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Biomedical subjects

G Lehmann

Publications and source records attributed to G Lehmann.

At least 73 records · Page 4Linked to original sources
PubMed1995

Acute alterations of oxygen uptake and symptom-limited exercise time in patients with mitral stenosis after balloon valvuloplasty.

STUDY OBJECTIVES: To determine the acute influence of improvement in orifice area in mitral stenosis by percutaneous transluminal valvuloplasty (PTVP) on cardiopulmonary exercise capacity, treadmill walking time (TWT), oxygen uptake parameters at maximum exercise as well as at highest comparable workloads and parameters of breathing work were assessed pre- and post-PTVP. PATIENTS AND INTERVENTIONS: PTVP was carried out in 16 patients who had moderately severe mitral stenosis, bringing about an average increase in mitral valve orifice area from 1.0 +/- 0.1 cm2 to 2.2 +/- 0.5 cm2 (p < 0.0005). Based on standardized conditions, the patients (six in functional class A, five in class B, and five in class C according to Weber's classification) underwent symptom-limited treadmill cardiopulmonary exercise testing before as well as 2 days after PTVP. In addition, subgroup analysis (eight patients in sinus rhythm, eight patients in atrial fibrillation) was performed to determine a potential influence of the underlying cardiac rhythm on cardiopulmonary exercise parameters. To rule out a PTVP-independent training effect, a control group of ten patients with mitral stenosis underwent the same kind of cardiopulmonary exercise testing on 2 consecutive days. MEASUREMENTS AND RESULTS: After-PTVP, TWT augmented by 19% (p < 0.0005) in all patients. Maximum oxygen uptake in percent of predicted maximal values at peak exercise and at anaerobic threshold was enhanced by 10% (p < 0.005). Ventilation at highest comparable workload was diminished by 10% (p < 0.025), whereas oxygen uptake and oxygen pulse at highest comparable workload did not differ, reflecting both unaltered cardiac output at comparable workloads and a more economic ventilation, respectively. Furthermore, PTVP-mediated alterations of TWT, but not of oxygen uptake at peak exercise were more pronounced in patients in sinus rhythm than in those in atrial fibrillation, reflecting more effective economization of cardiac work and ventilation in the former subgroup. Except for a statistically significant increase of TWT of 5%, no clinically relevant differences between both exercise tests were found with respect to oxygen uptake in the control group. CONCLUSIONS: Impaired cardiopulmonary fitness in patients with moderately severe mitral stenosis is improved substantially by PTVP immediately after the intervention, mainly the result of acute reduction of pulmonary congestion and subsequent decrease in dead space to tidal volume ratio. Adherence to standardized conditions is considered crucial for comparability of cardiopulmonary data.

Adult↗
PubMed1995

[An anatomo-clinical case of dementia in endovascular large-cell lymphoma].

Cerebral angiotropic large cell lymphoma is a rare fatal neurologic disorder characterized by multifocal intravascular proliferation of large pleomorphic cells within vessels of all caliber, predominantly skin and nervous system. Clinical manifestations in previously reported cases were dominated by focal neurologic signs, epilepsia and progressive dementia. We report a case of a 70 year-old man with subacute dementia, epileptic seizures and cerebrovascular events. There was no evidence of a systemic disease outside the nervous system. Cerebrospinal fluid contained 13 leukocytes/mm3 (49% of lymphocytic cells) and more than 100 mg/dl of protein. Cytology was negative. Cranial MRI demonstrated cerebral atrophy and an increased paraventricular signal in T 2 weighted images. A frontal brain biopsy revealed only neuronal dystrophy and astrocytic gliosis. Despite treatment with corticosteroids the patient died 18 months after the onset of the first symptoms. Autopsy was performed and revealed B cell lymphoma.

Aged↗
PubMed1993

Pharmacokinetics and additional anti-ischaemic effectiveness of amlodipine, a once-daily calcium antagonist, during acute and long-term therapy of stable angina pectoris in patients pre-treated with a beta-blocker.

Amlodipine 10 mg was evaluated for additional anti-ischaemic and anti-anginal efficacy in 14 patients pre-treated with a beta-blocker who had documented coronary artery disease, stable angina pectoris, and > or = 2 mm of exercise-induced ST segment depression. For 2 days the patients received open-label amlodipine and then, according to a randomized, placebo-controlled, cross-over and double-blind protocol, they were treated with amlodipine or placebo, respectively, once a day for 3 weeks each. Exercise tests and blood sampling for plasma concentrations of amlodipine were performed at 8 and at 24 h after dosing on both days of acute testing as well as on day 18 of chronic treatment. During chronic treatment, when plasma concentrations fluctuated between 23.5 ng.ml-1 at 8 h and 14 ng.ml-1 at 24 h post-dosing, ST segment depression at an individually comparable workload was significantly decreased by 28% compared with placebo (P < 0.005) at both points in time. Increases in ischaemia-free workload capacity amounted to 76% (P < 0.005) and to 81% (P < 0.01) at 8 and at 24 h, respectively. The number of anginal attacks was reduced by 39% (P < 0.05). Conversely, after initial dosing, i.e. when plasma concentrations declined from 4.7 ng.ml-1 to 3.9 ng.ml-1, influences upon ischaemic parameters compared to control values were markedly less at 24 h as opposed to 8 h. There were no untoward side effects observed at any point in time.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1992

Characteristics of bovine Staphylococcus aureus with special regard to clumping factor activity.

The occurrence of the following groups of bovine Staphylococcus aureus with characteristic patterns of biochemical reactions and sensitivities to phages was confirmed by the present investigation of 662 isolates from the udders of cows in 53 dairy herds: (1) host-specific variety (v) bovis, (2) not alloted strains with the basic marker, crystal violet type A (group na CV A), (3) group na CV C. The latter was split into three subgroups clearly differing in phage susceptibility patterns: I/119, I without 119 and III, respectively. Lack of clumping factor activity occurred in 323 out of 346 (93%) phage pattern I/119 strains examined while most or all isolates of the other groups of bovine strains proved to be clumping-positive.

Animals↗
PubMed1991

Enhanced effectiveness of combined sustained-release forms of isosorbide dinitrate and diltiazem for stable angina pectoris.

In 14 patients with documented coronary artery disease, the extent and duration of acute anti-ischemic, antianginal and hemodynamic effects of monotherapies with 120 mg of sustained-release isosorbide dinitrate and diltiazem were compared; their combined therapy administered once daily in the morning with diltiazem given again in the evening were also compared according to a randomized, double-blind, crossover, placebo-controlled protocol including exercise testing for assessment of ST-segment depression (ST decreases) at an identical work load, exercise capacity and determination of plasma concentrations of both substances. Comparison of individual substances revealed more marked and sustained effects of isosorbide dinitrate (ST decreases at 2 hours, -66%; at 6 hours, -50%; p less than or equal to 0.05 for both), remaining statistically significant up to 12 hours (-24%) than of diltiazem (2 hours, -30%; 6 hours, -16%; p less than 0.05). Combined therapy resulted in increased effects (ST decreases at 2 hours, -80%; 6 hours, -76%; 12 hours, -30%; p less than or equal to 0.05) as opposed to individual substances for a period of up to 12 hours. However, therapeutic coverage over 24 hours could not be demonstrated, even with renewed administration of sustained-release diltiazem in the evening. Plasma concentrations of isosorbide-5-mononitrate were greater than 250 ng/ml for 12 hours on days when isosorbide dinitrate was given, decreasing to less than 100 ng/ml at 24 hours. On days when diltiazem was given, plasma levels greater than 50 ng/ml were detected only at 2 and at 6 hours, and at 24 hours only after a second tablet was given.

Angina Pectoris↗
PubMed1990

[Effectiveness of various combination therapies in patients with coronary heart disease].

There is only a limited number of studies available comparing the effectiveness of various combinations of anti-ischemic and antianginal substances in the same patients with coronary artery disease and stable angina pectoris and even these are restricted to either only a few drugs or a single point in time for testing. Accordingly, this study was undertaken to determine to what extent the combination of two or three drugs with different anti-ischemic mechanisms of action such as the long-acting form of the beta-blocker metoprolol and isosorbide dinitrate (ISDN) in sustained-release form as well as the calcium channel blockers nisoldipine and diltiazem in sustained-release form, which previously have not been tested in combination, are capable of enhancing effectiveness and prolonging duration of action. In a double-blind, randomized, crossover study in eleven patients with documented coronary artery disease and stable angina pectoris the effects of monotherapy with 200 mg metoprolol in long-acting form were compared with those of combined treatment with 120 mg ISDN sustained-release or 10 mg nisoldipine or 120 mg diltiazem sustained-release as well as ISDN and nisoldipine and finally, ISDN and diltiazem by means of an intraindividual analysis. For assessment of anti-ischemic and antianginal effects, symptom-limited exercise testing was carried out before as well as three, eight, twelve and 24 hours after medication. The parameters analyzed were ST-segment depression at the highest comparable workload, ischemia-free and symptom-free exercise capacity (one minute prior to ST-segment depression of 1 mm or onset of angina pectoris) as well as the systolic blood pressure--heart rate product at the highest comparable workload and at the highest ischemia-free workload, that is one minute prior to an ischemic reaction of 1 mm. Based on the ST-segment depression, all combinations of two drugs (metoprolol and ISDN at three hours; metoprolol and diltiazem at eight hours) led to a significant or at least relative increase of effectiveness. On comparison of the various double combinations, those with nisoldipine showed an early dissipation of action which, twelve hours after administration, was significantly less marked than those with diltiazem. Of the two tested triple combinations, metoprolol, ISDN and diltiazem was either significantly more effective than the various double combinations (metoprolol and ISDN or metoprolol and nisoldipine, both at eight and twelve hours; metoprolol and diltiazem, twelve hours) or relatively more effective and showed clear prolongation of the effects in excess of twelve hours.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenergic beta-Antagonists↗
PubMed1990

[Treatment of symptomatic and asymptomatic myocardial ischemia using 120 mg delayed-action ISDN].

Most episodes of myocardial ischemia in patients with coronary artery disease are incurred asymptomatically during everyday physical activities. While the necessity for medical treatment of angina pectoris is clearly established, the indication for treatment of asymptomatic ischemia is based on prevention of structural myocardial damage or malignant arrhythmias and on the implication of improvement in prognosis. In this regard, however, no reliable data is available. Additionally, only relatively few controlled studies have been carried out to investigate the influence of medical treatment on the ischemic episodes. Moreover, on assessment of treatment with Holter monitoring, as opposed to standardized ergometric testing, the substantial spontaneous variability of the frequency of ischemic episodes from day to day must be taken into consideration. Accordingly, in 25 patients with documented coronary artery disease, using a double-blind, randomized, placebo-controlled protocol with two periods of 48 hours of Holter monitoring each, we analyzed the effects of 120 mg isosorbide dinitrate in sustained-release form on the frequency, duration and extent as well as the circadian variation of transient myocardial ischemia during everyday physical activities and differentiated these from the spontaneous day-to-day fluctuations. During the placebo phase, 277 episodes with ST-segment depression greater than 1 mm were detected, 81% of which were asymptomatic. During treatment with 120 mg isosorbide dinitrate in sustained-release form, the number of episodes was reduced significantly (p less than 0.05) to 119 (-57%) where the decrease in symptomatic and asymptomatic episodes of 54% and 58%, respectively, was comparable (Figure 1).(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1986

Hydroxylation of dibutylnitrosamine in the human liver and intestinal microsomal fractions.

The metabolism of the bladder carcinogen N-nitroso-di-n-butylamine (NDBA) was studied in microsomal preparations of tissues of patients of both sexes, aged 59-69 years undergoing abdominal surgery. Samples of liver, ileum, and colon were of normal histological appearance. For comparison, samples of rat liver and small intestinal mucosa microsomes were included in the study. Using 1-14C-labeled NDBA, the biotransformation to hydroxylation products retaining the nitroso group, NDBA-2-OH, NDBA-3-OH, and NDBA-4-OH, respectively, was investigated by reversed phase HPLC. In order to separate these metabolites, pooled samples were analysed by normal phase HPLC. The rate of hydroxylation of NDBA was found to be 5.5 times higher in rat liver microsomes compared to those from human liver (2.86 +/- 0.29 vs 0.52 +/- 0.03 nM X min-1 X mg-1). NDBA-3-OH proved to be the major metabolite formed (greater than 80% of total metabolites). The metabolism of NDBA was low but detectable in seven out of nine specimens of human gut, 0.1-0.5 nM X mg-1 in 1 h of incubation, and of the same order of magnitude in rat intestinal tissue (0.4-0.6 nM X mg-1).

Aged↗
PubMed1984

Effect of highly radiolabelled 2,4-dinitrochlorobenzene (DNCB) on experimental DNCB contact dermatitis in guinea pigs.

With the aid of epicutaneous application of 2,4-dinitrochlorobenzene (DNCB) solution in acetone, we induced a cutaneous allergic reaction of the delayed type. Our question was whether the development of the DNCB cutaneous sensitivity could be suppressed by highly radiolabelled DNCB. On the basis of the clonal selection theory and our own results with other in vivo-experimental animal models, one could suppose that the highly radiolabelled DNCB as haptens binds to the Ig-membrane receptors of the genetically determined T-lymphocyte clone, and that the conjugated radioactivity (125I) causes a selective radioactive damage to this competent T-lymphocyte subpopulation. By means of intracardially applied radiolabelled DNCB, we are able to induce either complete or very significant suppression of the cutaneous DNCB immune response. In the second experiment, the highly radiolabelled DNCB was not able to inhibit sensitization to a simultaneously applied 4-ethoxy-methylene-2-phenyl-oxazolone (oxazolone). This result clearly demonstrates the antigen specificity of this form of immune suppression.

Animals↗
PubMed1982

[Clinical and pathological study of a peculiar form of tuberculous meningitis: diagnostic and therapeutic problems (author's transl)].

The authors report a case of tuberculous meningitis in which multiple bacteriological samples were negative during the eleven months of the clinical course. There were no other visceral localizations. The fatal outcome was due to vascular lesions (multiple cerebral infarcts), and to CSF flow disorders. The findings of cranial computerized axial tomography and of the pathological examination are reported.

Adult↗
PubMed1982

[Therapy of hepatic encephalopathy. Changes in the cerebrospinal fluid concentration of catecholamine neurotransmitters, ammonia and amino acids in the course of an infusion treatment with branched-chain amino acids].

Infusions containing branched-chain amino acids have recently been used for the therapy of hepatic coma. Their mode of action was attributed to a reduction in the intracerebral concentrations of the aromatic amino acids with resultant normalization of the neurotransmitters noradrenaline, dopamine and serotonin, synthesized from these amino acids. In order to further clarify this therapeutic mechanism an infusion solution consisting of branched-chain amino acids and ammonia-reducing amino acids was administered to patients with porto-systemic encephalopathy. The amino acid pattern, the ammonia in plasma and liquor, and the neurotransmitters noradrenaline, adrenaline and dopamine, in the liquor were determined before and after the course of treatment. Our studies show that the therapeutic effect of branched-chain amino acids in the therapy of hepatic encephalopathy is based on an effective intracerebral reduction of the ammonia concentration by 61%. The actual concentrations of the neurotransmitters were not significantly modified by the therapy. This opens to question the hypothesis that the neurotransmitters are responsible for the development of hepatic encephalopathy.

Amino Acids↗
PubMed1981

Selective suppression of antibody production with the aid of radiolabelled birch pollen allergen.

In accordance with the clonal selection theory we intended to prevent the development of artificially induced birch pollen allergy in rabbits with the aid of the radiolabelled pollen allergen (75-1000 microCi125 I-pollen/animal) intravenously administered prior to pollen sensitization. The birch pollen allergen, is accordance with Burnet's working hypothesis, reacts only with a genetically determining B cell subpopulation. The fixation of the radiolabelled birch pollen allergen to the receptors of the competent B cell clone causes the lesion of the latter. Compared with the control group, this group of rabbits showed an extensive suppression of anaphylactic reagin-like PCA-antibodies, and haemagglutinating antibodies in the blood as well as in nasal secretion. In addition, we tried to influence the already ongoing synthesis of the antibodies with the aid of subsequent intravenously administered radiolabelled birch pollen allergen (750-100 microCi 125 I-pollen/animal). An intensive suppression of the synthesis of antibodies could also be proved in this case. The simultaneous immunization of the control rabbits with birch pollen and egg albumin resulted in the production of antibodies against both antigens, as expected. The hot-labelled birch pollen antigen intravenously injected before or after immunization with egg albumin and birch pollen led selectively to suppression of anti-birch-pollen PCA antibodies. The synthesis of anti-egg albumin PCA antibodies was unaffected.

Allergens↗
PubMed1980

[Results of managing prostate adenomyomatosis over a period of 5 years].

It is reported on the treatment of 382 patients with adenomas in the period from 1974 to 1978. The operative process is briefly described. The results and the complications are shown. The shorter duration of stay, the smaller number of the postoperative complications and the smaller postoperative lethality prove the advantage of the TUR in the treatment of the adenomyomatosis of the prostate compared with the adenomectomy.

Aged↗