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Biomedical subjects

G Grimm

Publications and source records attributed to G Grimm.

At least 37 records · Page 2Linked to original sources
PubMed1995

The impact of implantable cardioverter-defibrillators on mortality among patients on the waiting list for heart transplantation.

Implantable cardioverter-defibrillators were investigated for their impact on mortality in 228 consecutive heart transplant candidates on the waiting list for transplantation (207 patients without and 21 with implantable cardioverter-defibrillator therapy). The mortality rate in 207 patients without implantable cardioverter-defibrillator therapy was 23.2% and in 21 patients with implantable cardioverter-defibrillator therapy was 4.7%. In a Cox proportional hazards model for all 228 study patients (mortality while on the waiting list: 21.5%; transplantation rate: 54.8%), the absence of an implantable cardioverter-defibrillator was only a marginally significant predictor of mortality (p = 0.079). However, the absence of an implantable cardioverter-defibrillator was a powerful predictor of mortality for a subgroup of 134 patients with high-grade ventricular arrhythmias on Holter electrocardiography (mortality while on the waiting list: 26.1%; transplantation rate: 54.5%; p = 0.022) and for a subgroup of 58 survivors of sudden cardiac death (mortality while on the waiting list: 22.4%; transplantation rate: 56.9%; p = 0.018). Implantable cardioverter-defibrillator therapy can be strongly recommended in transplant candidates with a history of sudden cardiac death. Recommendations for an expanded, prophylactic use of implantable cardioverter-defibrillator therapy in heart transplant candidates cannot be given.

Arrhythmias, Cardiac↗
PubMed1995

[Strategies in management of heart transplantation candidates with tachycardic ventricular arrhythmia anamnesis].

We followed up 73 consecutive patients with a history of syncopal ventricular tachyarrhythmias on the waiting list for a heart transplant between 1st March 1992 and 15th September 1994 with the aim of evaluating the impact of implantable cardioverter defibrillator (ICD) on survival. On registration 60 patients were considered fit enough to be ambulant whilst awaiting transplantation. 30 were given ICD therapy (group 1) and 30 were not (group 2). 13 patients required inpatient supervision for ventricular arrhythmias whilst awaiting transplantation, but received no ICD therapy (group 3). The 13 in-patients were in a worse clinical state (NYHA) than the 30 out-patients not given ICD (p < 0.05). With respect to all other clinical and hemodynamic characteristics all groups were comparable. Waiting time for transplantation was also comparable in all groups (n.s., log-rank method). ICD therapy resulted in a significant improvement of survival in these high-risk patients prior to transplantation. Only 1 out of the 30 ICD patients (group 2) and 5 out of the 13 in-patients (group 3) (p < 0.05 log-rank method). During the waiting time group 3 patients were hospitalised longest (p < 0.05), but there was a clear trend that also ICD patients had to be hospitalised to an increased extent (n.s.). Cox multivariate regression analysis of this study population showed that the cardiac index (p = 0.001) and lack of ICD therapy (p = 0.035) were the only independent significant predictors of mortality on the waiting list. ICD therapy had no influence on mortality after transplantation (n.s. log-rank method).

Adult↗
PubMed1994

Serial recording of sensory evoked potentials: a noninvasive prognostic indicator in fulminant liver failure.

Sensory evoked potentials are markedly changed in patients with fulminant liver failure. It is unknown, however, whether serial recordings of sensory evoked potentials provide useful prognostic informations for patient management in fulminant liver failure. Ninety recordings of bilateral median nerve-stimulated short- and long-latency sensory evoked potentials were performed in 25 patients with fulminant liver failure (9 patients spontaneously recovered and survived, 8 patients were referred to emergency liver transplantation and 8 patients died). In all nine survivors the cortical long-latency sensory evoked potential N70 peak was constantly detectable between 74 and 162 ms. In all eight patients who subsequently underwent liver transplantation and in seven of eight patients who died, loss of the N70 peak developed during the course of fulminant liver failure. In 4 of 15 patients who were selected for liver transplantation according to the King's College criteria, the N70 peak was constantly detectable. All four transplantation candidates spontaneously recovered and survived without transplantation. In contrast, eight patients never did fulfill the criteria for liver transplantation. Five of them with constantly detectable N70 peak recovered spontaneously. However, in the remaining three patients loss of the N70 peak developed, and they ultimately died. The probability of correct outcome prediction by sensory evoked potentials is superior to that based on clinical criteria alone (0.96 vs. 0.72). Therefore serial recording of sensory evoked potentials may help identify (a) a subgroup among liver transplantation candidates who may spontaneously recover without transplantation and (b) a subgroup of patients with severe brain dysfunction who should undergo early liver transplantation even though they do not fulfill King's College criteria.

Adolescent↗
PubMed1994

Cognitive brain function in non-demented patients with low-grade and high-grade carotid artery stenosis.

Atherosclerotic stenosis of the carotid arteries decreases cerebral flow volume and perfusion, and may result in brain dysfunction. We studied the relationship between the degree of carotid artery stenosis and cognitive brain function in non-demented patients. Cognitive brain function was assessed in 76 patients with carotid artery stenosis (38 patients with low-grade stenosis of 50% or less, and 38 patients with high-grade stenosis of 75% or more) by recording of cognitive P300 auditory evoked potentials and trailmaking test. Results were compared to 70 age-matched healthy subjects. The P300 peak latency was prolonged in patients with high-grade carotid artery stenosis as compared to patients with low-grade stenosis (403 vs. 371 ms, P < 0.01, vertex; 400 vs. 370 ms, P < 0.01, frontal; means). Analysis of variance revealed that the degree of carotid artery stenosis is an independent predictor of prolonged P300 peak latency (P = 0.0001). P300 amplitude (12 vs. 15 microV, vertex; 13 vs. 15 microV, frontal, NS) and trailmaking test (60 vs. 54 s; NS) tended to be worse in the high-grade stenosis group. There was no difference in cognitive brain function between patients with low-grade stenosis and age-matched healthy subjects. Confirmed on sensitive cognitive P300 measurements, we conclude that (a) cognitive brain function is impaired in non-demented patients with high-grade carotid artery stenosis but unaffected in low-grade stenosis; and (b) cognitive brain dysfunction is directly related to the degree of carotid artery stenosis.

Aged↗
PubMed1994

Acute renal failure in the elderly 1975-1990.

Two hundred and forty-two elderly patients (> 65 years) with acute renal failure (ARF) treated at a predominantly medical intensive care unit between 1975 and 1990 were retrospectively analyzed for underlying diseases, severity of disease (as evaluated by the rate of ventilated patients, septicemia and APACHE II score, respectively), causes of ARF, acute and chronic risk factors for the development of ARF, complications during treatment and outcome. Overall mortality was 61%; 28 patients (12%) died in spite of resolution of ARF so actually, 49% of the patients died in ARF. Outcome was comparable to other age groups with overall mortality being 57% in patients < 18 years and 59% in those 19-65 years. Moreover, within the group of elderlies mortality did not increase with age and was 60% in those aged 65-68 and 54% in those aged > 80 years, respectively. The need for renal replacement therapy, plasma creatinine > 6 mg/dl, anuria, BUN > 120 mg/dl, ventilator dependency and the presence of septicemia all negatively affected outcome. During the years 1975 to 1990 mortality decreased from > 70% to < 50% (p < 0.02). This improvement of survival was seen in spite of an increase in the severity of disease (1975-1982: 20% ventilated patients, 24% with septicemia, 1983-1990 51% and 40%, respectively, p < 0.01). We conclude that age per se is not an important determinant of survival in patients with ARF and that prognosis has improved considerably during the last 15 years and this was seen in spite of an increase in the severity of disease. It is not justified to withhold therapy in elderly patients acquiring ARF.

Acute Kidney Injury↗
PubMed1994

Oropharyngeal decontamination with gentamicin for long-term ventilated patients on stress ulcer prophylaxis with sucralfate?

The incidence of nosocomial pneumonia in long-term ventilated patients has been reduced by stress ulcer prophylaxis with sucralfate. In a double-blind trial we studied whether gentamicin administered topically to the oropharynx (OPG) had additional clinical benefits in these patients. 67 critically ill adult patients fulfilled entry criteria for > or = 5 days on ventilation. The OPG group received 40 mg gentamicin, the control group received 5% dextrose topically administered to the oropharynx 4 times a day. During OPG, pharyngeal colonization rate (21 vs 44%) and tracheal secretion colonization rate (12 vs 41%) were significantly lower than during placebo (p < 0.05). Despite these differences nosocomial pneumonia rate (3 vs 12%), duration of mechanical ventilation [15.8 +/- 11.1 vs 19.9 +/- 37.5 days (means +/- SD)] and mortality (27 vs 41%) were not significantly affected by OPG. Moreover, 13 of 15 bacteria (87%) that occurred during OPG were resistant to gentamicin. Despite its reduction of bacterial colonization rates of pharyngeal and tracheal secretions, OPG did not seem to offer additional clinical benefits in long-term mechanically ventilated patients on stress ulcer prophylaxis with sucralfate.

Administration, Topical↗
PubMed1993

Molecular cloning of the cDNA for a human amyloid precursor protein homolog: evidence for a multigene family.

Alzheimer's disease is a degenerative neurological disorder characterized by neural loss and brain lesions associated with plaques containing large amounts of the beta/A4 amyloid peptide. Molecular cloning of the cDNA for this peptide from human brain has shown it to be derived by proteolysis from a much larger precursor called the amyloid precursor protein (APP). The biological role of the precursor is unknown, but it has been shown to be transcribed in many human tissues in addition to brain. In the present report, we describe the molecular cloning from a human placental library of a full-length cDNA for a molecule closely related to APP. This novel molecule, which we have called amyloid precursor protein homolog (APPH), shares overall domain organization with APP. It is 763 amino acids in length and appears to encode a signal peptide, a large apparent extracellular domain including a Kunitz inhibitor domain, a transmembrane region, and a short cytoplasmic domain. Northern analysis indicates that it occurs in at least two molecular forms and is transcribed in human brain, heart, lung, liver, and kidney, in addition to placenta. On the basis of its extensive sequence similarity and conservation of domain structure, APPH is the nearest relative of APP yet identified in an emerging multigene family.

Amino Acid Sequence↗
PubMed1993

Early prediction of individual outcome after cardiopulmonary resuscitation.

Prediction of individual outcome after cardiopulmonary resuscitation is of major medical, ethical, and socioeconomic interest but uncertain. We studied the early predictive potency of evoked potential recording after cardiac arrest in 66 resuscitated patients who returned to spontaneous circulation but were unconscious and mechanically ventilated. Detailed long-latency and short-latency sensory evoked potentials were recorded and neurological evaluations were done 4-48 h after admission to intensive care. In all 17 patients with favourable outcome (cerebral performance categories 1 and 2) the cortical evoked potential N70 peak, a reliable measure of cortical function, was detected between 74 and 116 ms. In 49 patients with bad outcome (categories 4 and 5) the N70 peak was absent in 35 or found with a delay between 121 and 171 ms in 14 (p < 0.05 vs favourable outcome). Thus the predictive ability was 100% with cutoff of 118 ms. To confirm reproducibility and validity, repeated tracings, and linked-earlobe referenced techniques were done and gave similar results. Early recording of long-latency evoked potentials after cardiopulmonary resuscitation is highly predictive of outcome.

Adolescent↗
PubMed1993

Energy metabolism in acute hepatic failure.

BACKGROUND: Conflicting data are available concerning energy metabolism in liver disease. Changes should be most pronounced in acute hepatic failure in which loss of 85% of liver cell mass is reported. Metabolic rate could be decreased due to impairment in liver mass but may also be increased as a result of systemic-mediator actions. To clarify this issue we studied energy metabolism in acute hepatic failure. METHODS: Energy metabolism was evaluated by indirect calorimetry in 12 patients with acute liver failure and 22 sex-, age-, and body size-matched healthy individuals. In controls and 5 patients, studies were performed in the postabsorptive state; the remaining 7 patients received glucose at a rate of 8 mumol/kg body weight.min to prevent hypoglycemia. RESULTS: Resting energy expenditure was increased in acute liver failure compared with healthy controls (5.1 +/- 0.14 kJ.min-1 x 1.73 m-2 vs. 3.97 +/- 0.08 kJ.min-1 x 1.73 m-2; mean +/- SEM; P < 0.001). Respiratory quotient and oxidation rates for major fuels were not different between the total patient-group and controls. In patients without glucose supply, energy derived from fat was higher and from carbohydrate lower than in healthy controls and patients with glucose supply. CONCLUSIONS: Energy expenditure is increased in acute liver failure. Altered substrate oxidation can be normalized by glucose supply.

Adult↗
PubMed1993

Evaluation of the polymerase chain reaction for diagnosis of herpes simplex virus encephalitis.

Cerebrospinal fluid samples from 257 patients with suspected herpes simplex virus encephalitis were prospectively analyzed by herpes simplex virus polymerase chain reaction. The polymerase chain reaction indicated herpes simplex virus encephalitis in 9 serologically proven cases and in 14 additional patients. Increased polymerase chain reaction signals were observed together with more severe neurological symptoms (P < 0.01) and within the first days of acyclovir treatment (P < 0.05).

Acyclovir↗
PubMed1993

Wilson's disease: evidence of subgroups derived from clinical findings and brain lesions.

Using exploratory factor analysis, we prospectively investigated neuropsychiatric symptoms and structural brain lesions of 47 patients with proven Wilson's disease and identified three subgroups. The first subgroup clinically exhibited bradykinesia, rigidity, cognitive impairment, and an organic mood syndrome and by MRI showed a dilatation of the third ventricle. The second subgroup was characterized by ataxia, tremor, reduced functional capacity, and focal thalamic lesions. The third subgroup showed dyskinesia, dysarthria, an organic personality syndrome, and focal lesions in the putamen and in the pallidum.

Adolescent↗
PubMed1993

Early experience with sequential bilateral lung transplantation.

We performed 20 sequential bilateral lung transplantation in 19 consecutive patients from April 1990 to May 1992. Perioperative mortality was low (2 patients). One-year actuarial survival was 70%. All survivors had normal blood oxygen tension (82 mm Hg, mean) while breathing room air and continuing improvement of pulmonary function. Bronchial dehiscence did not occur. Stents were implanted in 7 patients to control bronchial stenosis. Aggressive treatment of graft rejection has been effective in preventing obliterative bronchiolitis.

Bronchial Diseases↗
PubMed1993

Effect of immunoglobulin administration on blood rheology in patients with septic shock.

The hemorrheological determinants plasma fibrinogen, plasma viscosity, red cell aggregation, and hematocrit were studied in 11 patients before and 4 and 24 hr after a 15 g immunoglobulin infusion to assess the effect of intravenous immunoglobulin administration on blood rheology in septic shock. Four hr after the immunoglobulin administration, plasma fibrinogen decreased significantly [472 (175-950) vs. 522 (182-1,050) mg/dl before administration; median (range); P < 0.01]; after 24 hr, plasma fibrinogen tended to increase again [501 (185-980); n.s.]. No changes were seen in plasma viscosity, red cell aggregation, hematocrit, and coagulation status 4 and 24 hr after immunoglobulin administration. In patients with septic shock, intravenous immunoglobulin administration leads to a decrease in plasma fibrinogen, whereas plasma viscosity and red cell aggregation remain unaffected. The explanation for the decrease in fibrinogen remains speculative.

Adult↗
PubMed1992

Diagnosis of gallbladder perforation in acute acalculous cholecystitis in critically ill patients.

In the presence of ascites ultrasound is not appropriate to distinguish between gallbladder perforation and acute acalculous cholecystitis. However, the correct and early diagnosis of gallbladder perforation is important for the treatment and prognosis. We report 4 critically ill patients with ascites. All patients had evidence of gallbladder perforation by ultrasound and underwent cholecystectomy: 2 patients had gallbladder perforation, but 2 had acalculous cholecystitis without perforation. Markedly elevated serum alkaline phosphatase was the only discriminating finding indicating gallbladder perforation.

Adult↗
PubMed1992

Detailed evaluation of evoked potentials in Wilson's disease.

Detailed evoked potentials (EPs) were studied in 52 patients (28.7 +/- 11.9 years) with Wilson's disease (WD). Various peak latencies, interpeak latencies and amplitudes of somatosensory, auditory brain-stem and visual EPs were significantly abnormal in the group of 28 neurologically symptomatic patients as compared to controls. Interhemisphere latency and amplitude differences tended to be increased without reaching significance, indicating a symmetrical rather than focal subclinical brain involvement. Selected conduction times of at least 1 EP modality were prolonged in all 4 patients with severe, in 16 of 18 with moderate, in 4 of 6 with mild, and in 4 of 24 patients without neurological symptoms. Auditory brain-stem and somatosensory EPs were more frequently prolonged than visual EPs (more abnormalities with check sizes of 13 than 54 min of arc). Cortical somatosensory EPs correlated well (P much less than 0.01) with either Fz or earlobe reference.

Adolescent↗
PubMed1992

Short-term energy balance in patients with infections: carbohydrate-based versus fat-based diets.

The effects of a carbohydrate-based diet (50% carbohydrate calories, 30% fat calories, 20% protein calories) versus a fat-based diet (28% carbohydrate calories, 55% fat calories, 17% protein calories) on oxidation rates of carbohydrate, fat, and protein were assessed in 12 patients with infections by indirect calorimetry and estimation of urea nitrogen production rate. The diets were given continuously for 18 hours in a randomized cross-over study on 2 consecutive days. Energy supply (kcal/d) was adjusted individually to meet the energy expenditure measured on the preceding day after an overnight fast and was 1,647 +/- 129 (SEM) for the carbohydrate-based diet and 1,655 +/- 131 for the fat-based diet. Oxidation rates (kcal/d) for carbohydrate (carbohydrate-based diet, 525 +/- 70; fat-based diet, 363 +/- 84) were different between the diets (P less than .05), whereas no difference could be found for fat (carbohydrate-based diet, 820 +/- 117; fat-based diet, 968 +/- 136) and protein (carbohydrate-based diet, 252 +/- 29; fat-based diet, 236 +/- 23). However, during carbohydrate-based feeding, carbohydrate balance (288 +/- 93 kcal/d) and fat balance (-327 +/- 107 kcal/d) were significantly different from zero (P less than .05), indicating continuous oxidation of endogenous fat and storage of administered glucose. During the fat-based diet, carbohydrate and fat balances were not different from zero. A correlation between energy and substrate balances was not seen during either diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗