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Biomedical subjects

F Loogen

Publications and source records attributed to F Loogen.

At least 37 records · Page 2Linked to original sources
PubMed1985

Doppler versus contrast echocardiography for diagnosis of tricuspid regurgitation.

Sixty-eight patients (mean age 49 years) were studied with contrast echocardiography (CE) and Doppler echocardiography (DE) to evaluate both methods for detecting and grading tricuspid regurgitation (TR). In all patients, right ventricular (RV) angiography was performed. The severity of TR was graded on a 4-point scale. Only 68 of 88 patients who underwent RV angiography (77%) could be evaluated, but 65 of 68 patients who underwent CE (96%) and all 68 who underwent DE (100%) could be evaluated. TR was present in 33 patients as seen on RV angiography. CE and DE correctly diagnosed 27 and 30 patients, respectively, corresponding to a sensitivity of 82% for CE and 91% for DE. Specificity was 100% for CE and 86% for DE. CE and DE grading, respectively, of TR vs RV angiographic grading showed no difference in 50 and 47 patients, a 1-level difference in 8 and 13 and a 2-level difference in 7 and 5 cases. (CE-RV angiography, r = 0.84, p less than 0.001; DE-RV angiography, r = 0.82, p less than 0.001). Thus, CE and DE are accurate methods for routine diagnosis of TR, with DE having higher sensitivity and easier grading. Considering the possibility of false-positive findings of our standard RV angiography, sensitivity and specificity of CE and DE could be even higher.

Adult↗
PubMed1985

[Cimetidine and ranitidine in intensive care patients. Double-blind randomized cross-over study on intravenous administration: hemodynamics, plasma coagulation, blood gases and acid-base status].

Intravenous cimetidine 200 mg, and ranitidine 50 mg were administered as 2 minute infusions to 50 intensive-care patients. Cimetidine and ranitidine differed significantly in their effect on systolic arterial blood pressure measured during the second minute (alpha = 0.01). In the case of cimetidine the haemodynamic parameters measured over 10 minutes revealed a clearly defined fall in systolic, diastolic and mean arterial blood pressure as well as a rise in heart rate. The initial values were regained 5 minutes after drug application. Adverse effects of ranitidine on haemodynamics were much less than those of cimetidine. Neither drug produced any essential change in clotting parameters (partial thromboplastin time, plasma thrombin time, thromboplastin time and fibrinogen) measured before and 5 minutes after application, nor had they any effect on blood-gases or acid-base status.

Acid-Base Equilibrium↗
PubMed1985

Long-term follow-up of pulmonary hypertension in patients with and without anorectic drug intake.

Over a period of up to 18 years, 24 patients (mean age: 33.8 years) with primary vascular pulmonary hypertension (PVPH) of unknown aetiology (group A) and 18 subjects (mean age: 45.3 years) with PVPH due to anorectic drug intake (group B) were comparatively studied. The following main tendencies became apparent: 1) The 10-year cumulative survival rate in group A (0.31) was lower than in group B (0.63). 2) Patients of group A showed more marked X-ray and ECG signs of pulmonary hypertension and right ventricular hypertrophy in comparison with group B. In contrast to group B, the ECG signs of hypertrophy in group A increased during the observation period. 3) Mean pulmonary artery pressure (PAP) significantly increased in group A (from 48.8 to 61.0 mmHg), while it decreased (from 47.6 to 33.3 mmHg) in group B. 4) The diameter of the descending branch of the right pulmonary artery increased with rising PAP only in group A, while the relationship between PAP and the Sokolow-Lyon index was significant only for the whole group of PVPH patients but not for the subgroups A and B. A regression of pulmonary hypertension in patients with anorectic drug intake was obvious, in contrast to the course in patients with PVPH of unknown aetiology.

Adolescent↗
PubMed1985

[Follow-up of patients with minor grades of dilated cardiomyopathy].

It is not known whether dilated cardiomyopathy (DCM) with a slight reduction of left ventricular contractions represents an "early form" and is liable to deterioration. 29 patients (mean age 45 +/- 10 years; 66% women) with mild DCM (angiographic ejection fraction between 50 and 60%, mean 56 +/- 3%) were prospectively studied for 4.0 +/- 1.7 years. No patients died. Comparing the beginning of this study (I) with its end (II) the mean clinical class (I 2.0 +/- 0.4, II 2.0 +/- 0.4), cardio-thoracic ratio (I 0.48 +/- 0.05, II 0.47 +/- 0.04), the end-diastolic diameter of the left ventricle (I 52.2 +/- 6.2 mm, II 53.0 +/- 5.2 mm) and fractional shortening in M-Mode echocardiography (I 28.3 +/- 6.8%, II 29.4 +/- 7.1%) remained unchanged. Compared to the angiographic ejection fraction at the start of the study, this parameter was slightly reduced in the final examination by 2-dimensional echocardiography (46 +/- 7%). One patient with definite echocardiographic and clinical deterioration showed from the outset a distinct increase in end-diastolic size of the left ventricle. Four patients with improvement in M-Mode parameters did not fundamentally differ from the rest of the patients. Our results indicate that a slight reduction in contractions rarely deteriorates further, and should thus not always be considered as an early form of DCM.

Arrhythmias, Cardiac↗
PubMed1985

[Transprosthetic catheterization of a Björk-Shiley aortic prosthesis with fatal outcome].

Retrograde transprosthetic catheterization of a Björk-Shiley aortic prosthesis (type ABP) using a Sones catheter resulted in sticking of the tilting disc. Every attempt to withdraw the catheter failed and the patient died before he could be transferred for emergency reoperation. We advise against transprosthetic catheterization of tilting or bileaflet prostheses, which has been reported to be easily to perform without apparent risk. If left ventricular catheterization is mandatory after aortic valve replacement, the transseptal approach should be used. This is the only procedure which permits accurate evaluation of the functioning of the prosthesis or a concomitant mitral valve disease.

Aortic Valve Stenosis↗
PubMed1984

Prosthetic valve endocarditis: clinical findings and management.

Prosthetic valve endocarditis (PVE) was shown in 46 patients out of a group of 2163 carrying prosthetic heart valves. The cumulative rate of early PVE was 1.4% and 1.5% for PVE occurring between the 60th day and 10 years after surgery. In 37% of all cases this was caused by staphylococci, 20% by streptococci, and 13% Gram negative species. Fungi were found in 9% and mixed infections in 21%. The incidence of staphylococci, Gram negative pathogens and fungi was significantly higher in early PVE. In 5 patients, valve involvement consisted in echocardiographically shown vegetations and/or obstructive thromboendocarditis. In 90% of 37 patients who developed paravalvular leakages, there was high intravascular haemolysis uncharacteristic of the type of prosthesis implanted. In 70% fluoroscopy revealed disproportionate tilting of the prosthetic annulus, and in 75% there was a distinct echocardiographic pattern in the closing movement of the valve poppet. The cumulative survival rate after six months was 31% for the conservatively treated, and 66% for the medically plus surgically treated patients. Survival rates at the end of a maximum follow-up of 20 years was 15% with conservative treatment and 51% after primary surgical therapy. The prognosis was worse (P less than 0.01) in patients who, during aortic PVE, developed heart failure refractant to therapy due to haemodynamically significant prosthetic valve dysfunction, to sepsis that persisted for more than 72 h despite antibiotic therapy, to major septic embolism or to acute renal failure. The retrospective prognosis was more favourable for patients with early aortic (P less than 0.02) or mitral (P less than 0.05) valve re-replacement than for patients who had been treated medically only.

Adult↗
PubMed1984

Bacteriological assistance for optimal antibiotic therapy of endocarditis.

The specific anatomical changes of the infected valvular tissue demand the best bactericidal antibiotic therapy of endocarditis. However, quantitative antibiotic sensitivity testing and determination of the bactericidal effectiveness is not sufficiently routinely practised. It is presented how appropriate bacteriological assistance to achieve the optimum antibiotic therapy for endocarditis leads to favourable clinical results. Establishment of reference laboratories for quantitative antibiotic sensitivity testing in every case of endocarditis is proposed. Active cooperation between these centres would provide excellent data for method and result comparison.

Anti-Bacterial Agents↗
PubMed1984

[Electromyographic determination of the fatigability of respiratory and leg muscles before and after aortocoronary bypass operation].

To study the effect of postoperative confinement to bed on respiratory muscle fatigue, 31 male subjects (age, 34-66 years) undergoing coronary artery revascularization were examined. Fatigue of both respiratory muscles (musculi intercostales externi) and leg muscles (musculus gastrocnemius) was determined by electromyography prior to and 7 and 12 days after operation. Additionally, oscillatory resistance to breathing and phase angle were measured. Pre- and postoperative routine lung function tests were performed. A comparison between preoperative and postoperative measurements reveals that respiratory as well as leg muscle fatigue occurred at higher loads during the preoperative and the second postoperative than during the first postoperative determination. After surgery vital capacity, total lung capacity, 1-second capacity, and, to a lower extent, thoracic gas volume were diminished, while specific airway conductance, oscillatory resistance to breathing, phase angle, residual volume, and relative 1-second capacity remained unchanged. The constancy of the latter parameters indicates that neither airway obstruction nor a significant restriction of the lung and/or thorax occurred due to surgery. Therefore, the increase of respiratory muscle fatigue after surgery may more probably be attributed to a lack of training of respiratory muscles which may contribute to limitation of ventilation in bedridden patients.

Adult↗
PubMed1984

[Echocardiographic follow-up in latent cardiomyopathy].

Follow-up studies of left ventricular dimensions and function in latent cardiomyopathy (LCM) (as defined by abnormal left ventricular function during exercise in otherwise "normal" heart) have not yet been published. 36 patients with normal left ventricular data at rest (echocardiography, left ventricular angiography, coronary angiography, pulmonary artery pressure), but at least one pathologic function parameter during exercise, were studied prospectively by clinical means and by one- and two-dimensional echocardiography (mean follow-up 3.3 +/- 1.3 years). No patients died. The mean clinical class remained unchanged. The echocardiogram did not reveal an increase of left ventricular end-diastolic dimensions in any case. On average the end-systolic diameter of the left ventricle and shortening fraction in the M-mode echocardiogram did not change either. However, in 5 out of 9 patients with left bundle branch block the 2D-echocardiogram showed the development of a slight reduction of left ventricular contractions (without an increase in the end-diastolic dimensions). This was not to be observed in any patient without LBBB. Another finding was that the dimensions of the left atrium of LCM patients exceeded those of a group of normal subjects (p less than 0.02) with a further increase in the course of the disease (p less than 0.001). Thus, regarding the follow-up of patients with LCM without LBBB, there is no indication of any increase in the size of the left ventricle or reduction of its contractions at rest (mean follow-up 3.3 years). However, our results seem to underline the suspicion of a deterioration in left ventricular function of patients with LBBB.

Bundle-Branch Block↗
PubMed1984

[Early and late hemodynamic changes following operative therapy of hypertrophic obstructive cardiomyopathy].

10 patients (8 men, 2 women; 24 to 72 years of age at the time of operation) with hypertrophic obstructive cardiomyopathy (HOCM) underwent exercise tests a mean of 10 +/- 3.7 months before as well as 12 +/- 1.1 and 52 +/- 6.3 months after subvalvular septal myectomy. The following hemodynamic parameters were assessed: heart rate, arterial pressure, total body oxygen consumption, arterio-venous oxygen difference, stroke volume, cardiac output, and pulmonary artery pressure. Clinical symptoms improved in all patients after surgery, at the first postoperative investigation in 8 patients by one class and in 2 patients by two classes according to the New York Heart Association's classification. At the second postoperative study, 2 patients reported a further improvement, 5 patients no further change, and 3 patients a partial deterioration of symptoms. Exercise tolerance, however, did not decrease in any patient. It increased from a preoperative mean of 68 +/- 7.5 watts to 90 +/- 10.0 watts (p less than 0.02) at the first and 102 +/- 14.1 watts at the second postoperative study. The hemodynamic parameters showed the following alterations at the highest exercise levels (mean 68 +/- 7.5 watts) reached by individual patients in all three exercise studies: heart rate, at the first postoperative study, was an average of 16 bpm, i.e. 13% lower than in the preoperative test, and then remained constant. Arterial blood pressure showed no definite alterations. Total body oxygen consumption was unchanged at the first postoperative evaluation, but increased at the second postoperative test by an average of 132 ml/min, i.e. 10% (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Calculated and measured oxygen saturation. A valid comparison of the Kelman, Severinghaus, and Siggaard-Anderson formulas for calculating oxygen saturation of patients in intensive care].

The validity of calculation of oxygen saturation by means of Kelman's, Severinghaus ' and Siggaard -Andersen's formulas was investigated in 329 arterial and 26 mixed venous blood samples of intensive-care patients. The spectrophotometric measurement of oxygen saturation with Radiometer's Hemoximeter OSM2 served as reference. In spite of good coefficients of correlation regarding the total number of samples (r 0,963/ Kelman's formula; r = 0,964/ Severinghaus and Siggaard -Andersen's formula) there were not as satisfactory correlations in some individual patients. The study shows that there was a decrease in conformity between measured and calculated oxygen saturation with decreasing oxygen tension in the blood. Sufficient accuracy of calculation of saturation can be expected only with pO2 greater than 80 mmHg. Siggaard -Andersen's formula was slightly superior to the other tested algorithms.

Adult↗
PubMed1983

Clinical course and prognosis of patients with typical and atypical hypertrophic obstructive and with hypertrophic non-obstructive cardiomyopathy.

In a total of 339 patients with hypertrophic cardiomyopathies (typical HOCM, n = 224; atypical HOCM, n = 30; HNCM, n = 80) the clinical course, the Sokolow-Lyon index in the ECG and the prognosis as demonstrated by cumulative survival rates were analysed to get more differentiated information for the characterization of these myocardial disorders. No change in the type of hypertrophic cardiomyopathy was found, indicating different clinical entities. No increase of the Sokolow-Lyon index was observed during follow-up. Only a small proportion of patients seemed to benefit from treatment with propranolol. Surgical treatment appears to be the therapy of choice, at least in the advanced stage of the disease refractory to medical treatment. In addition, strong evidence was obtained that surgical treatment improved the prognosis in patients with typical HOCM.

Adult↗
PubMed1983

Exercise performance in hypertrophic cardiomyopathies.

Based on bicycle ergometer tests in 50 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 19 patients with hypertrophic non-obstructive cardiomyopathy (HNCM) if clinical (NYHA) class I to IV, the profile of several haemodynamic parameters (heart rate, stroke volume index, cardiac index, pulmonary artery pressure) during exercise was evaluated. The following pattern was found: (1) with increasing degree of clinical symptoms, the mean values of stroke volume decrease and the mean values of pulmonary artery pressure increase; (2) stroke volume does not show the normal increase during exercise in a considerable number of patients (48% of HOCM, 26% of HNCM patients); (3) failing increase in stroke volume is in part compensated by increase in heart rate; (4) pathological increase in mean pulmonary artery pressure correlates with severity of clinical symptoms, but even a considerable number of clinically asymptomatic patients exhibit extremely pathological pressure increase; (5) there is no fundamental difference of the behaviour of the measured haemodynamic parameters between HOCM and HNCM; (6) there is marked overlapping of exercise-induced haemodynamic changes between patients of different NYHA classes of clinical impairment. Therefore, measurements of exercise haemodynamics are necessary to define clearly the degree of functional impairment in the individual patient. Based on identically performed exercise tests in 53 patients with HOCM, the clinical and haemodynamic effects of medical therapy with propranolol (n = 12) or verapamil (n = 25) and of surgical treatment (n = 21) were compared. Maximal exercise capacity was on an average not changed after propranolol but increased after verapamil and, most significantly, after surgery. This could be attributed to corresponding haemodynamic changes, especially concerning cardiac output and pulmonary artery pressure. As a whole, verapamil was clinically and haemodynamically superior to propranolol, but not as effective as surgical treatment.

Adult↗
PubMed1983

Arrhythmias in hypertrophic obstructive and non-obstructive cardiomyopathy.

The surgical therapy of hypertrophic cardiomyopathy (HOCM) has been shown to improve symptoms and the haemodynamic status. The prognosis after transaortic subvalvular myectomy seems to be relatively better compared to those patients with HOCM who undergo medical therapy. Complex ventricular arrhythmias have been shown to influence prognosis. Therefore, a study was undertaken to analyse the influence of surgery on ventricular arrhythmias in patients with HOCM. Thirty-one patients (23 male, eight female), mean age 44 +/- 13.6 years (range 13 to 72 years) underwent 48 h ambulatory monitoring pre- and postoperatively. Additionally 15 patients with hypertrophic non-obstructive cardiomyopathy (HNCM) were studied. Mean age was 49 +/- 11.5 years (range 28 to 69 years). Complex ventricular arrhythmias were defined as pairs (two consecutive QRS complexes) or non-sustained ventricular tachycardia (VT) (much greater than 3 QRS). Results in the operative group (HOCM) were as follows: The overall frequency of ventricular extrasystoles was low. There was no difference in the mean hourly ventricular extrasystole counts pre-operatively as compared to postoperatively. Thirteen patients had no pairs or VT pre- and postoperatively. Six patients had VT or pairs pre- and postoperatively. In five patients complex arrhythmias were detected only before surgery, whereas in another seven patients VT was first documented after operation. Overall, 11 patients had complex ventricular arrhythmias pre-operatively (pairs n = 3; VT n = 8, 3 to 8 QRS, rate 142 +/- 15 beats/min). Thirteen patients had complex ventricular arrhythmias after operation (pairs n = 4; VT n = 9, 4 to 10 QRS, rate 150 +/- 40 beats/min). Results in patients with HNCM were as follows: The overall frequency of ventricular extrasystoles was low, only three patients had a mean extrasystole count of more than 20 beats/h. Five patients had pairs and three patients ventricular tachycardia (5 QRS, rate 110 to 160 beats/min).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗