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Biomedical subjects

H Barth

Publications and source records attributed to H Barth.

At least 109 records · Page 6Linked to original sources
PubMed1989

[Aneurysm of the vein of Galen as a possible cause of congestive heart failure: a report of 5 new cases].

We report on five newborns with an arterio-venous malformation of the vein of Galen. All newborns were cyanotic and in congestive heart failure without any evidence of congenital heart disease. Congestive heart failure in these cases was mainly due to an almost two-fold increase in cardiac output of approximately 8 l/min/m2 (normal: 4.5 l/min/m2). According to previous reports, mortality is very high in patients with this malformation when becoming symptomatic during infancy, and therapy by surgery or embolization is only successful in 10-30%. While three of our patients died shortly after diagnosis because of untreatable heart failure, the other two were operated on either by subtotal ligation of the draining vein or by ligation of 4 arterial feeders. In the first case secondary thrombosis of the aneurysm occurred and cardiac failure subsided. In the second case a large shunt remained and a balloon-embolization was performed successfully. However, in both patients severe neurologic defects occurred, the severity of which remains to be assessed later since the post-operative observation period is only 2 and 5 months, respectively.

Cerebral Angiography↗
PubMed1989

[The injured cervical spine with and without lesions of the nerve structures. Clinical results of surgical therapy].

The operative treatment of the cervical spine injuries with and without neurological deficit was active developed in the last 25 years. The surgical management has been determined by the type of deformity, and also by the anatomical and functional specialties. The indication, the diagnostical and therapeutical strategy and the results of surgical treatment of 304 cases are discussed.

Bone Plates↗
PubMed1987

[Continent proctocolectomy--difficulties caused by previous operation].

Since 1981 23 Patients (19 with adenomatosis coli, 4 with colitis ulcerosa) underwent proctocolectomy with preservation of continence: total colectomy, proctomucosectomy, ileo-anal anastomosis with formation of an ileal S-pouch, and protective loop ileostomy. In 3 patients previous operations caused difficulties in performing the procedure. Critical points of the operative technique are explained, with special regard to the possibility of previous surgery. Postoperative complications and functional results are presented.

Adenomatous Polyposis Coli↗
PubMed1987

Reliability and practicability of the fluorometric-fluoroenzymatic histamine determination in pathogenetic studies on peptic ulcer: detection limits and problems with specificity.

Histamine, among various "biologic-physiologic" abnormalities, is considered as a pathogenetic factor in chronic duodenal ulcer disease. The 10-30 per cent difference between its concentration in gastric and duodenal mucosa of patients compared to healthy controls, however, has to be demonstrated to be specific for the disease. It has to be shown to be neither a methodological artefact nor a common effect, concomitant factor or consequence. This study, after a series of pathogenetic trials examines systematic errors (biases) in the fluorometric-fluoroenzymatic histamine assay under the conditions of field studies including tests on specificity over a time period of 10 years. It concentrates on sensitivity (detection limits) and specificity of a standard technique described herein. A modified Shore procedure for large scale assays in human biopsies was developed including reference luminescence values for all reagents, cleaning material and glassware, reduction of OPD concentration to 0.05%, purification of n-heptan, omission of centrifugation steps in the extraction procedure and use of 2 ml 1 M HClO4 in the homogenization step to prevent losses of histamine due to adherence to the mechanical homogenizer. This assay was sensitive enough to measure histamine without difficulty in any biopsy taken. The detection limit was 3 ng/biopsy, but the smallest quantities of the amine ever obtained were 10.6 and 18.3 ng/biopsy (depending on both histamine content and biopsy weight). A series of problems had to be solved both in achieving and demonstrating specificity. It had to be defined not only for the assay in general, but also for assessing the difference in histamine content between ulcer patients and healthy controls. Exogenous more than endogenous fluorescing material interfering with the determination had to be excluded. A series of pitfalls were detected which had to be overcome in demonstrating the specificity of the assay by physicochemical and enzymatic tests. The specificity of the identification tests was more often impaired than the histamine assay itself. Fluorescing material interfering with the assay occurred in the homogenization, extraction and condensation steps, was found in water, OPD, the organic solvents, the cleaning material and in all kinds of plastic vessels. Plasticizers were shown by physicochemical characteristics including fluorescence spectra to be most likely responsible for this interfering material. Rules were developed to exclude such hazards in specificity in longterm pathobiochemical studies. Enzymatic identification test were applied to exclude endogenous fluorecing substances interfering with the standard technique. Simil

Biopsy↗
PubMed1987

Anaphylactoid reactions and histamine release do not occur after application of the opioid tramadol.

After an i.v. application of 100 mg tramadol in 13 healthy volunteers no change in plasma histamine concentration could be detected,( systemic anaphylactoid reactions did not occur, cutaneous reactions were not rated as anaphylactoid since itching and erythema were seen only once after tramadol whereas erythema was also observed twice after saline, blood pressure and heart rate were only very slightly and transiently elevated without any abnormalities in ECG-readings and only side effects typical for opioid therapy were observed.

Anaphylaxis↗
PubMed1987

[Continuous-wave Doppler velocimeters and blood pressure difference in aortic coarctation. A simultaneous comparative study of 52 children].

Sixty examinations in 52 children with coarctation of the aorta (eight pre- and postoperative studies) were performed to assess the relation of the Doppler derived gradient using the simplified Bernoulli equation (delta p = V2 X 4) with the blood pressure difference simultaneously measured with an automated oscillometer. There was a close correlation (r = 0.89, y = 16.1 + 0.73x, syx = 7.38 mmHg) with significant overestimation of the blood pressure difference in mild stenoses (p less than 0.0001). If the patients are divided in two groups, an operative (group 1: symptomatic patients, n = 24) and a nonoperative group (group 2: asymptomatic patients, in the majority recoarctations, n = 36) it becomes clear that the overestimation is due to the latter. The velocity superior to the coarctation was higher in the second than in the first group (152.1 +/- 31.5 vs. 114.5 +/- 43 cm/s, p less than 0.004) (mean +/- SD). If the prestenotic velocities are taken into account, the correlation is nearly the same (n = 37, r = 0.9, y = 9.4 + 0.73x, syx = 7.3 mmHg) with slight underestimation in high-grade and overestimation in mild coarctations. A pandiastolic increased velocity was found in 79% of the patients in the operative group, but in none of the nonoperative group. The reasons for the overproportional increased jet velocity in group 2 as discussed are that: the peak pressure gradient may exceed the peak-to-peak pressure gradient; the prestenotic velocity must be taken into account, if the modified Bernoulli equation is used; and the collateral vascularization may be substantial.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Quantitative evaluation of left heart obstructions (including aortic isthmus stenosis) in children using Doppler echocardiography].

To assess the accuracy of pulsed and continuous-wave Doppler echocardiography (DE) in evaluating pressure drops across left heart outflow obstructions we examined 27 children with valvular aortic stenosis (n = 13), fixed subaortic stenosis (n = 14) and 16 children with coarctation. Doppler examination was performed within 24 hours of cardiac catheterization in 15 patients, in 17 patients 2-42 months (mean 13 months) after catheterization. Simultaneous blood pressure measurements in both upper and lower limbs with an automated oscillometer were taken in 12 cases with coarctation. Using three standard positions (suprasternal, high right parasternal and apical) we found a close Doppler-catheter correlation in patients with aortic and subaortic stenosis (r = 0.94). The correlation in cases with coarctation was poor (r = 0.17) because of one patient with severe stenosis and another with atresia and a huge collateral vascularization, in whom a poststenotic jet could not be located. Surprisingly the postoperative pressure gradient was much overestimated in one of these patients by DE. We conclude that a "multi-channel system" due to collateral vascularization excludes the use of the simplified Bernoulli equation. Apart from these anatomically related false Doppler estimates we found a good correlation (r = 0.90), with slight overestimation in mild stenosis. Thus, Doppler ultrasound provides an accurate noninvasive method for estimating pressure gradients in patients with aortic and subaortic stenosis and to a lesser extent in patients with coarctation. In particular DE is helpful for determining subsequent clinical management.

Aortic Coarctation↗
PubMed1986

[Quantitative evaluation of right heart obstructions in children using Doppler echocardiography].

To assess the accuracy of pulsed and continuous-wave Doppler echocardiography (DE) for estimating pressure drops across right ventricular outlet obstruction, we examined 27 children (valvular pulmonary stenosis n = 16, complex congenital heart lesion with prior pulmonary banding n = 11). The Doppler evaluation was performed within 24 hours of cardiac catheterization in 17 patients, in 10 it was done 2-24 months (mean 12.2 months) after catheterization. We found a good correlation (r = 0.93) with slight underestimation of pulmonary valve gradient. Using three windows (left parasternal, suprasternal and subcostal) the ultrasound beam can be better aligned parallel to the excentric jet of a malformed valve than using the left parasternal position alone. In children with complex congenital heart disease and normally related great arteries Doppler ultrasound reliably estimates the gradient across a pulmonary artery band using the left parasternal transducer position (r = 0.92). In patients with malposition of the great arteries the use of multiple windows is necessary. Thus, DE provides an accurate noninvasive method of estimating pressure gradients in patients with right ventricular outflow obstructions and is helpful in determining the subsequent clinical management.

Blood Pressure↗
PubMed1986

[Clinical anatomy of the lateral intervertebral region of the 3d-7th cervical vertebrae].

Under consideration of the ventrolateral approach, the Regio intervertebralis lateralis was demonstrated for 25 isolated cervical vertebral columns under clinical-anatomical and morphometrical aspects. For obtaining mean values and as a comparison of the sides, the M. longus colli, the bony structures under special consideration of the Foramen intervertebrale in the cranio-caudal and medio-lateral extension, the A. vertebralis with its Rami spinales, the system of the venous blood pathways, the Ganglion spinalis and the spinal nerve root were examined.

Adolescent↗
PubMed1986

[Hypertrophic cardiomyopathy in childhood: studies of the clinical picture and course].

30 children with hypertrophic cardiomyopathy and a mean age of 4.9 +/- 4.4 years, 11 infants and 19 children, were followed up for an average of 6.6 +/- 5.6 years. Apart from a systolic murmur in nearly all patients, only a few had symptoms. 7 patients from 5 families had a positive family history. The ECG often showed left ventricular hypertrophy, twice a deep Q wave, and no cases of giant T wave. A subaortic pressure gradient greater than or equal to 40 mm Hg was measured in 6 children, a secondary cardiomyopathy was excluded by biopsy in 8. Associated lesions were coarctation (n = 2) and patent ductus arteriosus (n = 2). 7 children died: 1 infant in congestive heart failure, 3 children suddenly, and 3 postoperatively. The annual mortality rate was 3.5%. Also in childhood, beta-blocker therapy may not prevent sudden cardiac death, nor may operation prevent late complications. In spite of the lack of pressure gradients, the children did not fulfil the criteria of hypertrophic non-obstructive cardiomyopathy.

Cardiac Catheterization↗
PubMed1986

Bioavailability of enteral tramadol formulations. 1st communication: capsules.

The absolute bioavailability of tramadol hydrochloride (rac-1(e)-(m-methoxyphenyl)-2-(e)-(dimethylaminomethyl)cyclohexan- 1(a)-ol hydrochloride, CG 315) after the oral administration of Tramal capsules was determined in a balanced cross-over study in 10 male volunteers. Each volunteer received two single doses of 100 mg tramadol hydrochloride, one by oral (2 Tramal capsules) and one by intravenous route (2 ampoules of Tramal 50 solution for injection). The formulations were administered in the morning on an empty stomach, and the interval between the two applications was one week. Serum concentrations of tramadol were determined by gas chromatography-mass spectrometry and the bioavailability was ascertained by calculation of the areas under the serum concentration curves. The absolute bioavailability of tramadol in Tramal capsules was 68 +/- 13% (means +/- SD; n = 10) with a range of 41-84% and a 95% confidence interval of 55.0-79.2%. The areas under the serum concentration curves of tramadol hydrochloride (AUC) were 2488 +/- 774 ng X h/ml (p.o.) and 3709 +/- 977 ng X h/ml (i.v.). Peak serum concentrations of 280 +/- 49 ng/ml were reached 2 h after oral administration of two Tramal capsules; a serum concentration of 100 ng/ml (assumed as the threshold value for analgesic efficacy) was reached after 0.68 +/- 0.17 h and was maintained for 9.0 +/- 2.2 h. The half-life of absorption was 0.38 +/- 0.18 h and the lag-time 0.48 +/- 0.14 h. In the terminal phase the biological half-lives of tramadol were 5.1 +/- 0.8 h (p.o.) and 5.2 +/- 0.8 h (i.v.).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Clinico-topographical anatomy of the lateral intervertebral region in the area of the 3d to the 7th cervical vertebrae].

Under consideration of the ventrolateral approach, the Regio intervertebralis lateralis was demonstrated for 25 isolated cervical vertebral columns under clinical-topographical and morphometrical aspects. For obtaining mean values and as a comparison of the sides, the M. longus colli, the bony structures under special consideration of the Foramen intervertebrale in the craniocaudal and medio-lateral extension, the Arteria vertebralis with its Rami spinales, the system of the venous blood pathways, the Ganglion spinalis and the spinal nerve root were examined.

Adolescent↗