Search PubMed⌕ Search

Biomedical subjects

H J Engel

Publications and source records attributed to H J Engel.

At least 55 records · Page 3Linked to original sources
PubMed1977

[Patient's opinions on doctors' explanations (author's transl)].

An inquiry by means of a questionnaire among 1043 persons (566 in-patients, 269 employees of industrial firms, 208 teachers) revealed: 32.5% were "often not" and 26.5% were "nearly always" satisfied with the medical information provided by their doctors. They were mainly interested in the causes of complaints (77.7%), in the prognosis (66.4%), in the effect of the medicament (44.5%) and in the diagnosis, using technical terminology (37.7%). Nearly all of them wanted to know about the contents of the specialist's report: 35.5% would like to read the report for themselves and 61.4% wanted an intelligible explanation by the family doctor. In incurable malignant disease, 49.5% preferred the patient to be fully informed, whereas 24.4% wanted information about a serious illness which might lead to death. Other questions concerned the information of relatives and between doctors.

Confidentiality↗
PubMed1977

[Ectopic coronary ostia and their importance for coronary and valvular surgery (author's transl)].

The incidence of ectopic coronary ostia location was investigated in coronary angiograms of 5350 adult patients without associated congenital heart disease. Ectopic coronary origin from the right coronary sinus was observed more than twice as frequently than ectopias from the left coronary sinus. The most common variation (0.7% of all patients) was the origin of the left circumflex branch from the right coronary sinus. Praeoperative knowledge and angiographic demonstration of ectopic coronary arteries is essential in order to avoid damage of these vessels during prosthetic valvular surgery or by aortotomy, to achieve complete revascularization in bypass surgery, and to prevent complications during intraoperative coronary perfusion.

Angiocardiography↗
PubMed1977

Transmural myocardial infarction in young women taking oral contraceptives. Evidence of reduced regional coronary flow in spite of normal coronary arteries.

A normal coronary arteriogram after transmural myocardial infarction is a well-recognised phenomenon, but the pathophysiology remains unclear in most cases. A possible aetiological role of oral contraceptives is suggested by the occurrence of unequivocal myocardial infarction with normal or near normal coronary arteries in 4 young women who had been taking oral contraceptives. While the cause-effect relation of coronary thrombosis and myocardial infarction remains controversial in patients with coronary atherosclerosis, a primary occlusion of macroscopically normal coronary arteries by cellular elements of blood appears possible in these cases. The action of contraceptives, the, would be analogous to their thrombogenic effect in peripheral veins and cerebral arteries. Absence of atherosclerotic lesions in these patients favours spontaneous thrombolysis and restoration of normal vessel patency in many of these cases. Myocardial blood flow in the region of the damaged left ventricular wall remains low in spite of normal coronary arteries. Reduced perfusion in infarcted areas is assumed to be the consequence of structural and functional alterations at precapillary and capillary level rather than an effect of obstructive coronary disease.

Adult↗
PubMed1976

Quantitative scintigraphic display of myocardial blood flow. Technique and clinical evaluation.

Immediately after coronarography 10 mCi 133Xenon were injected into the left or right coronary artery. A scintillation camera was placed above the thorax of the patient. A computer unit (KRUPP EPR 2500) with magnetic tapes and discs is available for data processing and data storage. Sequential images of the heart are taken over a period of 2 min in a two-second-frame mode and stored on magnetic tape. The total image was divided into 5 - 5 mm areas. From each area a functional curve was registered and the Myocardial Blood Flow (ml/min/100 g myocard) could be calculated from that. For a precise evaluation of the image of the Myocardial Blood Flow, any influences originating from other regions of the body had to be excluded. Therefore all curves are rejected which did not (a) reach their maximum value within 15s after injection, or (b) where the maximum was less than 10% of the highest maximum value of the reference curve. The values of the Myocardial Blood Flow calculated in this manner are displayed on a TV-screen. These values can be transformed into 10 colors or grey levels. This method has been proven to be useful in clinical practice for functional studies, especially for the judgement of the effectivity of pharmaceuticals. The quantitative display technique of the "Myocardial Blood Flow" improves the clinical statement in comparison to a scintigraphic picture.

Coronary Artery Bypass↗
PubMed1976

Coronary artery spasm as the cause of myocardial infarction during coronary arteriogarphy.

Catheter-induced coronary artery spasm has been observed frequently. It is usually transient, reacts to the administration of nitroglycerin, and its distribution is generally confined to an area in proximity ot the intubated catheter. A 43-year-old woman with recurrent chest pain was found to have a rather long segment of tight proximal obstruction of the right coronary artery and experienced a myocardial infarction during coronary catheterization. Because of recurrent attacks of severe chest pain, coronary artery bypass surgery was performed which failed to result in significant improvement of her symptoms. Two repeat coronary cineangiograms seven weeks and three years after surgery revealed the proximal right coronary artery to be free of stenotic lesions or of luminal irregularities. After considering possible mechanisms of myocardial necrosis in the presence of normal coronary arteries it is concluded that myocardial necrosis can result from catheter-induced coronary artery spasm in spite of administration of nitroglycerin.

Adult↗
PubMed1976

[Compromised lumen of ectopic left circumflex coronary artery by prosthetic valve (author's transl)].

Implantation of an aortic valve prosthesis in patient with aberrant left circumflex coronary artery arising from the initial portion of the right coronary artery resulted in compression of this vessel by the prosthetic valve and in pump failure after interruption of cardiopulmonary bypass. Incidence and significance of variations in coronary artery origin and course are mentioned.

Aortic Valve↗
PubMed1976

[Transfemoral coronary angiography. I. Report on the decreasing complication rate in the increasing number of cases].

4950 coronary arteriographies performed by the percutaneous transfemoral technique (Judkins) are reviewed with respect to mortality, morbidity of myocardial infarctions and cerebral emboli, incidence of femoral thrombectomies and incidence of threatening events like arrhythmias and contrast reactions. With increasing number of coronary arteriographies that were performed yearly the incidence of all complications could be reduced by more than 90%.

Angiography↗
PubMed1976

[Transfemoral coronary angiography. II. Technical aspects of risk lowering].

Based on an experience of 4950 coronary arteriographies and a review of the literature common complications of transfemoral coronary arteriography are named, their mechanisms are analyzed and technical modifications of the procedure are suggested that we found useful to decrease the risk associated with this diagnostic test. Since throboembolic complications are a central problem of the transfemoral technique, various mechanisms producing myocardial and cerebral emboli are carefully analyzed. The significance of routine systemic heparinization has been emphasized repeatedly, but the contribution to safety of mechanical catheter tip debridement that can be reliably achieved by a meticulous ritual of appropriate steps is not universally recognized. These steps include a careful guidewire technique, insisting on spontaneous free back-dripping of blood from newly introduced catheters after removal of the guidewire, aspiration of blood with a syringe and flushing with saline and contrast. Careful observation of the blood pressure contour is mandatory whenever the catheter is advanced. In view of the time-thrombogenicity relation of catheter material, the procedure has to be performed expeditiously. After apparent solution of the problem of thromboembolic accidents, the only major complications occurred in patients with severe left main coronary artery lesions. Whenever disease of the left main coronary artery can be anticipated by a suggestive history, by highly abnormal ECG changes with exercise or by calcifications of the coronary arteries, the number of contrast injections should be reduced to a minimum necessary to adequately demonstrate the severity of the stenosis and the anatomy of the peripheral vessels for possible bypass surgery.

Angiography↗
PubMed1975

[Proceedings: Diagnostic value of myocardial perfusion scintigraphy in coronary sclerosis].

UNLABELLED: Perfusion scintigrams with Technetium-labeled microspheres were performed in 60 patients undergoing selective coronary angiography. The scintigrams were analyzed semiquantitatively with the aid of a computer. In addition, angiograms were quantitated with regard to proximal obstructions as well as regional wall changes of the left ventricle (VCF). RESULTS: 1. A reduction of scintigraphic activity was already seen in narrowings of lesser degrees (50%); 2. scintigraphic activity followed the degree of obstruction rather than the contraction abnormality. Perfusion scintigrams are helpful in selecting patients for revascularization.

Coronary Disease↗
PubMed1975

Angiographic estimation of relative coronary artery flow based on terminal branching patterns.

Angiographically "terminal" coronary arterial branches were counted in 100 normal coronary cineangiograms to investigate the possibility that three left ventricular wall regions might be defined by identifying patterns of arterial inflow. An average of 45% of the terminal branches were counted in the anterior region supplied by the anterior descending coronary artery; 25% were counted in the lateral region supplied by diagonal and obtuse marginal arterieistal circumflex and distal right arteries. Based upon the hypothesis that blood flow through an artery is directly proportional to the number of small branches into which it ramifies, this approach affords an estimate of the relative contribution by individual coronary arteries to total left ventricular perfusion. This concept could prove useful in defining a quantitative grading system of coronary arterial inflow obstruction.

Cineangiography↗