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Biomedical subjects

H Neuss

Publications and source records attributed to H Neuss.

At least 19 recordsLinked to original sources
PubMed2006

[First clinical experience with a video presentation informing patients before surgery for inguinal hernia].

BACKGROUND: Although it is a significant part of surgical treatment, informing patients beforehand seems to be more and more neglected, mainly due to the enormous amount of work and time pressure on surgical personnel. MATERIAL AND METHODS: A video clip explaining groin hernia surgical repair was produced as additional information for patients. In it, visual material from actual practice describes the disease, the operation itself, all the perioperative aspects, and patients' own experiences. In a prospective comparison study, the length of patient education, its quality, patient satisfaction, and the duration of hospitalization and time off work were compared between patients who saw the video clip (n=50) and those who did not (n=50). RESULTS AND CONCLUSION: In summary, the time spent informing the video group was shorter (P<0.05) and their total satisfaction and evaluation of the information material were both higher (P>0.05) for comparable duration of treatment and time off work. This informative video was adopted without problems in our daily clinical life and, besides reducing the time needed to inform patients, it has significantly improved patient understanding of the operative procedure and their satisfaction with treatment.

Adult↗
PubMed2005

Subcutaneous gentamycin implant to reduce wound infections after loop-ileostomy closure: a randomized, double-blind, placebo-controlled trial.

BACKGROUND: After loop-ileostomy closure subcutaneous wound infection is the most frequent postoperative complication. Implantation of local antibiotics has been shown to reduce the incidence of wound infection after different surgical procedures, therefore, a subcutaneous application of a gentamycin implant may also decrease infection rate after ileostomy-closure. METHODS: We conducted a randomized, double-blind, placebo-controlled trial to evaluate the effectiveness of a subcutaneous gentamycin-collagen implant to reduce wound infection after loop-ileostomy closure. Patients had the same perioperative treatment and standardized anastomotic and closure technique. A collagen sponge with gentamycin was used in the treatment group and an identical collagen implant without antibiotics was used in the placebo group. RESULTS: Eighty patients (40 per group) were included. There was no difference between the groups with respect to demographics or in the postoperative course. The total wound infection rate was 10 percent with no difference between the gentamycin (n=4) and the collagen group (n=4) (P = 1.0). CONCLUSION: Subcutaneous implantation of a gentamycin sponge yields no clinically relevant reduction of the wound infection rate after loop-ileostomy closure so that routine use is not recommended in this procedure.

Aged↗
PubMed2002

[What is the value of the internet as a source of information for patients with inguinal hernias? First results of an observational study].

INTRODUCTION: The increasing use of the internet has led to a variety of medical web pages and an increasing amount of information about hospitals. Little is known about the extent to which this new medium is already used by patients as a source of information. For patients with inguinal hernia, for example, a frequent surgical symptom with large method variety, the value of the internet as a source of information should be examined. METHODS: One hundred patients facing an elective inguinal hernia repair at the Surgical Department Charité Berlin took part in a prospective observation study (a questionnaire with 10 questions) between July 1999 and March 2001. The questions referred to the possibility of PC/internet access, other sources of information (e.g., general practitioner, friends, internet) as well as the criteria by which the clinic was chosen. Patients were asked to answer basic questions about the development and treatment of inguinal hernia and to give a self-assessment of their knowledge of inguinal hernia (0 = no knowledge; 10 = maximum knowledge). RESULTS: The questionnaire revealed that 39% of the patients (average age 47 +/- 16 years) had a PC in their homes, 24% of those with internet access; 11% had internet access at other places. It also showed that 53% of the patients sought medical information from their general practitioner, 29% from friends, and 18% from the internet. Young patients (median age 29 years), employees and patients with private internet access use the internet with significantly more frequency. Their medical knowledge as well as their self-assessment of medical knowledge was significantly higher (median 19 versus 7 points and median 8.6 versus 5.7, respectively) and they chose the clinic because of the information from their research on the internet. CONCLUSION: At present, the internet still plays a subordinate role as a source of information for patients with an inguinal hernia. The increasing presence of this medium as well as the higher internet acceptance of future patients indicates that it has a promising future as a source of medical information.

Adult↗
PubMed2000

[Double ventricular excitation in dual atrioventricular node conduction physiology: catheter ablation of the slow conduction pathway of the dual atrioventricular node].

A variety of electrocardiographic manifestations of dual AV nodal physiology have been reported. The specific subtype dual ventricular response is considered as a very rare phenomenon. We present the case of a 53 year old lady who suffered from paroxysmal regular tachycardias for more than seven years. In the last 6 months the symptomatology of the cardiac arrhythmia changed to more persistent und irregular rhythm disturbances. Treatment with class Ia antiarrhythmic drugs and beta-blocking agents failed. The latter even seemed to worsen her very disturbing palpitations. After examination of the ECG recordings, the diagnosis of dual AV nodal physiology with double ventricular response was made--the lady was referred to our institution for electrophysiological testing and radiofrequency catheter ablation of the slow pathway. An invasive electrophysiological study reconfirmed the diagnosis of a dual AV nodal conduction pattern with irregular double ventricular response. The radiofrequency catheter ablation of the the slow pathway achieved a complete cessation of the double ventricular response. This satisfactory outcome was confirmed by analysis of a postinterventional 24 hour holter recording and an exercise stress test. During a follow-up period of three months, the patient remained free of symptoms and there was no recurrence of dual AV nodal conduction physiology in the surface ECG.

Atrioventricular Node↗
PubMed1991

A 6-week double-blind comparison of amlodipine and placebo in patients with stable exertional angina pectoris receiving concomitant beta-blocker therapy.

This study was a multicenter, double-blind comparison of the antianginal efficacy and safety of amlodipine and placebo as adjunctive therapy with constant recommended maintenance doses of beta-blockers. Patients with stable exertional angina pectoris were randomized to placebo or amlodipine at a starting dose of 5 mg once daily. The amlodipine dose was adjusted to 10 mg daily after 2 weeks if angina attacks were not abolished. Antianginal efficacy was assessed throughout the study with angina diaries, investigators' and patients' global evaluations, and with bicycle exercise tests during a placebo run-in period (baseline) and after 2 and 6 weeks of double-blind treatment. On baseline-final analysis, the exercise time to angina onset increased by 13% with amlodipine compared to 6% with placebo (p < 0.05). The total exercise time increased by 11% on amlodipine compared with 2% on placebo, though this difference did not reach statistical significance. Angina attack frequency and nitroglycerin consumption were both reduced by adding amlodipine to beta-blocker treatment. Amlodipine in combination with beta-blocker therapy was well tolerated, with a low incidence of side effects and laboratory test abnormalities. The study showed clearly that addition of amlodipine to beta-blocker therapy in patients with stable angina pectoris was well tolerated and gave improved antianginal efficacy.

Adolescent↗
PubMed1989

The vasopressor system in patients with heart failure due to idiopathic dilated cardiomyopathy--influence of the clinical stage of disease and of chronic drug treatment.

Alterations in the vasopressor system found in cardiac failure are part of compensatory measures that may modify pharmacologic-therapeutic response. Therefore, in 64 patients with dilated cardiomyopathy, we investigated its enhanced activity in different clinical stages of the disease as compared to normal controls. Patients in NYHA class II (n = 20) demonstrated increased activity of the sympathico-adrenal, renin-angiotensin-aldosterone, vasopressin, and atrial natriuretic factor systems, while maximum values were found in patients of NYHA class IV (n = 24). In these patients, noradrenaline was enhanced by a factor of 7, adrenaline by a factor of 2, plasma-renin-activity by a factor of 7, angiotensin II by a factor of 2.5, aldosterone by a factor of 5, vasopressin by a factor of 1.5, and ANF by a factor of 4 as compared to normal controls. Clinical NYHA classes correlated to a certain degree with the various plasma hormones. Patients treated with an aldosterone inhibitor in addition to digitalis and diuretics revealed significantly higher values for aldosterone, vasopressin, and angiotensin II as compared to those who received digitalis and diuretics alone. The addition of ACE-inhibitor therapy resulted in a decrease of angiotensin II, aldosterone, and vasopressin. Plasma catecholamines and ANF, however, did not change under the influence of cardiac medication. Diuretic treatment in NYHA class II patients reduced plasma volumes (p less than 0.01). Plasma volume in NYHA class IV patients only was found to be higher than in normal controls. Thus, analysis of the neurohumoral system can aid both in the identification of the clinical degree of dilated cardiomyopathy and in its optimal therapy.

Adult↗
PubMed1988

Long-term efficacy and safety of flecainide for supraventricular tachycardia.

Eighty-three patients with paroxysmal supraventricular tachycardia (Wolff-Parkinson-White syndrome in 47 patients and atrioventricular nodal reentry in 36 patients) underwent electrophysiologic study before and after intravenous administration of flecainide. Sixty-seven of these 83 patients entered an open clinical trial to evaluate the efficacy and safety of long-term oral treatment with flecainide. Efficacy was evaluated by a patient diary of spontaneously occurring attacks during flecainide treatment and periods of withdrawal. In 24 patients, electrophysiologic study was repeated during oral therapy. During a mean follow-up of 22.8 months, the therapeutic response to flecainide (mean dose 263 mg/day) was good in 48 patients (71%) and fair in 7 patients (10%). In 8 patients (10%), an arrhythmogenic effect was seen (increased number and prolonged duration of supraventricular tachycardia episodes in 4 patients, spontaneous episodes of atrial fibrillation in 2 patients and sinoatrial block in 2 patients). No consistent abnormalities were seen in the laboratory tests. Extracardiac side effects were of minor importance and usually subsided spontaneously or disappeared after reduction of dosage. It is concluded that flecainide is a useful addition to the drugs already available for short- and long-term treatment of supraventricular tachycardia due to Wolff-Parkinson-White syndrome and atrioventricular nodal reentry.

Cardiac Pacing, Artificial↗
PubMed1987

[Neopterin in the serum and urine in the differential diagnosis of disorders of kidney function following kidney transplantation].

In a period of 10 months neopterin in serum and urine was determined by radioimmunoassay in 33 renal allograft recipients treated with cyclosporin A. While in allograft rejections the highest neopterin concentrations were found in the serum, patients with viral infections after renal transplantation showed the most elevated concentrations in the urine. For early diagnosis of allograft rejection the ratio of neopterin clearance and serum-neopterin was the most significant criterion of the parameters measured in this study. Patients without complications during the follow-up showed slightly elevated and stable neopterin levels in serum and urine. The presented results indicate that neopterin is a useful parameter for the follow-up after renal allograft transplantation and for the diagnosis of immunological complications.

Adult↗
PubMed1986

Electrophysiologic effects of an acute beta-blockade induced by bisoprolol in patients with supraventricular tachycardia as assessed by His-bundle electrograms.

The acute electrophysiologic effects of 10 mg bisoprolol (B, given intravenously) were evaluated during an electrophysiological study in 10 patients with a history of paroxysmal tachycardia. Drug administration resulted in a significant decrease of sinus rate (Control [C]; 70.8/min; B: 59.4), and in an increase in sinus node recovery time (+20%). AV-nodal depression was marked at high heart rates during incremental atrial pacing. A second-degree AV-block occurred at a pacing cycle length (CL) of 329 ms (182/min) before and at a CL of 378 ms (158/min) after drug administration. Depression of AV-nodal conduction was negligible at low heart rates; the AH-interval at sinus rhythm was not affected (C: 84 ms, B: 86 ms); and functional and effective refractory periods of the AV-node were only slightly prolonged. Conduction intervals and refractory periods on atrial and ventricular level did not change. In 5 of 6 patients with accessory AV-pathways, circus movement tachycardia (CMT) could be elicited prior to as well as after B. Due to AV-nodal delay, CMT CL was slightly prolonged after B. Echozone and refractoriness of accessory pathways were not affected. In 1 of 2 patients with ectopic atrial tachycardia, B prevented the induction of paroxysms. In one patient with paroxysmal atrial fibrillation, the ventricular response decreased from 128/min to 94/min. The findings suggest that the electrophysiologic effects of B are due to a selective beta-adrenergic antagonism. Therapeutic efficacy is only to be expected if an increased adrenergic drive is a prerequisite for induction and continuation of a tachycardia.

Adrenergic beta-Antagonists↗
PubMed1985

Analysis of the efficacy of the new cardiotonic agent TA-064.

TA-064 is a new cardiotonic agent which is also effective orally, according to investigations conducted in Japan. We analyzed computer-assisted alterations of pressure-volume relationships serially and of indirect myocardial oxygen consumption (MVO2) estimations on line during TA-064 influence in 16 patients with congestive cardiomyopathy: left ventricular function was moderately decreased in seven patients (group A) and drastically decreased in nine (group B). Results showed that TA-064, 8 micrograms/kg/min intravenously, exerted positive inotropic effects in both groups and induced mean maximal delta percentage changes at about 5 minutes of infusion as follows: left ventricular stroke work index +65% and +47%; dP/dtmax +61% and 59%; left ventricular efficiency +62% and 53%; MVO2 +31% and +11% (p less than 0.05). TA-064, 20 mg by mouth induced serum levels (group A = 23.8 +/- 12ng/ml and group B = 26.4 +/- 20 ng/ml) corresponding to the effects with dosages of 1 to 2 ng/kg/min intravenously (p greater than 0.05), thus implying that significant changes in left ventricular function require higher oral dosages. We conclude that TA-064 improves left ventricular function, primarily via a contractility increase, also in group B patients without toxic side effects. On-line indirect MVO2 assessment and analysis of serial pressure-volume relationships helped to provide a more complex definition of the mechanism and efficiency of the cardiotonic agent under study.

Administration, Oral↗
PubMed1985

Malignant ventricular tachyarrhythmias in association with propafenone treatment.

During treatment with the class Ic antiarrhythmic agent propafenone, the drug appeared to cause malignant ventricular tachyarrhythmias in five patients. Sudden cardiac death occurred in two of them. Three patients exhibited a transition from non-self-terminating ventricular tachycardia to ventricular fibrillation. In the other two patients electrocardiography during syncope revealed ventricular fibrillation. The observed malignant arrhythmias occurred within the first three days of treatment for chronic complex ventricular ectopic activity. Two of the five patients had markedly impaired left ventricular function. All patients received digoxin and low dose diuretic therapy. In contrast to drug induced arrhythmias encountered with other type I antiarrhythmic agents, the proarrhythmic effects of propafenone were not associated with marked QT prolongation. QRS duration was only slightly affected.

Adult↗
PubMed1985

Unusual mechanism of PR interval variation and nonreentrant supraventricular tachycardia as manifestation of simultaneous anterograde fast and slow conduction through dual atrioventricular nodal pathways.

Noninvasive recordings in a 69-year-old woman showed two distinct PR intervals of about 0.21 and 0.58 s, suggestive of dual AV nodal conduction. Various unusual mechanisms of transition from short to long and from long to short conduction intervals and phenomena of concealed conduction were due to the presence of two functionally separated intranodal pathways. Refractoriness of the slow pathway was associated with bradycardia. Episodes of tachycardia exhibited a one-to-two relationship between P-waves and ventricular activations as a consequence of simultaneous anterograde fast and slow conduction leading to double ventricular responses to single P-waves.

Aged↗
PubMed1985

Long term use of flecainide in patients with supraventricular tachycardia.

The acute effects of intravenous flecainide on electrically-induced paroxysmal supraventricular tachycardia and the safety and efficacy of long term prophylaxis with orally administered flecainide were assessed in 37 patients with paroxysmal supraventricular tachycardia refractory to treatment with 'conventional' antiarrhythmic drugs. Over a mean treatment period of 14.2 months, flecainide 200 to 400mg daily completely suppressed paroxysmal supraventricular tachycardia in 9 of 20 patients with paroxysmal supraventricular tachycardia due to Wolff-Parkinson-White syndrome, while 3 patients reported only transient episodes of paroxysmal supraventricular tachycardia, and 1 patient had a decreased ventricular response to chronic atrial fibrillation. Of 17 patients with paroxysmal supraventricular tachycardia due to atrioventricular nodal re-entry, flecainide 200 to 500mg daily for a mean period approaching 26 months totally prevented episodes of paroxysmal supraventricular tachycardia in 8, and reduced the frequency and duration of episodes of paroxysmal supraventricular tachycardia in 3 others. Flecainide prolonged action potential refractoriness in a few patients in each group; however, an increased frequency of occurrence of paroxysmal supraventricular tachycardia occurred due to a simultaneous decrease in the re-entry circuit conduction velocity. In both patient groups the acute electrophysiological effects of flecainide were often predictive of the long term efficacy of the drug in the prophylaxis of paroxysmal supraventricular tachycardia. Side effects usually involved the central nervous system and were most commonly manifested by disturbances in vision, balance, and taste and increased nervousness. These side effects generally subsided following 1 to 2 months' treatment with flecainide. No abnormal trends were observed in laboratory analysis of blood samples taken from patients during long term treatment with flecainide.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

[Tachycardias caused by double ventricular responses and unusual atrioventrio-ventricular relations in linear dissociation of the AV node].

Noninvasive recordings in a 69-year-old woman showed phasic shifts between two distinct PR intervals of about 0.21 and 0.58 s suggestive of dual AV nodal conduction in the presence of two intranodal pathways. Episodes of tachycardia exhibited a one to two relationship between P waves and QRS complexes, with the same short and long PR intervals interpreted as simultaneous anterograde fast and slow conduction via the two AV nodal pathways, leading to a double ventricular response to single P waves. Various mechanisms of transition from short to long or long to short conduction times and concealed conduction phenomena could be demonstrated supporting the concept of two functionally separated intranodal pathways.

Aged↗
PubMed1984

[Mechanically-induced intraventricular block caused by a right-heart floating catheter--frequency and electrophysiologic findings].

During the course of 2,434 right heart catheterizations with 2,019 floating 3F Grandjean catheters and 415 5F Swan-Ganz catheters we observed 7 patients (0.3%) with catheter-induced infranodal conduction impairment: right bundle branch block (RBBB) in 3 patients, left anterior fascicular block (LAFB) and subsequent RBBB in 1 patient, and complete heart block in 3 patients with pre-existing left bundle branch block (LBBB). There was no apparent difference regarding the incidence of blocks between the two types of catheters. Three patients (one with LAFB + RBBB and two with LBBB) underwent electrophysiologic studies. All three patients exhibited a prolongation of the HV-interval due to coexisting pathologic changes of the right bundle. LBBB patterns disappeared during distal His bundle pacing in two patients, indicating a proximal site of block and suggesting incomplete involvement of the right bundle. Additional mechanical trauma, probably in this region, produced the blocks. Thus, use of balloon tipped or flexible catheters does not provide complete protection against transient lesions of the conduction system.

Adult↗
PubMed1984

[Effects of the new cardiotonic agent TA-064: serial computer-assisted analyses of pressure-volume relations and online myocardial 02 consumption].

UNLABELLED: According to investigations conducted in Japan, TA-064 is a new cardiotonic agent, which is also effective orally. We analyzed computer-assisted alterations of pressure-volume relations serially and of MVO2 online (Bretschneider) during TA-064 influence in 16 patients with congestive cardiomyopathy: LV-function of 7 patients was only moderately decreased (group A) and in 9 patients massively (group B). RESULTS: 1) TA-064, 8 micrograms/kg/min, i.v. had positive inotropic effects in both groups and induced mean maximal delta% changes at about the 5th minute of infusion as follows: LVSWI + 65% and 47%; DP/DTmax + 61% and 59%; LV-efficiency + 62% and 53%; MVO2 + 31% and + 11% (p less than 0.05). 2) TA-064, 20 mg p.o. induced serum levels (A: 23.8 +/- 12 and B: 26.4 +/- 20 ng/ml) corresponding to the effects with the dosages 1-2 micrograms/kg/min, i.v. (p greater than 0.05), thus implying that significant changes in LV-function require higher p.o. dosages. 3) TA-064 i.v. on the 6th day of exposure to the medication produced less LV-function improvement than on day 1 (p greater than 0.05). CONCLUSIONS: In both groups A and B TA-064 improves LV-function primarily via increased contractility, without toxic side effects. For a more complex definition of the efficiency and mechanism of cardiotonic agents, the validity and importance of using on-line MVO2 assessment and analysis of serial pressure-volume relations is stressed.

Adult↗
PubMed1984

[Hemodynamic significance of the coordination of atrial and ventricular systole in tachycardia].

In 15 patients, aged 55.6 +/- 3.7 years with normal LV-function, the comparison of hemodynamic results as induced by ventricular pacing (VP) (at 110, 140 and 170 bpm) versus atrio-ventricular pacing (AVP) (AV-sequences: 30, 130 and 230 msec) revealed the following: VP with increasing rates inversely proportionally compromised AO-pressure by an average of -7, - 19 and -28% respectively, and cardiac output (CO) by an average of -2, -12 and -26% respectively. However, AVP with an AV-sequence of 130 msec, at the same 3 basic rates, clearly proved hemodynamically superior in comparison, in that AO-pressure dropped significantly (by an average of -13%) only at 170 bpm, an CO even showed tendencies to increase at 110 and 140 bpm (by an average of +17 and +7% respectively), finally decreasing by a mere -11% at 170 bpm only. Pacing, when using AV-sequences of 30 and 230 msec, resulted in an impairment of AO-pressure and CO of the same range as during VP at equal rates. Thus, beneficial hemodynamic results, AVP versus VP, have been proven also for rapid-rate pacing in normal ventricles, provided the AV-sequence is optimal (130 msec for the present patient group) but not in any incoordinate range of AV-sequences (as for instance 30 and 230 msec), with which beneficial atrial transport function cannot be achieved.

Blood Pressure↗