[Clinic internal hypertext information system].
Explore the source record for details and available documents.
Hospital Information Systems↗
Biomedical subjects
H Klepzig
Publications and source records attributed to H Klepzig.
[Determinants of treatment costs of unstable angina pectoris].
BACKGROUND AND AIM: Unstable angina, a common serious clinical entity, is associated with a high rate of complications. The aim of our study was to evaluate treatment costs of patients with uncomplicated and complicated follow-up in order to evaluate the economic consequences of new therapeutic strategies, like the introduction of GPIIb/IIIa blockers at our hospital. METHODOLOGY: All 103 patients who were admitted to the medical intensivecare unit of Johann Wolfgang Goethe-University Hospital, Frankfurt am Main between March 2, 1992 and October 31, 1997 for unstable angina of Braunwald class III B were enrolled in the study. Clinical events were the occurrence of refractory ischemia, nontransmural or transmural myocardial infarction or cardiac death. The following were documented: duration of treatment in the ICU and in the general ward, cardiac catheterizations, balloon angioplasties (PTCA), and bypass operations. Treatment costs were calculated on the basis of daily rates, flat rates, and special fees. RESULTS: Following successful primary treatment, a clinical event occurred in 48 of the 103 patients, recurrent refractory ischemia in 34 patients, nontransmural infarction in eight patients, transmural infarction in three patients, and death in four patients. Patients with events were significantly less likely to have had a history of PTCA (38% vs 60%, p < 0.05) and were significantly less likely to be undergoing long-term treatment with aspirin (63% vs 80%, p < 0.05). Other sociodemographic data as well as the initial treatment strategies were comparable. The occurrence of a complication significantly prolonged the duration of treatment in the ICU from 2.6 days (95%-CI [2.1; 3.0]) to 3.6 days (95%-CI [3.1; 4.1]) and the total duration of treatment from 7.0 days (95%-CI [5.7; 8.4]) to 12.8 days (95%-CI [9.6; 16.1]). The total treatment costs rose accordingly from DM 14,360 (95%-CI [12,360; 16,360]) to DM 26,690 (95%-CI [23,150; 30,240]). CONCLUSION: The data show that ischemic complications following successful primary treatment of unstable angina constitute a common problem. Such complications are associated with significantly more intensive treatment and significantly longer hospitalization times, resulting in a near doubling of treatment costs.
Adult↗
Extracellular matrix structure after heart transplantation.
Following heart transplantation remodeling of the donor heart causes changes in the extracellular myocardial matrix. We investigated 20 right ventricular endomyocardial biopsies taken 17+/-4 days (group I, n=9) and 63+/-13 days (group II, n=11) after heart transplantation from 16 patients transplanted for end-stage cardiomyopathy (15 dilated/1 ischemic). Immunohistochemical staining for collagen I, collagen III, collagen IV, and fibronectin was used. Evaluation was performed at a magnification of 400x using a computer-assisted image analyzing system measuring the relative area stained by the immunoperoxidase method, the number of cells in the given area, and the total area. Collagen I per cell was 13.9+/-5.9 microm2 in group I and increased significantly 66+/-13 days after heart transplantation in the perimysium around the myocardial cells as well as in the endocardium to 49.9+/-15.1 microm2 (P<0.05). No quantitative change in collagen III was noted (75.7+/-12.4 versus 75.5+/-16.0 microm2 n.s.). Collagen IV was found in the perimysial, in the capillary bed and in the vascular network. Significant quantitative change in the amount of collagen IV was not found (64.1+/-12.6 versus 61.0+/-8.9 microm2). Fibronectin was found in the entire perimysial extracellular matrix and in the endocardium in relationship with collagen I and III. An increased amount of fibronectin from 87.09+/-9.9 microm2 (group I) to 140.8+/-17.9 microm2 (group II, P<0.05) was found. The cell area and cell diameters were not significantly different (group I; cell area 772+/-227 microm2, diameter 31.3 microm; group II; cell area 776+/-224 microm2, diameter 31.4 microm). It is concluded that remodeling of the donor heart after transplantation is characterized by a specific increase in collagen I and fibronectin, whereas a change in other collagen subtypes was not observed.
Analysis of Variance↗
Sulfonylureas and ischaemic preconditioning; a double-blind, placebo-controlled evaluation of glimepiride and glibenclamide.
AIMS: Glimepiride is a new sulfonylurea for diabetes treatment which is supposed to impact less on extra-pancreatic ATP-dependent K+ channels than the conventional drug glibenclamide. This study was performed to evaluate whether this results in a better maintenance of ATP-dependent K+ channel mediated ischaemic myocardial preconditioning. METHODS AND RESULTS: In a double-blind placebo-controlled study the period of total coronary occlusion during balloon angioplasty of high grade coronary artery stenoses was used as a model to compare the effects of both drugs. Quantification of myocardial ischaemia was achieved by recording the intracoronary ECG and the time to the occurrence of angina during vessel occlusion. All patients underwent three dilatations. The first dilatation (dilatation 1) served to determine the severity of ischaemia during vessel occlusion. During dilatation 2, baseline values were recorded. Thereafter, glimepiride (15 patients: 1.162 mg), glibenclamide (15 patients: 2.54 mg) or placebo (15 patients) were intravenously administered over 12 min. Dilatation 3 started 10 min after the beginning of the drug administration. Mean ST segment shifts in the placebo group decreased by 35% (dilatation 2: 0.23; dilatation 3:0.15 mV; CI -0.55 to 0.00 mV; P=0.049). A similar reduction also occurred in the glimepiride group, in which repetitive balloon occlusion led to a 34% reduction (dilatation 2: 0.35; dilatation 3: 0.23 mV; CI -0.21 to -0.02 mV; P=0.01). There was little influence however, on mean ST segment shifts in the glibenclamide group (dilatation 2 and dilatation 3: 0.24 mV; CI -0.10 to 0.25 mV; P=0.34). Accordingly, time to angina during balloon occlusion slightly increased (by 30%) in the placebo group (dilatation 2: 37 s; dilatation 3: 48 s; CI 0.0 to 15.0 s; P=0.16); increased by 13% in the glimepiride group (dilatation 2: 40 s; dilatation 3: 45 s; CI 0.0 to 14.0 s; P=0023); and remained unchanged in the glibenclamide group (dilatation 2 and dilatation 3: 30 s; CI -7.5 to 7.5 s; P=0.67). CONCLUSION: These results show that glimepiride maintains myocardial preconditioning, while glibenclamide might be able to prevent it.
Adult↗
[Treatment costs in a medical intensive care unit: a comparison of 1992 and 1997].
BACKGROUND AND OBJECTIVE: Treatment in an intensive care unit (ICU) is very expensive. Aim of this study was to determine the exact composition of costs and to analyse what factors are responsible for the rise in costs over the last 5 years. METHODS: In a prospective investigation all 790 patients who had been treated at the ICU of the Medical Department of Frankfurt University during 1992 were included, findings being compared with data on all 208 patients treated in the ICU in May and June 1997. All important diagnostic and therapeutic measures were quantitatively determined each day. RESULTS: The mean age of the ICU patients rose in the 5 years from 55 to 59 years (P < 0.001). Mean period of stay in the ICU remained unchanged (4.1 days), total duration of hospital stay (15 and 12 days, respectively), and treatment intensity (sum of points according to the "Therapeutic Intervention Scoring System" per ICU stay: 96 and 77, respectively). The mortality rate in the ICU fell from 16.3% to 10.6% (P = 0.02), hospital mortality rate from 23% to 14% (P = 0.01). Total cost rose from DM 797,860 to DM 1,148,945 per 100 patients (+44%). Of this total, personnel costs were DM 286,885 in 1992 and 356,091 in 1997 (+24%), costs for apparatus-based diagnostic and therapeutic tests were DM 169,743 and 245,156, respectively (+44%), DM 98,496 and 129,222 for drugs (+31%), and DM 60,399 and 186,671 (+209%) for blood and clotting products (in each category per 100 patients). Per case costs rose from DM 7970 to 11,489, per day costs from DM 1943 to 2831. 90% of cost increases were due to new strategies in the treatment of patients with myocardial infractions and those with severe clotting disorders and a rise in personnel costs. CONCLUSION: The costs of a stay in the ICU has greatly increased over the last 5 years, the main causes being a change to new forms of treatment, especially in patients with myocardial infarction and those with haemophilia.
Adult↗
Prescription of cardiovascular drugs in outpatient care: a survey of outpatients in a German university hospital.
AIMS: We evaluated ambulatory prescriptions by general practitioners for outpatients with cardiovascular (CV) disease referred to the cardiology outpatient clinic of the Frankfurt University Hospital in order to prove adherence to generally acknowledged therapy standards for treating CV disease. METHODS AND RESULTS: Appropriateness of current CV medication was assessed according to the following criteria: aspirin or anticoagulants obligatory after myocardial infarction (MI), unless contraindicated; beta-blockers should be prescribed after MI, unless contraindicated or not tolerated; ACE inhibitors should be given in left ventricular dysfunction (LVD) after MI, unless contraindicated; and hypertension should be adequately controlled. 346 patients (28-94 years) received a median of 3 CV drug prescriptions (range 0-7). 240 patients had CAD, 142 patients previous MI, 121 patients had LVD (59 after MI), 143 patients were hypertensive. Aspirin was used appropriately in 80% of all MI patients, 13% received oral anticoagulants due to atrial fibrillation. However, 7% received no antithrombotic therapy. ACE inhibitors were administered in 65% of the MI patients with LVD. beta-blockers were used in 25% of the MI-patients. In the remaining patients, beta-blockers were contraindicated, not tolerated, and/or verapamil had been prescribed. However, in 14% of the patients beta-blockers were withheld without evident reason or alternative drug. In 41% of the hypertensive patients, blood pressure was not sufficiently controlled. CONCLUSION: A considerable number of ambulatory prescriptions for CV drugs are not in accordance with current therapeutic guidelines. The role of a cardiology outpatient clinic to detect the misuse or underuse of CV drugs is emphasised.
Adult↗
[Quality assurance in invasive cardiology. A prospective study for the evaluation of indications for coronary angiography and coronary dilatation using the "Rand Corporation" method].
OBJECTIVE: To assess the indications for coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) according to the criteria of the RAND Corporation's expert panel ratings; to compare the results with those already published in the literature; and to examine the method with respect to its appropriateness as a measure of quality control. PATIENTS AND METHODS: The parameters necessary for rating according to the RAND Corporation's published criteria were prospectively obtained in 116 consecutive patients (89 men, 27 women; mean age 59.4 +/- 10.7 years) undergoing coronary angiography and 138 patients (112 men, 26 women; mean age 61.5 +/- 9.4 years) undergoing PTCA. RESULTS: For coronary angiography the >>inappropriate rate << was 22.4%, for >> uncertain indications << 15.5%, >> appropriate indications << 24.1%, and for >> necessary indications << 37.9%. 38.6% of coronary angiographies, performed in the course of angiographic control after PTCA, were >> inappropriate <<, but only 12.5% of other coronary angiographies (P < 0.01). In 48.6% of >> appropriate << or >> necessary << procedures invasive treatment followed, compared with 19.2% of those rated >> inappropriate << (P < 0.05). In 10.1% of patients the indications for PTCA were judged >> inappropriate <<, in 32.6% as >> uncertain <<, in 13.0% as >> appropriate << and 44.2% as >> necessary <<. There was no correlation between ratings and the acute results of PTCA. These findings pertaining to indications for coronary angiography and PTCA correspond to those reported in the literature. CONCLUSIONS: As the RAND criteria take inadequate account of individual peculiarities, they are not suitable for individual clinical decisions. But they are useful as screening method in a quality control project, because procedures for which indications have not been adequately proven are singled out by an unfavourable rating and can thus be thoroughly analysed in the individual case.
Angina Pectoris↗
[Balloon mitral valve commissurotomy in pregnancy].
HISTORY AND CLINICAL FINDINGS: A 31-year-old woman with known postrheumatic mitral valve stenosis developed for the first time left heart failure in the 19th week of her fifth pregnancy. After intensive drug treatment she was in stage 3 (New York Heart Association classification). Apart from that the patient was in a good general condition and obstetrical status was according to the estimated duration of pregnancy. Auscultation revealed an apical diastolic murmur and mitral opening snap. INVESTIGATIONS: Echocardiography demonstrated a mitral valve opening area of 0.85 cm2 (pressure-half time method); the mean gradient was 19 mm Hg. TREATMENT AND COURSE: Because of the severity of the findings a percutaneous transvenous balloon valvotomy (according to Inoue) was performed in the 27th week of pregnancy, after careful lead shielding of abdomen and pelvis. Radiological screening time was 10 min. The invasively measured transvalvar pressure gradient was reduced from 28 to 4 mm Hg, echocardiographically determined mitral opening area increased to 1.5 cm2. Delivery was induced in the 36th week of pregnancy because of third-degree renal pelvis congestion. A healthy child, weighing 2850 g was delivered vaginally. CONCLUSION: High-grade symptomatic mitral stenosis can, if necessary, be treated with a low-risk to mother and child by percutaneous balloon valvotomy.
Adult↗
Protective action of hydroxyethyl rutosides on singlet oxygen challenged cardiomyocytes.
1. The effect of a standardized mixture of beta-hydroxyethyl rutosides against oxidative damage in singlet oxygen-challenged isolated cardiac myocytes from adult rats was investigated. The morphology of the myocytes was evaluated as an indicator for cell viability (elongated, rod shaped cells vs. hypercontracted, rounded cells). The determination of the production of thiobarbituric acid reactive substances served as an indicator for lipid peroxidation. 2. Exposure to singlet oxygen which was generated by photo-excitation of rose bengal (10(-7) M) reduced the number of rod shaped (vital) cardiomyocytes by 78.5 +/- 2.5% and increased the production of thiobarbituric acid reactive substances by 1180 +/- 150% in comparison to incubation with control buffer. 3. Coincubation of the cells with beta-hydroxyethyl rutosides (concentration range: 6.7 pg ml-1 to 670 micrograms ml-1) increased the number of rod shape cardiomyocytes after exposure to singlet oxygen in a dose-dependent bell-shaped manner. A significant protective effect was observed at beta-hydroxyethyl rutosides concentrations ranging from 0.67 ng ml-1 to 67 ng ml-1. 4. In spite of their protective action, beta-hydroxyethyl rutosides did not reduce the accumulation of thiobarbituric acid reactive substances, used as an indicator for lipid peroxidation. 5. The data suggest that beta-hydroxyethyl rutosides exert a protective action against oxygen radical-induced damage of cardiac myocytes at very low concentrations without interfering with lipid peroxidation.
Animals↗
[Multiplicity of clinical symptoms and manifestations of unruptured aneurysms of the sinus of Valsalva--3 case reports].
Sinus Valsalva aneurysms belong to the less common congenital or acquired structural cardiac anomalies. However, in patients with known cardiac anomalies and uncertain or uncharacteristic cardiac symptoms the existence of a sinus Valsalva aneurysm must be taken into consideration. A sinus Valsalva aneurysm can be clinically silent as in the case of the 56-year-old patient with an accompanying bacterial endocarditis. An increasing aortic regurgitation after dilatation of a coarctation of the aorta can also proceed with an ecstasy of the ascending aorta and an aneurysm of the sinus Valsalva (case 2). Furthermore, a rapid dilatation of a non-ruptured sinus Valsalva aneurysm can cause a severe compression of coronary arteries with subsequent myocardial infarction, as in the 27-year-old patient with congenital aortic stenosis and acute endocarditis in case 3.
Adult↗
[Electronic data processing in a surgical and medical intensive care unit].
A prospective documentation of patients data on an internal and a surgical intensive care unit (ICU) has been transacted. The physician and nursing staff used an online electronic documentation program, which has been developed in Frankfurt. Main emphasis has been placed on the epidemiological data, clinical diagnoses as well as diagnostically and therapy costs. The medical ICU of university hospital of Frankfurt has been analysed since 1992 and the surgical ICU of Städtisches Krankenhaus of Lüneburg since 1994. Up to now data from 2001 patients from Frankfurt are available. Period spent on the ICU was 4.7 +/- 0.16 days (average +/- SEM), mortality was 15%. 47% of the whole group suffered from cardiac disease, of which 211 had an acute myocardial infarction (10.6%), 156 patients a serious ventricular arrhythmia (7.8%) as well as 88 patients an unstable angina (4.4%). Long-term observation revealed a rise of the duration spent on the ICU (from 4.1 +/- 0.17 to 5.5 +/- 0.38 days, P < 0.0002), an increasing number of technical examinations (for example: chest x-ray from 2.25 +/- 0.13 to 4.52 +/- 0.4/patient, P < 0.0001) and a steady mortality between 1992 and 1994. Detailed analysis of patients with acute myocardial infarction showed an impressive reduction of total mortality within the 3 years observed. In Lüneburg data of 1004 patients have been recorded so far. The average time spent on the ICU was 6.4 +/- 0.33 days. 4.1% patients passed away. Neoplasia of gastric intestinal tract (143; 14.2%), femoral neck fracture (64; 6.4%) and ilei (54; 5.4%) have been the most frequent diagnoses. Patients underwent 2.2 +/- 0.12 chest x-rays and 1.4 +/- 0.1 ultrasound investigations. The study shows that an online data processing is practicable and can be integrated in the daily work flow. Furthermore, it can be seen that the collected data play an important role to secure the increasing administrative requisition to the modern medicine in view of costs and quality management.
Adult↗
[Evaluation of the sympathetic nervous system in silent ischemia with 123I-metaiodobenzylguanidine (MIBG)].
AIM: Examination of the integrity of the sympathetic nervous system in patients with angiographically proven coronary artery disease and ECG documented asymptomatic ST-segment depression. METHOD: Stress and rest myocardial perfusion scintigraphy using either Thallium-201 or 99mTc-isonitrile was performed in SPECT technique in order to localize ischemia or scar associated perfusion defects. 15 min and 4 h p.i. static anterior 123I-MIBG uptake was acquired. In order to localize norepinephrine depletion 4 h p.i. additional 123I-MIBG SPECT acquisition was performed. Incidence of arrhythmias was investigated by Holter ECG. Patients with diabetes mellitus were excluded. RESULTS: SPECT images showed in all patients regional 123I-MIBG depletion which corresponded with scintigraphically infarcted or ischemic regions. Well perfused myocardial regions matched with regular 123I-MIBG uptake. There was no evidence of increased arrhythmias in long-term ECG. CONCLUSION: The finding of regular 123I-MIBG uptake in well-perfused myocardium and infarction- or ischemia-associated regional 123I-MIBG depletion confirms that silent ischemia is not caused by a global sympathetic nervous dysfunction in a sense of cardiac polyneuropathy.
3-Iodobenzylguanidine↗
[Implantable defibrillator in the long QT syndrome].
A 29-year-old otherwise symptom-free patient had undergone a partial thyroidectomy 5 years ago followed by an episode of ventricular tachycardia and (after lidocaine injection) ventricular fibrillation requiring external defibrillation. No cause for the arrhythmias had been found at that time. Two subsequent syncopes led to her hospitalization. An asystole occurred while she was being monitored, and during the resuscitation there were several periods of ventricular fibrillation, which responded to external defibrillation. Subsequently several episodes of self-limiting ventricular tachycardia were recorded. A long QT syndrome with torsade-de-pointes tachycardia was diagnosed on the basis of typical ECG changes (QT interval 545 ms). Extensive diagnostic tests failed to find a cause. To prevent further tachycardias she was given propranolol, 40 mg three times daily, and an automatic defibrillator was implanted as a precaution. But no defibrillator discharge has so far been required (more than 10 months).
Adult↗
Captopril in acute myocardial infarction. Beneficial effects on infarct size and arrhythmias.
OBJECTIVE: It is known from experiments that angiotensin converting enzyme (ACE) inhibitors can limit infarct size. We examined the effect in patients. METHODS: In a prospective, randomized, placebo-controlled double blind study, 22 patients were given 1.5-2.0 mg captopril/h i.v., while 24 patients were given placebo. Medication was started between 2 hours and 18 hours from the onset of infarction. The two groups were matched for age, infarct location, and time of intervention. With exception of one patient in either group, all were concurrently given nitroglycerin. The necrosis parameters were provided by the quantitative measurement of the QRS complex. RESULTS: The Q wave decreased with captopril treatment (-0.003 mV), but increased with placebo (+0.14 mV) (p < 0.05). The number of ventricular premature beats at 24 hours from the start of treatment was 25/h with placebo, and 9/h with captopril (p < 0.02). Ventricular fibrillation occurred 7 times in the placebo group, but did not occur in the captopril group. The creatine kinase (CK) infarct weight was 59 gram-equivalents (gEq) with placebo, and 45 gEq with captopril (p = NS). The mean arterial pressure was reduced by 12 mmHg with captopril treatment. CONCLUSIONS: The results show a beneficial effect of captopril on infarct size and electrical instability, over and above the effect of standard management with nitroglycerin and thrombolysis.
Arrhythmias, Cardiac↗
Captopril in acute myocardial infarction: beneficial effects on infarct size and arrhythmias.
It is known from experiments that angiotensin-converting enzyme inhibitors can limit infarct size. In a prospective, randomized, placebo-controlled double-blind study, 22 patients were given 1.5-2.0 mg captopril/h i.v., while 24 patients were given placebo. Medication was started between 2 and 18 h from the onset of infarction. The two groups were matched for age, infarct location, and time of intervention. With the exception of one patient in either group, all were concurrently given nitroglycerin. The necrosis parameters were provided by the quantitative measurement of the QRS complex. The Q wave decreased with captopril treatment (-0.003 mV), but increased with placebo (+0.14 mV, p < 0.05). The number of ventricular premature beats at 24 h from the start of treatment was 25/h with placebo, and 9/h with captopril (p < 0.02). Ventricular fibrillation occurred seven times in the placebo group, but did not occur in the captopril group. The creatine kinase infarct weight was 59 gram-equivalents (gEq) with placebo, and 45 gEq with captopril (p = NS). Mean arterial pressure was reduced by 12 mmHg with captopril treatment. The results show a beneficial effect of captopril on infarct size and electrical instability, over and above the effect of standard management with nitroglycerin and thrombolysis.
Angiotensin-Converting Enzyme Inhibitors↗
Sympathetic re-innervation after heart transplantation: dual-isotope neurotransmitter scintigraphy, norepinephrine content and histological examination.
Cardiac transplantation entails surgical disruption of the sympathetic nerve fibres from their somata, resulting in sympathetic denervation. In order to investigate the occurrence of sympathetic re-innervation, neurotransmitter scintigraphy using the norepinephrine analogue iodine-123 metaiodobenzylguanidine (MIBG) was performed in 15 patients 2-69 months after transplantation. In addition, norepinephrine content and immunohistochemical reactions of antibodies to Schwann cell-associated S100 protein, to neuron-specific enolase (NSE) and to norepinephrine were examined in 34 endomyocardial biopsies of 29 patients 1-88 months after transplantation. Anterobasal 123I-MIBG uptake indicating partial sympathetic re-innervation could be shown in 40% of the scintigraphically investigated patients 37-69 months after transplantation. In immunohistochemical studies 83% of the patients investigated 1-72 months after transplantation showed nerve fibres in their biopsies but not positive reaction to norepinephrine. Significant norepinephrine content indicating re-innervation could not be detected in any biopsy. It was concluded that in spite of the lack of norepinephrine content there seemed to be immunohistological and scintigraphic evidence of sympathetic re-innervation. An explanation for this contradictory finding may be the reduced or missing norepinephrine storage ability compared to the restored uptake ability of regenerated sympathetic nerve fibres.
3-Iodobenzylguanidine↗
Comparison of calculated and measured mixed venous oxygen saturation in critically ill patients.
OBJECTIVE: According to the Fick principle the calculation of cardiac output and shunts is based on the exact determination of oxygen saturation. In this study an intraindividual comparison of two frequently applied methods was done. DESIGN AND SETTING: The calculated saturation by measuring partial oxygen pressure was compared with a gold standard, the reflectometrically measured saturation. PATIENTS: 75 patients of an intensive care unit in whom a Swan-Ganz catheter was introduced to answer clinical questions. RESULTS: Overall, most calculated values were higher than the measured ones, the mean difference was 5.9% (+/- 8.03%), ranging from -10.4 to +37%. In lower saturations (< 65%) the difference between both estimated values was larger than in the range above 65%. CONCLUSIONS: Especially when handling with lower oxygen saturations, calculation of saturation with an automatic gas analyzer leads to overestimated values. The Fick principle can only be applied for hemodynamic calculations when oxygen saturation can be determined by an easy and correct method.
Blood Gas Analysis↗
[Clinical relevance of equilibrium radionuclide ventriculography].
Explore the source record for details and available documents.
Coronary Artery Bypass↗