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Biomedical subjects

G Kober

Publications and source records attributed to G Kober.

At least 181 records · Page 10Linked to original sources
PubMed1982

[Coronary circulations in patients with valvular aortic stenoses (author's transl)].

This study was done to substantiate the observation that there is a high coincidence of predominant left coronary circulations in patients with valvular aortic stenoses, Between 1973 and 1980, 506 patients, who underwent coronary angiography and ventriculography, were investigated: patients with mitral stenosis (group I; n = 77), mitral regurgitation and combined mitral valve dysfunction (group II; n = 50), aortic regurgitation with or without mitral valve disease (group III; n = 61), pure aortic stenosis (group IV; n = 49) and the combination of aortic stenosis and insufficiency with mitral valve disease group V; n = 69). Patients with coronary heart disease (group 6; n = 200) served as control. Predominant left circulation was present in a comparable frequency in the valve-patient group 1 (8%), group 2 (10%) and group 3 (8%) and with patients with coronary heart disease (7.5%). A distinctly higher frequency was observed in group 4 (33%; p less than 0.001) and in group 5 (19%; p less than 0.01). We conclude that valvular aortic stenosis and predominant left coronary circulation might have the same genetic or developmental background.

Adult↗
PubMed1981

[Consequence of habitual use of laxatives (author's transl)].

Though habitual, but not excessive use of laxatives can be observed frequently, no accompanying clinical symptoms have yet been described. The frequent observation of tetany and edema is striking, there is a marked decrease of potassium clearance and an incipient impairment of creatinine clearance. A secondary hyperaldosteronism can be ruled out. The electrocardiograms of 9 patients show signs of mild hypokalemia, which in 2 patients were first misinterpreted as myocardial ischemia and in one patient taken as indication of myocarditis. Oral administration of potassium normalizes the electrocardiograms.

Adolescent↗
PubMed1981

Direct determination of hepatic extraction of verapamil in cardiac patients.

Hepatic extraction of verapamil was determined directly in cardiac patients undergoing diagnostic catheterization and receiving 10 mg verapamil intravenously or intra-arterially. The extraction curves of verapamil concentrations in blood from the ascending aorta and hepatic vein were similar to those reported after single intravenous doses of indocyanine green. The rectilinear fall in concentration lasted 10 to 15 min. Mean hepatic extraction of verapamil in four patients who received intravenous doses was 0.86 (range 0.84 to 0.89) and in four who received intra-arterial doses was 0.87 (range 0.83 to 0.89). These estimates are the same as those for hepatic first-pass extraction determined by indirect methods based on areas under plasma concentration-time curves and requiring calculation of apparent hepatic blood flow. The results were considered to be proof that the first-pass effect of verapamil after oral doses is attributable mainly, if not entirely, to hepatic elimination.

Adult↗
PubMed1981

[Changes in diameters of small pulmonary venous and arterial vessels after nitroglycerin (author's transl)].

Diameters of the small arterial and venous pulmonary vessels were studied in 17 patients, using selective pulmonary angiography. The majority had coronary heart disease. Pulmonary and systemic hemodynamics were also evaluated. In 11 patients, these procedures were repeated 3 minutes after the sublingual administration of 1.6 mg of nitroglycerin (Group I). The remaining 6 patients served as controls (Group II). In Group I, pulmonary circulatory pressures, left ventricular filling pressure, and pulmonary vascular resistance declined significantly compared with Group II. The diameters of the small pulmonary veins declined by more than 10 percent in Group I while remaining constant in Group II. Differences between the two groups in terms of the response of the small arterial vessels was less evident. Increases in vessel cross-sectional area were observed despite considerably reduced intravascular pressure. The increase in elasticity and capacitance of the pulmonary vessels following nitroglycerin is more pronounced on the venous than on the arterial side. These findings suggest that the pulmonary vascular bed contributes significantly to the therapeutically important pooling effect caused by nitroglycerin in the treatment of angina pectoris and pulmonary edema.

Coronary Disease↗
PubMed1981

[Improved myocardial function after transluminal coronary angioplasty (author's transl)].

To assess the results of transluminal coronary angioplasty (TCA), 42 patients (mean age 50 years) with for coronary artery disease were investigated at rest and during exercise with the ECG (n = 40), thallium-201 myocardial scintigraphy (n = 23) and equilibrium-radionuclide ventriculography (n = 32). Each method of stress testing was quantified: the exercise ECG by means of an ischemia score, incremented with increasing ST-segment depression and decremented as a function of duration of exercise and workload in watts; thallium-201 scintigraphy by means of an index for minimal to maximal perfusion region (vitality index) and redistribution factors; equilibrium-radionuclide ventriculography by means of global ejection fraction and maximum systolic volume change with respect to the end-diastolic volume. The patients were divided into three groups: 30 had successful TCA defined as demonstrating at least a 20% reduction in the stenosis; six underwent aortocoronary bypass operation (nine grafts; complete revascularization in four patients); and in six patients TCA was unsuccessful. TCA was successful in 24 LAD stenoses, 5 RCA stenoses, and in one proximal anastomosis of an aortocoronary bypass graft. Dilatation could not be achieved in three LAD stenoses and three stenoses of the RCA. In those in whom it was successful, TCA yielded an average reduction of coronary artery stenosis from 84 to 43%. Both TCA and bypass operation (OP) led to comparable degrees of functional improvement. The ischemia score decreased from 2.8 to 0.9 after TCA and from 1.6 to 0 after OP. The vitality index increased from 67 to 77% and from 74 to 81% after TCA and OP respectively while the corresponding redistribution factors decreased (TCA: at 1 hour from 5 to 1% and at 3.5 hours from 11 to 4%; OP: at 1 hour from 2.2 to 1.4% and at 3.5 hours from 7.6 to 4.1%. The global ejection fractions at rest improved from 46 to 52% and from 38 to 45% and during exercise from 42 to 50% and from 36 to 43% after TCA and OP respectively. The maximum--dV/dt/EDV increased at rest (TCA: from 2.7 to 3.5 per second; OP: from 2.1 to 3.8 per second) and during exercise (TCA: from 3.1 to 4.0 per second; OP: from 2.6 to 3.3 per second). In the group with unsuccessful TCA, no significant differences in the latter parameters were observed. Ten of the 30 patients who had undergone successful dilatation were reinvestigated after three months. Maintenance of good functional results could be documented in eight while deterioration was seen in two patients, one with a significant restenosis and one who developed a new narrowing distal to the successfully dilated stenosis. Thus, the results show that in selected cases, TCA can render improved ventricular function and perfusion comparable to that of aortocoronary artery bypass surgery.

Adult↗
PubMed1981

[Effect of bypass surgery on the presence and quality of collaterals in coronary heart disease (author's transl)].

The presence and quality of collaterals in coronary angiograms were studied in 89 patients with CHD before and after bypass surgery as well as in 12 unoperated patients who also underwent left heart catheterization twice. Total and local evaluation of collaterals was made in terms of global and regional collateral scores as well as collateral flow rates. Total revascularization generally leads to an entire disappearance of collaterals in the angiogram and represents a criterium for assessing the success of bypass surgery. In non-revascularized as well as unoperated patients, the quality of collaterals improves. This is attributable to additional surgically induced changes in the coronary arteries and progression of the underlying disease, respectively. Partially revascularized patients display no definite changes in total collateral score. In these cases, collaterals to the revascularized regions diminish, whereas those to non-revascularized regions increase. Myocardium not revascularized directly by an aortocoronary bypass graft is thus indirectly revascularized via the secondary appearance of collaterals, which enhance regional perfusion.

Adult↗
PubMed1981

[The effect of diltiazem and nifedipine on exercise-induced ST-segment depression and heart rate in patients with coronary heart disease (author's transl)].

In 10 patients with angina pectoris and angiographically proven coronary heart disease, the effect of 60 mg of orally administered diltiazem (D) and 20 mg of nifedipine (N) on heart rate and exercise-induced ST-segment depression was investigated under randomized double-blind conditions. A significant reduction in mean ST-segment depression could be observed at 90 and 180 minutes for N (-36% and -33%) and D (-28% and -27%). One patient did not improve after D; two patients showed a paradoxic increase in ST-segment depression after N. Mean heart rate at rest, during, and after exercise compared to the drug-free periods was lower for D and higher for N. The difference in mean heart rate between N and D was significant (p less than 0.001). In respect to their ability to reduce ST-segment depression, 20 mg of N appears to be nearly equipotent to 60 mg of D. The different effects of D and N on heart rate and AV condition must be considered in certain clinical settings.

Adult↗
PubMed1981

[Significance of collaterals in protection of resting myocardial function in coronary heart disease (author's transl)].

The significance of collaterals for left ventricular function at rest was studied on the basis of 345 consecutive angiographies of patients with coronary heart disease. According to the severity of coronary stenosis, patients were assigned to groups with one-, two-, and three-vessel disease. Subgroups were formed based on the extent of narrowing in percent. All angiograms were examined for the presence and absence of collaterals. The significance of the collaterals in evidence was quantified in terms of a collateral score. To assess left ventricular function, global (left ventricular enddiastolic pressure, left ventricular enddiastolic volume, left ventricular ejection fraction) and regional (percentage hemiaxis shortening) parameters were employed. Within the groups with the same degree of coronary stenosis, no differences in left ventricular function were observed even when regrouping was carried out according to the presence or absence of collaterals. The collateral score, however, suggested that left ventricular function was better in patients with good collaterals than in those with poor collaterals. Regional parameters of left ventricular function underscore the protective effect of collaterals for left ventricular function at rest particularly clearly. Global parameters of left ventricular function do not demonstrate this relationship quite as decisively, since regional disturbances of contractile function may be compensated for by hypercontraction of other wall areas.

Coronary Angiography↗
PubMed1981

[Correlation between isovolumic and auxotonic indexes of left ventricular contractility at rest and during exercise (author's transl)].

The validity of isovolumic parameters of left ventricular contractility in assessing ventricular function at rest has been questioned repeatedly, and with some justification. By contrast, auxotonic parameters such as left ventricular ejection fraction provide a clinically useful index of functional impairment even under resting conditions. The correlation between isovolumic and auxotonic parameters during exercise remains unclear, however. To evaluate this relation, isovolumic m (max dP/dt, Vpm) and auxotonic (EF, Vcf) parameters of contractility were determined simultaneously at rest and after both leg raising and exercise using a manometer-equipped angiography catheter in 45 patients. Under resting conditions, there was no significant correlation between the parameters (Vpm: Vcf,r = 0,226). After leg raising (r = 0.543) and exercise (r = 0.801), the correlation became markedly closer. The presence of hypo- or akinetic regions did not affect the correlation. In patients with cardiomyopathy and uniform functional impairment, the correlation did not improve in comparison with the group of patients characterized by asynergy. The specificity of the various parameters was evaluated in patients with and without significant coronary-artery stenosis. The Vcf values during exercise yielded virtually optimal separation of the two groups, whereas isovolumic parameters were far less specific.

Blood Volume↗
PubMed1980

[Frequency, localization and severity of coronary artery stenoses in correlation to age (author's transl)].

Angiograms of three different groups of patients were examined as to incidence, localization and severity of regional and overall coronary stenoses in correlation to age (group I = 217 patients with valvular and congenital heart disease, 174 patients with coronary heart disease without [group II] and after infarction [group III = 251 patients]). In group I the incidence and number of stenoses increased significantly with age, but not the severity of stenoses. In group III the age dependency of the number of stenoses was less significant and again there was no age correlation to the severity of stenoses. In group II no correlation of the examined parameters to age was found. Judging the severity of coronary sclerosis by a special score, there was a significant increase in group II compared to I and in III compared to II. Furthermore, this coronary score correlated to age in group I and III. In all three groups the stenoses were most frequently found in the proximal parts of the vessels independent from age. Stenosing coronary sclerosis is not an age-induced disease. Its more frequent incidence in older patients is caused by the longer lasting effect of risk factors with aging. Once symptomatic with angina pectoris, the coronary anatomy, does not depend on age. Thus regarding coronary anatomy, coronary bypass grafting should be equally possible in the elderly patients as in the younger ones. In patients with myocardial infarction, the number of diseased vessels increased with age.

Adult↗
PubMed1980

[Incidence and quality of collaterals in coronary heart disease estimation of size and function in the angiogram by a score-system (author's transl)].

345 angiograms obtained from consecutively catheterized patients with ischemic heart disease (112 without infarction, 215 with infarction, 18 with possible small infarction) were studied for the presence and quality of collateral coronary vessels. Patients were classified according to one- two-, or three-vessel disease as well as the percentage of coronary occlusion. Collateral quality was quantified using a point system (collateral score) which included four individual criteria: 1) degree of opacification, 2) quality of retrograde filling, 3) extent of collateralization, and 4) flow rate. Good reproducibility was obtained using this approach. The development of 10 various collateral types is dependent upon the stenosed coronary artery. Collaterals are only demonstrable when vessels narrowing exceeds 60 percent. With more severe degrees of stenosis both collateral incidence (%) and score are increased. The individual range of collateral development for any given degree of stenosis varies widely. The coronary score appears to represent a useful, semiquantitative means of assessing the functional significance of collateral vessels in man.

Collateral Circulation↗
PubMed1980

[Mechanical dilatation of coronary artery obstructions (transluminal angioplasty) (author's transl)].

29 procedures of transluminal angioplasty were performed in 25 patients with 26 coronary artery stenoses. Of 18 stenoses passed with the dilatation catheter 14 could be successfully dilated (dilatation of stenoses of greater than or equal to 30%). Localization of stenoses was: left main (3), left anterior descendens (10), left circumflex (2), right coronary artery (10), and aortocoronary bypass (1). Long-term follow up over 2 to 19 months (mean 7 months) showed favourable results in 11 patients, while in 3 restenosis occurred.

Adult↗
PubMed1980

[Transluminal angioplasty: control of efficiency by nuclear medical methods after non-operative dilatation of critical coronary artery stenoses (author's transl)].

Preliminary results are reported using 201Tl-myocardial scintigraphy (MSC) with quantitated analysis of redistribution kinetics immediately after ergometry (climbing step test) two to four hours later respectively and (Dual-ROI-) Equilibrium-Radionuclide-Ventriculography (ERNVG) with 99mTc-in vivo-labeled erythrocytes during bicycle exercise prior to and after nonoperative transluminal angioplasty (TAP) in nine patients with critical coronary artery stenosis. ERNVG showed a good reproducibility (r = 0,972, n:20 double check) of LVEF. Successful TAP was associated with 1. increase of LVEF from 41,8 (before) to 49,8% (after TAP), 2. increase of mean normalized systolic ejection rate (MNSER = LVEF/ET) from 1,30 (before TAP) to 1,66 (after TAP), 3. increase of maximal volume change during systole (dV/dtmax/EDV) from 2,12 (before TAP) to 3,03 s-1 (after TAP). Parameters of 201Tl-redistribution kinetics (in MSC) were normalized. Ischemic reaction index increased from 62,9 +/- 5,5 (before) to 79,1 +/- 6,9% (after TAP). The degree of 201Tl-redistribution was normalized from 10,3 +/- 7,4 (before TAP) to 2,1 +/- 1,9 (after TAP, between three and four hours after exercise) as a sign of disappearance of exercise-inducible regional myocardia ischemia after successful TAP. These preliminary results underline the effectiveness of non-operative TAP in selected cases of critical coronary artery stenosis.

Cardiac Output↗