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Biomedical subjects

D Hausmann

Publications and source records attributed to D Hausmann.

At least 73 records · Page 4Linked to original sources
PubMed1988

[Pseudostabilization of unstable angina pectoris: disappearance of symptoms in persistence of silent myocardial ischemia].

We studied a patient hospitalized with unstable angina pectoris; ST-segment analysis during Holter ECG revealed several silent ischemic attacks despite complete disappearance of anginal symptoms under medical treatment. Prior to cardiac catheterization the patient went into acute myocardial infarction. Immediate intravenous thrombolysis and subsequent angioplasty of a high-grade stenosis abolished the ischemic events. ST-segment analysis during Holter ECG offers a method to detect ischemic events despite the disappearance of anginal symptoms in the clinical course of unstable angina pectoris. This technique might therefore identify patients with unstable angina pectoris at higher risk for further cardiac events.

Adult↗
PubMed1988

[Post-traumatic imbalances of plasma amino acids--interference factors or defense mechanisms? A study of protein metabolism in severe craniocerebral trauma].

This prospective study examined 44 patients with severe brain injury (33 survivors, 11 non-survivors), in order to clarify the question whether plasma amino acid deviations should definitively be considered detrimental or if this process might be part of a defense mechanism. Over an 8 day follow-up period the nitrogen balance, urea production, creatinine and 3-methyl-histidine excretion, as well as the plasma aminogram were determined. The survivors as the less traumatized group were compared to the non-survivors with higher-grad injuries. Most parameters showed no significant differences between the 2 groups. However, the non-survivors did reveal higher nitrogen losses primarily mobilized from muscle tissue. As a reaction to trauma a deviation from normal limits was found for the amino acid concentration which might facilitate to withstand the stress of injury. In contrast to the non-survivors, the survivors showed a much more increase of the total amino acid concentration as well as the concentrations of arginine, methionine and proline. It is concluded that these increases outside of normal limits must be a defense mechanism and therefore are not to be forced to the so-called normal values in the early posttraumatic period.

Adult↗
PubMed1988

[Value of stress and long-term ECG in the diagnosis of silent myocardial ischemia in patients with coronary heart disease].

Symptomatic and asymptomatic myocardial ischemia during exercise testing and during daily activities (ST-segment analysis on 24-h Holter ECG) was studied in 109 patients with stable angina pectoris and proven coronary artery disease (coronary stenoses greater than 70%) (group I) and in 20 patients with angiographically normal coronary arteries or minimal changes (group II). During exercise testing, 94/109 (86.2%) group I patients and 6/20 (30%) group II patients showed ST-segment depression greater than or equal to 0.1 mV. During Holter ECG, transient ST-segment depression (greater than or equal to 0.1 mV; greater than or equal to 1 min) was observed in 76/109 (69.7%) group I patients and in 5/20 (25%) group II patients; all patients with positive Holter ECG also had a positive exercise tests result. Heart rate and exercise duration at the onset of ischemia during stress testing were useful parameters to estimate the incidence of ischemic episodes during Holter ECG. Patients with asymptomatic positive exercise tests showed a significantly higher percentage of asymptomatic ischemic episodes during Holter ECG than patients with a symptomatic positive exercise test (89% vs. 68% asymptomatic ischemic episodes; p less than 0.001). Therefore, in patients with coronary artery disease and stable angina pectoris, the exercise test provides information also about the activity of ischemic heart disease during daily activities.

Adult↗
PubMed1987

[ST segment analysis in 24-hour long-term ECG in patients with stable angina pectoris and angiographically detected coronary sclerosis].

ST-segment analysis on 24-hour Holter ECG was performed in 64 patients with angiographically proven coronary artery disease, a positive exercise test and chronic stable angina. During 125 days of recording, 494 episodes of transient ST-segment depression were observed, at an average of 4.0 +/- 3.7 episodes (1-13 episodes, median: 3 episodes) per day. The duration of ST depression per episode was 13.2 +/- 14.4 min (1-90 min; median: 8 min). No episodes of ST-elevation were observed. Only 27 (5.5%) ischemic episodes occurred during the night, between midnight and 6:00 a.m., but they were frequently observed during the morning hours between 7:00 and 12:00 a.m. Nearly all episodes of ischemia were preceded by an increase in heart rate. However, heart rate at the onset of significant ST-segment depression was significantly lower during Holter monitoring than during exercise test (p less than 0.001); this indicates that factors additional to the increase in myocardial demand might be relevant for transient myocardial ischemia during daily life. 382 of the 494 episodes (77.3%) of ischemia were asymptomatic; heart rate at the onset of ST-segment depression was similar in symptomatic and asymptomatic episodes; however, in asymptomatic episodes, maximal heart rate was significantly lower (p less than 0.001) and the duration of the episodes significantly longer (p less than 0.001). The percentage of asymptomatic episodes was very high in patients with one-vessel disease, whereas the duration and amount of ST-segment depression, as well as heart rate, at the onset of ischemia, were not dependent on the extent of coronary artery disease.

Aged↗
PubMed1987

[M-mode echocardiography determination of the severity of aortic stenosis: is the assumption of constant wall stress a realistic approach?].

We reevaluated a previously described M-mode echocardiographic method for the assessment of the hemodynamic severity of an isolated or predominant, advanced aortic stenosis in 89 adult patients without significant associated coronary artery disease. Endsystolic left ventricular wall thickness and diameters were measured using the echocardiogram and left ventricular systolic pressure was calculated under the assumption of a constant left ventricular wall stress (235 mm Hg); the results were compared with the pressure values measured during catheterization. The correlation between the echocardiographic and the invasively determined pressure values was poor and without any clinical relevance; r-values ranged between 0.14 and 0.46. Calculated left ventricular wall stress showed a large scatter with values between 126 mm Hg and 468 mm Hg. Our data indicate that in adults with aortic stenosis, M-mode echocardiographic determination of the hemodynamic severity is not possible, and the assumption of a constant left ventricular wall stress in these patients is misleading.

Adult↗
PubMed1985

Combined enteral-parenteral nutrition versus total parenteral nutrition in brain-injured patients. A comparative study.

A comparative nutritional study in brain-injured patients (BIP) was performed to assess the influence of a combined enteral-parenteral nutrition (CN) and a total parenteral nutrition (TPN) on protein catabolism in the early posttraumatic period. 20 male BIP (Glasgow coma scale 5-7) were randomized to one of the two feeding regimes. Nutritional support was based on 150-175% basic energy expenditure. Amino acid intake was 1.4 g/kg/day in the TPN and 2.4 g/kg/day in the CN group. Negative nitrogen balance (NNB) averaged means = 11.3 g/m2/day (SEM = 3.06 g/m2/day) in the TPN group and means = 10.2 g/m2/day (SEM = 2.33 g/m2/day) in the CN group. Between both feeding regimes not statistically significant differences could be observed concerning mortality, N-balance, creatinine and 3-methylhistidine excretions. Protein concentration of the regurgitated gastric fluid was significantly higher in the CN than in the TPN study group. Data imply that both alimentary regimes are of similar value, but BIP with impaired gastric function, such as high tube reflux, are better treated by TPN.

Adolescent↗
PubMed1985

Chronic aortic regurgitation: reassessment of the prognostic value of preoperative left ventricular end-systolic dimension and fractional shortening.

The prognostic significance of a preoperative echocardiographic left ventricular end-systolic dimension (ESD) greater than 55 mm and/or fractional shortening (FS) of 25% or less was evaluated retrospectively in 84 patients who had undergone aortic valve replacement for isolated chronic aortic regurgitation due to various causes. Postoperative survival, improvement in symptoms, and echocardiographic evidence of regression of left ventricular dilatation and hypertrophy were compared between patients with a preoperative ESD greater than 55 mm (category 1) and those with an ESD of 55 mm or less (category 2) and between patients with FS of 25% or less (category 3) and those with FS greater than 25% (category 4). Patients in categories 1 and 3 had a higher preoperative left ventricular end-diastolic dimension (EDD) and cross-sectional area than those in categories 2 and 4, respectively, but their preoperative functional impairment (NYHA class) was similar. There were 13 deaths, only two of which (one early, one late) could be attributed to left ventricular dysfunction. In both, FS was 25% or less and in one ESD was greater than 55 mm. There was a weak association without useful positive predictive value between the echocardiographic variables and postoperative death due to all causes. Among 42 patients with a preoperative ESD greater than 55 mm and/or FS of 25% or less, 33 (79%) were alive at a mean follow-up of 29.5 months. Symptoms improved in all categories of survivors, with the postoperative NYHA class being similar between categories 1 and 2 and between categories 3 and 4. Among 48 survivors with high-quality echocardiograms both before and after surgery, EDD fell in all groups but fell to a lesser extent in category 3 than in category 4. Postoperative cross-sectional area fell to the same level in all categories. Follow-up intervals were similar in all categories. We conclude that in patients undergoing aortic valve replacement for chronic aortic regurgitation, a preoperative ESD greater than 55 mm or an FS of 25% or less does not reliably predict early or late death, does not correlate with lack of improvement in symptoms, and does not preclude postoperative regression of left ventricular dilatation and hypertrophy. Thus these echocardiographic criteria alone cannot be used for the timing of surgical intervention in these patients.

Adolescent↗
PubMed1983

[Enteral-parenteral feeding with high protein content in++ severe cranio-cerebral injuries].

Brain injured patients (BIP) usually have hugh losses of nitrogen in the early posttraumatic period. Investigations on protein catabolism in 10 young male BIP, not being moribund, were performed to answer the question whether N-loss can be minimized by an enteral-parenteral nutrition with high protein content (greater than 2 g protein/kg body weight). N-balance, 24-h urinary excretion of creatinin and 3-methylhistidine were measured for 8 days after the accident. The alimentary regime, being adapted to body weight, included for an adult 70-kg patient the intake of 470 g carbohydrates, 170 g aminoacids/proteins and 45 g fats per day (3040 kcal/day = 12700 kJ/day with 112 kcal/g N = 468 kJ/g N). Laboratory data indicated a stimulated muscle turnover rate and a considerable protein catabolism. The waste of endogenous sources could therefore not be prevented by the presented combined nutritional regime.

Adolescent↗
PubMed1983

[Secondary dislocation of a vena basilica catheter].

An extreme dislocation of a central venous line inserted from the V. basilica dextra is reported, the catheter tip being displaced from the V. cava sup., which was the correct position, to the V. jugularis int. dext., thus covering a distance of 11.5 cm. The necessary of at least one additional X-ray after 24 hours to monitor the position of the catheter is emphasised, but daily X-ray control ist not necessary.

Aged↗
PubMed1983

[Automatic non-invasive blood pressure determination--comparative determinations and experiences with the DINAMAP Vital Data 845 XT Monitor in the intensive care station].

An improved version of a well-established monitor for the noninvasive measurement of blood pressure and heart rate was tested in critically ill patients in an operative intensive care-unit. The device utilizing the oscillometric method and a microprocessor proved to be safe, reliable and sufficiently precise for long-term monitoring. Data were shown clearly on a lighted digital display. Individual factors had much influence on the measurement. Deviations from intraarterial measurement occurred in the same patient almost permanently in one direction, but alterations of blood pressure were read out precisely. Irrespective of the individual influence, mean arterial pressure (MAP) and diastolic blood pressure were indicated too high, and the systolic pressure was recorded to low above 150 mmHg (= 20 kPa) and too high below 100 mmHg (= 13.3 kPa) obtained by the invasive method.

Blood Pressure Determination↗
PubMed1982

[The prognostic value of various intensive medicine parameters in long-term intubated neurosurgical patients].

The prognosis of 1693 patients of the intensive care unit of the Neurochirurgische Universitätsklinik Bonn was investigated. They all required intubation and mechanical ventilation, 912 of them for more than 24 hours (prolonged intubation). The overall mortality rate was 25.3%, while in cases with prolonged intubation it was 41%. No valid conclusion could be drawn from the duration of intubation as to survival. Next to the primary disease which was most important, the patient's age was of great prognostic value. Pneumonia (16% incidence) and prerenal failure (14.9%) seemed to be of minor importance, whereas renal failure (16.6%) worsened prognosis considerably by a mortality of 71-100%. Dexamethasone therapy proved to be of advantage in the management of brain tumors. No influence on the outcome of patients with severe head injury was seen. Patients with cerebrovascular disease were detrimentally affected by corticosteroid administration. Apart from extreme situations there were no satisfying predictors of outcome by means of which one could preselect patients to enter intensive care units. The decision to eventually withdraw life support can only be made on the basis of numerous factors.

Acute Kidney Injury↗
PubMed1981

[Late laryngeal and tracheal complications after prolonged naso-tracheal intubation (author's transl)].

The causes, incidence and means of preventing sequelae (late complications) after long-term intubation are discussed and the literature is reviewed. 6 of 353 surviving patients with neurosurgical disorders required treatment following prolonged intubation. The incidence of subglottic and tracheal stenoses was 1,14 per cent and of other laryngeal damages was 1,13 per cent. The primary disorder and unfavourable conditions attending its treatment appear to be responsible for the complications.

Adolescent↗
PubMed1978

[Bloom syndrome: review and definition].

The cases of Bloom-syndrome as described in the literature (till...) are reviewed and this syndrome is discussed as a defined entity which can be separated from congenital poikilodermias. The prognosis of this autosomal recessive disease is dubious.

Abnormalities, Multiple↗