[Ductus arteriosus Botalli persistens in adults with pressure compensation. Clinical symptoms and findings].
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Biomedical subjects
Publications and source records attributed to G Alber.
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41 patients with inferior myocardial infarction underwent both exercise stress testing and coronary arteriography. Coronary arteriography of 15 patients showed high-degree stenosis as well as occlusions of the right coronary artery and/or of the R. circumflexus of the left coronary artery alone. In 14 of these 15 cases exercise stress testing showed a normal result, in one case results were abnormal. However, we detected additional high-degree stenosis of R. interventricularis anterior and/or of R. diagonalis and/or of R. marginalis in the other 26 patients. In 22 of these 26 cases exercise stress testing showed an abnormal result, in 4 cases it was normal. Because of a sensitivy of 84,6% and a specificity of 93,3% we can assume, that abnormal results of exercise stress testing suggest additional high-degree stenosis of the RIVA-vessel system in patient after inferior myocardial infarction. Considering an eventual bypass operation it is possible to narrow the indication for coronary arteriography.
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The Huerthle cell tumor is quite frequent in southern Germany; this is shown by examinations of patients from our field hospital for nuclear medicine. Our findings conclude with data presented by Galvan (Salzburg). The certainly quite short observation period shows that Huerthle cell adenomas occur much more frequent than carcinomas, when a Huerthle cell neoplasm is diagnosed cytologically. Our investigations show, that Huerthle cell tumors of the thyroid gland are a not wellknown and rare disease, which necessitates a clear decision as result of the cytological finding as far as necessary surgical measures are concerned. This is probably the only way to improve the efficiency of measures for early diagnosis and treatment of tumors of the thyroid gland. Considering the want of clearness which still exists referring to the dignity of Huerthle cell tumors in our opinion even cases which had been diagnosed as adenomas histologically should be controlled regularly once a year during an observation period of ten years.
The therapy of myocardial infarction in elderly is submitted to restrictions and modifications especially regarding the selection and dosage of the used agents. Numerous antiarrhythmic agents are tolerated from patients in advanced age only with a reduced dose. The treatment of cardiogenic shock is the more problematic, the fewer is suffered a breakdown of blood pressure from the "central" organs brain, heart and kidneys. A rational therapy, adapted to the advanced age, which includes the application of anticoagulants, too, is outlined and founded.
Most of the pacemaker-patients are in the eight decade of life. The continuous follow ups of the patient with a pacemaker system have to reguard the often advanced age, the cardiac basic disease, other concomitant diseases and futhermore technical details of the device, the date of implantation and the expected longevity of the power source. The risk of the patient by pacemaker failure in the underlying rhythm disturbance can be estimated by short extinguish of the pacing activity. The additional medical treatment is determined by the findings and must be adapted to the mentioned circumstances.
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