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Biomedical subjects

F Nager

Publications and source records attributed to F Nager.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Therapy of angina pectoris--state of the art].

A rational therapy of angina pectoris has to consider two recent pathophysiologic insights: 1. Not only in patients with instable but also with stable angina a dynamic, vasospastic component in addition to stenosis plays an important role. Stable angina is often a mixed form of disease. 2. In many patients stable angina is complicated by silent ischemia. Therapy of stable angina has 3 goals: 1. prevention or alleviation of angina; 2. reduction of silent ischemia episodes (number, extent); 3. cardioprotection i.e. prevention of instable angina, infarction and sudden death. The pharmacotherapeutic cornerstones are the nitrates, beta-blocking agents and calcium channel blockers. Their generally equivalent efficacy in short and longterm use is clinically and hemodynamically proven without doubt. Mode of action, pharmacokinetic aspects and recent as well as controversial questions regarding this group of drugs are reviewed. The pharmacotherapy of first choice should be determined for each patient individually and not according to schematic prescription. It should encompass pathogenesis of ischemia, specific indications for or adverse effects of the 3 drug classes, the question of induction of tolerance, possible cardioprotective benefit, side effects, compliance problems and finally cost of treatment. The rational aspects of combination therapy (nitrates and beta-blockers, beta-blockers and calcium antagonists) are explained and the therapeutic procedures for instable angina are outlined.

Adrenergic beta-Antagonists↗
PubMed1990

[Clinical aspects of staphylococcal endocarditis].

Patients with staphylococcus endocarditis hospitalized at the Cantonal Hospital Lucerne from 1971 to 1988 are reviewed. A total of 50 patients fulfilled the diagnostic criteria (in 60% of the cases the diagnosis was definite, in 26% probable, and in 14% possible). These 50 patients with staphylococcus infection account for 29% of all patients with infective endocarditis seen during this time interval. Staphylococcus endocarditis affected the mitral valve in 48%, the aortic valve in 36% and--unexpectedly often--the tricuspid valve in 30%. In 54% previously normal valves were infected. Diminished host defence (predominantly intravenous drug addiction and diabetes) was a predisposing feature in 52% of the patients. The average duration of symptoms before diagnosis was 11 days, and in patients with right heart endocarditis it was 21 days. In 20% the condition was not diagnosed before autopsy. The clinical picture was relatively nonspecific: 50% of patients had no diagnostic heart murmur and 10% had no fever. The dominant--often misleading--symptoms were due to embolic complications. Two thirds of the cases with right heart endocarditis had pulmonary emboli. In 38% of the patients endocarditis resulted in heart failure. Overall mortality was 51% and correlated with age and the presence of heart failure, uncontrolled infection or cerebral embolism. In contrast to the high mortality in patients with mitral valve infection (61%), only one of the 11 patients with isolated right heart endocarditis died.

Endocarditis, Bacterial↗
PubMed1989

[Heart valve replacement in active infectious endocarditis].

A material of 87 patients who underwent cardiac surgery for active infective endocarditis from 1975 to 1987 is analyzed retrospectively. 91 emergency operations were performed in 19 women and 68 men with a mean age of 48 years. 72 native valves and 19 prosthetic valves were involved. Streptococci (41%) and staphylococci (27%) were the most frequent bacteriological isolates, whereas 19% of the cultures remained negative. Heart failure (52%), embolism (21%), uncontrolled infection (11%), prosthetic valve endocarditis (10%), atrioventricular block (4%) and ventricular septal defect (2%) were the indications for surgery an average of 22 days after diagnosis. 17 patients (19%) died, 9 during hospitalization from heart failure or septicemia and 8 in the later course. 16 patients required reoperation for valvular incompetence (5), paravalvular leak (4) or prosthesis infection (7). Five relapses (5.5%) and two reinfections (2.5%) were treated surgically while two reinfections responded to medical therapy alone. Postoperatively, 34 patients (39%) suffered severe complications such as neurological deficits, prosthetic valve endocarditis or anticoagulant haemorrhage. After a mean observation period of 52 months (range 1-147 months) 64 (91%) of the surviving patients were in NYHA classes I + II and 6 (9%) in NYHA classes III + IV.

Adolescent↗
PubMed1989

[Medical and psychological problems of smoking].

In the medical part of this review the devastating role of the "modern plague" smoking is exposed. The numerous and variable diseases of this habit or dependence are depicted. The most serious consequences of smoking concern--next to pulmonary diseases--the vascular system. Smokers are at risk for ischemic heart disease, cerebrovascular insults, peripheral arterial occlusive disease and thoracic and abdominal aortic aneurysms. The pathogenic mechanisms promoting atherosclerosis and thrombosis are reviewed: smoking promotes atherogenesis on one hand, on the other hand it initiates thrombotic and spastic vascular occlusion. Sympathico-adrenergic and hemostatic mechanisms thus affect the coronary system, partly in a reversible manner. This view is supported by the high incidence of mainly acute coronary events (infarction, instable angina, ventricular fibrillation) in smokers with rapidly improved prognosis after tobacco withdrawal. In the psychologic part of the review smoking is viewed as self-medication, and the attempt is made to depict the various types of smokers and their psychologic profiles.

Cardiovascular Diseases↗
PubMed1989

[Not Available].

Explore the source record for details and available documents.

Germany↗
PubMed1987

[Endocarditis with unusual causative agents].

In the period 1947-1985, 601 patients with infective endocarditis were seen at the University Hospital Zurich and the Kantonsspital Lucerne. Streptococci, enterococci and staphylococci were the predominant causative organisms in two-thirds of all cases. In more than 25% of the patients blood cultures remained negative. In 6 patients endocarditis was caused by very rare organisms, viz. Coxiella burnetii (2 cases), Hemophilus parainfluenzae, Corynebacterium bovis (diphtheroids), Brucella melitensis and Aspergillus terreus. The clinical and microbiological characteristics of these cases are described and compared with the results in the literature. Diagnostic and therapeutic problems are discussed. Only with special awareness of the role of these unusual organisms in causing infective endocarditis, especially Q fever endocarditis with its notoriously atypical course, can the number of "culture negative" cases be diminished and the prognosis thereby improved.

Adult↗
PubMed1987

[Diagnosis of lung embolism. Prospective study].

In a prospective study over the years 1983-1985, 300 cases of acute pulmonary embolism were analyzed in relation to predisposing factors, clinical signs, arterial blood gas analysis and isotope perfusion scanning. Comparison of this prospective study with an earlier retrospective one showed similar results, with the exception of isotope scanning, an investigation which has gained increasing diagnostic reliability (highly suggestive results in 94% of patients with massive pulmonary embolism and in 64% with submassive pulmonary embolism). In two thirds of the cases the diagnosis was established during the first day after hospitalisation. In 10% of the patients pulmonary embolism occurred despite anticoagulant therapy.

Aged↗
PubMed1984

[Clinical demonstrations: Heart rupture in acute myocardial infarct. Infectious endocarditis. Wolff-Parkinson-White syndrome].

This clinical demonstration includes three topics of clinical cardiology: myocardial rupture in acute myocardial infarction, infective endocarditis, and WPW-syndrome with paroxysmal supraventricular tachycardia. In the first part three cases with septal perforation or papillary muscle rupture are demonstrated. Our experience with myocardial rupture (free wall, septum, papillary muscle) during the last six years is summarized with special reference to the significance and the differential diagnosis of systolic regurgitant murmurs after myocardial infarction. Special features of acute mitral incompetence (papillary muscle dysfunction) in myocardial infarction are outlined and diagnostic guidelines for differentiation between septal perforation and papillary muscle rupture are discussed. In the second part two patients with aortic (e.g. mitral) valve rupture in the course of infective endocarditis are presented. The synoptic comparison of these two patients is related to the results of our own clinical studies on the changing pattern of infective endocarditis (epidemiologically, clinically) during the last three decades. The clinical picture of acute aortic valve rupture is outlined and the bedside signs indicating catastrophic complications of infective endocarditis are summarized. In the third part the odyssey of a patient with WPW-syndrome and consecutive paroxysmal supraventricular tachycardia is described. Progress in electrophysiological analysis of the re-entry circles in preexcitation syndromes is outlined.

Adult↗
PubMed1984

[Diagnostic problems in acute pulmonary embolism].

In a retrospective study over the years 1978-1982, 729 cases of acute pulmonary embolism were analyzed in relation to history, clinical signs and laboratory findings and the results compared with the findings of the urokinase pulmonary embolism trial. As far as history and clinical symptoms were concerned, breathlessness, chest pain, tachypnea, tachycardia and cyanosis were the dominating features. Among laboratory tests, the radiological and electrocardiographic findings of pulmonary hypertension were of little value. In contrast, arterial hypoxemia and isotope scanning provided the most reliable diagnostic information. The most frequent problem in differential diagnosis was acute myocardial infarction.

Acute Disease↗
PubMed1983

[The exercise test in cardiomyopathy].

The exercise test in 30 patients with hypertrophic (HCM) and 29 patients with dilatative cardiomoyopathy (DCM) showed a positive test with significant ST depression in half of each group. In 12 out of 30 patients with HCM and 7 out of 29 patients with DCM, exercise testing caused angina. Rhythm disturbances surprisingly did not occur in HCM but where unexpectedly frequent in DCM: in 4 cases exercise testing provoked frequent supraventricular premature beats, in 3 patients paroxysmal atrial fibrillation, and in 11 patients ventricular ectopic beats (Lown class II-IVb). Nine patients exhibited an exacerbation by at least one Lown class as compared with the electrocardiogram at rest. In patients with atypical angina pectoris and a pathological exercise test the possibility of cardiomyopathy - apart from coronary artery disease - should be increasingly considered. With provocation of arrhythmias the possibility of DCM should especially be borne in mind.

Cardiomyopathy, Hypertrophic↗
PubMed1983

[Interaction of amiodarone and digoxin].

A clinical investigation was carried out in 13 patients in order to answer the question of a possible interaction between amiodarone (A) and digoxin (D) and to study the extent to which plasma digoxin levels (PDL) may be influenced by A. Combined therapy with A + D was instituted in patients with supraventricular tachyarrhythmia where treatment with D alone was insufficient. All patients had normal renal function. Amiodarone was added to the treatment regimen of patients receiving D at doses ranging from 0.125 to 0.5 mg daily on a long term basis. The initial dosage of A was 1200 mg daily for 5 days to achieve saturation, followed by a maintenance dose of 200-400 mg daily. 3 PDL were measured before therapy with A was added and during combined A and D treatment at weeks 1, 2 and 3 and 3 months after the addition of A. In 11 patients a significant increase in PDL occurred as early as the 1st and 2nd weeks following the addition of A. In one patient PDL was elevated only after 3 months and in one other patient it remained unchanged. In 4 patients the PDL increase was associated with nausea. No other subjective or objective symptoms of digitalis intoxication were observed. This investigation has demonstrated a clinically relevant interaction between A and D. Regular monitoring of PDL is recommended during the first 3 weeks of combined treatment with A + D, and the D doses should be adjusted accordingly.

Adult↗
PubMed1983

The antiarrhythmic effects of controlled release disopyramide phosphate and long acting propranolol in patients with ventricular arrhythmias.

The antiarrhythmic effect of slow-release disopyramide phosphate (DR) 300 mg twice daily and of long-acting propranolol (PR) 1 X 160 mg daily was compared in a randomized cross-over study in patients with premature ventricular beats (PVB). 12 patients with PVB (Lown Classes II-V) were given: placebo I for 3 days, DR or PR for 7 days, placebo II for 5 days and PR or DR for 7 days. During each study phase Holter-ECG recordings were taken over a period of 24 h. With DR 6 patients showed a positive qualitative effect, improving by at least one Lown class, whereas only 2 patients did so with PR. With DR reduction of PVB greater than 80% occurred in 7 patients, and with PR in 2 patients. In all patients with any reduction in PVB, the median decrease was 85% with DR and 59% with PR. The overall results suggest that the antiarrhythmic effect of disopyramide phosphate in the slow-release preparation is at least satisfactory and comparable to that of disopyramide phosphate in the standard capsule formulation given in the usual and more complicated regime of four divided doses. The antiarrhythmic effect of PR in the recommended dose as given was not convincing.

Adolescent↗