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Biomedical subjects

E Deutsch

Publications and source records attributed to E Deutsch.

At least 91 records · Page 5Linked to original sources
PubMed1990

Influence of heparin therapy on percutaneous transluminal coronary angioplasty outcome in patients with coronary arterial thrombus.

The clinical and angiographic outcome of 18 patients with coronary thrombus undergoing percutaneous transluminal coronary angioplasty without antecedent heparin therapy was compared to that of a group of 35 patients receiving pre-procedural heparin therapy. The former group had a significant reduction in angiographic success (61 vs 94%, p less than 0.05) and a significant increase in immediate postprocedural thrombotic arterial occlusion (33 vs 6%, p less than 0.05). This difference existed despite equivalent frequencies of antiplatelet therapy. Prolonged intravenous heparin therapy before angioplasty in the setting of coronary thrombus improves the overall success rate and lessens the likelihood of periprocedural coronary arterial thrombosis.

Angiography↗
PubMed1990

99mTc complexes of alpha,alpha-disubstituted, alpha-hydroxy carboxylic acids.

99mTc complexes of 2-ethyl-2-hydrobutyric acid, 2-hydroxyisobutyric acid and (+)- and (-)-citramalic acid are readily prepared in high yield and high purity by reduction of 99mTcO4- in the presence of excess ligand. The resulting agents are very stable in vitro, but can undergo some decomposition during chromatographic analysis unless appropriate precautions are taken. Biodistribution studies in rats and dogs show that these new 99mTc agents accumulate primarily in the kidney and urinary bladder.

Animals↗
PubMed1990

Adaptation to ischemia during percutaneous transluminal coronary angioplasty. Clinical, hemodynamic, and metabolic features.

The clinical, electrocardiographic, and coronary hemodynamic responses to sequential 90-second occlusions of the left anterior descending coronary artery in 12 patients undergoing elective percutaneous transluminal coronary angioplasty were examined. Transmyocardial lactate metabolism was examined in an additional group of seven patients with clinical and hemodynamic features similar to the first group. We noted that in comparison with the initial balloon occlusion the second occlusion was characterized by less subjective anginal discomfort, less ST segment shift (0.44 +/- 0.13 versus 0.21 +/- 0.07 mV, p = 0.01), and lower mean pulmonary artery pressure (25 +/- 1.0 versus 20 +/- 1.7 mm Hg, p = 0.005). In addition, for the same heart rate-blood pressure product, cardiac vein flow during the second inflation was significantly lower than that recorded during the first inflation (96 +/- 1.4 versus 83 +/- 2.4 ml/min, p = 0.005). Finally, there was significantly less myocardial lactate production during the second inflation (lactate extraction ratio: first inflation, -0.11 +/- 0.03; second inflation, -0.03 +/- 0.02; p = 0.04). We conclude that the lessened clinical, electrocardiographic, hemodynamic, and metabolic evidence of myocardial ischemia during the second of two periods of coronary artery occlusion during percutaneous transluminal coronary angioplasty supports the concept of adaptation to myocardial ischemia (ischemic preconditioning).

Adaptation, Physiological↗
PubMed1990

Gene technology in medical diagnostics and criminal procedure and liability for malpractice in Germany.

The increasing employment of gene technological procedures in medical diagnostics and criminal procedure has forced both the medical and the legal professions to focus their attention on the complex question of liability of physicians, lab technicians, and other personnel involved in applying these measures. This article gives an outline, by citing practical cases, of the major aspects of liability for malpractice that are relevant under German law. Bearing in mind that this article will be read predominantly by members of the Anglo-American common-law legal system, the legal aspects - even though they are German legal aspects - are viewed in the light of the common law. The article examines three major issues: (a) liability for diagnoses employing gene technological procedures: (b) liability for wrong testimony based on 'genetic finger-printing': and (c) the donor's rights concerning his or her DNA-probe.

DNA Fingerprinting↗
PubMed1990

[Interactive relations between sexual behavior and post-menopausal replacement hormone therapy: a survey].

A study carried out in 1988 using a representative sample of the French male and female population aged between 52 and 70 provides information concerning one of the presumed motivations for the use of replacement hormone therapy: to "always be a woman". In 1988 the sexual activity of French couples decreased on average after the age of 50 or thereabouts in a proportion identical to that seen in 1970. The chief limiting factor is reduced libido in women, far more than simple dyspareunia or relative male impotence. The majority of women interviewed did not wish to react against this fall in sexual activity, had abandoned "seductive" behaviour, would not use treatment which would increase sexual appetite even if it were ideally active and free of side-effects and did not consider that the menopause had any influence whatsoever on their behaviour. Eighty per cent of women had never sought to use replacement hormone therapy. A minority, 17 p. cent of those interviewed, had used postmenopausal hormone therapy for a time at least. This sub-group had a far higher level of sexual activity, attached greater importance to their personal appearance, took more physical exercise and controlled their weight better. The group was also more educated and better informed regarding the possible consequences of the menopause. Differences in life style and dietary behaviour between spontaneous non-users and users of hormone replacement therapy could falsify the interpretation of a non-randomised epidemiological study.

Aged↗
PubMed1989

Coronary artery bypass surgery in patients on chronic hemodialysis. A case-control study.

STUDY OBJECTIVE: To determine the morbidity and mortality of cardiac catheterization and coronary artery bypass surgery in patients on chronic hemodialysis. DESIGN: Retrospective case-control study. SETTING: A referral-based university hospital. PATIENTS: Sixteen consecutive patients on chronic hemodialysis who had catheterization and bypass surgery: 30 controls matched for age, sex, year of operation, severity of coronary disease, left ventricular function, hypertension, diabetes, and urgency of surgery: and 34 consecutive controls having bypass surgery. MEASUREMENTS AND MAIN RESULTS: No major complications of catheterization occurred. Of 16 patients on dialysis, 7 had urgent surgery within 24 hours of catheterization. One patient on dialysis and 3 consecutive controls died, but none of the matched controls died. Postoperative morbidity was increased in the hemodialysis group as measured by the duration of mechanical ventilation (4.7 +/- 2.3 compared with 1.5 +/- 0.8 days in matched controls [mean +/- SE]), the duration of hemodynamic support (4.2 +/- 2.3 compared with 0.8 +/- 0.2 days), the length of stay in the intensive care unit (6.4 +/- 2.4 compared with 2.8 +/- 0.9 days), and the length of postoperative stay in the hospital (15.4 +/- 2.1 compared with 10.8 +/- 1.1 days) (all P less than 0.05). Four intraoperative myocardial infarctions occurred in patients on dialysis compared with two patients in the case-matched controls. Differences in morbidity between the two control groups were not significant. CONCLUSIONS: Morbidity is increased in patients on hemodialysis having coronary artery bypass surgery compared with controls matched for severity of coronary disease; however, the outcome in all but one patient on dialysis was good. Bypass surgery is an acceptable treatment for patients on dialysis with advanced coronary artery disease. Because urgent surgery is often needed in these patients, earlier evaluation of the need for revascularization may improve clinical results.

Adult↗
PubMed1989

Biodistribution of Tc-99m methoxy-isobutyl-isonitrile (MIBI) in humans.

Hexakis (methoxyisobutilisonitrile) technetium(I), 99mTc-MIBI, has been proposed for myocardial perfusion studies. We have evaluated the biodistribution of this new agent in normal volunteers at rest and after stress. The biodistribution of 99mTc-MIBI is characterized by rapid blood clearance and a consequently early myocardial uptake. The initial intense hepatic activity is cleared into the gallbladder at 1 h after injection, and the best target to non target ratio is observed at 60-90 min after injection. Absorbed radiation dose calculations show that the thyroid is the critical target organ (230 mRad/mCi at rest), presumably because of 99mTc-pertechnetate generated in vivo. Our results indicate that 99mTc-MIBI is a promising tracer for myocardial perfusion imaging.

Adult↗
PubMed1989

Cardiac ischemia and endothelial function in the isolated rabbit heart.

Truly effective prevention of reperfusion myocardial damage is precluded in part by a lack of understanding of the earliest events which accompany ischemia. The purpose of this study was to assess the coronary endothelial response to two forms of ischemic injury in an isolated crystalloid perfused rabbit heart. Global cardiac ischemia, confirmed by NADH fluorescence photography, was induced either by mechanically reducing coronary flow by 90% (MRCF, N = 11) or by an infusion of N-formyl-methionyl-leucyl-phenylalanine (fMLP, N = 11), a known stimulus for leukotriene synthesis and coronary vasospasm. Compared with control, MRCF resulted in an increase in effluent concentrations of both prostacyclin (152 +/- 22 pg/ml vs 951 +/- 214 pg/ml, P less than 0.05) and plasminogen activator (0.8 +/- .3 IU/ml vs 1.4 +/- 0.5, P less than 0.05) but no detectable increase in effluent thromboxane B2 or leukotriene C4 concentrations. fMLP infusion resulted in an immediate reduction in coronary flow coincident with diffuse myocardial ischemia. In contrast to MRCF, however, fMLP-induced ischemia resulted in a significant but smaller increase in effluent prostacyclin concentration (210 +/- 47 pg/ml vs 606 +/- .55 pg/ml, P = 0.05) and a marked increase in both thromboxane B2 (less than or equal to 33 +/- 4 pg/ml vs 1141 +/- 375 pg/ml, P less than 0.05) and leukotriene C4 (less than 0.25 ng/ml vs 3.3 +/- 1.2 ng/ml, P less than 0.05) concentrations. Additionally, fMLP caused a reduction in effluent plasminogen activator activity (0.5 +/- 0.1 IU/ml vs 0.39 +/- 0.1 IU/ml, N = 4).(ABSTRACT TRUNCATED AT 250 WORDS)

6-Ketoprostaglandin F1 alpha↗
PubMed1989

Technetium-99m complexes of dimethylaminomethylene diphosphonate (DMAD)--I. Anion exchange HPLC characterization of 99mTc(NaBH4)-DMAD mixtures.

Radiopharmaceutical analogs prepared by sodium borohydride reduction of 99mTcO4- in the presence of DMAD have been characterized by anion exchange HPLC (high performance liquid chromatography) separation of the resulting mixture into component 99mTc-DMAD complexes. The distribution of complexes within a radiopharmaceutical formulation can be manipulated by controlling technetium concentration, pH, presence or absence of air, and time post reaction.

Borohydrides↗
PubMed1989

Technetium-99m complexes of dimethylaminomethylene diphosphonate (DMAD)--II. Biological distributions of 99mTc-DMAD components isolated by anion exchange HPLC.

HPLC isolated components of 99mTc(NaBH4)-DMAD mixtures exhibit significantly different biological properties than do analogous components of 99mTc(NaBH4)-MDP and 99mTc(NaBH4)-HEDP mixtures. Most importantly, 99mTc-DMAD components desorb from normal bone whereas analogous 99mTc-MDP and 99mTc-HEDP components do not. However, within an osteogenic rat model, an HPLC isolated 99mTc-DMAD component does not exhibit an unusually high abnormal/normal tibia uptake ratio.

Animals↗
PubMed1989

Controlled clinical trials in drug research: permission versus notification.

1. Controlled clinical trials by competent investigators in appropriate clinics or scientific institutions should be allowed upon notification of the health authority. 2. The notification should include the pharmacological and toxicological data, the name of the principal investigator and the institution he or she is working for. 3. In countries where there are no specific statutory provisions concerning clinical trials, the protocol should be approved by an ethics committee. In the case of a multicentre study, the approval of one committee should be sufficient. 4. Local law should provide the authorities with the power to stop or curtail the study if it appears to become dangerous.

Clinical Trials as Topic↗
PubMed1989

The right not to be treated or to refuse treatment.

The corollary to the right to refuse treatment is the requirement that, in general, informed consent be obtained before treatment. The Declaration of Lisbon recognises this: "The patient has the right to accept or to refuse treatment after receiving adequate information." The information to be given to the patient is of three kinds, but a special problem in relation to the doctrine of informed refusal places a special duty on the doctor to inform the patient about the possible consequences of refusing treatment. Related topics, such as refusal in part, refusal by a parent or guardian, the novus actus interveniens, the living will, and contributory negligence are touched upon.

Adult↗