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Biomedical subjects

H Mannebach

Publications and source records attributed to H Mannebach.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Percutaneous transluminal coronary angioplasty (PTCA) in unstable angina pectoris: results and complications with reference to a new classification].

Percutaneous transluminal coronary angioplasty (PTCA) of patients with unstable angina pectoris is an established therapy, although the rate of major complications (death, myocardial infarction, emergency coronary artery bypass operation) is higher than in patients with stable angina. This study analyzes the results of PTCA in 168 patients (136 men, 32 women, mean age 60.6 +/- 9.6 years) treated between January 1989 and June 1990 for unstable angina pectoris. Unstable angina was classified according to the criteria proposed by Braunwald in 1989. PTCA was successful in 141 patients (83.9%) and failed in 27 patients (16.1%). No patient died. One patient (0.6%) suffered an acute myocardial infarction related to PTCA. After failed PTCA 16 patients (9.5%) underwent emergency coronary artery bypass grafting (CABG), 10 patients had no complication. In patients of unstable angina class III (angina at rest within the last 48 h before PTCA) emergency CABG was needed in 20.3% compared to 3.6% (p less than 0.01) in patients with unstable angina class II (last attack of angina at rest more than 48 h before PTCA). Also 30% of patients with unstable angina within 2 weeks after myocardial infarction (clinical subgroup C) needed emergency CABG after failed PTCA as compared to only 6.9% (p less than 0.01) of patients with primary unstable angina pectoris without previous infarction (clinical subgroup B). The highest frequency (66.6%/6 of 9 patients) of emergency CABG was observed in patients with class III and subgroup C. We conclude that the classification of unstable angina pectoris proposed by Braunwald might be helpful to identify patients with risk in PTCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Right ventricular outflow obstruction due to accessory tricuspid valve tissue in corrected transposition of the great arteries with ventricular septal defect].

A 27-year-old man known to have corrected transposition of the great arteries (CTGA) associated with a ventricular septal defect (VSD) was admitted to our hospital with a suspected increase of the shunt volume. The patient is a first class bodybuilder. Heart catheterization confirmed the diagnosis of a "right-ventricular" mass obstructing the "right-ventricular" outflow tract, which had already been seen at echocardiography. The intraoperative finding showed the tumor to be accessory tissue of the anterior tricuspid leaflet prolapsing through the VSD into the subvalvular outflow tract of the right ventricle. The accessory tricuspid valve tissue was removed by transatrial access. The VSD was closed by a dacron patch using the same route. The postoperative course was uneventful.

Adult↗
PubMed1990

[Early ambulation and rehabilitation following heart surgery from the viewpoint of the cardiologist for adults].

Traditional concepts about the early phase of postoperative remobilization after cardiac surgery favor physical inactivity--as did earlier concepts for rehabilitation after myocardial infarction like the armchair treatment philosophy. For an overwhelming majority of our patients, however, this concept does not hold, according to our experience during the last decade. In contrast, we propose a model of stepwise mobilization and rehabilitation starting the first postoperative days. At the end of the first week most patients are able to climb staircases. In the second week group physical therapy can be started. At the 14th postoperative day, discharge from the surgical ward is warranted. During this step of early mobilization some exceptions have to be made and some special aspects have to be considered. Early mobilization must be postponed in patients with overt heart insufficiency, a low ejection fraction, complex ventricular arrhythmias or pericardial effusions. Cautious mobilization is also required in patients with mitral valve replacement and persistent elevation of pulmonary pressure and resistance. This holds also for patients with valve replacement during acute endocarditis, patients with repair of a dissecting aneurysm of the aorta and patients with perioperative myocardial infarction. The stage of early postoperative mobilization usually ends after the second week and is followed by the next step, the rehabilitation phase during weeks 3 to 6. The goals of the rehabilitation program are; increasing the physical fitness of the patient, thereby increasing his self-assurance and self-esteem; establishing a health-education program, increasing the patients health competence and his coping capacities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Optimal long-term control of arterial hypertension. Experiences with ambulatory, sports-oriented groups of patients with hypertension].

Out-patient groups of hypertensives were organized in an effort to improve long-term treatment results with greater attention to general measures and to increase compliance. Under supervision of a doctor and a physiotherapist 45 patients (aged 54 +/- 10 years) with mild or moderately severe hypertension were enrolled in a sports training programme after thorough examination. At the same time they were given advice and instructions on self-measurement of blood pressure, diet, medication, general life style and relaxation techniques. In the first 20 patients (observation period of more than one year) a significant reduction in both resting (systolic of -9%) and exercise (systolic of -12%) blood pressures was noted. At the same time exercise tolerance was raised (+18%), while body-weight and total cholesterol concentrations were lowered. It was possible to reduce drug dosage in seven patients, in three more it was discontinued. Left-ventricular wall thickness fell slightly but not significantly. There were no complications. It is concluded that group therapy with sport as a vehicle and advice on general life style are satisfactory means for controlling hypertension and achieve better compliance.

Adult↗
PubMed1988

[Bradycardia factitia].

Repeated intake of 240-400 mg non-retard verapamil by a 26-year-old male nurse brought about interference dissociation resulting from extreme sinus bradycardia, passive AV nodal rhythm and hypotension. Because of a history of myocarditis a recurrence was suspected and an organic cause of the arrhythmia assumed at first, until its self-inflicted origin was discovered. The case demonstrates the need to consider self-medication, even if at first denied, in the differential diagnosis of arrhythmias even in the absence initially of any clear-cut pointers towards it.

Adult↗
PubMed1987

[Color Doppler echocardiography in the diagnosis of aortic dissection and aortic wall abscesses].

In eleven patients with aortic dissection or perforated endocarditic aortic wall abscess cavity, the diagnostic usefulness of Color Doppler Echocardiography (CDE) for the identification of true and false lumen as well as the perforation jet was assessed by comparison with the findings of angiography, digital subtraction angiography, computed tomography and surgery. The information gained in addition to that of these procedures, as well as to that of the four conventional echocardiographic techniques was evaluated. Six patients had aortic dissections of DeBakey type I or III; in all of them the diagnosis had been established with conventional ultrasonic techniques. Similarly, in all patients with aortic dissection of DeBakey type I, a clear differentiation between true and false lumen in the aortic root and ascending aorta could already be made by grey-scaled echocardiography. In these patients, however, CDE made the additional demonstration of the perforation jet into the false lumen possible. In those three patients with aortic dissection of DeBakey type III as well as in the abdominal aortic region of DeBakey type I, color Doppler echocardiography was the only method to define true and false lumen and to clearly localize the perforation sites. Two further patients were found to have a small, local dissection, which could only be assumed by conventional echocardiography; the color Doppler M-mode image led to a clear diagnosis. In three patients an endocarditic abscess cavity of the aortic wall could be detected by conventional echocardiography. Two-dimensional color Doppler echocardiography additionally enabled us to visualize the presence and the course of perforation flows. In two patients color-coded Doppler echocardiography made it possible to detect perforations in regions which could not be localized either with conventional echocardiographic techniques or the above-mentioned control procedures.

Abscess↗
PubMed1986

[Long term therapy of coronary heart disease with 120 mg slow release isosorbide dinitrate once a day. Study of duration of action and development of tolerance].

Twenty-one patients (3 women, 18 males, mean age 55.7 +/- 6 years) with coronary heart disease proven by coronary angiography entered a double blind randomised study with isosorbide dinitrate slow release 120 mg once a day. 2, 12 and 24 hours after acute medication patients underwent a symptom-limited exercise-ECG. The following parameters were measured: ST-depression, blood pressure, heart rate and working capacity. After one week of therapy the same parameters were measured to look for the development of tolerance. Two and twelve hours after acute medication working capacity increased to 220% and 139% respectively. After 24 hours there was no statistically significant effect. The sum of ST-depression in three leads decreased from 4.85 +/- 3.02 mV to 1.87 +/- 0.96 mV (38.5%; p less than 0.05) 2 hours after medication, and to 2.10 +/- 1.73 mV 12 hours after medication. 24 hours after medication there was still a slight but not significant reduction of ST-depression. There was no statistically significant effect in the placebo group. After one week of therapy there was a slight reduction of action, but no development of tolerance.

Clinical Trials as Topic↗
PubMed1985

[4 different nitrate preparations with regard to the possible development of tolerance in long-term treatment].

Thirty-two hospitalized patients with angiographically-documented coronary artery disease and stable angina pectoris (NYHA class III) were randomly assigned to one of four treatment groups. After a one-week washout period, baseline examinations (systolic time intervals, blood pressure and exercise ECG) were performed. The patients were then treated with either 20 mg isosorbide dinitrate in sustained-release form (sustained-release ISDN), 20 mg isosorbide 5-mononitrate (IS 5-MN), 2.5 mg buccal nitroglycerin in sustained-release form (NTGB) or 6.5 mg oral nitroglycerin in sustained-release form (NTGO) and one hour thereafter, the heart rate, blood pressure and systolic time intervals were determined. Subsequently, the patients were treated with the respective nitrates four times daily for two weeks. On the seventh and 14th days, the heart rate, blood pressure and systolic time intervals were again determined before and after the first dose of the day. Additionally, after the first dose on the 14th day, an exercise ECG was performed. The effect of the nitrates on the venous capacitance system is reflected by the increase in the PEP/LVET ratio where NTGO and NTGB elicited marked actions and those of sustained-release ISDN and IS 5-MN were of a lesser extent. An effect on systolic and diastolic blood pressure at rest and during exercise could be documented only after administration of NTGB. The anti-ischemic effect of the nitrates was based on the reduction of ST-segment depression during exercise; after two weeks of treatment, sustained-release ISDN and IS 5-MN were associated with complete tolerance development while NTGO continued to exert a slight, and NTGB a clear reduction in ST-segment depression. Personal protocols documented that nitrate consumption and rate of anginal attacks during longterm treatment were unaffected by sustained-release ISDN, IS 5-MN and NTGO, but were reduced by 50% while on treatment with NTGB.

Administration, Oral↗
PubMed1984

[Prevention of coronary heart disease--practical viewpoints].

The recently published intervention studies have shown that effective prevention of coronary artery disease can be done by risk factor modification. Identification and care for patients with higher risk is a challenge for the attending physician. He should focus his attention on the three major risk factors: hypertension, hypercholesterinemia and smoking. Normalisation of eating behaviour is the basis in the treatment of hypertension and hypercholesterinemia. For smoking cessation family members should also be advised to stop smoking, too. An effective reduction in the risk profile by life style changes can only be achieved if a good relation between patient and physician can be established.

Cholesterol↗
PubMed1983

Correlation between R-wave amplitude and left ventricular volume at rest and with exercise.

In 52 patients with exercise angiography (12 normals, 31 with coronary heart disease, 9 with congestive cardiomyopathy) exercise ECGs were examined for R-wave changes. An increasing R-wave amplitude was found an insensitive sign of ischemia in patients with coronary heart disease (sensitivity 29%, specificity 81%). Sensitivity and specificity of the observed ST depression in this study were 83% and 71%, respectively, as reported by others. There was no positive correlation between the changes in the R-wave amplitude and left ventricular end-diastolic volume during exercise, thus there was no proof of the existence of the so-called Brody effect in humans.

Cardiac Catheterization↗
PubMed1983

[Current status of ambulatory coronary groups in West Germany. Results of a nation-wide survey].

The aim of the study was to gather detailed information on the structure and function of ambulatory coronary training groups in Germany by means of a nationwide survey. The response rate was 66.7%; the results are therefore representative for the FRG. From the collected data it can be estimated that approximately 500 coronary clubs care for approximately 9 000 patients. Sponsorship, financing, group structure, and club activities, as well as data on morbidity and complications, are presented in detail. Statements by both physicians and patients support the view that the main benefit of coronary clubs is not the improvement of physical fitness, but the improvement in the quality of life of the participants.

Ambulatory Care↗
PubMed1982

The influence of beta-adrenoceptor antagonists with and without intrinsic sympathomimetic activity on local wall motion abnormalities in patients with coronary heart disease.

1 A single-blind randomized study of the effects of a beta-adrenoceptor antagonist with intrinsic sympathomimetic activity (pindolol 0.4 mg i.v., n = 10) and a drug lacking this property (metoprolol 5 mg i.v., n = 11) on local wall motion abnormalities was carried out in 21 patients with coronary heart disease and anterior wall hypokinesia. 2 The drugs produced similar changes in left ventricular end diastolic pressure (LVEDP) and end diastolic volume index (EDVI) but differed in their effects on heart rate and ejection fraction. Pindolol did not exert any marked effect on heart rate or ejection fraction whereas after metoprolol treatment both were significantly decreased. 3 Shortening of the hypokinetic wall segments was improved by both drugs. Shortening of the non-hypokinetic contralateral segments was unchanged after pindolol administration but was decreased after metoprolol. 4 The differing effects of beta-adrenoceptor antagonists on regional wall motion appear to be dependent on the presence or absence of intrinsic sympathomimetic activity.

Adrenergic beta-Antagonists↗