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Biomedical subjects

H Klein

Publications and source records attributed to H Klein.

At least 163 records · Page 9Linked to original sources
PubMed1992

Rectal prolapse after oral cathartics.

Complete rectal prolapse or procidentia is an uncommon condition long recognized but of uncertain pathogenesis. We report two patients, seen a decade apart, both of whom developed complete rectal prolapse after ingestion of oral cathartics in preparation for diagnostic studies. To our knowledge, cathartic-induced complete rectal prolapse has not been reported previously in the current medical literature, despite the thousands of bowel preparations performed annually. These two cases address the implications of such an occurrence, and we discuss the pertinent management issues.

Aged↗
PubMed1992

Catheter ablation of ventricular tachycardia: role of the underlying etiology and the site of energy delivery.

The role of DC catheter ablation (CA) to treat patients with sustained monomorphic ventricular tachycardia (VT) is still debated. To assess the efficacy of VT CA, we studied the follow-up of 49 patients with VT who underwent CA. There were 33 patients with an old myocardial infarction (MI) (group G I) and 16 patients had noncoronary VT (group G II): CA was performed at the earliest endocardial activation (EEA) (20 patients in G I, 14 patients in G II) or at the area of slow conduction (ASC) (13 patients in G I, 2 patients in G II). During the mean follow-up of 35 +/- 25 (1-79) months, there were 17 patients in G I (52%) and 12 patients in G II (75%) with VT recurrences (P less than 0.05). Recurrences of VT was observed in 4 of 15 patients (27%) when CA was performed at the ASC, compared to 25 of 34 patients (74%) with CA at the EEA (P less than 0.01). These data show that DC CA is more successful in patients with coronary artery disease, particularly when CA is performed at the ASC.

Adult↗
PubMed1992

Effect on ventricular performance of direct current electrical shock for catheter ablation of the atrioventricular junction.

In ten patients undergoing catheter ablation of the atrioventricular junction (CAVJ) because of therapy refractoriness of supraventricular arrhythmias, the effect of repeated high energy direct current (DC) shock on left ventricular function has been investigated. End-systolic pressure-volume relation (ESPVR) and the positive first derivative of ventricular pressure (dP/dt) have been used as indices of left ventricular systolic function, while the time constant of isovolumic pressure decay, the diastolic stiffness, and the negative dP/dt represented the diastolic function parameters, respectively. Each patient received at least two and no more than three DC shocks for successful CAVJ, with an energy of 360 joules. Significant acute reduction of both systolic and diastolic function was noted after each DC shock, with a slow partial recovery of both phases. The recovery process involved the systolic phase earlier and more completely than the diastolic one. The alterations observed could not be predicted from preablation values, but were significantly related to cumulative energy dose index for body weight. In conclusion, repeated high energy DC shocks acutely, but reversibly, impair left ventricular function; in addition, the ventricular function reduction is primarily related to the total ablation energy indexed for body weight.

Adult↗
PubMed1992

Early and long-term results of catheter ablation in patients with incessant ventricular tachycardia.

Catheter ablation of sustained monomorphic ventricular tachycardia (VT) with high energy DC shock (360-400 J) was performed in 11 patients with incessant VT (duration greater than 24 hours), refractory to antiarrhythmic drugs, and DC cardioversion. There were ten patients with coronary disease and one patient had dilated cardiomyopathy. Direct current energy was delivered at the earliest endocardial activation in six patients (group I) or at the area of slow conduction in five patients (group II). Incessant VT was terminated by DC ablation in nine patients (82%). After the ablation procedure VT remained inducible in four patients in group I (67%) and in one patient (20%) in group II. Two patients in group II had to go to emergent surgery. During the mean follow-up of 31 +/- 26 (1-66) months nonfatal VT recurrences occurred in five patients in group I and in one patient in group II.

Adult↗
PubMed1992

Pharmacokinetics of ANF and urodilatin during cANF receptor blockade and neutral endopeptidase inhibition.

Urodilatin is a new member of the family of natriuretic peptides. It is of renal origin. Previous reports indicate that urodilatin is natriuretic in lower doses than atrial natriuretic factor (ANF)-(99-126) and that it might be more effective than ANF in the treatment of cardiovascular edema. The present study was designed to compare the pharmacokinetics of the hydrolysis and clearance of 125I-labeled urodilatin and 125I-ANF. In control rats, the volume of distribution (Vss), metabolic clearance rate (MCR), and distribution half-life (distribution t1/2) of urodilatin in plasma were not significantly different from those of ANF. Infusion of clearance (c)ANF-(4-23), a specific ligand for receptors that clear ANF in excess amounts (i.e., a bolus injection of 100 micrograms/kg followed by a continuous infusion of 10 micrograms.kg-1 x min-1), increased the amount of intact peptide in the plasma to the same extent for both urodilatin and ANF. In addition, cANF-(4-23) decreased the Vss and the MCR and increased the distribution t1/2 of both peptides to about the same degree. Prior treatment of rats with SQ-28,603, a specific neutral endopeptidase (NEP; EN 3.4.24.11) inhibitor, was without significant effect on the metabolic clearance of urodilatin, whereas it decreased the clearance of ANF by 65%. Furthermore, an infusion of SQ-28,603 suppressed the appearance of the hydrolytic products of ANF in blood but not of urodilatin. Moreover, the inhibitor increased the total amount of ANF recovered in the kidneys to five times the control values, whereas it did not alter the renal uptake of urodilatin.(ABSTRACT TRUNCATED AT 250 WORDS)

Alanine↗
PubMed1992

Splenic megakaryocytopoiesis in primary (idiopathic) osteomyelofibrosis. An immunohistological and morphometric study with comparison of corresponding bone marrow features.

An immunohistochemical and morphometric study has been performed on splenic tissue of 10 patients with primary (idiopathic) osteomyelofibrosis (OMF) to determine characteristic features of megakaryocytopoiesis in myeloid metaplasia. Using the periodic acid-Schiff reaction (PAS) and particularly the monoclonal antibody CD61 (Y2/51), all elements of this cell lineage including precursors could be identified. In comparison with bone marrow specimens from our file material (40 patients with OMF, 15 control cases) which were processed in a similar way, megakaryocytes in the spleen revealed significant differences. These differences included smaller cell sizes, a disturbed nuclear-cytoplasmic ratio, and a conspicuous increase in the relative frequency of promegakaryoblasts. In conclusion, extramedullary megakaryocytopoiesis in OMF did not only show more pronounced abnormalities of differentiation, but also a higher degree of immaturity. Our finding of a significant accumulation of megakaryocytic precursors in the spleen as opposed to the bone marrow, corroborates the so-called filtration theory which has been introduced to explain the evolution of splenic myeloid metaplasia in OMF.

Aged↗
PubMed1992

Regulation by prostaglandin E2 of cytokine-elicited nitric oxide synthesis in rat liver macrophages.

Nitric oxide (NO), apart from its properties as a vasodilator, is a cytotoxic agent released from macrophages upon stimulation with immunomodulating agents such as interferon-gamma and endotoxin. In rat Kupffer cells endotoxin causes the release of NO as well as of tumor necrosis factor-alpha and prostaglandin E2 (PGE2). This eicosanoid and its second messenger, cyclic AMP, have been shown to increase nitric oxide formation in Kupffer cells treated with endotoxin (Gaillard et al. (1991) Pathobiology 59, 280-283). But not only added PGE2 but also the prostaglandin produced endogenously upon stimulation with endotoxin increases NO synthesis. Neither tumor necrosis factor-alpha nor interleukin-1 beta stimulate NO synthesis by themselves, but together with PGE2 they are as effective as lipopolysaccharide plus PGE2. To replace PGE2 in the combination with the cytokines, however, dibutyryl cAMP has to be present in higher concentrations than with LPS. Interleukin-6 alone or in combination with PGE2 or dibutyryl cAMP is without any effect. Anti-TNF-alpha as well as anti-PGE2 antibodies reduce the release of NO upon stimulation with LPS. Consequently, the effect of LPS on NO production seems to be in part due to the self-stimulating effect of PGE2 and some cytokines, both produced by Kupffer cells upon LPS stimulation.

Animals↗
PubMed1992

The fatty acid synthase (FAS) gene and its promoter in Rattus norvegicus.

Screening of rat liver genomic libraries yielded 5 overlapping clones for rat fatty acid synthase (FAS). From these clones we determined the 18,170 bp sequence of the rat FAS together with 5,028 bp of the 5'-flanking region and 515 bp of the 3'-adjacent genomic sequence. The two FAS transcripts which differ only in the positions of their polyadenylation/termination sites consist of one untranslated and 42 translated exons. Surprisingly, the substrate binding site for enoyl reductase, one of the FAS component functions, is interrupted by an intron. The sizes and the boundaries of the individual domains could be mapped in relation to the exon/intron structure of the gene. These eight partial functions coincide with discrete units of exons. The acyl carrier protein with its prosthetic 4'-phosphopantetheine group is located within a single exon supporting the idea that rat FAS has evolved by gene fusion. Using primer extension the main transcription start site of the FAS mRNA in both hepatic and mammary gland tissues was located at 5,028 bp in the sequence determined. As expected of a gene which is pretranslationally regulated the 5'-flanking region contains, in addition to TATA and CAAT boxes, consensus sequences for several DNA binding proteins.

Amino Acid Sequence↗
PubMed1992

[Implantable defibrillators].

Automatic implantable defibrillator therapy has changed the approach to life-threatening ventricular tachycardia completely and essentially improved survival after aborted sudden cardiac death. Since the first implantation of a defibrillator in 1980, 20,000 patients have received such a device. Nonetheless, in Germany still too many patients die of sudden cardiac death because defibrillator therapy fails to be known enough and keeps not being made use of (no more than 1,000 implants to date). In this group of patients characterized by poor ventricular function, antiarrhythmic drug therapy proved to be unreliable or even dangerous in many cases, while electrophysiologically-guided surgical interventions use to be impossible. The introduction of the implantable defibrillator enabled the incidence of sudden cardiac death to be reduced to about 2% during the first year after implant, and to 5% in the third year, respectively. In most centers with more extensive experience in defibrillator implantations, operative mortality is about 2-3%. Long-term results with defibrillator patients are controlled by the course of the underlying disease, which is coronary artery disease with large scars due to infarction in some 75% of cases. In a large group of about 10,000 patients, total mortality has been calculated to be 15% after three years. Defibrillator systems of the latest generation offer multiple programmability of tachycardia identification parameters and permit differentiated modification of therapeutic intervention. Defibrillator therapy has now been improved essentially by the introduction of endocardial lead systems and, in addition, by the defibrillator being combined with an antitachycardia pacing system.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Pacing, Artificial↗
PubMed1992

[Long-term follow-up of patients after interruption of the atrioventricular conduction by electrode catheter and DC shock: experiences with 100 patients].

Long-term follow-up (44 +/- 21 months) was studied in 100 patients (pts) (mean age 56 +/- 12 years) who underwent direct current ablation because of drug-resistant supraventricular arrhythmias. In 85 pts (85%) complete atrioventricular (AV) block was initially achieved. During the follow-up period, AV conduction resumed in 15 pts (15%). Thirteen pts underwent another ablation session and complete AV block was achieved in 11/13 pts (85%). After catheter ablation complete AV-block was achieved in 96 pts and the remaining four pts had second-degree AV-block. Complications like pericardial effusion, arterial hypotension or ventricular arrhythmias occurred in 18 pts. Total mortality was 13% (13 pts): one patient died suddenly, and seven pts died from cardiac causes (heart failure in six pts, reinfarction in one patient). Transcatheter direct-current ablation is an effective method to interrupt AV conduction and to treat patients with drug-resistant supraventricular arrhythmias. Although there is a small risk of severe complications, this procedure should be reserved for pts with supraventricular arrhythmias who do not respond to conventional drug treatment.

Adult↗
PubMed1991

Composite tissue transfer in limb-salvage surgery.

After extensive resection due to extremity sarcoma, the inability to cover the defect for satisfactory healing and limb function has been an indication for amputation rather than limb salvage. We report herein our experience with seven limb-salvage cases in which we closed difficult and complex defects with composite tissue transfers utilizing microvascular techniques. Free-flap transfers were used to cover soft-tissue defects after extensive resection of primary and locally recurrent tumor and to manage radiation-induced complications. The grafts healed well when infected irradiated tissue was covered, and the grafts tolerated postoperative irradiation. Composite tissue transfer also provided soft-tissue coverage around distal joints that would not have been adequately protected with a skin graft. Complications were minimal, and all patients maintained good extremity function. No patient who underwent composite tissue transfer has had a local recurrence. A free-flap composite tissue transfer can extend the indications for limb-salvage surgery and offers an alternative to amputation in selected patients.

Adolescent↗
PubMed1991

Liver transplantation in HBs antigen (HBsAg) carriers. Prevention of hepatitis B virus (HBV) recurrence by passive immunization.

Liver transplantation in HBs-antigen (HBsAg) positive allograft recipients is associated with a high risk of HBV recurrence some time after surgery. So far, results of measures to prevent recurrent HBV-infection by means of treatment with interferon, hepatitis B vaccination and short-term passive immunization with hepatitis B immunoglobulin (HBIg) or monoclonal antibody to HBsAg (anti-HBs) have been disappointing. In the present study the results of long-term, anti-HBs monitored passive immunization with HBIg is reported. In 23 HBsAg-positive liver transplant recipients an anti-HBs level of greater than or equal to 100 IU/l was maintained for 6 or 12 months, respectively. The rate of recurrent infection was found to be less than 20% under HBIg substitution, whereas 11 graft recipients with no or only short-term HBIg prophylaxis were reinfected by month 15 after transplantation. HBV recurrence was associated with chronic liver disease and recurrent cirrhosis in the allograft.

Adolescent↗
PubMed1991

Lack of prognostic value of syncope in patients with Wolff-Parkinson-White syndrome.

Syncope in patients with Wolff-Parkinson-White syndrome may be considered a premonitory event heralding the future development of sudden death. Therefore, the clinical and electrophysiologic data of 101 patients with Wolff-Parkinson-White syndrome referred for invasive evaluation of known arrhythmias were reviewed to assess the incidence and clinical relevance of syncope. Thirty-six patients reported the occurrence of one or more syncopal episodes (group 1) and 65 patients had no syncope (group 2). These two groups did not differ significantly with regard to age, gender, incidence and characteristics of arrhythmia, clinical history, frequency of arrhythmic events and presence of associated cardiac disease. There were 10 patients in group 1 and 12 in group 2 who had ventricular fibrillation. There were no statistical differences between the two groups with respect to the effective refractory period of the right atrium, atrioventricular node, accessory pathway and right ventricle. Furthermore, no differences between the two groups were noted with respect to cycle length of circus movement tachycardia, mean heart rate during atrial fibrillation, and minimum RR interval during atrial fibrillation. In addition, the accessory pathway location was not significantly different between group 1 and group 2. The occurrence of syncope could not be predicted from any electrophysiologic finding and this symptom had a low sensitivity and specificity for recognition of dangerous rapid heart rates. Furthermore, the prognostic value of syncope was less accurate and predictive than the shortest RR interval during atrial fibrillation and the anterograde effective refractory period of the accessory pathway for aborted sudden death occurrence.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗