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Biomedical subjects

J Jehle

Publications and source records attributed to J Jehle.

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

[Indications for coronary angiography in patients with acquired heart valve diseases with reference to risk factors].

The aims of the study were to examine the frequency of coronary artery disease (CAD) in patients with acquired valvular heart disease and to investigate the parameters by which significant coronary artery stenosis can be identified without invasive measures in these patients. For this reason 266 consecutive patients with acquired valvular heart disease (aortic, mitral or combined lesions) were examined retrospectively. In 24 patients (9%) a significant (50% or more reduction of the diameter) coronary artery stenosis was found. The prevalence of CAD increased with age: only one patient younger than 50 years, but 23 patients (13%) older than 50 years revealed significant CAD (19% men, 7% women). Increased levels of cholesterol and/or triglycerides were found more frequently in patients with CAD (33% and 29%, respectively) than in those without (6% and 12%, respectively). No differences were found in patients with aortic and mitral valve disease. Patients with typical chest pain revealed CAD in 30% of cases, whereas only 5% of the patients without angina pectoris (or 4% with atypical chest pain) showed a significant coronary artery stenosis. A high percentage (62%) of patients with typical chest pain and mitral valve disease revealed CAD. None of the 77 female patients without typical angina pectoris had significant coronary artery stenosis, whereas 11% of the male patients showed significant CAD even without typical symptoms. In 51 patients without typical angina pectoris and with no risk factors, no CAD was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Percutaneous transluminal coronary angioplasty: determination of left ventricular function in physical stress using intravenous digital subtraction angiocardiography].

24 patients with coronary artery disease underwent intravenous digital subtraction angiocardiography at rest and during exercise before and after percutaneous transluminal coronary angioplasty (PTCA). Before PTCA mean pulmonary artery pressure increased pathologically in 20 patients (on average from 22 +/- 4 to 40 +/- 9 mm Hg, p less than 0.001). The increase in cardiac index from 4.2 +/- 1.3 to 6.2 +/- 2.01 I X min-1 X m-2 (p less than 0.01) was achieved by an increase in heart rate from 77 +/- 13 to 119 +/- 16 min-1 (p less than 0.001) as stroke volume remained unchanged during exercise (52 +/- 14 ml X m-2, resting value: 53 +/- 13 ml X m-2). Though end-systolic volume increased from 32 +/- 11 to 41 +/- 13 ml X m-2 (p less than 0.001) and ejection fraction fell from 63 +/- 8% to 56 +/- 10% (p less than 0.005), stroke volume remained unchanged due to an enhanced diastolic filling (EDVI: 86 +/- 19 ml X m-2 at rest, 92 +/- 18 ml X m-2 during exercise, p less than 0.001). After angiographically successful PTCA in 21 of 24 patients average mean pulmonary artery pressure during exercise remained pathologically elevated (36 +/- 9 mm Hg, no significant difference from value before PTCA). It normalized in only 6 of 17 patients. On the other hand there was a marked improvement of left ventricular systolic performance. Ejection fraction during exercise (65 +/- 11%) was higher than before PTCA (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Results of coronary revascularization in occluded coronary arteries].

In a total of 82 patients (age 37-71 years) with an occluded left anterior descending artery (LAD) the results of coronary revascularization were evaluated 7 months postoperatively on average. In all patients the indications for revascularization was given by clinical symptoms (angina pectoris) or by prognostic reasons. In patients with multivessel disease. In patients with anterior wall infarction viable myocardium was proven by thallium-scintigram at rest and during exercise. 29 patients were evaluated by coronary angiography postoperatively, in 19 patients the angiograms of the left ventricle could be assessed quantitatively. Total patency rate was 76%, for the LAD 69%, for the circumflex artery 73% and for the right coronary artery 83%. The relatively low patency rate for the LAD was caused by an increased collateral flow to the occluded LAD and therefore by a significantly lower bypass flowrate measured during surgery. Angina pectoris improved markedly, 55% of patients had angina pectoris class III or IV versus 10% postoperatively. These changes were observed in all patients irrespectively of patency rate or occluded grafts to the LAD. Left ventricular volumes and ejection fraction did not change on average after revascularization. Only end-diastolic volume increased significantly in patients with an occluded graft to the LAD. There was a tendency of the end-systolic volume to decrease postoperatively in patients with complete revascularization or at least an open graft to the LAD. The results show a similar clinical improvement in these patients with occluded LAD as shown after "usual" revascularization in other patients. Preoperative coronary angiograms are helpful in judging the postoperative outcome of grafts to the occluded LAD.

Adult↗
PubMed1985

[Left ventricular function at rest and by stress in patients with aortic valve diseases. Study using digital subtraction angiocardiography].

Using digital subtraction angiocardiography left ventricular (LV) function and mean pulmonary artery pressure (PPA) at rest and during exercise were examined in 49 patients with aortic valve disease, 23 patients with aortic stenosis (AS), 12 patients with combined aortic valve lesions (kAV) and 14 patients with aortic regurgitation (AI). Muscular hypertrophy was present in all patients. LV-mass-to-volume ratio was significantly higher in patients with AS and kAV than in patients with AI. There was no significant difference in heart rate at rest or during exercise among the three groups. During exercise PPA increased significantly in all groups. The increase was significantly higher in patients with AS than in those with AI. End-diastolic and end-systolic volumes increased significantly in patients with AS and kAV on the average, showing no change in patients with AI. Ejection fraction decreased significantly in patients with AS and kAV and remained unchanged in patients with AI. Due to the increase in heart rate cardiac index increased significantly during exercise in all groups. In patients with pressure overloaded left ventricles (AS and kAV) the increase in filling pressure partly results in a decrease of compliance caused by hypertrophy. Thus in these ventricles LV function cannot be judged by LV filling pressures alone. In those patients in whom the indication for valve replacement was given without knowing the results of the exercise test, the changes of LV volumes and ejection fraction were abnormal during exercise on the average.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Qualitative evaluation of myocardial perfusion using digital subtraction angiocardiography].

The purpose of this study was to discover whether the passage of contrast medium through the myocardium can be visualized by digital subtraction angiocardiography and whether myocardial perfusion can be determined qualitatively from the difference images. Cineangiograms (duration 20 s) were obtained during routine coronary angiography and analyzed by means of a computerized image processing system. The results show that the passage of contrast medium through the coronary artery system, myocardium and coronary veins can be visualized. In 10 patients myocardial perfusion at rest was classified qualitatively into four categories (well perfused, slightly reduced perfusion, markedly reduced perfusion and perfusion defect) from local contrast intensity and the time dependent wash-in phase of the contrast medium. Intra- and interobserver comparison of the qualitative estimation of myocardial perfusion showed a close correlation (p less than 0.001 to p less than 0.0001). In the same 10 patients myocardial perfusion at rest was evaluated from Tl-201 scintiscans by two independent observers. A comparison between the qualitative classification of local myocardial perfusion assessed by both methods revealed a close correlation (p +/- 0.049). These results indicate that myocardial perfusion at rest can be visualized by digital image processing and evaluated qualitatively from cineangiograms.

Adult↗
PubMed1985

[Evaluation of myocardial perfusion based on digital subtraction angiocardiography measured contrast medium flow times].

The purpose of this study was to discover whether myocardial perfusion can be determined quantitatively by digital subtraction angiocardiography from the passage of contrast medium through the myocardium. Cineangiograms (duration 20 s) were obtained during routine coronary angiography and analyzed by means of a computerized image processing system. Regional myocardial contrast intensity was plotted versus time as a densogram for quantitative assessment. The parameter "medium rise time" showed a good reproducibility (r = 0.92). The average of medium rise time was 2.9 s in well-perfused areas, 3.7 s in less perfused areas, 5.2 s in areas with markedly reduced perfusion and 5.8 s for perfusion defects or scars using Tl-201 scintigrams as reference. The differences between the four groups were significant except between areas of markedly reduced perfusion and perfusion defects or scars (p less than 0.05). The correlation of medium rise time to the extent of the stenosis of the coronary vessel supplying the corresponding myocardial region revealed that the medium rise time on an average was 3.2 s distal to unstenosed vessels, 3.2 s distal to slightly stenosed vessels, 5.4 s distal to highly stenosed vessels and 4.7 s distal to vessel occlusion. The differences between the groups were not significant except between the groups of patients with low and high-grade coronary stenoses. These results indicate that the parameter "medium rise time" of the intensity-time curves determined by digital image processing provides a quantitative assessment of myocardial perfusion from cineangiograms.

Adult↗
PubMed1985

[Transprosthetic catheterization of a Björk-Shiley aortic prosthesis with fatal outcome].

Retrograde transprosthetic catheterization of a Björk-Shiley aortic prosthesis (type ABP) using a Sones catheter resulted in sticking of the tilting disc. Every attempt to withdraw the catheter failed and the patient died before he could be transferred for emergency reoperation. We advise against transprosthetic catheterization of tilting or bileaflet prostheses, which has been reported to be easily to perform without apparent risk. If left ventricular catheterization is mandatory after aortic valve replacement, the transseptal approach should be used. This is the only procedure which permits accurate evaluation of the functioning of the prosthesis or a concomitant mitral valve disease.

Aortic Valve Stenosis↗
PubMed1984

[Assessment of the functional parameter of left ventricular end-diastolic pressure].

In patients with an increase in enddiastolic pressure an impairment of left ventricular function is assumed. However, changes in left ventricular geometry (e.g. hypertrophy) or in elastic properties of the myocardium result in an increase in enddiastolic pressure, too. To differentiate the underlying mechanisms the elastic properties of the ventricle and myocardium, respectively, have to be determined. Our investigations show that the usually used determinations are not appropriate, if ventricular volumes are determined by means of angiography. The elastic properties can be calculated more exactly considering relaxation and thus the early filling phase of diastole. Moreover it is possible to perform this analysis by means of routinely determined hemodynamic parameters. So we propose a simple expression for the calculation of the elastic properties of the ventricle and get more information about the case of an increased enddiastolic pressure in clinical practise.

Aortic Coarctation↗
PubMed1984

[Left ventricular function at rest and during exercise in patients with arterial hypertension. Studies using digital subtraction angiocardiography].

Using digital subtraction angiography, left ventricular function and pulmonary artery pressure at rest and during submaximal exercise (98 +/- 33 watts) were examined in 25 patients with systemic hypertension. All patients had normal coronary arteries and a normal left ventricular function at rest. Heart rate increased in all patients (from 82 +/- 14 to 134 +/- 20 min-1, p less than 0.001). Systolic blood pressure also increased significantly in all patients (from 153 +/- 12 to 190 +/- 14 mmHg, p less than 0.001). End-diastolic and end-systolic volumes did not change on average (89 +/- 22 and 87 +/- 19 ml/m2, 28 +/- 8 and 28 +/- 10 ml/m2, respectively), neither did stroke volume nor ejection fraction (61 +/- 18 and 59 +/- 16 ml/m2, 68 +/- 7 and 67 +/- 9%, respectively). The increase in end-systolic volumes and concomitantly the decrease in ejection fraction during exercise in 8 patients points to an impairment of left ventricular function. This effect is frequently found in ventricles with less distinct hypertrophy. Cardiac index increased in each patient (from 5.1 +/- 2.1 to 8.2 +/- 2.9 I/min/m2, p less than 0.001). This is caused by the increase in heart rate while stroke volume remains unchanged. Mean pulmonary artery pressure increased in all patients from 19 +/- 6 to 35 +/- 10 mmHg on average (p less than 0.001). A pathologic increase could be observed in 18 patients. There was no correlation to angiographic parameters of left ventricular function. The exercise test was stopped in 12 patients mainly because of dyspnea. In 11 of these patients a pathologic increase of mean pulmonary artery pressure was found. As in these patients the angiographic parameters of left ventricular function were normal, the increase in pulmonary pressure is related to an impairment of diastolic function caused by hypertrophy.

Adult↗
PubMed1984

[Digital subtraction angiocardiography: accuracy of measuring left ventricular wall thickness and wall volume during intravenous contrast media injection].

A comparison of left ventricular wall thickness and wall volume determined by intravenous digital subtraction angiocardiography and by conventional left ventricular angiocardiography was performed by linear regression analysis: wall thickness: WDDSA = 0.90 X WDLV , Syx = +/- 0.16 cm, r = 0.74; wall volume: WVOLDSA = 0.87 X WVOLLV , Syx = +/- 48 ml, r = 0.85. Compared to the deviation and scatter of corresponding data measured from two consecutive beats in conventional left ventricular angiocardiographies , the error of determination of wall thickness and wall volume, determined by intravenous digital subtraction angiocardiography, is more pronounced. The regression analysis of wall volumes under rest and bicycle exercise evaluated by digital subtraction angiocardiography revealed a similar inaccuracy ( Syx = +/- 46 ml). This is due to faults in recognition of the inner and outer contours of left ventricular wall. Our results show that measurements of left ventricular wall thickness and wall volumes by means of intravenous digital subtraction angiocardiography can only be performed with greater deviations compared to conventional left ventricular angiocardiograms.

Angiocardiography↗
PubMed1984

[Fibrinolysis in right ventricular thrombus].

After fracture of his toes, a 34-year-old male patient developed deep leg vein thrombosis and subsequent pulmonary embolism. Because of progressive heart enlargement, 2D-echocardiography was performed. A floating mass measuring 4.5 cm X 3.5 cm was found in the right ventricle. On account of the deep leg vein thrombosis and the lung perfusion deficits detected by scintigraphy, the floating mass was thought to be a thrombus. Because of the severity of the patient's state and the lack of success of a heparin therapy with 32,000 IU/d, fibrinolytic treatment with streptokinase was started. After initial improvement in pulmonary gas exchange the patient died about 7 hours later from progressive cardiopulmonary insufficiency. Necropsy revealed a smaller right ventricular thrombus than that seen by echocardiography. There were typical surface erosions caused by the fibrinolytic treatment. Many younger and older emboli which in part were fragmented could be shown in the pulmonary vessels. A fragmentation of the right ventricular thrombus and subsequent lethal occlusion of pulmonary vessels had to be considered. With respect to the course of the described case and some case reports in the literature we think fibrinolysis is more dangerous than surgical thrombectomy in right ventricular thrombosis.

Adult↗
PubMed1983

Comparative effects of acute and chronic administration of amphetamine on local cerebral glucose utilization in the conscious rat.

The 2-deoxyglucose method was employed in rats following either acute or chronic administration of d-amphetamine. The drug was given either by a single intravenous and/or repeated daily intraperitoneal injections or by osmotic pumps implanted subcutaneously. Each mode of administration resulted in a specific constellation of metabolic effects. Acute doses of d-amphetamine, 5 mg/kg, stimulated glucose utilization in a number of cerebral structures, particularly the components of the extrapyramidal motor system. No effects were observed in components of the mesolimbic dopaminergic system. Repeated daily doses of 5 mg/kg for 2 weeks had no effects unless the dosage was progressively increased to toxic levels of 15 mg/kg over a 3-week period. Dosage sustained by osmotic pumps (12-15 mg/kg/day for 1 week or 6-7 mg/kg/day for 2 weeks), however, resulted in a selected increase in glucose utilization in the nucleus accumbens, an important component of the mesolimbic system. This finding may be of significance to the mechanism of amphetamine psychosis, which is sometimes regarded as a model of schizophrenia and is considered to be evidence in support of the dopamine hypothesis of the disease.

Animals↗
PubMed1983

Results of surgical therapy in patients with left ventricular aneurysm.

The clinical, angiographic and haemodynamic findings in 87 patients with left ventricular aneurysm were investigated before and after different surgical interventions. Thirty-four patients underwent aneurysmectomy alone (group I), 35 patients had additional coronary revascularization (group II), and 18 patients had revascularization alone because of the findings during operation (group III). The size of aneurysm was not significantly different in the three groups. Postoperatively, it decreased only in groups I and II. The majority of the patients in group I (predominantly one-vessel disease) had no angina pectoris, with no significant change early and late (more than 12 months) after operation. The patients in groups II and III (with more two- and three-vessel diseases) showed an improvement in angina pectoris. Preoperatively, most patients had experienced exertional dyspnoea. Overall, there was no significant change after operation, but most patients showed an improvement in angina and dyspnoea when these symptoms had been the major indication for surgical therapy. Heart rate, systolic and end-diastolic pressures in the three groups did not change significantly after surgery. End-diastolic and end-systolic volumes decreased and ejection fraction increased significantly in groups I and II. In group III these variables did not change. Circumferential fibre shortening velocity in the residual ventricle increased significantly only in group I. Haemodynamic studies during exercise were performed in a total of 32 patients. In group I the increase of mean pulmonary pressure was significantly lower postoperatively; there was no significant change in groups II and III.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

The local metabolic effects of somatosensory stimulation in the central nervous system of rats given pentobarbital or nitrous oxide.

General anesthetics are used to eliminate perception of stimuli, yet there have been few studies of the cerebral metabolic effects of stimulation during anesthesia, and of these studies, the results are discrepant. The authors therefore applied the quantitative 2-[14C]deoxyglucose method in a study of the effects of electrical stimulations (5 volts, 0.5 ms, 10 Hz) of a rat's saphenous nerve on glucose utilization in structures of the sensory pathway after administering pentobarbital or nitrous oxide. Under both conditions, stimulation produced a 75 to 108% increase in glucose utilization in the ipsilateral dorsal horn of the spinal cord, and a 9 to 11% increase in only a small fraction of the contralateral somatosensory cortex. No unilateral metabolic effect was seen in the dorsal column nuclei, ventroposterolateral thalamus, periaqueductal gray matter, dorsal raphe nuclei, or the reticular formation. The results of this study show that during peripheral stimulation, little metabolic response is seen in the brain even if the animal is receiving only nitrous oxide (70%), while the dorsal horn of the cord responds dramatically under the same conditions. Moreover, anesthesia with the potent cerebral metabolic depressant pentobarbital does not substantially alter the metabolic responsiveness of the cord or brain to stimulation. Thus, although there are marked differences between the rest in rate of metabolism produced by 70% nitrous oxide and pentobarbital, in terms of their effects on the metabolic response to stimulation, the agents are quite similar.

Animals↗