological parameters of autoreactivity that might explain the chronic clinical course over a period of 10 years.

Adult↗
PubMed1990

[Changes in atrial natriuretic peptide in patients with lung embolism and obstructive respiratory tract disease].

Plasma levels of atrial natriuretic peptide (ANP) correlate closely with the pressure and mural tension of the right atrium and with pulmonary arterial pressure. We determined ANP levels in eight patients with scintigraphically confirmed pulmonary embolism, before and after reperfusion. Furthermore, ANP was measured in ten patients with acute obstruction of the airways, and during the course of clinical recovery. Peripheral venous blood was saved for determination of ANP plasma levels. The hormone concentrations were measured by radioimmunoassay. In ten patients with scintigraphically confirmed pulmonary embolism clearly higher ANP plasma levels were determined than after complete reperfusion (p less than 0.05). In patients with acutely exacerbated airways obstruction, hormone levels were measured which were significantly higher than those observed after clinical improvement (p less than 0.01). Since it is known, that ANP reduces pulmonary arterial smooth muscle tone and resistance, the hormone appears to be of physiological significance in pulmonary embolism and acute airways obstruction by lowering right ventricular afterload.

Adult↗
PubMed1989

[Secondary immunopathogenesis in myocarditis, diseases of the heart muscles and infarct-associated arrhythmia in childhood and adulthood].

In histologically proven or clinically diagnosed perimyocarditis in children and adults alterations in cellular and humoral effector mechanisms are demonstrable: OKIaI-positive B- or activated T-lymphocytes are increased in the peripheral blood, whereas natural killer cell activity is reduced. Antibodies are directed to the membranes of isolated human atrial myocytes and, to a lesser extent with lesser specificity, to endothelial cells and to the extracellular matrix. AMLAs are of diagnostic relevance if they belong to the IgM class, indicating a recent humoral immune stimulation and, if they fix complement, indicating a functional property which is complement associated lysis of target cells. Immunohistological studies demonstrate fixation of immunoglobulins to the autologous biopsy specimens, which are diagnostic only if they also belong to the IgM class and fix complement. In acute rhythm disturbances in the context of a recent "common cold", similar humoral immune reactions can be found in children, which are compatible with a secondary immunopathogenesis after viral illness involving the myocardium.

Adult↗
PubMed1989

Autoreactive mechanisms in infective endocarditis.

Infective endocarditis is not a simple interaction between a microbial agent and a cardiac valve. For the infection of a non-bacterial thrombotic vegetation, predisposition is required which is at least partially operative by a decreased suppressor T cell activity. During infection, peripheral blood natural killer cell activity is decreased, but normalizes under anti-microbial therapy. Non-major histocompatibility complex-restricted lymphocytotoxicity to isolated heart cells can be present in one third of patients. Circulating immune complexes normalize during therapy. They may be the cause of many clinical symptoms of infective endocarditis. Anti-bacterial and also anti-sarcolemmal antibodies which are cross-reactive to the bacterium are secreted in a polyclonal immune response. Anti-sarcolemmal antibodies which are cytolytic in vitro in the presence of complement may partly explain the myocardial factor of heart failure in patients with only marginal valve incompetence due to the endocarditic vegetation.

Animals↗
PubMed1989

Effect of bisoprolol on cardiac performance in coronary heart disease.

The effects of 5 and 10 mg bisoprolol once daily for 7 days on exercise ECG, myocardial perfusion and left ventricular function in 25 patients with stable coronary heart disease have been assessed in a double-blind, randomized, parallel group trial design. ST-segment depression during exercise was reduced by 56% by 5 mg bisoprolol and by 64% after 10 mg; the difference between the dose levels was significant. Heart rate, systolic and diastolic blood pressure and the rate-pressure product were reduced to similar extent both at rest and during exercise by both doses. Left ventricular thallium-201 scintigrams indicated a significant reduction in myocardial perfusion defects after 10 mg bisoprolol compared to baseline; however, the difference between the two active treatments was not significant. Left atrial and left ventricular diameters obtained by one-dimensional echocardiography, and the calculated shortening fraction, remained unchanged after bisoprolol, and so gave no evidence of a negative inotropic action. It is concluded that 5 mg bisoprolol was effective in once-a-day treatment of angina pectoris due to coronary heart disease, and a further improvement can be expected on increasing the dose to 10 mg.

Adrenergic beta-Antagonists↗
PubMed1989

Influence of pacing mode and rate on peripheral levels of atrial natriuretic peptide (ANP).

The effect of acute modifications of pacing mode and rate on plasma ANP levels was evaluated. ANP was determined in ten resting patients with DDD pacemakers due to binodal disease or intermittent second-and third-degree AV block. At 82/minute pacing rate the ANP plasma levels (normal range 2 to 30 fmol/mL) corresponded to those under AAI (4.05 +/- 2.10 fmol/mL) and DDD (4.18 +/- 2.02 fmol/mL) pacing, but increased significantly (P 0.05) during VVI pacing (6.96 +/- 3.70 fmol/mL). Acceleration of DDD stimulation frequency from 82 to 113/minutes led to significant increase of ANP levels by the factor of three in all chosen AV delays. The lowest ANP plasma levels were measured at 175 msec AV delay under 82/minute pacing rate in DDD mode. Under 113/minutes the differences of ANP concentration after variations of AV delays were less pronounced. The influences of altered atrial pressure and tension on ANP release are discussed to account for changes in ANP plasma levels following different modes and rates of pacemaker stimulation.

Aged↗