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Biomedical subjects

H Seibold

Publications and source records attributed to H Seibold.

At least 37 records · Page 2Linked to original sources
PubMed1987

Effect of right ventricular hypertrophy on cardiac performance and the relation between right ventricular systolic peak pressure and end-systolic volume.

To investigate the role of hypertrophy of the right ventricle upon right heart performance and the significance of the peak systolic pressure/end-systolic volume (P/V) ratio in terms of right ventricular systolic performance, simultaneous measurements of radionuclide ventriculograms and central hemodynamics were done in 32 patients with chronic obstructive pulmonary disease. In 26 of the patients (80%) technically adequate two-dimensional echocardiograms could be performed. In the subset of patients with increased (greater than or equal to 6 mm) right ventricular end-diastolic wall thickness no relationship between pulmonary artery pressure and right ventricular ejection fraction (RVEF) existed in comparison with the remaining patients. P/V indices and cardiac output were not decreased. Considering the patients, whose P/V ratio did not increase from rest to exercise, RVEF decreased highly significantly more than in the remaining patients. The ratio of wall thickness and end-diastolic radius as determinant of peak systolic stress was significantly decreased in these patients compared with the remaining patients. In the patients with right ventricular hypertrophy despite significantly higher values of pulmonary artery pressures and resistances, the afterload in terms of systolic wall stress is markedly reduced. We conclude that in the hypertrophic state, right ventricular performance is not impaired despite decreased RVEF values. In the patients whose P/V ratio does not increase from rest to exercise, an inappropriate high peak systolic wall stress may exist both due to inadequate wall thickness and increased diameter of the right ventricle. The role of P/V in terms of prognosis and development of decompensated right heart failure remains undetermined.

Biomechanical Phenomena↗
PubMed1987

[Radionuclide ventriculography--a noninvasive method of diagnosis and quantification of tricuspid valve insufficiency].

The diagnosis of tricuspid regurgitation (TR) is difficult to make by simple clinical methods or by invasive techniques. Contrast echocardiography and Doppler echocardiography have improved diagnostic results, but a golden standard is still not available. Radionuclide ventriculography (RNV) is a well-established method for the detection and quantification of a volume load on the left ventricle: the regurgitation fraction can simply be derived from the regurgitant index as the ratio of enddiastolic-endsystolic count-rate differences between the left and right ventricle. In left heart valvular regurgitation a regurgitant index exceeding the upper normal limit can be expected. This study was performed to evaluate the diagnostic accuracy of an abnormally low regurgitant index in detecting TR, which is accompanied by an isolated volume load on the right ventricle. A series of 33 patients with TR on physical examination and cardiac catheterization underwent RNV and was compared with 48 patients with right ventricular enlargement or pressure load on the right ventricle. In addition, the specificity of the method was evaluated in 470 consecutive patients with various forms of heart disease. In 18 out of 20 subjects with isolated TR a regurgitant index below the lower normal limit was found. The remaining 2 cases with minor TR had a regurgitant index within the normal range, which is 0.89 to 1.97 in this laboratory. In patients with additional volume load on the left ventricle, the sensitivity of the method was found to be low, as could be expected from the principle of the method. The time-activity curve over the liver was usually in phase with that recorded over the atria in subjects with TR. Therefore, the additional examination of a region of interest over the liver was particularly useful in these patients with concomitant aortic or mitral valve regurgitation. None of the 48 patients with right ventricular enlargement or pressure load on the right ventricle had a falsely positive result. A total of 17 out of 470 consecutive patients had a regurgitant index below the normal range; left ventricular function was severely impaired in 9 of these patients. The remaining subjects had a regurgitant index slightly below the lower normal limit. In conclusion, RNV has a high sensitivity in the diagnosis of TR in patients without left heart valvular regurgitation and a high specificity in patients without severely impaired left ventricular function and without left-to-right shunt through an atrial septal defect.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

Left heart function in chronic obstructive lung disease.

In patients with varying degrees of chronic obstructive pulmonary disease (COPD), simultaneous measurements of central hemodynamics and left ventricular radionuclide ventriculograms at rest and during exercise were made. In 21 of these patients, satisfactory echocardiograms could be performed. In seven of the patients, arterial blood pressure at rest was increased. Decreased compliance of the left ventricle was thought to be present in patients with COPD and additional arterial hypertension. The left ventricular ejection fraction (LVEF) at rest was in the high normal range in all patients. During exercise, no further increase was observed. This pattern of LVEF response seems to be typical in patients with COPD. Because the highest values were observed in the more severe COPD and right ventricular hypertrophy, it is unlikely that an impairment of left ventricular function is caused by COPD. In five of 27 patients, an abnormal decrease of LVEF and regional hypokinesis occurred during exercise, thus suggesting additional coronary heart disease. The fact that at least 30% of the patients with COPD suffered from arterial hypertension and 20% of the patients exhibited unexpected ischemia detected by regional hypokinesis in RNV during exercise, but not in the ECG, may be of practical relevance. Coronary angiography was not indicated because most of these patients were over 65 and the factor limiting the working capacity was ventilatory impairment and not angina pectoris, in all patients. For this reason, a diagnostic uncertainty remains with regard to additional coronary heart disease in the older patients with advanced chronic obstructive pulmonary disease.

Aged↗
PubMed1986

Pulmonary gas exchange and central hemodynamics at rest and during exercise in patients with chronic obstructive pulmonary disease.

Right-heart catheterization and ergometry with arterial and mixed venous blood gas analysis were performed in 27 patients with a wide range of chronic obstructive pulmonary diseases. The purpose of the examination was to evaluate the risk in patients for lung surgery or to detect additional heart diseases. Patients who developed exertional hypoxia (group 1) were compared with others who did not (group 2). In all patients the steady-state maximal workload was determined by ventilatory dysfunction. Both groups had normal values for mixed venous pO2 and normal increase of the circulatory parameters during exercise. The patients with exertional hypoxia differed from the others in that they showed no decrease of venous admixture and alveolar-arterial oxygen gradient. In addition, these patients had increasing pCO2 values at rest compared with exercise, indicating alveolar hypoventilation and ventilation-perfusion mismatching. Because of the good correlation of the absolute values of FEV1 (forced expiratory volume in 1 s) with pulmonary artery pressures, parameters of gas exchange and working capacity, this lung function parameter seems to have a central role in predicting the functional state of patients with chronic obstructive disease. Ergometry and blood gas analysis should be performed in addition because these values cannot be predicted with the calculated postoperative FEV1.

Aged↗
PubMed1985

Right ventricular function in patients with chronic obstructive pulmonary disease.

Simultaneous right heart catheterization and radionuclide ventriculography were performed in 27 patients with a wide range of chronic obstructive pulmonary disease. Central hemodynamics and radionuclide studies were done at rest and during exercise. In the resting state the right ventricular ejection fraction (RVEF) was in the normal range (43.3 +/- 6%). During exercise a significant (p less than 0.001) decrease of RVEF to 38.8 +/- 6.7% occurred. The pulmonary artery mean pressures were 19.9 +/- 3.8 at rest. During exercise a significant (p less than 0.001) increase to 41 +/- 9.8 mm Hg occurred. There was a linear relationship between pulmonary pressures and RVEF during exercise in patients with pulmonary artery pressures not exceeding 35 mm Hg. In patients with right ventricular end-diastolic wall thickness greater than or equal to 6 mm a curvilinear relationship between these parameters could be observed with a flattening of the curve at higher pressures (greater than 35 mm Hg) and lower ejection fractions (less than 35% RVEF). Radionuclide ventriculography cannot substitute for right heart catheterization. Echocardiography is useful for interpretation of right ventricular ejection fractions in advanced chronic obstructive pulmonary disease.

Aged↗
PubMed1985

Limitations of radionuclide ventriculography in the non-invasive diagnosis of coronary artery disease. A correlation with right heart haemodynamic values during exercise.

A consecutive series of 56 patients with chest pain but no evidence of previous myocardial infarction was prospectively studied by radionuclide ventriculography to determine the value of global and regional radionuclide indices in detecting coronary artery disease. The results were correlated with the clinical judgment of chest pain, the results of the exercise electrocardiogram, and the right heart haemodynamic measurements during exercise. As a result of the criteria for entry, the study group was representative of the population seen in such a clinical setting. Only 25% of patients had coronary artery disease. The predictive power of radionuclide ventriculography was limited. The conventionally used criterion that normal subjects have an increase in left ventricular ejection fraction of at least 5% with exercise provided only 78% sensitivity and 57% specificity. Fourier analysis and visual interpretation of radionuclide studies wrongly diagnosed three out of 10 patients with extensive disease requiring surgery. These results suggest that radionuclide ventriculography is of limited value in the non-invasive diagnosis of coronary artery disease.

Adult↗
PubMed1984

On the pathogenesis of spondylosis deformans and arthrosis uncovertebralis: comparative form-analytical radiological and statistical studies on lumbar and cervical vertebral bodies.

To investigate the etiopathogenesis of the common clinical symptoms of the lower lumbar spine (LS) and cervical spine (CS) (lower back pain and local cervical spine syndrome), the dimensions of the third to fifth lumbar vertebral bodies (LVB) and the fifth to seventh cervical vertebral bodies (CVB) were studied quantitatively and morphometrically in frontal and sagittal planes, as a function of sex and age, in 105 human cadavers of both sexes aged between 16 and 91 years. The evaluation was done in X-ray pictures of 100-micron-thick polished bone sections with the aid of the Macro Facility of the Leitz Texture Analysis System. In each case, the maximum and minimum heights and widths and depths and the computed differences in heights, widths, and depths were determined. The results were evaluated statistically and compared within and between the two regions of the spine, using regression-correlation analyses. The heights, widths, and depths of the VB are all greater in men than in women; their behavior during ageing is, however, identical for both sexes. The heights of all the VB examined remain constant throughout life after termination of growth. The maximum widths and the width differences reveal an increase in both LVB and CVB in old age. All depth parameters reveal constancy in the case of the LVB but an increase in the case of the CVB in old age. The correlation coefficients of the maximum width of the VB within the spinal regions are very high in the LVB, but lower in the CVB. Between the two regions, in contrast, they are very low. This behavior suggests a superordinate action principle within each of the spinal regions which is based on characteristic anatomical construction and functional stressing. The static stressing of the LVB leads, laterally to disc protrusions. As a result of this, traction forces acting on the weak lateral elements of the anterior longitudinal ligament, stimulate the accretion of spondylotic osteophytes at the point of insertion of the ligament on the vertebral body. Anteriorly, in contrast, the particular strong anterior longitudinal ligament prevents such a remodelling process. Posteriorly, the longitudinal ligament is attached to the intervertebral discs, and can thus not stimulate the vertebral body to produce osteophytes. The dynamic stressing of the CVB leads laterally to friction between the VB in the region of the uncovertebral joints and to the formation of arthrotic osteophytes. Anteriorly, owing to the weak configuration of the anterior longitudinal ligament in this aspect, disc protrusion occur and, subsequently, spondylotic osteophytes accrete.

Adolescent↗
PubMed1981

Ultrastructure of platelets before and during atrial stimulation. Differences in the coronary sinus and aortic blood in patients with angina pectoris.

We studied 15 patients with strain-induced angina pectoris performing an ultrastructural analysis of platelets withdrawn simultaneously from the aorta and coronary sinus. In coronary sinus blood, all platelets exhibited shape changes with pseudopod formation but without degranulation. In the aortic blood we observed on average fewer shape changes of the platelets. During tachycardia stress, shape change formation did not increase in most patients. In three patients however, micro-aggregation of the platelets was observed only in the aortic blood. These patients had a paucity of risk factors. They also had fewer critical coronary artery stenoses compared with the other patients. We conclude that there may be minority among the patients with angina pectoris exhibiting hyper-aggregation of the platelets.

Angina Pectoris↗
PubMed1980

Interaction of circulating immune complexes with granulocyte function in patients with rheumatoid arthritis.

The sera and peripheral blood granulocytes of 10 patients with rheumatoid arthritis and of 10 healthy controls were investigated for the presence of soluble immune complexes and for cellular dysfunction. Using the Rajicell-radioimmunoassay, immune complexes were detected in 7 out of 10 rheumatoid sera. In one patient the presence of immune complexes was demonstrated by immunofluorescence. In all rheumatoid patients with circulating immune complexes decreased chemotactic reactivity and diminished bactericidal capacity of the neutrophils were observed. Incubation of rheumatoid granulocytes with pooled AB-serum or pretreatment of neutrophils of healthy controls with immune complexes containing rheumatoid sera resulted in a reduced number of comparable cellular dysfunctions including increased release of lysosomal enzymes, strongly correlated with the presence of intracellular phagocytosed immune complexes. Phagocytosis and increase of oxidative cell metabolism during phagocytosis were not influenced by circulating immune complexes. Based on our in vitro findings we suggest that the described immune complex-dependent granulocyte dysfunctions are possible responsible for the high risk of local or systemic bacterial diseases in patients with rheumatoid arthritis.

Adult↗
PubMed1980

Fibroelastosis of the right ventricle in two brothers of triplets.

We present an autopsy report of endocardial fibroelastosis of the right heart in two brothers of triplets. Beside this anomaly no other macroscopical malformations in the hearts were found. Morphologically an unusual hypertrophy of the subendocardial myocardiocytes in the right heart was observed. A history of tocolysis (sympathomimetic drugs for treatment of premature labour) was the main reason for publishing this case report. We could not answer the question if the drug was causative or only coincident with the observed lesions.

Autopsy↗
PubMed1980

[Changes in form and structure of vertebrae as a manifestation of mechanical loading (author's transl)].

In 240 autopsy cases of both sexes, aged between 19 and 88 years and with no evidence of clinically manifest bone disease, the structure of the spongy bone and the external form of the 3rd and 5th lumbar vertebrae were investigated quantitatively and morphometrically on the basis of high-contrast X-ray images of 100 mu-thick polished bone sections, using the Leitz texture analysis system. The structure of the spongy bone was analysed on the basis of the parameters volumetric density, surface density and specific surface in horizontal "fifths", the form being determined by measuring the greatest and smallest heights and widths. In the individual "fifths", the structural parameters manifest a "stepped" distribution, the highest values being in the outer, the lowest values in the middle "fifths". With increasing age, this distribution pattern flattens to differing degrees so that, in old age, only the outer"fifths"differ from the middle and inner"fifths". The form parameters of the vertebrae reveal an age-independent constant heigh and an age-dependent increase in maximum width. The vertebral bodies are subjected mainly to compressive forces and represent a compound construction of spongy bone and fluid-filled medullary cells. The inhomogeneity of the vertebral structure is the constructional equivalent of the intravertebrally regionally differing mechanical forces. Also the structure of the residual spongy bone resulting from the age-dependent remodelling process, is oriented to these mechanical forces. Despite the considerable intravertebral remodelling of structure, the form of the vertebral bodies remains largely constant. The increase in maximum width is based on an increase in the tensile forces acting upon the outer edges of the vertebral bodies consequent upon degenerative intervertebral disc changes.

Adult↗