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Biomedical subjects

J Nitsch

Publications and source records attributed to J Nitsch.

At least 19 recordsLinked to original sources
PubMed2003

Intrapericardial instillation of mitoxantrone in palliative therapy of malignant pericardial effusion.

BACKGROUND: Pericardial effusions occurring with pericardial or myocardial metastases often cause serious complications, necessitating temporary or emergency relief by percutaneous pericardiocentesis. However, this often results in recurrences. For long-term therapy success, the intrapericardial instillation of anti-neoplastic agents is an alternative to surgical methods, which are stressful for the patient. Following our positive experiences with mitoxantrone in the treatment of malignant pleural effusions, we applied this substance for the therapy of malignant pericardial effusions. PATIENTS AND METHODS: 16 patients with cytologically verified malignant pericardial effusions (8 with bronchial carcinoma, 7 with carcinoma of the breast, 1 with adenocarcinoma of the stomach) received an intrapericardial instillation of mitoxantrone 1-3 x10-20 mg. Responses were evaluated by echocardiography 30 days after completion of therapy. RESULTS: 12 of 16 patients showed complete remission (no recurrence of a detectable effusion). 3 patients showed a partial remission (recurrence of non-drainage-dependent effusion) (CR + PR = 94%). Within the mean follow-up period of 189 days no recurrences occurred. The rate of side effects was low. CONCLUSION: Intrapericardial instillation of mitoxantrone is a feasible and effective palliative method for the control of malignant pericardial effusions with little strain on the patients, short duration of hospital stay, cytotoxic characteristics of the substance with a correspondingly high rate of response and low side effects.

Adult↗
PubMed1998

[Löffler fibroblastic endocarditis in the thrombotic stages in isolated right ventricular tissue eosinophilia].

We report on a male, 31 year old, Turkish patient with an intracardiac mass in the right ventricle, reduction of performance and weight, as well as intermittent fever. No eosinophilia was documented in the peripheral blood; cardiac function was primarily normal. Besides the differential diagnosis of Löffer's endocarditis (endomyocardial fibrosis) an inflammatory disease and a malignant cardiac tumor were suggested. The diagnosis of Löffler's endocarditis could not be confirmed morphologically by echocardiography nor histologically by right ventricular biopsy. Operative removal of the mass lesion was necessary because of fast tumor progression, fulminant pulmonary embolism, and infiltration of the tricuspid valve. Only then, histologically Löffler's eosinophilic endocarditis of thrombotic stage was diagnosed. Antiphlogistic therapy with cortisone was initially performed. With a dose reduction after 6 months, a relapse of the thrombotic mass occurred. Therefore, continuous treatment with cortisone and azathioprine was induced followed by further tumor regression and further clinical stabilization since 8 months of treatment.

Adult↗
PubMed1993

Efficacy and safety of combination therapy with amiodarone and type I agents for treatment of inducible ventricular tachycardia.

In a prospective study the efficacy of amiodarone in combination with the three Class I drugs mexiletine, flecainide, or encainide was evaluated consecutively in 12 patients with recurrent ventricular tachycardias (VT) by programmed stimulation. None of the tested drug combinations suppressed induction of sustained VT. The combination of amiodarone with Class IC drugs flecainide and encainide prolonged the cycle length of VT significantly, whereas the combination with mexiletine did not have the same degree of slowing on the VT cycle length. Several proarrhythmic effects occurred during the combination therapy with encainide: (1) frequent, spontaneous recurrences of hemodynamically well tolerated VT in four patients; (2) enhanced inducibility of VT in three patients; (3) impaired termination of VT in three patients. Though a marked increase in QRS and QTc intervals was observed by combined treatment with encainide, no significant correlation could be established between aggravation of arrhythmia and plasma levels of encainide, degree of QRS widening, JT or QTc prolongation. The only predictor for the occurrence of proarrhythmic events was found in left ventricular ejection fraction. These findings suggest that in patients refractory to amiodarone alone or a combination with mexiletine, the combined treatment of amiodarone with other Class IC drugs prolongs the VT cycle length but does not suppress induction of VT during programmed stimulation. Combination therapy of amiodarone with encainide was associated with a high incidence of proarrhythmic effects.

Adult↗
PubMed1992

[Measuring blood flow velocity in the coronary sinus with Doppler catheters].

Measurements of the coronary sinus blood flow velocity with Doppler catheters (Medtronic Floscan; Millar DC201) were performed to assess coronary flow reserve and significance of coronary artery stenosis. In seven patients with normal coronary angiogram coronary sinus blood flow velocity (Doppler catheters) and coronary sinus blood flow volume (thermodilution) were simultaneously recorded. Coronary flow reserve was calculated as the quotient of the peak flow velocity (peak flow volume) and resting flow velocity (resting flow volume) after infusion of 0.5 mg/kg dipyridamole intravenously. The correlation coefficient was r = 0.88. Coronary sinus blood flow velocity was measured in 31 patients at resting conditions and after injection of contrast media during coronary angiography. At resting conditions blood flow velocity was 3.6 +/- 1.5 cm/s (n = 31), 3.5 +/- 1.8 cm/s (n = 9; controls), and 3.6 +/- 1.1 cm/s (n = 9; significant stenosis of the left anterior descending; not significant). After injection of contrast media flow velocity amounted to 2.2-fold resting flow in controls and to 1.5-fold resting flow in patients with stenoses of the left anterior descending artery (p less than 0.01). Measurement of coronary sinus blood flow velocity with Doppler catheters is a valuable adjunct for determination of coronary flow reserve and for assessment of stenosis severity of the left anterior descending artery. Continuous on-line monitoring of phasic flow velocity provides important information of the myocardial perfusion, e.g., during angioplasty.

Blood Flow Velocity↗
PubMed1990

[Acute myocardial uptake of lidocaine, mexiletine and amiodarone].

To assess acute myocardial uptake of antiarrhythmic drugs, we measured drug concentrations simultaneously in the aorta and in the coronary sinus during diagnostic cardiac catheterization. Measurements were taken 1, 2, 3, 4, 5, 7, and 10 minutes after intravenous bolus application of lidocaine (n = 10, 25 mg), mexiletine (n = 5, 25 mg and n = 10, 100 mg), or amiodarone (n = 10, 25 mg). Drug levels were measured by high-pressure liquid chromatography. Maximal concentrations were observed after 2-5 min. After 3-5 min coronary sinus levels exceeded aorta levels, indicating the end of net myocardial drug uptake. In contrast to lidocaine and amiodarone, no mexiletine was found in the coronary sinus 15 s after the end of drug application, obviously indicating a high myocardial drug content. Furthermore, the data provide an explanation for the acute efficacy of amiodarone. The myocardial uptake may result in various pharmacodynamic effects of antiarrhythmic drugs.

Amiodarone↗
PubMed1990

Myocardial oxygen supply in coronary artery disease.

In patients with coronary artery disease investigated during cardiac catheterisation, myocardial blood flow and myocardial oxygen consumption were significantly decreased as compared to control patients without signs of coronary artery disease. At the same time left ventricular function was impaired. In addition to regional contraction abnormalities observed in 77% of the patients, mean heart index and mean left ventricular work were diminished and mean enddiastolic pressure elevated. Among the coronary artery disease group, patients with normal blood pressure had a significantly higher left ventricular enddiastolic pressure than patients with hypertension.

Coronary Circulation↗
PubMed1990

[Indications for pacemaker therapy in ophthalmoplegia plus and Kearns-Sayre syndrome].

Mitochondrial myopathies can affect the skeletal muscle, the central or peripheral nervous system, and they may be associated with chronic progressive external ophthalmoplegia (CPEO). In 7/29 patients with mitochondrial myopathies and CPEO a cardiac involvement (Kearns-Sayre syndrome) was found: incomplete right bundle branch block (n = 1), right bundle branch block (n = 1), left anterior fascicular block and right bundle branch block (n = 2), complete atrioventricular block (n = 3); congestive cardiac failure (ejection fraction 40%) (n = 2); 3/10 patients had prolonged infranodal conduction on His-bundle electrography (HV-interval 60 ms). The cardiac involvement in ophthalmoplegia plus is characterized by progressive impairment of fascicular conduction. The need for prophylactic pacemaker implantation appears to exist in patients with bifascicular block and prolonged His-ventricle conduction.

Adolescent↗
PubMed1990

[Computer-assisted contour detection in a complete heart cycle by levocardiography with adaptive raster tracking--validation of the method].

A method for computer-assisted edge detection in a full heart cycle of the left ventricular cineangiogram is presented. Left ventricular cineangiograms were acquired in the 30 degrees RAO position on cinefilms with 50 frames/s. A selected heart cycle was digitized with a spatial resolution of 512 x 512 pixels and a grey-value range from 0 to 255. In the first frame of the heart cycle a raster was calculated from contour points marked by an operator. The raster was automatically adapted to the left ventricular contour in the following frames. The contour points were determined on the adaptive raster by a gradient method. The automatic calculation of all contours of the systolic contraction was possible in 28 of 30 cineangiograms, operator interaction was necessary in two cineangiograms. The calculation of the diastolic contours requested operator interaction in 4 of 30 cineangiograms. The mean deviation of the calculated from the true contours ranged from -1.2 +/- 1.9 mm to 0.9 +/- 2.9 mm. The correlation coefficients between volumes calculated from the computer-determined and manually drawn contours ranged from r = 0.98 to r = 1.0 at beginning of systole, midsystole, endsystole, middiastole, and enddiastole with a standard error of the estimate between 2.8 ml and 5.2 ml. A repeated automatic determination of the contours after an independent remarking of the starting points resulted in a linear correlation of the calculated volumes with a correlation coefficient of r = 1.0 and a standard error of the estimate between 1.3 ml and 4.7 ml. The correlation coefficient for the ejection fraction was r = 0.99 with a standard error of the estimate of 1.9%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Increased atrial natriuretic peptide in essential hypertension--relation to right atrial pressure behavior].

The role of atrial natriuretic peptide (ANP) in the pathogenesis of essential hypertension has not yet entirely been clarified. We investigated whether the increase of ANP in essential hypertension may be explained by elevated right atrial pressures and/or a different relationship between right atrial pressures and ANP secretion. Patients with stable essential hypertension undergoing right and left heart catheterization because of suspected coronary heart disease had significantly higher ANP levels than normotensives: 58.7 +/- 6.7 pg/ml in hypertensives versus 42.0 +/- 4.1 pg/ml in normotensives (p less than 0.01). Matching hypertensives with normotensives at identical levels of left ventricular enddiastolic pressure revealed significantly higher mean pulmonary artery pressures in hypertensives. Right atrial diastolic pressure (v-wave) after matching for LVEDP was 4.8 +/- 0.5 mm Hg in hypertensives and 3.1 +/- 0.2 mm Hg in normotensives (p less than 0.05). In addition, at any given mean right atrial pressure hypertensives showed higher ANP levels than normotensives. These results demonstrate that hypertensives exhibit raised pressures in the pulmonary artery independent of left ventricular pressure load. The elevation in right atrial pressures and the steeper relationship between these pressures and ANP are a suitable explanation for raised ANP levels in hypertension. ANP in essential hypertension may represent a counterregulation against elevated pulmonary resistance.

Adult↗
PubMed1989

Acute induction of sustained ventricular tachycardia: a new porcine model.

In this study we evaluated the possibility of initiating long-lasting ventricular tachycardias acutely, using isolated porcine hearts and thus avoiding an open-chest operation model. This set-up was designed especially to investigate defibrillating or antitachycardiac pacing devices, which terminate these malignant arrhythmias if medical treatment fails. The experiments were performed on 42 pigs, weighing 20-25 kg. After thoracotomy their hearts were removed and adapted to a Langendorff perfusion system. Supplied with their own blood, beating hearts were manipulated in three different ways: direct current impulses (4.5 V, 750 ms) or programmed ventricular stimulation, creation of a small myocardial infarction, and application of antiarrhythmic drugs (ajmalin, lidocaine, sotalol). Out of all possibilities the combination of ajmalin (mean concentration 0.041 micrograms/ml) and a small anteroapical myocardial infarction (3-6 cm2) along with direct current impulses (4.5 V), led to sustained ventricular tachycardias in the highest proportion (93%) of trials (P less than 0.001). The heart rate was 251 beats per minute on average. Lidocaine trials were less successful (53%), while programmed ventricular stimulation and sotalol failed to induce ventricular tachycardias. This study supports the evidence that the combination of ajmalin and a small myocardial infarction with direct current impulses is a reliable model for sustained ventricular tachycardias in isolated pig hearts. Although it is a rather artificial organ model, tachycardias can be induced acutely without any long-term pretreatment. Animal models based on chronic myocardial infarctions will therefore be unnecessary for the investigation of defibrillating systems and antitachycardiac pacing devices.

Animals↗