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Biomedical subjects

K L Resch

Publications and source records attributed to K L Resch.

At least 73 records · Page 4Linked to original sources
PubMed1994

[The concept of myocardial infarct rehabilitation in phase III].

The benefit of outpatient rehabilitation in coronary artery disease is well documented in literature. Despite this, there is evident lack of rehabilitation facilities during phase III WHO in our country. Departments of Physical Medicine and Rehabilitation seem to be well suited to run ambulant rehabilitation programmes. Therefore we developed a comprehensive rehabilitation programme including physical training, dietary counselling and teaching lessons for patients. Physical training is strictly aerobic according to the guidelines of medical training therapy. Training time will rise systematically. To keep risks low, precise in- and exclusion criteria are defined. Regular training for the staff is mandatory. Uniformity of therapeutic interventions and documentation provide quick evaluation of therapeutic success.

Ambulatory Care↗
PubMed1994

Reviewer bias: a blinded experimental study.

Peer review is the ordinary method for judging the acceptability of scientific papers for publication. Yet there are few prospective data defining the accuracy or reproducibility of this method. This study was aimed at evaluating interrater consistency in reviewing a single manuscript and at determining whether a referee's likely predisposition (inferred from his or her own published papers in the field) influences his or her attitude toward this manuscript. A computerized search identified 33 first authors of research papers about transcutaneous electrical nerve stimulation. They were asked to review part of a fictitious scientific paper on the topic; they were not made aware of being tested. Reviewers' ratings were recorded by multiple-choice answers in a structured questionnaire. The answers revealed poor interrater reliability. Furthermore, referees were clearly influenced by their own preconceptions and judged according to their own published experience in that particular medical subject. That is, referees who would be expected to agree with the paper's findings tended to judge is less harshly than did referees who would be expected to disagree. These results suggest significant impact of reviewer bias on referee's judgment and imply that the peer review system in its present form has room for improvements in fairness and consistency.

Humans↗
PubMed1994

The viscoelasticity of blood and plasma in pig, horse, dog, ox, and sheep.

There is little data on blood viscosity in different animals. Therefore a comparison was performed between five species by an in-vitro method using oscillatory flow. At shear rates from 1 to 150/sec the viscous and the elastic component of the complex blood viscosity was highest in pig, followed by horse, dog, ox, and sheep. Plasma viscosity and plasma density were similar in dog and sheep and were higher in ox. The differences in whole blood viscosity were obviously related to the variable interspecies hematocrit, and may also be influenced by different aggregation tendencies. Aggregation in ox was low despite a high plasma fibrinogen. It seems that erythrocytes in sheep and ox remain separately suspended in a relative dense plasma. This may indicate that formation of microthrombi is less likely to occur in ox and sheep than in pig, horse, and dog.

Animals↗
PubMed1993

Fibrinogen as a cardiovascular risk factor: a meta-analysis and review of the literature.

PURPOSE: To evaluate the possibility that fibrinogen represents a cardiovascular risk factor. DATA IDENTIFICATION: A computerized literature search (1980 to 1992) identified all published epidemiologic studies on fibrinogen and cardiovascular disease. Clinical and basic research data were found by separate searches. References of all papers thus obtained were studied and relevant papers included. STUDY SELECTION: Six prospective epidemiologic studies were included in a meta-analysis (one study was excluded because the study population was non-representative). Clinical papers were reviewed separately for other evidence of causation. DATA EXTRACTION: The correlation of fibrinogen levels on the subsequent incidence of myocardial infarction, stroke, and peripheral arterial occlusive disease was assessed and the causality of the association was analyzed. Calculations were made to examine fibrinogen level (in tertiles) versus cardiovascular risk. Odds ratios of high versus low tertile were computed. RESULTS OF DATA ANALYSIS: All prospective studies showed that fibrinogen was associated with subsequent myocardial infarction or stroke. A total of 92,147 person-years was covered by these investigations. Odds ratios varied between 1.8 (95% CI, 1.2 to 2.5) in the Framingham and 4.1 (CI, 2.3 to 6.9) in the GRIPS study, with a summary odds ratio of 2.3 (CI, 1.9 to 2.8). Associations existed between fibrinogen and other cardiovascular risk factors, but after multivariate analysis, only the association between fibrinogen and cardiovascular events remained. The majority of the preconditions for causality were fulfilled, indicating that fibrinogen is pathophysiologically related to cardiovascular events. CONCLUSIONS: Fibrinogen can be considered a major cardiovascular risk factor. Future studies of cardiovascular morbidity and death should include this variable.

Cardiovascular Diseases↗
PubMed1992

Fibrinogen and viscosity as risk factors for subsequent cardiovascular events in stroke survivors.

OBJECTIVE: To investigate whether abnormalities in blood viscosity predict a poor prognosis for subsequent cardiovascular events in stroke survivors. DESIGN: Nested case-control study among a cohort of survivors of a first stroke, followed for an average of 2 years. Patients with a second stroke, myocardial infarction, or cardiovascular death were matched with patients who did not have such events (control patients). SETTING: Buchberg-Klinik, Bad Tölz, Germany, a specialized center for stroke rehabilitation. PATIENTS: A total of 625 consecutive patients. Twenty-one patients (3.5%) were lost to follow-up. Sixty pairs were matched. MEASUREMENTS: Native and hematocrit-standardized blood viscosity at three shear rates, hematocrit, plasma viscosity, fibrinogen, erythrocyte sedimentation rate, total leukocyte count, and the matching variables. RESULTS: Eighty-five patients had a second stroke, myocardial infarction, or died due to a cardiovascular event. Patients with re-events had higher blood viscosity and fibrinogen levels than the control patients. In the 60 matched pairs, the mean of the paired differences between patients with re-events and control patients was 5.03 mPa.s (95% CI, 1.262 to 8.941; P = 0.01) for native blood viscosity at shear rate 0.7 s-1, for plasma viscosity, 0.044 mPa.s (CI, 0.006 to 0.083; P greater than 0.02), and for fibrinogen, 0.056 g/L (CI, 0.010 to 0.101; P greater than 0.02). Odds ratios were significantly increased only for plasma viscosity (odds ratio, 2.86; CI, 1.06 to 8.43) and fibrinogen (odds ratio, 3.67; CI, 1.31 to 11.69). CONCLUSIONS: Hyperfibrinogenemia is an independent risk factor for cardiovascular events in stroke survivors. Intervention trials with fibrinogen lowering measures may be warranted.

Aged↗
PubMed1992

Reviewer bias.

Explore the source record for details and available documents.

Observer Variation↗
PubMed1992

[Hemorheology and stroke].

The physiology of the blood and the vascular system suggest that the rheological properties of blood gain in importance as arteriosclerotic vascular changes progress. Thus, for example, in arterial segments distal to a stenosis, a decrease in perfusion pressure (in the nutritive vessels) occurs--a situation that is probably of causative relevance in a considerable percentage of patients with apoplexy. An increasing number of studies seem to indicate that blood and plasma viscosity, red cell aggregation and fibrinogen levels in these patients reveal significant pathological changes, and may well be of prognostic significance. It may be speculated that routine monitoring of these and possible other rheologically important parameters in patients with a relevant risk together with suitable treatment may contribute to more effective primary and secondary prevention of cerebrovascular diseases, in particular ischemic insults.

Blood Viscosity↗
PubMed1992

A viscometric method of measuring plasma fibrinogen concentrations.

A technique based on deducing the viscosity of serum from that of plasma was compared with the commonly used Clauss method. The two methods correlated closely (r = 0.914). The reproducibility of the viscometric method was slightly poorer than the Clauss technique at low fibrinogen concentrations, equal to that at medium fibrinogen concentrations, and marginally better at high concentrations. Fibrinogen can therefore be measured reasonably accurately with the viscometric method, and can be recommended as an alternative for laboratories possessing a viscometer.

Adult↗
PubMed1992

Does pentoxifylline prolong the walking distance in exercised claudicants? A placebo-controlled double-blind trial.

The aim of this study was to test whether in claudicants oral pentoxifylline, given for twelve weeks in addition to physical exercise, prolongs the walking distance more than placebo plus exercise. Forty outpatients were randomized into group A (2 x 600 mg oral pentoxifylline per day) or group B (placebo). Both groups received the same exercise program in addition. The maximal and painfree walking distances and blood viscosity were measured. Intergroup differences in terms of blood viscosity reached the level of significance only after twelve weeks (p = 0.006 at shear rate of 94.5 s-1), but values of group A continuously decreased and those of group B continuously increased. After one and eight weeks, but not after twelve weeks, the maximal walking distances were significantly longer in group A than in group B. At no point were there significant intergroup differences in terms of painfree walking distance. The data suggest that pentoxifylline is clinically effective in claudicants even when given in addition to exercise. The benefit of drug plus physical therapy compared with exercise alone could be observed mainly in the first weeks of treatment and may wear off during long-term therapy.

Administration, Oral↗
PubMed1991

Impaired blood rheology: a risk factor after stroke?

The hypothesis that blood rheology is of prognostic value in stroke patients was tested in a prospective study. A total of 523 patients in the rehabilitation phase of stroke (outside the acute phase reaction after stroke) were tested for blood, serum and plasma viscosity, haematocrit, fibrinogen, red cell aggregation and deformability, ESR, white cell count, cholesterol and triglycerides. Endpoints were defined as a second stroke (lethal or not) within 2 years after the initial examination. Patients suffering such endpoints exhibit elevated blood viscosity, red cell aggregation, plasma and serum viscosity, fibrinogen and cholesterol levels, compared to patients without endpoints. It is concluded that rheological factors are associated with the prognosis after a first stroke.

Aged↗
PubMed1991

Can rheologic variables be of prognostic relevance in arteriosclerotic diseases?

The hypothesis that blood rheology is of prognostic value in patients with arteriosclerotic diseases was tested in a prospective study of 843 patients at a rehabilitation clinic. They were tested for blood serum and plasma viscosity, hematocrit, fibrinogen, red cell aggregation and deformability, erythrocyte sedimentation rate, white cell count, cholesterol, and triglycerides. End points were defined as a second stroke or myocardial infarction or cardiovascular death within two years of the initial examination. Patients suffering such end points as compared with matched pairs (n = 74; matching criteria: identical manifestation of arteriosclerosis, identical sex and similar age and risk factors) had significantly higher native blood viscosity (p = 0.002), red cell aggregation (p = 0.01), serum viscosity (p = 0.01), fibrinogen (p = 0.02), and cholesterol (p = 0.01). It is concluded that rheologic factors are associated with the prognosis in patients with arteriosclerotic diseases.

Aged↗
PubMed1991

A single blind randomized, controlled trial of hydrotherapy for varicose veins.

Sixty-one patients suffering from primary varicosity were divided into 2 groups, one receiving regular hydrotherapy, the other no such treatment for 31/2 weeks. Objective evaluation of the venous competence showed an apparently greater benefit in the control group in respect to light reflex rheographic venous filling time. The leg volume changes, however, indicated a stronger and more persistent reduction in the experimental group. The same applied for ankle and calf circumferences, which were reduced significantly only in patients treated with hydrotherapy. Furthermore some (but not all) of the subjective symptoms yielded significantly more frequent improvement in this group. In conclusion this controlled study implies that hydrotherapy may help patients suffering from primary varicose veins, a notion which was previously often stated but so far not scientifically verified.

Female↗
PubMed1991

[Hyperviscosity. An independent risk factor after a survived stroke].

Several lines of evidence indicate that pathologic blood flow properties lead to a deterioration in the prognosis of patients with arteriosclerotic diseases, especially after a stroke. We tested this hypothesis in a prospective study including 625 patients with a first stroke that dated back less than five years (7.4 +/- 11.3 months, mean +/- sd). Investigated parameters were native and hematocrit standardized blood viscosity (at shear rates 0.7 s-1, 2.4 s-1 and 95.5 s-1) and its most important determinants (i.e. hematocrit, plasma viscosity, fibrinogen), erythrocyte sedimentation rate, leukocytes, cholesterol, triglycerides, blood pressure and BMI. For smoking patients were scored into four groups. Two years after these investigations a follow up was performed (response rate 96.3%). 71 patients with study endpoint (second stroke, heart attack or death due to the underlying cardiovascular disease) were identified. In 65 cases matching of a patient with and a patient without endpoint was possible. Criteria for matching were: cholesterol, triglycerides, diabetes, BMI, gender, age blood pressure, smoking, time interval between first stroke and rheologic measurements and concomitant diseases. Native blood viscosity was significantly higher in patients with endpoint (p less than 0.01) as compared to patients without (37.4 +/- 12.5 mPas vs 32.1 +/- 8.9 mPas at a shear rate of 0.7 s-1). All other variables did not differ significantly between both groups. It is concluded that in patients, who have survived a first stroke, high blood viscosity is a risk factor, independent from the accepted ones.

Blood Flow Velocity↗