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Biomedical subjects

H Hess

Publications and source records attributed to H Hess.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Local thrombolysis in peripheral arterial occlusion].

Peripheral arterial occlusions, with the exception of those induced mechanically or by vasospasm, are invariably caused by a blood clot resulting from either in-situ thrombosis or embolism. More than 10% of embolic occlusions in otherwise healthy arteries undergo spontaneous lysis due to the organisms tissue plasminogen activator. In thrombotic occlusion of arteriosclerotic vessels, probably due to insufficient activator release from the diseased arterial wall, spontaneous lysis is much less common. For more than 25 years, lysis has been aided with streptokinase (SK) or urokinase (UK) which, until eight years ago, had only been given systemically with a standard dosage of 2.4 million units daily for up to five days. Thrombotic femoral artery occlusions of up to six weeks old were successfully lysed in 48%, six to twelve weeks old in 25% and, in those older than twelve weeks only in exceptional cases. With embolic occlusion, systemic lysis is contraindicated due to the possibility of provoking new emboli. With conventional systemic SK treatment, in 7% of the patients there was severe bleeding which in 1.12% was fatal. The ultrahigh SK treatment (nine million units in six hours) has substantially fewer bleeding complications but no better rate of success. Systemic administration of SK and UK leads to activation of the entire circulating plasminogen and the correspondingly-associated clotting defects. Recombinant tissue plasminogen activator (rt-PA), the production of which was rendered possible by genetic engineering, is identical to human tissue activator, has a high affinity to fibrin-bound plasminogen, less affinity to circulating plasminogen. After systemic administration, however, the plasminogen in every vascular clot is activated such that, even without alteration of the clotting system, bleeding the emboli can be provoked. With local application of the activator, even extensive clots, provided they contain lysable fibrin, can be dissolved within one-half to three hours with comparably minimal doses. For local lysis treatment of peripheral arterial occlusions, SK, UK and rt-PA are well-suited. With a total dose of maximally 30,000 units SK, in contrast to the initially-used higher doses, there were no bleeding complications in more than 300 patients. Even with a total doses of 100,000 to 300,000 UK, albeit in a relatively small number of patients, and a total dose of 2.5 to 7.5 mg rt-PA which was given within three hours maximally to 85 patients, there were no bleeding complications.(ABSTRACT TRUNCATED AT 400 WORDS)

Angioplasty, Balloon↗
PubMed1988

Femoro-popliteal artery thrombolysis with intra-arterial infusion of recombinant tissue-type plasminogen activator--report of a pilot trial.

Recombinant tissue-type plasminogen activator (rt-PA) was infused at a rate of 10 mg/h into 50 thrombosed femoral and popliteal arteries. Patency was restored in 43 but a secondary angioplasty led to 2 reocclusions and in 3 patients early rethrombosis occurred. A favourable clinical result was thus obtained in 38 patients (76%). Thirteen bleeding complications occurred in 10 patients, mainly haematomas at puncture sites. One patient required blood transfusion for gastro-intestinal bleeding from a previously unknown ulcer. The angiographic recanalisation rate in 16 patients who received a slower infusion of rt-PA (5 or 3 mg/h) was 94% and the clinical success rate in this series was 81%. However, the incidence of bleeding complications was not decreased by the slower infusion rate. The data obtained confirm the feasibility of rt-PA thrombolysis in peripheral arterial thrombosis and warrant a comparative study with streptokinase.

Angioplasty, Balloon↗
PubMed1988

[Fibrinolysis with rt-PA in peripheral arterial occlusions].

First experiences using rt-PA for the local lysis of peripheral arterial occlusions have shown that it is a potent activator of the fibrinolytic system. 2 to 5 mg of rt-PA administered for 1 to 1 1/2 hours are sufficient to completely dissolve even long occlusions. With doses up to 20 mg over 2 hours no systemic bleeding was observed. With 50 mg given within 5 hours and with an infusion of 2.5 mg per hour for 48 hours there were two cases of systemic haemorrhaging entirely due to the fibrinolysis. No appreciable defects in the coagulation system and no other side effects were observed.

Aged↗
PubMed1987

[Local thrombolysis in the treatment of acute ischemia of the leg].

The results of local low-dose thrombolytic treatments of 564 peripheral arterial occlusions were as follows: Embolic occlusions up to 6 weeks could be removed in 72.7%, the longer lasting occlusions in 42.3%. Thrombotic occlusions lasting up to 6 months were successfully treated in 58%, still older ones in 36.2%. The cumulative patency after 5 years was 89.5% in embolic and 58.8% in thrombotic occlusions. Therefore, the differential therapy of acute peripheral ischemia has to be thought over anew together with the vascular surgeons.

Acute Disease↗
PubMed1987

Peripheral arterial occlusions: a 6-year experience with local low-dose thrombolytic therapy.

Early and long-term results of treatment with local low-dose thrombolysis in 554 patients with 564 peripheral arterial occlusions are reported. Of 92 embolic occlusions present for 2 months or more, 59 (64.1%) were recanalized with a cumulative patency of 89.5% after 5 years. Of 472 thrombotic occlusions present for up to 6 months and more, 254 (53.8%) were successfully treated with a cumulative patency of 58.8% after 5 years. The hospital mortality and amputation rate were 1.6% and 1.95%, respectively. The average age of the patients was 69.1 years and more than half of those treated had stage III or IV disease. A 6-year experience with local low-dose thrombolytic therapy has completely confirmed its efficacy and has led to improvements in technique, which are described. The doses of streptokinase and urokinase needed for a successful result have been substantially reduced and the duration of treatment shortened. The number of complications has also been reduced. Differential therapeutic considerations compared to vascular surgery are mentioned. The results should motivate a reconsideration of the diagnostic and therapeutic measures to be used in the treatment of peripheral arterial occlusions.

Adolescent↗
PubMed1986

Enhancement of the antiemetic action of metoclopramide against cisplatin-induced emesis by transdermal electrical nerve stimulation.

In a double-blind sequential trial, the influence of transdermal electrical nerve stimulation (TENS) was studied in patients who were treated with total infusions of metoclopramide 3.5 mg/kg to counter the emetic action of cisplatin 60-90 mg/m2. Transdermal electrical nerve stimulation further reduced the emetic episodes in ten of 11 treatment pairs (2 alpha = .10). This effect was blocked by naloxone. More surprisingly, TENS reduced the incidence of extrapyramidal effects of metoclopramide (i.e., akathisia and dystonia). These effects may be explained by the involvement of central nervous and peripheral TENS-induced production of opioid neuromodulators. An alternate hypothesis is the stimulation of serotonergic mechanisms via neuromodulation by opioid peptides, or by involvement of both systems.

Adult↗
PubMed1986

Immunochemical distribution of interphotoreceptor retinoid-binding protein in selected species.

An enzyme-linked immunosorbent assay (ELISA) was used to quantitate interphotoreceptor retinoid-binding protein (IRBP) in tissues of monkey and other species using rabbit antiserum against monkey IRBP. A 1:7500 antiserum dilution was found optimal with the linear range extending to 250 micrograms IRBP/ml. The highest IRBP concentration was found in cannulation fluid of the monkey interphotoreceptor space, although vitreous and aqueous humors also contained IRBP. The presence of IRBP in the vitreous was confirmed by Western blot and 3H-retinol binding studies. The pineal gland of monkey and rat also was found to contain IRBP, as assessed by ELISA and immunocytochemistry; IRBP was below the limits of detection in turtle and chicken retina. IRBP levels were uniformly low in retinas of human cases with hereditary retinal degeneration, including retinitis pigmentosa (three cases) and choroideremia (two cases). The presence of IRBP in pineal as well as in the vitreous and aqueous humors may indicate a broader role for this putative retinoid-transport protein than previously suspected.

Animals↗
PubMed1985

Drug-induced inhibition of platelet function delays progression of peripheral occlusive arterial disease. A prospective double-blind arteriographically controlled trial.

240 patients were admitted to a double-blind study to determine the effect of long-term treatment with platelet-function inhibiting agents on occlusive arterial disease in the lower extremities. Patients were randomised into 1 of 3 treatment groups: aspirin 330 mg; dipyridamole 75 mg and aspirin 330 mg; or matching placebo 3 times daily. The duration of treatment was 2 years. Arteriography was carried out at the beginning of the study and 2 years later or before if deterioration was observed. 199 patients completed the study according to the trial protocol. The serial arteriograms were assessed in pairs qualitatively, by means of simple comparative viewing, and semiquantitatively with Bollinger's score system. Progression of the disease was most pronounced in the placebo-treated group, less so in the aspirin-treated group, and least of all in the dipyridamole-and-aspirin group. Patients who smoke and those with hypertension may benefit most from treatment with the 2 preparations under investigation.

Arterial Occlusive Diseases↗
PubMed1985

Thrombolytic therapy and its combination with transluminal catheter dilatation.

The material for complete occlusion of an artery is predominantly thrombotic. The longer the occluded segment the worse are the results of PTA since the thrombotic material is not compressible. As long as this thrombotic material is not already organized, it can be lysed by thrombolytic therapy, and thus removed. Remaining stenoses can be dilated subsequently. Thrombolytic therapy was carried out either systemically, i.e. by intravenous infusion of high doses of streptokinase or by selective local infiltration of an occluding clot with low doses of the same drug via a catheter. This study deals in particular with local low-dose streptokinase therapy. Out of 205 patients treated, primary recanalization was achieved in 145 (75%) and in 107 of these cases additional balloon dilatation was necessary. In 36 patients (25%) reocclusion occurred within the first 2 weeks. Out of the other patients the cumulative patency rate after 2 years was 50%. The combination of PTA with local low-dose thrombolytic therapy has several advantages: It facilitates probing of the occlusion by softening the clot. It removes the lysable component of the clot, giving the possibility of restricting the dilatory procedure to a shorter segment and, thus, diminishing the vascular trauma and risk of rethrombosis. It helps to prevent rethrombosis by the after-effect of thrombolysis. It provokes hyperaemia lasting for 1 to 2 days. It is capable of rapidly dissolving early reocclusion or macroemboli. Local low-dose thrombolytic therapy in combination with PTA has effectively extended the number of non-surgical recanalizations of peripheral arterial occlusions in our clinic.

Angioplasty, Balloon↗
PubMed1985

Improved benefit/risk ratio of higher-dose metoclopramide therapy during cisplatin-induced emesis.

Metoclopramide (Paspertin) was infused intravenously in the high doses of 1.75, 3.5, 7.0, and 14 mg/kg body wt. per treatment cycle as antiemetic therapy for cisplatin-induced emesis (363 cycles, 25-120 mg/m2). The antiemetic potency of metoclopramide increased in a log linear manner, giving from 40% to 95% protection against emesis. Gastrointestinal motility showed a similar increase, i.e. diarrhoea. In contrast, the extrapyramidal reactions, namely akathisia, rigidity and acute dystonia, did not show a dose-dependent increase in frequency and remained constant over the dose range of 3.5-14 mg/kg per cycle. The results suggest increasing benefit of metoclopramide treatment with increasing doses of the drug.

Basal Ganglia Diseases↗
PubMed1985

Metoclopramide kinetics at high-dose infusion rates for prevention of cisplatin-induced emesis.

Eleven male subjects aged 24 to 58 yr received cisplatin, 90 to 120 mg/m2 iv, in combination with other cytostatic drugs such as doxorubicin HCl and bleomycin. To prevent emesis, two high-dose metoclopramide regimens were started 2 hr before cytostatic therapy. Regimen A (n = 7) consisted of a loading dose infusion of 1 mg/kg/hr over 2 hr, followed by a maintenance infusion of 0.5 mg/kg/hr over 24 hr (total dose was 14 mg/kg in each cytostatic cycle). Regimen B (n = 6) consisted of half the metoclopramide dose. The following kinetics were derived from the metoclopramide steady-state plasma levels and the t1/2 of the elimination phase 26 to 38 hr after dosing (median value and range are listed): Steady-state plasma concentration in group A and group B was 750 (480 to 1520) and 360 (300 to 480) ng/ml plasma. Drug clearance in group A and group B was 0.67 (0.3 to 1.0) and 0.70 (0.5 to 0.8) l/hr/kg. Volumes of drug distribution in group A and group B were 4.4 (1.9 to 6.5) and 4.3 (3.2 to 5.9) l/kg. Values for the t1/2 in the elimination phase in group A and group B were 4.7 (3.0 to 5.4) and 4.3 (3.7 to 5.1) hr. It appears that metoclopramide kinetics at high doses were dose linear, i.e., without evidence of cumulation. There were few side effects; vomiting was effectively suppressed by both regimens.

Adult↗
PubMed1985

[Group process studies within the scope of directed dynamic group psychotherapy].

Footing on specific prämisses of Intended Dynamic Group Psychotherapy three different types of development are described on the basis of factor analytical investigations towards the behaviour and experience of the group members and of the therapeut. At a period of 34 sessions of stationary psychotherapy data of 15 groups were comprehended and globally related to the effectivity. There are shown up the problems of therapeuticle behaviour, of indication and of effectivity.

Communication↗