[A solid state fiber optic system for continuous measurement of oxygen saturation and for cardiac output determination with the dye-dilution method (author's transl)].
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Biomedical subjects
Publications and source records attributed to F Bender.
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The detection of coronary artery calcification by roentgenoscopy is an important hint at possible ischemic heart disease. By the advent of image intensification and magnification, this examination can easily be performed. If no calcifications are visible, an ischemic heart disease must not be excluded. The presence of calcification in the coronary arteries however strongly favours the diagnosis of arteriosclerotic heart disease. The roentgenoscopical search of coronary calcification is considered to be a valuable procedure since it is inexpensive, noninvasive and widely applicable.
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The effect of 0.4 mg i.v. Prindolol on arterial blood pressure and heart rate was investigated with continuous measurement by telemetry. The 19 healthy subjects and 13 patients were controlled at rest supine, standing and finally during exercise. Following Prindolol a significant decrease of blood pressure and heart rate was observed, in particular in the group suffering from hypertension and tachycardia and under conditions of exercise, when compared with the pretreatment values. No side effects were noted.
In 20 patients with acute myocardial infarction hemodynamic controls were performed after digitalisation and following i.v. injection of 0,4 mg of Prindolol. Circulatory changes were most pronounced 5-15 min after Prindolol injection and consisted of decrease in heart rate of 7%, mean arterial blood pressure of 6%, cardiac output of 10,5%, stroke volume index of 5,1% and left ventricular work of 18%. An increase of pulmonary wedge pressure of 17%, pulmonary pressure of 9%, mean right atrial pressure of 16% and peripheral arterial resistance of 6% were calculated. In 5 cases a favourable effect on extrasystoles and in 2 cases on sinus tachycardia were observed. Not infrequently, during the initial phase of acute myocardial infarction, a hyperadrenergic state may be noted. Prindolol may be indicated, when circulatory changes or arrhythmias are suspect to be the result of this hyperadrenergic stimulation. A simultaneous digitalisation may inhibit a more intensive cardiodepression.
In 59 digitalized and 3 non digitalized patients the effect of digitalis during the 1st to 4th days after transmural myocardial infarction was controlled. Rhythm disturbances in acute myocardial infarction may arise secondary to a complicating cardiac failure and may be influenced by digitalis. In 9 of 17 cases (53 p.c.) with ventricular or supraventricular extrasystoles daily doses of 0,4 mg beta-Methyldigoxin or 0,4 mg Digoxin i.v. resulted in undisturbed sinus rhythm. In two cases supraventricular tachycardia and extrasystoles with rapid ventricular rate were abolished by 1,2 mg beta-Methyldigoxin within 12 hours, in three other cases an improvement was recorded. Dysrhythmias or other complications did not occur in previously non digitalized patients. When the antiarrhythmic effect of digitalis cannot be obtained cardiodepressive complications by treatment with typical antiarrhythmic agents are diminished. In patients on digitalis and in cardiogenic shock, digitalization should be performed carefully. Intoxication leads to a diminution of cardiac output and to cardiac dysrhythmias.
In 3 patients with a congenital aneurysm of the membranous portion of the ventricular septum diagnosis could be made by angiography. One of these patients was clinically asymptomatic, while the two other patients were transferred for surgery because of right ventricular outflow tract obstruction or intracardiac left-to-right shunt. These both patients underwent successful open heart corrections. Aneurysms with a different intracardiac localization could be found. One of the cases represents an unusual association with corrected transposition of the great vessels.
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The floating catheter technique is much more frequently used than before. So far, relatively rare complications become of practical importance. A report is given on three cases in which catheter fragments were cut off and floated into the right heart or pulmonary artery. In one case, the fragment was removed from the right heart after percutaneous insertion of a specially devised instrument similar to a myocardial bioptome. The question does not seem to be settled as yet, whether or not surgical interventions are indicated, when a fragment cannot be removed by these techniques.
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In 44 patients with single or multiple valvular protheses of the heart, the problem of secondary iron deficiency due to mechanical hemolysis was investigated. In 17 cases, elevated serum transferrin values were noted, compared to elevated serum iron levels in only 6 cases. Therefore, treatment should be based on the more reliable transferrin values. Severity and duration of mechanical hemolysis did not seem to be correlated with the occurrence or the degree of iron deficiency.