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Biomedical subjects

J Blume

Publications and source records attributed to J Blume.

At least 19 recordsLinked to original sources
PubMed1992

Treatment of chronic cerebrovascular disease in elderly patients with pentoxifylline.

A placebo-controlled, randomized, double-blind study was conducted to assess the efficacy and safety of pentoxifylline in 80 patients with symptoms of vascular dementia. Efficacy was assessed using neuropsychologic tests. With regard to the primary efficacy criteria, absolute changes in the active treatment group were more pronounced in both the protocol and endpoint analysis than in the placebo group. Compared with the placebo group, differences were statistically significant for the active treatment group. Similar changes were reported in a post-hoc defined subgroup of patients displaying "stepwise deterioration," an essential criterion of multi-infarct dementia (MID). Medication was generally well-tolerated. The present study shows that pentoxifylline is suitable for the symptomatic treatment of vascular dementia.

Aged↗
PubMed1992

[An epidemiologic study of the value and limits of physical therapy/exercise therapy in Fontaine stage II arterial occlusive disease].

Using a questionaire the members of the German Society for Angiology (DGA) were interrogated on the use of physical training for the treatment of peripheral arterial occlusive disease; from a total of n = 431 as much as n = 156 responded, i.e. making up a response of 36%. 104 of them conduct physical training either on their own or assign patients to it (67%). In most of the institutions exclusively walking/interval training (83%) or medical exercise (74%) are performed. In most cases the training is conducted by physiotherapeutists (71%). 13% of the patients are admitted exclusively to physical training, 34% undergo combined therapy, i.e. physical training and vaso-active medication. 22% receive mere medical, 31% surgical treatment. A general evaluation on the success of the different therapies applied turned out following frequency: 1. combined therapy (medical treatment/physical training); 2. surgical procedures as a therapeutic measure; 3. physical training; 4. medical treatment. A further study performed at three ambulatory centres offering physical training were to show what kind and to which extent such training is useful. In 34% of the cases (from a total of n = 201 patients with peripheral arterial occlusive disease in state II according to Fontaine) contraindications argue against the application of physical training. From a rest of 66% as much as 36% of the patients refuse to undergo physical training the reasons of which were stated with large transport distances and time problems. The remaining rest accepts the offer, although 24% attend such training only sporadically. The results show that mainly contraindications and insufficient patient compliance account for the fact that only one third of the patients attend physical training. The results are discussed and proposals are made to improve patient compliance.

Aged↗
PubMed1991

[Hyper- or isovolemic hemodilution in patients with stage II peripheral arterial occlusive disease].

The influence of hyper- and isovolaemic hemodilution using HES 200/0.5 6% (HES steril, Fresenius AG) on pain-free walking distance in patients with peripheral arterial occlusive disease stage II according to Fontaine was tested in a randomised investigation involving three groups. The increase in pain-free walking distance was significant both in the hypervolaemic and isovolaemic hemodilution group. The increase in both dilution groups did not differ but compared to a control group (infusion of Ringer lactate) it was significantly higher. Considerable changes concerning rheological parameters (decrease in haematocrit and plasma viscosity) were observed after isovolaemic hemodilution.

Adolescent↗
PubMed1990

[Vascular-induced disorders of cerebral performance in the elderly. Long-term therapy with pentoxifylline and psychological mental training].

In a six-week placebo-controlled, randomized, in part double-blind, study, the effectiveness and tolerance of pentoxifylline was investigated in 120 elderly patients with incipient cerebrovascular disorders (OPS). In addition to group I (placebo) and group II (2 X 600 mg pentoxifylline/d), a third group of patients (III) was treated with pentoxifylline plus psychological training. In the two pentoxifylline groups, the mental performance increased to a greater extent than in the placebo group. Despite a tendential superiority of the pentoxifylline plus training group, there was no statistically significant difference between groups II and III. With respect to "state of health and behavior" (summed score of the SCAG), the placebo group revealed a deterioration as compared with improvements in II and III, the improvement being more pronounced in the latter. Such an evaluation was also obtained when the changes in all the variables were considered. It has thus been shown that pentoxifylline is suitable for the symptomatic treatment of organic brain syndrome, and that its positive therapeutic effect can be improved by a simultaneous mental training program.

Aged↗
PubMed1990

Haemodilution with medium molecular weight hydroxyethyl starch in patients with peripheral arterial occlusive disease stage IIb.

The basic therapy of peripheral arterial occlusive disease stage IIb, according to Fontaine, is exercise. It should be determined whether a mild hypervolaemic haemodilution with hydroxyethyl starch or Ringer lactate can produce a further increase in walking distance. For this purpose, three groups of 25 patients each were formed. One group exercised three times weekly and the second group, in addition to exercise, underwent a mild hypervolaemic to isovolaemic dilution therapy with HES for a period of 6 weeks. In the final group the haematocrit was reduced to the same extent by venesections and volume substitution using Ringer lactate. The walking distance in the HES group increased from 216 m to 311 m (44%), in the Ringer lactate group from 214 m to 258 m (20%), and in the exercise group from 213 m to 242 m (14%). On comparison of the groups, the increase in pain-free walking distance in the HES group differs significantly (P less than 0.05) from that achieved in the other groups. It was demonstrated that haemodilution with HES in combination with exercise brings about a clinical effect three times that achieved by exercise alone. Venesection with subsequent administration of Ringer lactate and exercise is superior to exercise alone but markedly inferior to the combination therapy with HES.

Adult↗
PubMed1989

[Hemodilution in patients with multiple morbidity and peripheral arterial occlusive disease].

The treatment of multi-morbid patients suffering from peripheral arterial occlusive disease (PAOD) is rendered difficult due to concomitant diseases such as coronary heart disease, chronic obstructive pulmonary affection, arterial hypertension or diabetes mellitus. Haemodilution can be a clinically efficient therapy for some of the concomitant diseases as well. It is, however, necessary to use a weak colloidal solution which has no additional volume effect as an iso-oncotic substance. Hydroxyethyl starch 200/0.5 6% meets all these demands. In a double-blind, placebo-controlled study over a period of 6 weeks a marked and significant increase of almost 40% in painfree walking distance was achieved for 19 of 37 multi-morbid patients with PAOD II by moderate hypervolaemic haemodilution with venesections. Besides the clinical improvement, blood fluidity also increased through a reduction in haematocrit, plasma viscosity, and erythrocyte aggregation.

Adult↗
PubMed1989

[Iso- and hypervolemic hemodilution with hydroxyethyl starch (HES 200/.05 10%) in patients with II b peripheral arterial occlusive disease].

The basic therapy in stage IIb of peripheral arterial occlusive disease (PAOD) according to Fontaine is exercise. The aim of this study was to test whether (given initial physiological hematocrit values of 43 to 46%) a mild hypervolemic to isovolemic to hematocrit values of 40% with HES 200/0.5 10% or Ringer lactate in combination with exercise is even more favorable. In order to answer this question, 3 groups of 25 patients each were formed. One group exercised three times weekly and the second group, in addition to exercise, underwent a mild, hypervolemic to isovolemic 6-week dilution therapy with HES. In the final group the hematocrit value was reduced to the same extent by means of venesection and volume substitution with Ringer lactate. The walking distance increased in the HES group from 216 to 311 m (44%), in the Ringer lactate group from 214 to 258 m (20%), and in the exercise group from 213 to 242 m (14%). In comparison of the groups, the increase in pain-free walking distances in the HES group is found to differ significantly from those in the other groups. It was clearly demonstrated that hemodilution with HES in combination with exercise brings about a clinical effect of an order three times of that achieved by exercise alone. Venesection with subsequent administration of Ringer lactate and exercise is superior to exercise alone, but is markedly inferior to the combination therapy with HES.

Adult↗
PubMed1988

[Bag plasmapheresis in patients with stage IIb peripheral arterial occlusive disease].

The clinical effect of bag-plasmapheresis was investigated in 60 patients with peripheral arterial occlusive disease stage II according to Fontaine. The initial number of patients was subdivided in three groups of 20 individuals using a randomised double-blind placebo-controlled design. Each patient gave 300 ml of blood twice a week for a 6 week duration. Blood plasma was separated in two groups and replaced with Hydroxyethyl-starch (200/0.5 10%) in group 1 and with Laevulose 5% in group 2. Patients in group 3 received their whole blood without any processing. All patients had to undergo a physical training of 45 minutes three times a week. The group who received Hydroxyethylstarch presented a 20% increase in walking distance whereas the increase in the Laevulose group was 5% and approximately 1% in the group receiving whole blood. The increase in walking distance in the Hydroxyethylstarch-group was significant on the 0.1%-level and significantly better than the improvement in walking distance of the other groups. Additionally in this group plasma viscosity showed a 3% decrease, erythrocyte aggregation was reduced by 10%. Results in the Laevulose group were only half as good as in the Hydroxyethylstarch group while parameters remained unchanged in the whole-blood-group. Bag plasmapheresis with Hydroxyethylstarch as substitute leads to an improvement in the walking capacity and blood fluidity thus offering a promising therapy for peripheral vascular occlusive disease.

Adult↗
PubMed1987

[Hemodilution in patients with stage IIb peripheral arterial occlusive disease: prospective randomized double-blind comparison of middle-molecular weight hydroxyethyl starch and low-molecular weight dextran solution].

Isovolemic hemodilution is a simple method of treating patients with peripheral arterial occlusion disease and hematocrit values of 43% or more. Dextran, a plasma substitute, has been used for that purpose since the early 1950s. However, the use of dextran in some diseases, e.g., hemorrhagic diathesis, kidney insufficiency, and microangiopathy is not without risk. Anaphylactic reaction, too, has occurred in some cases. Since the end of the 1970s hydroxyethyl starch, a plasma substitute, is available for the therapy of microcirculatory disorders and hemorrhagic diathesis. The side effects of hydroxyethyl starch are less serious and anaphylactic reactions are less frequent and moderate in extent. The clinical efficacy of both substances was compared in this survey. It could be stated that middle molecular hydroxyethyl starch is even clinically superior to low molecular dextran because the distance that the patients could walk increased significantly.

Arterial Occlusive Diseases↗
PubMed1986

Conservative drug therapy and walking exercise in stage IIb peripheral arterial occlusion disease.

In cases of peripheral arterial occlusion disease in Fontaine's stage IIb (PAOD IIb) with a walking distance of less than 200 m, the therapy that has priority, besides removing risk factors, is physical exercise. Very often it seems that concomitant rheological treatment with drugs is advisable to support the therapy and to improve compliance. The experience gained in the last 30 months in the treatment of PAOD IIb in a large angiological outpatient establishment is presented. All the patients were given thorough medical examination before the start of the therapy, and their angiological and rheological status was recorded. Depending on the results of the examinations, the patients with PAOD IIb were given one of three treatment variants: Patients with a haematocrit less than 43% and moderately altered rheology (group I; therapy: physical exercise). Patients with a haematocrit less than 43% and severely altered rheology, in particular increased erythrocyte rigidity (group II; therapy: physical exercise combined with naftidrofuryl treatment). Patients with a haematocrit of 43% or more and severely altered rheology (group III; therapy: physical exercise with haemodilution combined with naftidrofuryl treatment). Before the drug treatment was started, the possibility of surgical reconstruction of the vessels or angioplasty was discussed and the conservative therapy was undertaken only after surgery or when surgery had been rejected. Every course of treatment included reducing the risk factors as far as possible. All three conservative therapies were implemented for a period of at least 6 months. The increase in the walking distance was 157% (n = 27) after physical exercise alone, 238% (n = 27) with the naftidrofuryl combination therapy and 311% (n = 27) with the naftidrofuryl/haemodilution combination therapy.

Adult↗
PubMed1986

[Isovolemic hemodilution in stage-IIb peripheral arterial occlusive diseases. Prospective randomized double-blind comparison of middle-molecule hydroxyethyl starch and electrolyte solution].

Blood-letting to a haematocrit of 0.40 to 0.42 was performed over a period of six weeks on 30 randomized patients with peripheral vascular disease (intermittent claudication), stage IIb (after Fontaine), in addition to standardized gymnastics and physical exercise (walking). Subsequently, 15 randomly selected patients received after each blood-letting middle-molecular hydroxyethyl starch solution, another 15 randomized patients received isotonic sodium chloride solution, both groups under a double-blind protocol, gymnastics and walking exercise being continued. At the beginning of the study both groups were comparable with respect to clinical and vascular parameters and results of laboratory tests. Those of the former group had a significantly greater increase in pain-free walking distance than the latter. Blood pressure levels remained unchanged in the former, but significantly rose in the latter. Peak flow during reactive hyperaemia increased significantly in both legs in the first group, remaining unchanged in the second. An increase in spontaneous platelet aggregation occurred only in the second group; alpha 2-macroglobulin concentration rose only in patients of the first group, while fibrinogen decreased significantly in both.

Adult↗
PubMed1986

[Comparative study of low molecular dextran or hydroxyethyl starch as a volume substitute in hemodilution therapy].

Rheological therapy, as an immediate treatment in conjunction with physical therapy and the removal of risk factors, plays a significant role in the management of patients with peripheral vascular disease experiencing reduced walking tolerance. An essential element of rheological therapy is hemodilution. Currently, is still uncertain which plasma substitute solution would be the most appropriate in such cases. This study compared the effectiveness of low molecular hydroxyethyl starch to low molecular dextran during a 16-day hemodilution in combination to physical therapy. The clinical improvement observed with both plasma substitute solutions was comparable, yet in view of the cardiac volume overload, dextran demonstrates greater circulatory stress due to the transient pressure increase and more side effects. For this reason, we prefer to administer low or middle molecular hydroxyethyl starch in the dilution treatment of peripheral arterial occlusive disease as a chronic degenerative vascular disease.

Adult↗