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Biomedical subjects

K H Günther

Publications and source records attributed to K H Günther.

At least 19 recordsLinked to original sources
PubMed1991

Isoenzyme (lactate dehydrogenase, aspartate aminotransferase) and dipeptidyl peptidase IV activity changes in blood plasma likely indicative of organ involvement due to arterial hypertension.

The plasma activities of LDH and ASAT isoenzymes as well as of DP IV were studied in patients with essential hypertension and related to blood pressure, haemodynamic indicators of latent heart failure and to ischaemic heart risk indicators. Patients with elevated systolic or diastolic blood pressure showed significantly increased activities of ASAT m. In hypertensives with elevated pulmonary artery pressure markedly increased activities of ASAT, ASAT m, LDH M and DP IV could be observed. Distinctly increased activities of ASAT, ASAT m, LDH M and DP IV were also found in patients with elevated plasma cholesterol. The results obtained suggest that changes of LDH and ASAT isoenzymes as well as of DP IV indirectly reflecting alterations in organ metabolism might provide useful additional information with respect to uncovering hypertension-linked complications.

Adult↗
PubMed1990

[Semi-invasive measurement of pulmonary pressure as a method of evaluating cardiac function in hypertension and ischemic heart disease. Experience at Charité Hospital for more than 20 years].

Since 1969, microcatheterization (floating catheterization) of the pulmonary artery has systematically been used at the Hospital Charité in Berlin for measuring (indirectly) the left ventricular filling pressure. That seemed especially be justified in patients in whom conventional catheterization was not needed. Noninvasive techniques had not been available. Since then, our interest was focused on the hypertensive heart, earlier under the aspect of early discovering and influencing heart insufficiency, later concerning a developing myocardial ischemia, in relationship to left ventricular hypertrophy. At the Charité more than 1,000 microcatheterizations in more than 400 hypertensive cases have been performed, mostly in combination with nuclear-cardiological measurements. The rate of complications was found minimal. Thus, cardiac function could be characterized hemodynamically, at rest and even under ergometric load. Special programmes served the acute application of drugs for diagnostic or therapeutic reasons. In the meantime a longterm study could also be finished by using hemodynamic measurements, starting with hygienic means and followed by a antihypertensive basis therapy, in newly detected hypertensives. That included repeated catheterizations of the pulmonary artery.

Catheterization, Peripheral↗
PubMed1989

[Use of nitrates in hypertension. Cardiac and peripheral effects before and during antihypertensive therapy at rest and during stress].

The acute effects of 1.6 mg glycerol trinitrate (2 x 0.8 mg) on the hemodynamic function were compared in 11 healthy subjects and 25 hypertensive patients (WHO stages I and II), at rest and during exercise. The nitrate testing was performed before the beginning of antihypertensive treatment, during nonmedical therapy, as well as under additional oral therapy with diisopropylamin. Right-heart-catheterization, echocardiography, radionuclide-ventriculography and venous occlusion plethysmography were performed. Nitroglycerin consistently led to a reduction of blood pressure in the systemic and pulmonary circulation both at rest and during exercise. There was a small decrease of peripheral arterial resistance (TPR) at rest and a more pronounced decrease of pulmonary arteriolar resistance (PAR) at rest and during exercise. The documented effects may be important with regard to combined antihypertensive treatment. In addition, the application of nitrates in hypertensive crises may be useful.

Administration, Sublingual↗
PubMed1989

[Differential therapy of myocardial ischemia in females].

Peripheral perfusion abnormalities are considered a possible reason for myocardial ischemia in the absence of visible coronary artery stenoses. In 85 women (age: 41-58 years, mean age: 46 +/- 8) with pathological exercise ECG (precordial mapping: 50 leads), hemodynamic studies were performed without medication, after sublingual nitroglycerin (NTG, 0.8 mg), sublingual Nifedipin (N, 30 mg), and intravenous Dipyridamol (D, 0.5 mg/kg). Eighteen women showed normal coronary arteries and a normal myocardial perfusion (group I), 21 an impaired perfusion due to coronary stenoses (Group II), and 46 women a reduced perfusion without visible changes (Group III). Reference methods were measurement of pulmonary artery pressure, 201-TI-scintigraphy, and coronary angiography. In group II, enddiastolic and endsystolic left ventricular volume (EDV, ESV) as well as enddiastolic pulmonary artery pressure (pAd) were increased, the ejection fraction (EF) was reduced, and cardiac output (CO) was normal. In group III, ESV, EDV, EF, and CO were significantly reduced, while pAd increased. In group II, N led to a normalization of ESV, EDV, EF, and pAd. In group III, NTG led to a reduction of pAd and EDV, and concomitantly to a further reduction of the already low CO. In both groups the reduction of ST-segment depressions after NTG was significant. N led to a moderate reduction of pAd and ST-segment depression, but to an increase of CO in both groups. D exhibited a comparable effect in group III. In group II an increase of ST-segment changes and of pAd with unchanged CO was observed. With regard to longterm treatment of women in group III, N and D seemed to be more efficacious than nitrates due to a beneficial effect on cardiac output.

Administration, Sublingual↗
PubMed1989

[General, non-medicamentous treatment of arterial hypertension].

This review focuses on the following aspects of nonpharmacological management concerning elevation of blood pressure: historical development, highlights and theses, possibilities of intervention, as well as favorable observations, advantages (in early diagnosis), disadvantages, fields of application, and integration of this form of treatment into a comprehensive strategy of hypertension control at a population level. A selection of detailed results is elaborated including: possible failure in primary classification of elevated blood pressure and its consequences, the reducibility of the hypertension problem if nonpharmacological measures are generally used, risk factor prevalences in medical and non-medical university cadres, blood pressure reduction in a spa, and hemodynamic changes induced by nonpharmacological or combined antihypertensive treatment simultaneously with drugs. Finally, reference is made to international results, as well as to the importance of the relation between diagnosing and treating blood pressure elevation concomitantly with a simultaneous management of other main risk factors that must be influenced in order to reduce the cardiac risk in hypertensives.

Adult↗
PubMed1988

Diagnosis of silent myocardial ischemia in women.

The diagnosis of silent ischaemic heart disease may be important in men as well as in women. However, diagnosing women by exercise ECG is limited due to the higher rate of false positive results. For improving diagnostic validity the following investigations were done. In 310 women, aged 41-63 years (mean age 47 years', revealing 'pathological' exercise ECG, further testing was performed using nitroglycerin (NTG 0.8 mg). As a reference method, pulmonary artery (PA) pressure measurement was used. As a result of NTG testing, two groups could be separated: (a) those in whom ST segment depression remained constant (N = 217, NTG negatives = 70%). Since the end-diastolic PA pressure was found normal, these results were interpreted to be false-positive. (b) NTG effected a reduction or normalization of exercise induced ST segment changes (N = 93, NTG positives = 30%). There was a correspondence with exercise inducible end-diastolic PA pressure decrease. Consequently, true positives were assumed. Analysis of angina pectoris history indicated typical chest pain in 2% of NTG negatives only, but in 16% of NTG positives. In agreement with this during exercise, angina was reported by NTG negatives in 3% of cases and by NTG positive in 17%. The rest of this group (83%) is considered having exercise induceable silent myocardial ischaemia. When checking-up after five years, exercised-induced angina could be found in 4% of NTG negatives again, but in 36% of NTG positives. It was concluded that exercise testing by additionally using nitroglycerin is a rather important approach for diagnosing myocardial ischaemia in women.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

Comparative studies in hypertension under different continental conditions.

Preventive studies were undertaken according to the same protocol (questionnaire, blood pressure and cholesterol assay standardized) integrated in the Public Health Services of the GDR and Cuba. In a German community (Cottbus-Land) 5,377 people (2,340 males/3,037 females) and in the Havana region 1,179 people (437 males/742 females), all aged 30-50 years, were followed up. The Germans revealed higher proportions of hypertension and hypercholesterolemia, the Cubans those of (heavy) smoking. Conditioning factors, such as overweight, physical inactivity and psychic stress, were found to be quite differently distributed, explaining however only in part prevalence differences between the continental regions even when both sex and localization of living were considered separately.

Adult↗
PubMed1987

[Perfusion studies of the myocardium using computerized tomography. Comparative studies in normal persons and patients with coronary heart disease].

As a noninvasive method of examination, conventional computer tomography (CT) has assumed an important role in assessment of pathologic anatomy of the heart. In contrast, previously, CT has not been applied for routine investigations of myocardial perfusion. In this study, a new method is described which, with intravenous injection of contrast medium, enables delineation of perfusion differences in the myocardium. Studies were performed in ten healthy male subjects and 71 patients with angiographically-documented coronary artery disease with a Somatom SF (Siemens) with a scanning time of five seconds. Prior to contrast injection, a native scan was obtained in the short axis view of the left ventricle as well as in apical and central view. After injection of 30 ml of contrast medium through a 7F ring catheter positioned in the inferior vena cava, imaging was again performed and then repeated subsequent to administration of 0.5 mg/kg dipyridamole. Quantitative evaluation of the CT images was carried out through circumferential analysis of the apical and central segments. The circumference was divided into 60 segments of six degrees each and for each segment ten density measurements were performed to obtain average values subendocardially, intramurally and subepicardially. After correction for the density value of the ascending aorta in healthy subjects, the density profile was constructed. The density profile of the healthy subjects was designated as the mean value curve. The circumferential profile of patients with coronary artery disease was tested against the mean value curve from which two indexes for description of perfusion disturbances were defined.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Social conditions and ischemic heart disease in the female].

In the development of ischemic heart disease (IHD) in women, there are a variety of factors which, possibly, may exert an influence. The recognition of such factors must be considered prerequisite to a preventive approach to the disease. Possible relationships between socio-economic conditions, in particular education level and occupation as well as marital status and number of children, with manifestations of IHD or presence of risk factors have been studied. Recently, results have been published from the Cottbus Prevention Study/GDR (CGPPS), the World Health Organization Project Eberbach-Wiesloch/FRG and US-American analyses (NHANES II). On evaluation of available data and assessment of the coronary risk profile in women, it should be taken into consideration that comparison is encumbered by the facts that the studies did not employ uniform definitions of socio-economic classification, risk factors and IHD and that they were subject to differing historical developments. Similar to that observed in men, arterial hypertension and overweight was seen significantly more frequently in women factory workers and rural women than in their more sophisticated counterparts. As in other studies, the prevalence of hypercholesterolemia in women did not differ among the socio-economic stratifications. The number of smokers was significantly higher in those at the upper levels of education than in women factory workers and rural women or office workers and housewives. There was an inverse relationship between the level of education and mean arterial blood pressure. There was no relationship, however, between income and cholesterol levels. In women working at the lower levels of employment, there was a higher incidence of IHD.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1987

[New aspects in the diagnosis of ischemic heart disease in females].

To investigate still uncertain aspects of the diagnosis of ischemic heart disease (IHD) in women, between 1969 and 1984, repeated exercise studies were performed in 706 asymptomatic women (between the ages of 17 and 63 years). On observation of pathologic ST-segment depression of more than 0.1 mV, the exercise study was repeated after administration of 0.8 mg nitroglycerin. Pathologic ST-segment depression was seen in 310 women (44%). In 217 patients (31%), nitroglycerin had no effect (NTG negative); in 93 women (13%), there was normalization of the ST-segment changes (NTG positive). Additionally, in selected subgroups of patients, pulmonary artery pressure was measured at rest and during exercise and ECG mapping performed (n = 114); radionuclide ventriculograms (n = 64) and 201-thallium scintigrams (n = 99) were obtained and coronary angiography (n = 85) was performed. In the NTG-negative women, ejection fraction, myocardial perfusion and coronary arteries were normal. NTG-positive women had lower mean ejection fractions but still within normal limits and indications of impaired myocardial perfusion. High-grade coronary stenoses were found in 25%. No patient with pathologic ST-segment depression had mitral valve prolapse. NTG-positive women had significantly more risk factors than NTG-negative women. In the former group, pulmonary artery pressure measurements showed pathologic exercise hemodynamics, only in 25% of whom IHD with significant stenosis was found to be the cause. For this condition, differential diagnostic considerations include cardiomyopathy or small vessel disease.

Adolescent↗
PubMed1987

Relation between renal and hepatic excretion of drugs. VI. Influence of pretreatment with phenol red on renal excretion and accumulation capacity of kidney or liver slices of immature and adult rats.

Pretreatment with phenol red causes a significant increase in renal excretion of p-amino-hippurate (PAH) in adult rats. In vitro experiments have shown that phenol red pretreatment significantly enhances the accumulation of PAH in renal tubular cells of adult rats. Thus the stimulation of active renal tubular PAH transport is at least in part responsible for its accelerated excretion via urine. A similar phenol red administration does not enhance the renal excretion of this dye, neither in adult nor in immature rats. In accordance with these in vivo findings the renal accumulation of phenol red is not increased after pretreatment with this dye. Remarkably the repeated administration of phenol red causes a distinct reduction of phenol red accumulation capacity in liver tissue. The rate of accumulation of both PAH and phenol red in renal cortical slices increases significantly during maturation; in liver tissue slices such an intensification does not occur. Under anaerobic conditions an active energy requiring uptake of phenol red does not take place and an accumulation by active transport of the dye can also be excluded. Therefore a passive uptake of phenol red and a binding of the dye in renal tubular cells could explain the distinct accumulation of phenol red in tissue slices from the kidney under nitrogen atmosphere. In 55-day-old rats the anaerobic phenol red accumulation in the liver is diminished after pretreatment with this dye.

Aging↗
PubMed1986

Haemodynamic and humoral reaction in arterial hypertension during acute blood pressure lowering induced by nitroglycerin.

The aim of the study was to test whether there are typical changes in haemodynamics and humoral regulation in untreated hypertensives compared to normotensives with acute lowering of blood pressure (and venous return) induced by nitroglycerin (NTG). 23 hypertensives were investigated by radiocardiography and microcatheterization of the pulmonary artery as well as by means of humoral analyses in comparison to 10 normotensives. After performing the studies at rest and during exercise, 0.8 mg NTG was given and the investigations were repeated. There were only insignificant differences in cardiac output and left ventricular filling pressure (PAEDP) at rest and during exercise between both groups. The pressure reductions due to NTG were also similar. Plasma renin activity and plasma kallikrein did not differ in hypertensives and normotensives either at rest and during exercise or after NTG. The prostaglandins (PgE, PgF2-alpha, PgI) were extremely variable. In hypertensives, only PgI was decreased, with increase after NTG, at rest. Thus, PgI is the only humoral indicator participating in blood pressure lowering induced by NTG.

Adult↗