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Biomedical subjects

H Stopfkuchen

Publications and source records attributed to H Stopfkuchen.

At least 37 records · Page 2Linked to original sources
PubMed1990

Cardiovascular responses to dobutamine determined by systolic time intervals in preterm infants.

We investigated the effects of dobutamine therapy on myocardial function in premature infants. Left ventricular performance was assessed by measuring left ventricular systolic time intervals: rate-corrected pre-ejection period (PEPI), rate-corrected left ventricular ejection time (LVETI), and pre-ejection period to left ventricular ejection time ratio (PEP/LVET) which was obtained by echocardiography. Measurements were performed in 17 hemodynamically unstable premature infants who had an elevated PEP/LVET ratio before and 30 min after starting dobutamine infusion (10 micrograms/kg.min). Dobutamine infusion resulted in a significant decrease in PEPI (from 108 +/- 16 [SEM] to 95 +/- 17 msec; p less than .01) and in PEP/LVET ratio (from 0.55 +/- 0.16 [SEM] to 0.45 +/- 0.17; p less than .01), and in a significant increase in LVETI (from 255 +/- 15.7 [SEM] to 264 +/- 16.2 msec; p less than .01). Heart rate increased significantly from 146 +/- 17 (SEM) to 163 +/- 16 beat/min; p less than .01. Mean arterial pressure increased in 12 of 14 infants. These results show that dobutamine enhances left ventricular performance in premature infants who have depressed left ventricular function.

Birth Weight↗
PubMed1989

Hemodynamic monitoring in childhood.

Hemodynamic monitoring is indicated in children with impending or manifest cardiocirculatory failure. Since cardiocirculatory failure is characterized by an imbalance between oxygen delivery and oxygen demand due to perfusion failure, the parameters monitored should aid in the assessment of these oxygen variables. Oxygen delivery depends on oxygen content and cardiac output. Cardiac output is determined by heart rate and stroke volume; stroke volume by preload, afterload and contractility. Since the direct measurement of oxygen consumption routinely is almost impossible, global oxygen utilization represented by mixed venous oxygen saturation may be used to quantify the relationship between oxygen delivery and oxygen consumption. Justification of invasive hemodynamic monitoring depends among other things on an optimal balance between usefulness of information and complications associated with the techniques used. In future, the development of further noninvasive techniques and the scientific evaluation of recommended monitoring techniques are prospects in cardiovascular monitoring in childhood.

Cardiac Output↗
PubMed1989

Continuous monitoring of mixed venous oxygen saturation in infants after cardiac surgery.

Continuous mixed venous oxygen saturation (SvO2c) was measured in 16 infants immediately after cardiac surgery. A polyurethane 4F, dual channel catheter (Opticath, Modell U440, Oximetrix) with fiberoptic filaments was introduced into the pulmonary artery during cardiothoracic surgery. The catheters were left in place for an average of 67.5 h (range 27 h -125 h) and there were no catheter-related complications. Correlation between continuous in vivo SvO2 values and in vitro values was satisfactory (r = 0.85), whereas a correlation between SvO2c and arterial oxygen saturation (SaO2) was not found (r = 0.07). The sampled arterial lactate values were inversely correlated to the simultaneously measured SvO2c, but the correlation coefficient was only r = -0.4. There was an inverse correlation between SvO2c and arteriovenous oxygen content difference (Ca-vDO2) (r = -0.82), and a marked inverse correlation to the calculated oxygen utilization ratio (r = -0.97). Therefore SvO2c continuously reflects the overall balance between oxygen consumption and delivery, but the use of SvO2 as a predictor of blood lactate levels is unreliable. A further purpose of the present study was to demonstrate the clinical applications and to show the usefulness of SvO2c-monitoring; particularly as a surveillance and early warning system, as a guide for assessing therapy and its relevance in interpreting other monitored parameters. In our opinion continuous SvO2 measurement is a reliable and valuable indicator of cardiopulmonary function in the immediate post-operative period, even in infants with complicated repair of cardiac malformations.

Blood Gas Analysis↗
PubMed1989

Acute hemodynamic response to intravenous enoximone: an animal study and preliminary report in infants after cardiac surgery.

In light of previous studies in adults, we considered that enoximone could be useful in treating children with therapy-resistant cardiovascular insufficiency. Prior to clinical administration, we investigated the cardiovascular properties of enoximone in anesthetized and ventilated piglets characterized by small stroke volume and high heart rate. Enoximone was administered intravenously in increasing doses (0.25, 0.5, and 1 mg/kg). The animals were monitored with heart rate, systemic and pulmonary arterial pressures, and continuous electromagnetic flow. Enoximone induced a dose-dependent flow increase, whereby heart rate and systemic arterial pressure changed only slightly. With regard to persistent pulmonary hypertension in newborns, enoximone was also used in piglets to investigate the effects on endotoxin-induced, dopamine-resistant pulmonary hypertension. Enoximone (1 mg/kg i.v.) was given immediately after E. coli endotoxin (1.5 micrograms/kg i.v.) and inhibited the endotoxin-induced, eicosanoid-mediated pulmonary hypertension, whereas during infusion of dopamine (2 mg/kg/h), no drop in systemic blood pressure could be observed. In the clinical study, six infants with post-cardiac surgery low output syndrome despite maximal catecholamine inotropic support were given enoximone (i.v. bolus of 0.2, 0.5, or 1 mg/kg followed by continuous infusion of 7.5-10 micrograms/kg/min). Continuously measured mixed-venous oxygen saturation increased in a dose-related manner. Cardiac output increased significantly by 28%, accompanied by a decrease of arteriovenous oxygen content difference and O2 utilization ratio. The preliminary results show that intravenous enoximone produces acute useful hemodynamic effects in infants, in particular allowing a weaning of vasoactive amines.

Animals↗
PubMed1988

The effect of nifedipine alone or combined with low dose acetylsalicyclic acid on endotoxin-induced pulmonary hypertension in the piglet.

Cardiovascular responses to the calcium antagonist nifedipine, alone and combined with low dose acetylsalicyclic acid (ASA), were evaluated in a piglet model of endotoxin-induced pulmonary hypertension. All animals were anesthetized, paralyzed and mechanically ventilated. Cardiac output (CO), pulmonary artery pressure (PAP), aortic blood pressure (SAP), pulmonary capillary wedge pressure (PCWP), right atrial pressure (RAPM) and arterial blood gases were measured before and after induction of pulmonary hypertension by E. coli endotoxin and after treatment. Results of treated groups were compared to a control group of piglets subjected to the same dose (0.15 micrograms/kg i.v.) of endotoxin. Control animals responded to a bolus injection of endotoxin within 15 min with an increase in mean PAP by 110%. Pulmonary vascular resistance (PVR) increased by 144%. Mean arterial pressure did not change significantly from baseline values. In animals treated with a single dose of 1 mg/kg ASA prior to endotoxin, the initial pulmonary response was not quantitatively different from control values, whereas ASA 20 mg/kg abolished the pulmonary vascular reaction. The increase of systemic vascular resistance (SVR) produced by endotoxin was aggravated by high dose ASA. In piglets treated with nifedipine (4 micrograms/kg/min) over 30 min after the application of endotoxin with and without additional infusion of nifedipine 60 min prior to endotoxin the PVR could be attenuated. The combination of nifedipine and low dose ASA showed synergistic effects compared to control. The increase of mean PAP was significantly reduced, the PVR remained in baseline range due to a marked elevation of cardiac output.

Animals↗
PubMed1988

[Supravalvular pulmonary stenosis following anatomic correction of transposition of great vessels: report of a successful balloon dilatation].

Primary anatomical repair of TGA has several theoretical advantages over conventional atrial baffle techniques. However, one of the most common postoperative complications of the new technique is the development of an obstruction at the arterial anastomosis to the pulmonary artery (PA). A supravalvular pulmonary stenosis developed progressively over the first months after an arterial switch operation of a simple TGA in a newborn infant. The diagnosis was easily performed by Doppler-echocardiographic follow-up studies. Hemodynamic assessment by cardiac catheterization performed when the patient was five months old revealed a systolic gradient of 76 mm Hg at the arterial anastomosis. Percutaneous balloon angioplasty was successfully performed.

Catheterization↗
PubMed1988

[Congestive heart failure in a newborn infant with arteriovenous malformation of the vein of Galen: diagnosis using color-coded Doppler image echography].

Arteriovenous malformations of the vein of Galen are rare disorders that may appear in the newborn period with severe congestive heart failure mimicking many intrinsic cardiac defects. Using combined two-dimensional ultrasound and color-coded blood flow mapping arterio-venous aneurysm of the vein of Galen and congenital atrial septal defect could be diagnosed in an newborn with congestive heart failure. In addition to the presented clinical value of the new two-dimensional color Doppler echography physiological aspects of intracranial arteriovenous fistula in infancy discussed.

Cerebral Veins↗
PubMed1987

Evaluation of pediatric intensive care in Europe. A collaborative study by the European Club of Pediatric Intensive Care.

There are no reports analyzing the results of pediatric intensive care in Europe. We evaluated quantitatively the severity of illness and the amount of care required for 714 consecutively admitted patients. We used simultaneously the Clinical Classification System (CCS) the Acute Physiology Score (APS) and the Therapeutic Intervention Scoring System (TISS). Overall mortality at 1 month was 15%. The mortality rate was higher for CCS Class IV patients (32.3%) than for CCS III (4.5%) and CCS II (3.2%). The difference was significant between CCS IV and CCS III and II respectively (p less than 0.001) but no difference was observed between CCS III and CCS II. The patients were also classified among 7 major organ system failures: cardio vascular, respiratory, neurologic, gastro intestinal, renal, metabolic, hematologic. Three of them were primarily involved: respiratory (44.9%) cardio-vascular (20.7%), neurologic (18.8%). Among these 3 groups the highest mortality was observed in cardio-vascular patients (p less than 0.01 v.s. respiratory, p less than 0.05 v.s. neurologic). The death rate was 22% among the 264 neonates, 9.7% among the 247 infants (p less than 0.01) and 12.6% among the 198 children. APS and TISS scores increased significantly with the CCS classes.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1987

Effects of dobutamine on left ventricular performance in newborns as determined by systolic time intervals.

To evaluate the effects of dobutamine on myocardial function in newborns, left ventricular systolic time intervals (STI) - normalized pre-ejection period (PEPI), normalized left ventricular ejection time (LVETI) and pre-ejection period to left ventricular ejection time ratio (PEP/LVET) - were assessed by echocardiography in 18 newborns treated with dobutamine for clinically diagnosed heart failure. Examinations were performed prior to and 30 min after starting dobutamine infusion (7.5 or 10 micrograms/kg per min). Patients were assigned to two groups according to their PEP/LVET prior to dobutamine administration: group I (n = 9) with pre-treatment PEP/LVET less than or equal to 0.35 and group II (n = 9) with pre-treatment PEP/LVET greater than 0.35. While there was no change of STI in group I, dobutamine infusion resulted in a significant decrease in PEPI (from 102 +/- 4.8 to 87.8 +/- 4.2; mean +/- SEM; P less than 0.01) and of PEP/LVET (from 0.56 +/- 0.05 to 0.45 +/- 0.05; mean +/- SEM; P less than 0.01) and in a significant increase of LVETI (from 237.6 +/- 5.6 to 253.3 +/- 5.2; mean +/- SEM; P less than 0.01) in group II. Heart rate increased significantly in both groups. Left ventricular end-diastolic dimension, also assessed by echocardiography, did not change in the eight studies performed. An increase in mean arterial pressure was found in three out of five newborns of group II and in one out of four patients in group I. It is concluded that dobutamine can improve cardiac performance in newborns with impaired left ventricular function. This effect is probably due to an improvement in myocardial contractility.

Cardiotonic Agents↗
PubMed1987

Changes of the cardiovascular system during the perinatal period.

After describing the particular features of the fetal circulation, changes in the pattern of blood flow at the time of birth and during early neonatal life are explained. From animal studies it is wellknown that during the first hours and weeks after birth newborns are characterized by an extremely high cardiac output due to high metabolic demands. In order to meet this marked volume loading, already under resting conditions the neonatal heart appears to be operating nearly at its full capacity without reserves in contractility, preload and afterload. Consequently the newborn heart has less ability to cope with additional acute afterload and/or preload stress. Few investigations on cardiac output and myocardial performance in healthy human newborns provide presumptive evidence that the postnatal human heart performs probably as well as the heart of other species. These observations may influence the therapeutic approach in clinical situations with additional alterations in loading conditions.

Cardiovascular Physiological Phenomena↗
PubMed1987

[Color-coded Doppler echocardiography in an infant with an aortopulmonary window. A pre- and postoperative study].

The clinical value of the new two-dimensional color Doppler echocardiography (2D-color Doppler) for the non-invasive visualization of shunting across the aorticopulmonary window (APW) in a 5-month-old infant is described. The quality of the color-coded bloodflow mapping may be equal to that of angiography. The sensitivity of the method is demonstrable by the minimal diastolic shunt across the operated APW. The 2D-color Doppler may enhance the diagnostic impact of 2D-echocardiography, especially by improving diagnostic accuracy non-invasively in critically ill infants.

Aorta, Thoracic↗
PubMed1985

[Poisoning as a method of suicide in children and adolescents].

The number of suicides by children and juveniles has remained similar or even slightly reduced in the last 5 years. This correlates with the constancy or slight reduction in the number of the under-20-years population over this period. Comparison with deaths due to suicide in Prussia (1894-1897) indicates that suicide in children and juveniles is not more common today than it was nearly a hundred years ago. Hanging and suffocation are the most frequent means, followed by poisoning. Less common are jumping from a height, shooting, drowning or stabbing. Cause of the suicide attempt is usually a disturbed relationship to a partner. Acute quarrel with parents dominates. The psychopathological background is abnormal reactions to experience and abnormal reactions to conflict. Neurosis and psychosis or infantile reactions are much less common.

Adolescent↗
PubMed1985

[Experiences with nifedipine in the treatment of acute hypertension in childhood].

The efficacy of Nifedipine (N) as an antihypertensive drug was assessed in 4 children aged 6-12 years with acute severe hypertension. In one child with a hypertensive encephalopathy N 10 mg administered sublingually in addition to other antihypertensive drugs caused a prompt fall in blood pressure followed by a rapid clinical improvement. In the other 3 children N 10 mg reduced systolic and diastolic blood pressure by 13.7% and 16.4% respectively. This antihypertensive action lasted for about 3-4 hours and was associated with an increase in heart rate by 11.5%. The antihypertensive effects of N are positively related to pretreatment blood pressure. These results provide support that N is a safe and effective drug for controlling blood pressure also in hypertensive emergencies of children.

Acute Disease↗