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Biomedical subjects

H Henning

Publications and source records attributed to H Henning.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Cyclosporin A in chronic active hepatitis. Results of a pilot study of 20 patients].

In 20 patients suffering from advanced chronic active hepatitis, type B or NANB, the therapeutic effect of cyclosporin A was studied. 15 of these patients already showed cirrhotic transformations and partial liver dysfunctions. In 15 cases an unsuccessful pretreatment with glucocorticoids and/or azathioprine had been performed. Only 3 patients showed an improvement of biochemical and morphological findings under treatment with cyclosporin. In spite of complete normalisation of the biochemical data in another case the morphologic aspects of a liver biopsy remained unchanged. Except for one case of obvious hepatoxicity no serious side effects of cyclosporin were observed under a therapeutic blood concentration between 200 and 400 ng/ml. From our observations we conclude that cyclosporin only in rare cases of advanced chronic active hepatitis may be promising. Furthermore we could not detect any particular criteria for predicting a response to cyclosporin in advance.

Cyclosporins↗
PubMed1987

Influence of obesity on morbidity and mortality after acute myocardial infarction.

The influence of being overweight or obese on hospital and late (1 year) mortality and reinfarction was studied in 1760 patients with acute myocardial infarction. Body mass index (BMI) was used to categorize patients as normal weight (BMI less than 25), overweight (BMI 25 to 30), and obese (BMI greater than 30). Clinical features and prognosis were compared in 658 normal weight patients, 884 overweight patients, and 218 obese patients. Complications during hospitalization and 1-year reinfarction rates following discharge were similar among the weight subsets. Hospital mortality was 13% in obese patients, similar to the 14% hospital mortality in normal weight patients, but significantly more than that in overweight patients (9%, p less than 0.05). When stratified according to age, 30% of obese patients greater than or equal to 65 years died in the hospital, compared to 13% of overweight patients (p less than 0.001), and 17% of normal weight patients (p less than 0.01). In patients less than 65 years, the obese group had a 6% mortality compared to a hospital mortality of 5% in overweight and 8% in normal weight groups (NS). In a multivariate analysis, obesity was an independent predictor of hospital death in the older, but not in the younger patient subset. One-year mortality for patients discharged from the hospital was significantly less in obese than in normal weight patients (7% vs 13%, p less than 0.05), but not different from the 11% mortality rate in overweight patients. Differences in mortality disappeared when patients were age stratified.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Low prevalence of particle-associated reverse transcriptase activity in serum from patients with non A - non B hepatitis.

Sera from 367 patients presumed to have NANB hepatitis were screened for reverse transcriptase activity. In 29 cases significantly increased enzyme activities could be observed. In contrast, sera from 338 patients did not contain significant reverse transcriptase activities. 207 healthy individuals, 7 patients with hepatitis A and 6 patients with hepatitis B who served as controls were all negative for reverse transcriptase activity. The specificity of the enzyme assay was demonstrated by estimation of reverse transcriptase activity in sera from 10 "healthy" HIV-1-antibody positive individuals. In 3 out of 10 cases significant reverse transcriptase activity was observed associated with the human immunodeficiency virus. Our results indicate that the presence of particle-associated reverse transcriptase activity in serum from patients with NANB hepatitis is indicative of the presence of a retrovirus-like agent in these cases. However, the relatively low prevalence of reverse transcriptase positive cases associated with the NANB hepatitis makes it rather questionable whether this agent is a frequent and specific factor in the etiology of NANB hepatitis.

Acquired Immunodeficiency Syndrome↗
PubMed1987

[Laparoscopic hemostasis following liver biopsy by instillation of a gelatin cartridge].

In 1981 Dagnini introduced his bio-plug-system for laparoscopic blood coagulation. This procedure represents a valuable new technique in case of bleeding or cholorrhea after liver biopsy. In more than 85% serious bleeding events could be managed successfully. In cholorrhea we have very limited experience since we have treated only three cases so far - one without success. In spite of our good results we feel that even in the future the proven techniques of blood coagulation, i.e. instillation of thrombin and electrocoagulation, for the management of complications under a laparoscopy should be kept at hand. In case of a failure the bio-plug-procedure can barely be repeated.

Biopsy↗
PubMed1986

Limitations and advantages of the ejection fraction for defining high risk after acute myocardial infarction.

Left ventricular (LV) ejection fraction (EF) is known to be related to prognosis after acute myocardial infarction (AMI), but its role alone and in combination with other factors in the definition of a high-risk group has not been adequately specified. Several recent multicenter studies emphasize that LVEF together with features of ventricular ectopic activity during ambulatory electrocardiography define a group at high risk for death for up to 3 years. However, these high-risk groups comprised only a small fraction of the population (less than 7.5%) and failed to include 75% or more (less than 25% specificity) of observed events. In our study, LVEF was determined close to the time of hospital discharge in 750 patients with AMI enrolled in a collaborative study. Used alone, an LVEF of less than 0.45 best defined a high-risk group (39% of the population) yielding 62% sensitivity and 64% specificity for total cardiac mortality by 1 year; it was 77% sensitive for sudden death alone. In a multivariate analysis together with other factors, LVEF was an independent predictor, but other markers of LV dysfunction entered before LVEF with similar sensitivity for total cardiac deaths, but with increased specificity (75%). When an LVEF of less than 0.45 was used together with the presence of complex arrhythmias to define a high-risk group (19% of the population), sensitivity decreased to 39% and specificity increased to 84%. Thus, LVEF is a simple and effective alternative to multivariate analysis for risk assessment after AMI.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Complexes, Premature↗
PubMed1986

The murmur of papillary muscle dysfunction in acute myocardial infarction: clinical features and prognostic implications.

The systolic murmur of papillary muscle dysfunction is a well-recognized feature of acute myocardial infarction (AMI), but no large prospective studies have determined its incidence, associated variables, and prognostic implications. Of 1653 patients who entered our data base with MI, 283 (17%) were classified as having a systolic murmur suggesting mitral regurgitation. At hospital discharge, there was a 5% incidence. There was a higher incidence of systolic murmur in non-Q wave AMI than in inferior or anterior Q wave MI (24% vs 13% and 15%, p less than 0.001). Advanced age, previous MI, and heart failure were all associated with systolic murmur (p less than 0.01). Persistent pain in the coronary care unit occurred more often in those with systolic murmur (45% vs 26%, p less than 0.0001). Systolic murmur was associated with an S3 and bibasilar rales (p less than 0.001) in the hospital; however, it was inversely related to peak creatine kinase and unrelated to heart failure or ejection fraction at discharge. Univariate predictors of mortality associated with systolic murmur included complex premature ventricular contractions at discharge and a non-Q wave location. Patients with systolic murmur had higher hospital and 1-year mortalities than those without systolic murmurs (p less than 0.01). When systolic murmur was present during hospitalization, the average time to reinfarction was 2.5 times earlier than when no systolic murmur was present (84 vs 214 days, p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Prophylactic sclerosing of esophageal varices--results of a prospective controlled study.

Of 60 patients suffering from various stages of esophageal varices with no previously recorded bleeding, 30 underwent combined peri- and intravascular fiberscopic sclerotherapy in a prospective controlled study. Each of the two groups consisted of 22 men and 8 women with an average age of 49 years. The cause of portal hypertension in 58 patients was a morphologically proven cirrhosis of the liver, due mainly to alcoholism. Portal vein thrombosis was present in two patients. The severity of the liver disease was first evaluated in accordance with the PUGH modification of the CHILD classification. 53% of the patients in the control, and 56% in the treatment, group belonged to the prognostically favourable CHILD A category. The period of observation was at least 26 months, with a mean of 36 months. Sclerotherapy lowered the risk of bleeding to 13.3%; in the control group it was 30%. The mortality rate during the overall observation period was lowered significantly (p less than 0.05) by sclerotherapy to 5.9% in the CHILD A group as compared with 25% in the control group. The mortality rate of CHILD B and C patients was over 40% in the control group and an unequally large 70% in the treatment group. The most frequent cause of death was bleeding from esophageal varices in the control group and liver failure in the treatment group. Complications were seen in 20% and paralleled the severity of the esophageal varices. All complications responded to conservative treatment and no fatality was seen.

Esophageal and Gastric Varices↗
PubMed1986

Myocardial infarction in young patients: an analysis by age subsets.

We examined, in age subsets, 2643 patients with acute myocardial infarction. Clinical features and 1 year morbidity and mortality were compared in 203 young patients (less than 45 years), 1671 patients 46 to 70 years old, and 769 elderly patients (greater than 70 years). Ninety-two percent of young patients were men, and a family history of premature coronary artery disease was more common in young patients (41% compared with 28% of middle-aged and 12% of elderly patients). More young patients were currently smoking cigarettes (82% compared with 56% of middle-aged and 24% of elderly patients), and only 8% of young patients had never smoked. Previous myocardial infarction and history of angina pectoris or congestive heart failure were less common (p less than .001) in the young patients than in middle-aged and elderly patients. In-hospital mortality was only 2.5% for young patients, compared with 9.0% in middle-aged and 21.4% in elderly patients (both p less than .001). Postdischarge 1 year mortality was also strikingly low in young patients, at 2.6% compared with 10.3% in middle-aged and 24.4% in elderly patients. The incidence of reinfarction during the 1 year of follow-up was similar in all subsets. The statistical significance of 65 variables as predictors of 1 year mortality and reinfarction was tested and the following found to be significant (p less than .05): hospital discharge on antiarrhythmic drugs, digoxin, or diuretics; history of previous myocardial infarction or congestive heart failure; chest x-ray findings of heart failure; low ejection fraction; and atrial fibrillation. Thus, young patients entering the hospital have an excellent 1 year prognosis, but those with prior infarction in whom there are selected abnormal findings at hospital discharge comprise a subgroup that may benefit from early aggressive management.

Adult↗
PubMed1986

[Value of laparoscopy in the diagnosis of chronic nonsuppurative destructive cholangitis].

39 female and 5 male patients with chronic non-suppurative destructive cholangitis (CNDC), excluding cases with the complete picture of a primary biliary cirrhosis, were examined. Besides clinical and immunological investigations in all patients laparoscopy was performed, in 18 cases repeatedly in order to control the course. As typical laparoscopic appearance in 43 of the cases we saw geographically outlined and generally communicating areas on the liver surface within somewhat brighter surroundings ("map-like-phenomenon"). Besides this a darker coloration in the center of the liver lobules was significant ("leopard skin-phenomenon"). Regarding the size, the consistency, the shape of the edge, and the structure of the surface of the liver we determined different stages of the disease. Our scale showed a good correlation to the copper-content of the liver, but did not always correlate to Scheuer's histological scheme. The significant uncertainties of histopathological interpretations of the findings in early stages of CNDC as well as differential diagnostic considerations are discussed. According to our results we believe that laparoscopy can significantly contribute to solve the diagnostic problems.

Adult↗
PubMed1985

Prediction of functional capacity and use of exercise testing for predicting risk after acute myocardial infarction.

This study evaluated whether an ischemic exercise test response or functional capacity could be predicted from data available during hospitalization in patients discharged after acute myocardial infarction (AMI). The value of exercise test variables for predicting death and new AMI within 1 year was also examined. Among 1,469 patients, 466 (32%) underwent treadmill exercise testing around the time of discharge. An ischemic exercise test response (ST-segment depression or angina) could not be predicted. Good functional capacity (more than 4 METs) could be predicted from age and ST-segment changes at rest. Among the 60% of the patients who were predicted to have functional capacity of more than 4 METs, only 15% had poor functional capacity at the time of testing. Multivariate analysis for predicting death and new infarction selected only functional capacity (continuous variable in METs), which classified 72% of the patients into a low-risk group with less than a 2% rate of death and new AMI in the first year. The high-risk group (29% of the patients) had an 18% rate of death or new AMI. It is concluded that functional capacity is the most important exercise test variable and that patients likely to have good functional capacity can be identified on the basis of age and ST-segment changes at rest. Further, the level of functional capacity on exercise testing can identify groups of patients with very low and relatively high risk of death or new AMI within 1 year.

Adrenergic beta-Antagonists↗
PubMed1985

Smoking status at the time of acute myocardial infarction and subsequent prognosis.

A population of 2955 patients admitted to the hospital with acute myocardial infarction (AMI) was followed for 1 year after AMI or until death. Smokers as compared to nonsmokers were over 10 years younger (p less than 0.001) and had a lower prevalence of hypertension (p less than 0.01), congestive heart failure (p less than 0.0001), angina pectoris (p less than 0.01), and diabetes (p less than 0.0001). They had less severe myocardial infarction evidenced, for example, by lower prevalence of pulmonary congestion on chest x-ray (p less than 0.01). Both early (1 month) and late (6 and 12 months) mortality rates were lower in the smoking population (p less than 0.0001 at 1 month, p less than 0.05 at 6 months, and p less than 0.01 at 1 year). Adjusting for age and other variables reduced but did not reverse the survival differential favoring smokers at 1 month, but adjusting for age alone eliminated the differences in mortality rates at 6 and 12 months. We conclude that while smoking is a risk factor for cardiovascular disease and may contribute to the occurrence of AMI at a younger age, smoking at the time of AMI does not appear to be an independent predictor of death during the first year after AMI.

Age Factors↗
PubMed1985

Survival after hospital discharge in matched populations with inferior or anterior myocardial infarction.

Prognostic differences between patients with anterior or inferior myocardial infarction are often related to such variables as previous infarction or the size of the myocardial infarct. We examined the determinants of mortality in 997 hospital survivors of acute Q wave infarction (anterior in 449, inferior in 548) who, although not preselected, were well matched with respect to age, sex and prior infarction or congestive heart failure. Additionally, there was no significant difference in peak serum creatine kinase (CK) between the groups with anterior and inferior infarction (1,459 +/- 1,004 versus 1,357 +/- 1,036). Among the patients with anterior infarction who died during the 1 year follow-up period, 56% died in the first 60 days after hospital discharge compared with 18% of those without inferior infarction (p less than 0.01). Survival curves then became nearly identical at 3 months, and remained so until 1 year when the total mortality rate was 10% for the anterior and 7% for the inferior infarction group (p = NS). Variables associated with heart failure during the hospital phase were more prevalent in anterior infarction, but rales above the scapulae during the hospital stay (p less than 0.0001) and ventricular gallop at the time of discharge (p less than 0.0001) were the top two predictors of 1 year mortality by both univariate and multivariate analysis in inferior infarction. Age (p less than 0.0001) and peripheral edema (p less than 0.0001) were the strongest predictors of mortality in anterior infarction. Previous infarction, although just as common in the group with anterior infarction, was present at 1 year in 48% of nonsurvivors of the group with inferior infarction compared with only 19% of survivors (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

Prognosis after extension of myocardial infarct: the role of Q wave or non-Q wave infarction.

We examined whether or not subsets of patients with extension of myocardial infarct were at high risk for early and late mortality. Some data suggest increased risk in patients with non-Q wave infarcts and we hypothesized that infarct extension in this group might be associated with a poorer prognosis than that for patients with extension of Q wave infarcts. A total of 1253 patients with acute myocardial infarction who were included in our data base were followed prospectively. The patients were classified according to electrocardiographic results into the following groups: those with non-Q wave (n = 277) infarcts and those with Q-anterior (n = 462) and Q-inferior (n = 497) infarcts. Extension was diagnosed by two of the following criteria: (1) recurrent chest pain 24 hr or more after admission to the hospital, (2) new persistent electrocardiographic changes, and (3) elevation or reappearance of creatine kinase. By these criteria 85 (6%) patients had extension (8% of non-Q wave infarcts, 6% of Q-anterior infarcts, and 6% of Q-inferior infarcts). Hospital mortality in patients with extension was 15% in those with Q wave infarcts vs 43% in those with non-Q wave infarcts (p less than .01). Nine hundred and fifty-two patients were followed for 1 year. In 24% of those who did not survive 1 year there was extension of infarct; only 6% of survivors had extension (p less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Complex ventricular arrhythmias in patients with Q wave versus non-Q wave myocardial infarction.

We examined whether or not subsets of patients with complex ventricular arrhythmias after myocardial infarction are at high risk with respect to 1 year mortality after hospital discharge. Based on previous studies showing increased risk for those with non-Q wave infarcts, we hypothesized that complex PVCs (premature ventricular complexes) in this group might be associated with a poorer prognosis than complex PVCs in patients with Q wave infarcts. Seven hundred seventy-seven patients entering our study with acute infarction were followed prospectively for 1 year after undergoing a predischarge 24 hr ambulatory electrocardiographic examination. Patients were classified by electrocardiographic criteria into the following groups: Non-Q wave (n = 191), Q wave anterior (n = 261), and Q wave inferior infarction (n = 325). The following arrhythmias were classified as complex: multiform PVCs, couplets, and ventricular tachycardia. Sixty-two percent of patients with non-Q wave infarcts who did not survive 1 year had complex PVCs, compared with 32% of survivors (p less than .01). No differences were seen in the Q wave subgroup. The survival for patients with Q wave and non-Q wave infarction without complex PVCs were nearly identical at 1 year (93% and 90%), whereas in patients with complex PVCs survival for those with Q wave and non-Q wave infarction was 92% and 76%, respectively (p less than .001). Of those with non-Q wave infarction, only 4% of nonsurvivors were free of any PVCs, as compared with 28% of nonsurvivors in the Q wave group (p less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1985

Semiquantitative and morphometric investigations on the histopathology of chronic hepatitis non-A, non-B.

Ninety-five cases (202 liver biopsies) with chronic hepatitis Non-A, Non-B (NANB) were investigated histologically. The alterations were analysed semiquantitatively. The histological indices (e. g. volume of the portal tracts, number of acidophilic bodies) of various case groups of chronic hepatitis NANB were determined morphometrically and the results were checked for internal statistical significance and for correlations with comparison groups of chronic hepatitis B. The large number of acidophilic bodies and sinusoidal cells are the sole characteristic histological sign of hepatitis NANB which enable its differential diagnosis, especially from hepatitis B. The chronic post-transfusion hepatitis NANB has a relatively good prognosis and in 80% of the cases shows the course of a chronic persistent hepatitis (CPH). In sporadic hepatitis NANB a chronic aggressive hepatitis (CAH) is present in 60%. The frequency of cirrhosis based on an already chronic stage is 12.6%. An indication for immunosuppressive therapy of sporadic chronic aggressive hepatitis NANB can only be established individually after a sufficiently long observation of the biochemical and histological alterations.

Biopsy↗