Search PubMed⌕ Search

Biomedical subjects

K L Neuhaus

Publications and source records attributed to K L Neuhaus.

At least 91 records · Page 5Linked to original sources
PubMed1988

[Follow-up after dilatation of congenital and acquired aortic stenosis].

Until 31 December 1987, a total of 85 transfemoral balloon valvuloplasties (TBV) had been performed for aortic valve stenosis, on 25 patients with noncalcified congenital and 58 (aged 66 +/- 10 years) with acquired (calcified) stenosis. The procedure had to be repeated in two infants because of early re-stenosis. The systolic transvalvular pressure gradient was reduced from 93 +/- 29 (mean +/- SD) to 51 +/- 20 mm Hg in acquired stenoses, and from 87 +/- 24 to 44 +/- 15 mm Hg in congenital stenoses. Invasive pressure measurements in 16 patients with acquired stenosis 3-11 months (mean of 8 months) post-TBV demonstrated partial or complete re-stenosis in all patients. In contrast, only 3 of 17 patients with congenital stenosis had significant re-stenosis 4-38 months (mean of 16 months) after TBV. These results demonstrate that TBV gives similar immediate results in acquired, calcified and congenital, non-calcified aortic stenosis. However, the intermediate and long-term results are much better in the congenital form, because re-stenosis is rare, whereas the primary success failed to persist in any of the patients with the acquired form.

Adolescent↗
PubMed1988

[A decline in hospital mortality in acute myocardial infarct during the last 10 years. An effect of acute intervention?].

The decline in hospital mortality after myocardial infarction was analyzed retrospectively in a cohort of 2147 consecutive patients with acute myocardial infarction, admitted to an University Hospital between 1978 and 1987. During this period the percentage of patients who had acute active interventions (thrombolysis, aortocoronary bypass surgery, percutaneous transluminal coronary angioplasty) increased from 6% (in 1978/79) to 50% (in 1986/87). During that same period, conventional treatment of acute myocardial infarction and the provisions for emergency admission and intensive care remained unchanged. At the same time there was a significant reduction in overall mortality from 29% (1978/79) to 17% (1986/87) (P less than 0.001). This decrease was especially marked for males (from 27% to 13% in the respective periods), and in patients with anterior-wall infarction (34% and 16%, respectively). These changes cannot be explained by differences in group characteristics. The main cause for the distinct reduction in hospital mortality of this cohort was the introduction and expansion of acute interventions.

Age Factors↗
PubMed1988

Acute haemodynamic effects of urapidil in patients with chronic left ventricular failure.

Urapidil, a new alpha 1-adrenoceptor blocking drug, has been shown to be effective in the treatment of hypertension. Ten normotensive patients with severe congestive heart failure were given Urapidil 25 mg i.v. twice in 15 min and the haemodynamic effects were measured. There was a significant fall in systolic blood pressure (-16%), mean blood pressure (-13%), left ventricular end-diastolic pressure (-38%), mean pulmonary artery pressure (-31%) and wedge pressure (-40%). Total peripheral resistance fell by 25%, whereas pulmonary arteriolar resistance did not change significantly. Cardiac output increased by 22%. The increase in cardiac output with decreasing peripheral resistance and LV pressures suggests that urapidil may be useful in the therapy of congestive heart failure.

Adult↗
PubMed1988

Intravenous recombinant tissue plasminogen activator (rt-PA) and urokinase in acute myocardial infarction: results of the German Activator Urokinase Study (GAUS).

The effects of recombinant tissue plasminogen activator (rt-PA) and urokinase on patency and early reocclusion of infarct-related coronary arteries were investigated in a single blind, randomized multicenter trial in 246 patients with acute myocardial infarction of less than 6 h duration. Both 70 mg of single chain rt-PA with an initial bolus of 10 mg and 3 million units of urokinase with an initial bolus of 1.5 million units were given intravenously over 90 min. The first angiographic study at the end of the infusion revealed a patent infarct-related artery (Thrombolysis in Myocardial Infarction trial [TIMI] grade 2 or 3) in 69.4% of 121 patients given rt-PA versus 65.8% of 117 patients given urokinase (p = NS). Among patients treated within 3 h from symptom onset a patent infarct-related artery was found in 63.9% of 72 patients given rt-PA versus 70% of 70 patients given urokinase (p = NS). There were five cardiac deaths in each group and one fatal intracranial hemorrhage in the rt-PA group. The in-hospital reinfarction rate was 8.9% versus 13.2% for patients treated with rt-PA and urokinase, respectively. There was no difference in left ventricular function at baseline and follow-up catheterization studies. Both drugs were well tolerated and there was no significant difference in cardiovascular or bleeding complications between the two groups. It is concluded that rt-PA and urokinase in the dosages used provide similar efficacy and safety in the treatment of acute myocardial infarction. Reocclusion during the first 24 h may be less frequent after urokinase treatment.

Adult↗
PubMed1988

[Intravenous infusion of recombinant tissue-type plasminogen activator (rt-PA) and urokinase in acute myocardial infarct: intermediate results of the G.A.U.S. study (German Activator Urokinase Study)].

The effects of recombinant tissue plasminogen activator (rt-PA) and urokinase on patency and early reocclusion of infarct-related coronary arteries were investigated in a single blind, randomised multicenter trial in up to now 125 patients with acute myocardial infarction of less than six hours duration. Both, 70 mg of single-chain rt-PA with an initial bolus of 10 mg, and 3 million U of urokinase with an initial bolus of 1,5 million U were given intravenously over 90 minutes. The first angiogram at the end of the infusion revealed a patent infarct-related artery (TIMI grade 2 or 3) in 68% of 62 patients with rt-PA vs. 63% of 63 patients with urokinase (n.s.). Twenty-four hours later patent infarct-related arteries occurred in the same frequency in the rt-PA group and in the urokinase group (71.5% vs. 74.6%, n.s.), although additional recanalisation procedures in sequence with the first angiography were performed more frequent in the rt-PA group. There were two cardiac deaths in either group. In-hospital reinfarction rate was 9.7% vs. 17.5% for patients treated with rt-PA and urokinase, respectively. Both drugs were well tolerated, no significant difference of cardiovascular or bleeding complications could be observed between the two groups. It is concluded that rt-PA and urokinase in the dosages used provide similar efficiency and safety in the treatment of acute myocardial infarction.

Adult↗
PubMed1988

[Balloon valvuloplasty of congenital pulmonary valve stenosis].

Percutaneous balloon valvuloplasty can be considered a therapeutic alternative to surgery for pulmonary valve stenosis. In this analysis, our results will be reported with respect to the various balloon sizes as related to the diameter of the valvular ring as well as differing balloon catheters and the presence of other anomalies in addition to pulmonary valve stenosis. Balloon valvuloplasty was carried out in 23 infants and children ranging in age from one month to eleven years and in two adults at the age of 22 and 50 years, respectively, with a systolic pressure gradient across the pulmonary valve of more than 50 mm Hg or, in the presence of pressure gradients between 40 and 50 mm Hg, in association with a right ventricular pressure of at least 60% of that of the systemic pressure. In all patients echocardiography was carried out prior to the procedure to rule out valve dysplasia and Doppler echocardiographic determination of the pressure gradient was performed before and after dilatation. The diameter of the valvular ring was measured echocardiographically as well as from the right ventriculogram and the size of the balloon chosen accordingly. After diagnostic catheterization, the balloon catheter was advanced to the pulmonary valve with a guidewire. Under fluoroscopy, the balloon was completely inflated then the contrast medium immediately withdrawn, a procedure of seven to 23 seconds with the single-balloon catheter and five to nine seconds with the trefoil catheter. At the first dilatation, the larger portion of the balloon was advanced to the main stem of the pulmonary artery and was placed proximally for subsequent dilatations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Valvuloplasty of congenital aortic stenosis].

While percutaneous transluminal valvuloplasty has largely replaced open commissurotomy for congenital pulmonary valve stenosis, the experience with valvuloplasty for congenital aortic stenosis is limited. Between August, 1984 and June, 1987, a total of 27 valvuloplasties were carried out in 25 patients with congenital aortic stenosis; nine infants and 16 patients ranging in age from four to 25 years (mean age 13 +/- 6 years). The indication for valvuloplasty was established on the basis of congestive heart failure or severe stenosis in infants and in the presence of a pressure gradient in excess of 60 mm Hg in those older than one year of age. In eight infants, valvuloplasty reduced the transvalvular pressure gradient from 73 +/- 5 to 36 +/- 9 mm Hg (p less than 0.01; Figure 1). In the 16 patients older than one year of age, the pressure gradient was reduced from 93 +/- 25 to 49 +/- 15 mm Hg (p less than 0.01; Figure 2). The size of the balloon chosen was based on two-dimensional echocardiographic measurements of the aortic ring diameter from inner edge to inner edge. In infants, coronary artery dilating catheters and balloon catheters with an inflated diameter of 4.2 to 8 mm were employed; in children, the balloon diameter selected was 1 to 3 mm less than that of the valve ring diameter, in 15 cases a single-balloon catheter and in one a trefoil catheter. After puncture of the femoral artery and retrograde advancement of a guide-wire into the left ventricle, the balloon catheter was positioned via the guide-wire across the aortic valve.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

A prospective placebo-controlled double-blind multicenter trial of intravenous streptokinase in acute myocardial infarction (ISAM): long-term mortality and morbidity.

Long-term mortality and morbidity of 1,741 patients with acute myocardial infarction, treated with intravenous streptokinase (1.5 million IU/h) or placebo, was assessed in a double-blind placebo-controlled trial (ISAM). At the 7 month follow-up, 94 (10.9%) of the 859 patients in the streptokinase group and 98 (11.1%) of the 882 patients in the placebo group had died; at an average follow-up of 21 months, 14.4% of the streptokinase group and 16.1% of the placebo group had died. The differences were not statistically significant. Long-term mortality was slightly higher in patients with anterior myocardial infarction and streptokinase treatment (20.1 versus 18.4%) and lower in patients with inferior myocardial infarction (10.2 versus 14.2%). Patients with previous myocardial infarction had a higher long-term mortality rate with streptokinase (34.9 versus 21.5% with placebo, p = 0.03). At 7 months, there were significantly more cases of reinfarction in the streptokinase group (7.2 versus 4.5%, p = 0.02). It is concluded that despite a significant limitation of infarct size by intravenous streptokinase, long-term mortality is only slightly reduced and reinfarction is significantly more frequent. Both findings suggest the need for complementary therapy such as revascularization procedures after thrombolysis.

Clinical Trials as Topic↗
PubMed1987

Changes in left ventricular diastolic function during exercise in patients with coronary artery disease.

In 10 controls and 43 patients with coronary artery disease (CAD) left ventricular (LV) diastolic pressure-volume (P-V) curves were obtained from biplane ventriculograms and simultaneous high fidelity pressure measurement at rest and during bicycle exercise. During exercise ventriculography 20 patients had angina pectoris, and 16 patients were asymptomatic. At rest there were no akinetic segments in 28 patients, and at least one akinetic segment was found in 15 patients. Shifts in the diastolic P-V relationship with exercise were quantitated from the constants a and b of the linear log P-V relationship. In the control group a and b did not change significantly, but in all CAD groups a significant decrease in a and a significant increase in b were observed during exercise. While no patient with angina had an unchanged diastolic P-V relationship, as many as 12 patients had significant P-V shifts in the absence of angina. A similar correlation was found for the diastolic P-V alterations and the exercise ECG. Fourteen patients without any ST-segment change during exercise showed significant P-V shifts, while no patient with signs of ischaemia in the ECG had an unchanged P-V curve. In another 20 patients with CAD the relative contribution of the Frank-Starling mechanism, diastolic compliance and the pericardium to the filling pressure rise during exercise was analyzed. Left ventricular and right atrial pressures--as an index of pericardial pressure--were measured simultaneously during rest and exercise ventriculogram. This was done when filling pressures exceeded 30 mmHg or when angina pectoris occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

Evaluation of three methods for quantifying valvular regurgitation using gated equilibrium radionuclide ventriculography.

The non-invasive quantification of mitral and aortic regurgitation using the left-to-right stroke count ratio (SCR) calculated with gated equilibrium radionuclide ventriculography (RNV), is affected by the overlap of atria and ventricles and the consequent difficult definition of the ventricular regions of interest (ROI). Various solutions of the problem have been proposed. In this study we evaluated the results obtained with a technique based on visual inspection of the RNV images (variable ROI method--VRI) and those of two approaches which utilize functional images (stroke volume image method--SVI--and Fourier amplitude ratio--FAR), by comparing them with the invasive quantification of valvular regurgitation according to Sandler et al. (stroke volume ratio--SVR). Forty patients (15 controls and 25 valvular patients) were studied. In the control group the range of the SVR was 0.81 +/- 1.11 (mean +/- 1 SD = 1.01 +/- 0.08). The SCR was 0.83-L28 (1.03 +/- 0.15) with VRI, 1.10-1.15 (1.30 +/- 0.14) with SVI and 1.11-1.58 (1.35 +/- 0.17) with FAR. The correlations between SVR and SCR were r = 0.47 (P less than 0.05), r = 0.62 (P less than 0.001) and r = 0.55 (P less than 0.01) respectively with VRI, SVI and FAR. The SCR of valvular patients fell in the range of controls in 11/25 using VRI, 6/25 using SVI and in 4/25 using FAR. This overlap was present in 2/25 with the invasive quantification. Irrespective of the method used, a reliable assessment of the valvular regurgitation was not possible in two patients with severely depressed left ventricular function. We conclude that the use of techniques based on functional images clearly improves the effectiveness of the non-invasive quantification of valvular regurgitation with the SCR even if this cannot be regarded as a substitute for invasive quantification and has a limited reliability in particular groups of patients.

Adult↗
PubMed1987

[Pulmonary fibrosis following instillation of mitomycin C in the urinary bladder].

Intravesical prophylaxis against recurrence of bladder carcinomas using mitomycin C has proved to be an effective treatment with few side effects. No side effects involving the lungs have so far been observed with systemic administration; with intravesical use, however, this is not the case. We report a 32-year-old man in whom pulmonary interstitial fibrosis occurred after intravesical instillation of mitomycin C. The clinical picture, including the therapy, and the differential diagnosis and practical consequences are all discussed.

Administration, Intravesical↗
PubMed1987

[Balloon dilatation of congenital aortic stenoses].

Percutaneous balloon valvuloplasty was performed between 1984 and 1987 on 27 occasions in 25 patients with congenital aortic valve stenosis. Eight infants underwent ten dilatation procedures (two redilatations included); seven of these eight infants had critical aortic valve stenosis and one infant asymptomatic severe valve stenosis. One additional 5-day-old newborn died after left ventricular perforation, probably caused by the exchange wire during cardiac catherization immediately before valvuloplasty, despite emergency operation. The transvalvular pressure gradient was reduced in these eight infants from 73 +/- 5 to 36 +/- mmHg (p less than 0.01). Five infants were restudied after an interval of 3-6 months and redilatation performed in two patients with residual stenosis. One infant developed mild aortic incompetence and in one infant, mild aortic regurgitation following commissurotomy did not increase after two dilatation procedures at the age of 2 and 7 months. No aortic regurgitation was noted in the remaining 6 infants after dilatation. Valvuloplasty was also performed in 16 children and adolescents (4-25 years old, mean age 13 +/- 6 years) using balloons with inflated diameters 1 to 3 mm smaller than the aortic valve ring (15 single balloons, 1 trefoil balloon). Peak systolic pressure gradient decreased from 93 +/- 25 to 49 +/- mmHg (p less than 0.01). Mild aortic regurgitation was present in six patients (three following surgery) before dilatation and remained unchanged in five patients. In one patient, aortic incompetence increased slightly after valvuloplasty. Ten patients showed no evidence of aortic regurgitation after dilatation. Embolectomy of the femoral artery was performed in two patients 1-3 days after valvuloplasty. No further complications occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗