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Biomedical subjects

K Steinbach

Publications and source records attributed to K Steinbach.

At least 55 records · Page 3Linked to original sources
PubMed1989

[Transvenous high frequency current ablation of atrioventricular conduction in therapy refractory tachycardic atrial fibrillation].

We present a case of radiofrequency ablation of the atrioventricular conduction system by means of intravenous catheter technique in a patient with drug-refractory paroxysmal atrial fibrillation. Total AV block was produced. Since the ablation and implantation of a pacemaker this female has had no recurrences. The advantages of this method compared with electrical fulguration are better control of delivered energy and reduction of complications (catheter perforation, thromboembolism). The disadvantage of radiofrequency ablation is the difficulty in positioning the catheter so as to give the most precise contact with the tissue, which is a very time-consuming procedure.

Aged↗
PubMed1989

Rapid identification of Haemophilus influenzae serovar b by gas liquid chromatography using carbohydrate fingerprints.

Carbohydrates from whole-cell hydrolysates of 18 strains of the species Haemophilus influenzae (5 strains belonging to serovar b) were analysed by gas-liquid chromatography. The identity of the carbohydrate components was confirmed by comparison with the retention times of reference sugars and by gas chromatography mass spectrometry. Evidence was obtained that Haemophilus influenzae serovar b can easily be identified by the presence of one large peak representing ribitol. The method described can be routinely applied in bacteriological laboratories equipped with a gas chromatograph. It gives results within approximately 4 h, it is reproducible and easy to perform. Even single colonies isolated directly from agar plates can be used for analysis without further subculturing.

Carbohydrates↗
PubMed1989

Problems of sensing tachyarrhythmias by an antitachycardia pacemaker (Symbios 7008).

Atrial burst pacing is an effective method of terminating supraventricular tachycardia. In the patient presented in this report, a Symbios 7008 pacemaker (Medtronic Inc., Minneapolis, MN, USA) was implanted for two reasons: (1) severe AV conduction defect (AH, 230 msec; HV, 150 msec) and bifascicular block following anterior myocardial infarction; and (2) paroxysmal atrial flutter. The conduction defect ruled out programming other than atrial burst in DDD mode. Activation of burst pacing required appropriate programming of the "tachycardia detection window" on the basis of the cycle length of the flutter waves. In the case reviewed, episodes of atrial flutter with variable cycle lengths of 230 to 280 msec necessitated reprogramming of the AV interval, the refractory period, and the upper rate interval. The use of an antitachycardia device in automatic mode may be limited by variations in tachycardia cycle length.

Aged↗
PubMed1988

[Treatment of ventricular tachyarrhythmias with an implantable cardioverter-defibrillator system].

5 patients (3 with coronary artery disease and chronic myocardial infarction, 2 with dilatative cardiomyopathy) with a mean age of 59 years (range 54-69 years) with drug refractory ventricular tachycardia and/or ventricular fibrillation received the automatic implantable cardioverter defibrillator (AICD). Intraoperative testing revealed a mean defibrillation threshold of 13 +/- 2.7 Joule. Over a mean follow-up period of 15.2 months (range 3-25 months) the patients received a total of 117 discharges. 15% of the delivered shocks were recorded during continuous ECG monitoring, 13% were associated with palpitations and 27% were discharged during syncope. 45% of shocks occurred in the absence of symptoms. No patient died suddenly. 1 patient died of intractable heart failure, 1 patient died of septic shock. In carefully selected patients the automatic implantable cardioverter defibrillator is an effective tool in the treatment of life-threatening ventricular tachyarrhythmias. Modifications of the device to incorporate programmability of the cut-off rate, the sensing criteria and the levels of shock energy, as well as the options for different pacing modes combined with memory functions are needed to improve antiarrhythmic strategies.

Aged↗
PubMed1988

Ketanserin combined with a beta-blocker or diuretic in essential hypertension. A multicentre study.

The antihypertensive effect of ketanserin 40 mg b.d. in combination with a beta-adrenergic blocking agent or a diuretic was assessed in an open study in 35 patients with essential hypertension, who had not responded to treatment with beta-blockers, diuretics or their combination. The ketanserin/beta-blocker combination decreased mean sitting systolic/diastolic blood pressure (SBP/DBP) from 169/107 mmHg to 156/91 mmHg at the end of the 12-week active treatment period. The decrease in systolic blood pressure was significant only at Week 8, while the decrease in diastolic blood pressure was highly significant at all times. A significant reduction in heart rate by 10 beats.min-1 was observed with the ketanserin + beta-blocker combination. The ketanserin/diuretic combination led to a significant reduction in mean SBP/DBP from 164/106 mmHg to 146/92 mmHg after 12 weeks, with no significant change in heart rate. Body weight slightly increased in both groups. There were significantly fewer adverse reactions with the ketanserin/diuretic combination than with the ketanserin/beta-blocker combination. The results indicate a potentially useful therapeutic role for ketanserin in combination with beta-blockers or diuretics.

Adrenergic beta-Antagonists↗
PubMed1987

Inhibitory effect of tetrachloro-p-hydroquinone and other metabolites of hexachlorobenzene on hepatic uroporphyrinogen decarboxylase activity with reference to the role of glutathione.

Exposure of rats to HCB caused a dose-dependent depletion of GSH. Chlorophenolic and sulfur-containing metabolites of HCB incubated with GSH-free rat liver cytosolic protein drastically diminished the UROD activity. In addition, HCB also exhibited inhibitory potency. The most effective compounds studied were TCH and its oxidation product, chloranil. Incubation of liver cytosolic protein and of GSH with HCB and its metabolites yielded results that suggested interaction between the compounds and cell constituents--an interaction that may cause inhibition of the hepatic UROD activity in the HCB-exposed organism.

Animals↗
PubMed1987

[Prognostic significance of early ergometry following acute transmural first-time myocardial infarct].

A submaximal exercise test (70% of the maximal age related heart-rate) was performed in 324 patients (214 m, 60 w, mean age 55.2 +/- 11.35 y, 154 anterior infarction, 117 posterior infarction, 3 BBB) within the third week after their first transmural infarction. 50 patients were unable to be exercised because of medical contraindications. The patients were divided in 3 subgroups according to the events during the follow up of 23.6 +/- 14.6 months: group I - patients with reinfarction (22 pts = 8.1%), 4 of them died, group II - patients who died because of cardiac events (sudden death or cardiac decompensation) (13 pts = 4.7%) and group III - patients who had no further events (239 pts = 87.2%). All patients were comparable concerning age, exercise tolerance, appearing of angina, T-shift, monophasic ST-segment-elevation, systolic blood pressure behaviour, ventricular arrhythmias or AV-block. ST-segment depression was significantly more frequent in the group I patients (p less than 0.02) as much as an obvious reduction of the working capacity. Patients who were not exercised (because of contra-indications) had a significant higher mortality during follow up (32% vs. 6%). We conclude that exercise test in the early phase after myocardial infarction gives no information concerning mortality, but there was found statistically more frequent ST-segment depressions in the group of patients with reinfarction as much as an obvious reduction of the working capacity. Thus, exercise test is of value for the detection of patients at risk for reinfarction.

Angina Pectoris↗
PubMed1986

[Effect of molsidomine on hemodynamics in patients with dilated cardiomyopathy].

The effect of 4 mg Molsidomine iv. followed by a continuous infusion of 3 mg per hour for 3 hours on arterial blood pressure, pulmonary artery pressure, cardiac index, peripheral and pulmonary vascular resistance and heart rate was evaluated in eleven patients suffering from chronic heart failure caused by non-ischaemic dilatative cardiomyopathy (NYHA II-III). A significant decrease in systemic blood pressure, systolic and mean pulmonary artery pressure and pulmonary wedge pressure was observed and also a marked decrease in total peripheral and pulmonary vascular resistance. There was a slight, but not significant increase in cardiac index. The heart rate did not change significantly. Treatment had to be stopped in one patient because of side effects (hypotension, nausea).

Adult↗
PubMed1986

[Use of markers for compliance control during long-term therapy].

The compliance of 9 patients in taking an antihypertensive therapy was studied by labelling the active substance with riboflavin. The results shows that with a relatively small amount of label it is possible to control the intake of preparations. This is a suitable method for the clinical routine and it allows the direct determination of the elimination of the riboflavin in the urine two hours after the intake of the drug. It is proposed that this method should be used obligatorily in all studies of new drugs for the assessment of their action in the oral long-term therapy. For the daily routine it offers a suitable method for the control of cases where an initial clinical efficiency is followed by therapeutic failures in long-term treatment.

Adult↗
PubMed1986

[Angina pectoris anamnesis in patients with their first myocardial infarct].

In 650 consecutive patients with first acute myocardial infarction the time interval between the first anginal attack and the acute infarction as well as the time interval between onset of symptoms suggestive for acute myocardial infarction and hospitalization were evaluated. Our results demonstrate that in 25% of patients the history of angina was less than 24 hours, in 50% of all patients less than three days; furthermore, the time interval from onset of symptoms of acute myocardial infarction to hospitalization correlated with the history of angina; the depression of left ventricular function after myocardial infarction was independent of a previous history of angina; in patients with a very short history of angina there was a significantly higher incidence of single vessel disease. Thus, prevention of acute myocardial infarction would have been possible only in about half of the patients with impending myocardial infarction due to the short duration of preceding angina.

Adult↗
PubMed1984

[Prognosis and management of patients with tachycardial heart arrhythmia ].

Improvement of diagnostic procedures and control of efficacy are prerequisites for the adequate treatment of malignant ventricular arrhythmias. This necessitates a close cooperation between specialized centers which are mainly involved in the treatment of arrhythmia patients and physicians in private practice. The significance of antiarrhythmic treatment concerning the improvement of prognosis of patients with ventricular arrhythmias has to be defined by follow-up.

Anti-Arrhythmia Agents↗
PubMed1984

[Value of ECG-telephone transmission in determining symptomatic heart-rhythm disorders].

The ECG-telephone-transmission (TTM) was used to record an ECG-strip during a typical symptomatic period in patients complaining of symptoms possibly caused by arrhythmias (palpitations, dizziness, paroxysm tachycardia, pulse irregularities; angina and dyspnea only if other reasons could be excluded). Patients complaining of syncope only were not admitted, because of the inability to make a telephone call successfully during such a symptomatic period. The ECG was transmitted to the CCU using a frequency modulation technique. In 60% of 196 patients an ECG-TTM could be achieved during a typical symptomatic period, whereas arrhythmias as cause for the symptoms could be excluded in 51 patients (26%). The remaining 66 patients (34%) demonstrated various arrhythmias ranging from simple SVPB and PVC to total AV-block and sustained VT. TTM, an easy-to-perform and cost-effective method allowed a successful ECG registration during a symptomatic period in almost two-thirds of symptomatic patients. In these patients arrhythmias could be verified or excluded as cause of the symptoms.

Adolescent↗
PubMed1984

[Vagus block in the therapy of bradycardial arrhythmias--the role of autonomic balance].

UNLABELLED: A medicamentous therapy of bradycardiac disturbances of heart rhythm can be performed on the one hand by stimulation of the sympathetic nerve, on the other hand by blockade of the parasympathetic system. An ester of the tropic acid, Ipratropiumbromide (IP), shall be used for answering the question to what extent the heart rate may be increased in such arrhythmias. In 10 patients (4 females and 6 males, m 60 +/- 9 years old) with asymptomatic bradycardiac arrhythmias (heart rate less than 60 per min in the routine ECG; 3 patients AV-block III, 1 patient AV-block II II, 6 patients sinus bradycardia) at first a 24-hour long-term ECG was recorded under ambulatory conditions, after this 1 mg IP was administered intravenously under continuous long-term ECG. After 4 days 10 mg IP orally thrice a day, in 3 patients also after 15 mg IP t.i.d. a repeated long-term ECG was performed. These were evaluated using the computer-assisted "multipass scanning" system. RESULTS: 1 hour after 1 mg IP intravenously the m heart rate significantly increased about 17-87% (m 55%) in all patients (p less than 0.001). Proportionally to the increase of the heart rate it lasted 7-14 hrs. till the initial heart rate was reached again. 1-4 hours after intravenous injection in 2 patients sinus tachycardias developed as an expression of an increased sympathicotonia. 10 mg IP led to an increase of the heart rate of m 8% of the patients, during the day m 9%, during the night 4%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Intravenous streptokinase therapy in acute myocardial infarction: assessment of therapy effects by quantitative 201Tl myocardial imaging (including SPECT) and radionuclide ventriculography.

To evaluate a potential beneficial effect of systemic streptokinase therapy in acute myocardial infarction, 36 patients treated with streptokinase intravenously were assessed by radionuclide ventriculography and quantitative 201Tl myocardial imaging (including SPECT) in comparison with 18 conventionally treated patients. Patients after thrombolysis had significantly higher EF, PFR, and PER as well as fewer wall motion abnormalities compared with controls. These differences were also observed in the subset of patients with anterior wall infarction (AMI), but not in patients with inferior wall infarction (IMI). Quantitative 201Tl imaging demonstrated significantly smaller percent myocardial defects and fewer pathological stress segments in patients with thrombolysis compared with controls. The same differences were also found in both AMI and IMI patients. Our data suggest a favorable effect of intravenous streptokinase on recovery of left ventricular function and myocardial salvage. Radionuclide ventriculography and quantitative 201Tl myocardial imaging seem to be reliable tools for objective assessment of therapy effects.

Adult↗
PubMed1984

Exercise test in patients over 65 years of age after the first myocardial infarction.

In 171 patients a submaximal exercise test was performed 3-6 weeks after the first acute myocardial infarction. No complications in connection with exercise test were observed. The incidence of ST/T-segment changes was significantly higher in patients over age 50. Patients over age 60 have a significantly higher incidence of PVCs as well as complex ventricular arrhythmias. In this patient group the incidence of ventricular arrhythmias was higher in patients with ST/T-segment changes during exercise. In the younger patients there was no correlation between incidence of ST/T-segment changes and arrhythmias. A high percentage of patients with no arrhythmias during exercise also had no arrhythmias during Holter. During follow up the average mortality rate was 3.6% and was not significantly different in the four age groups.

Aged↗
PubMed1984

Chronic hemodialysis: high risk patients for arrhythmias?

UNLABELLED: Patients with end-stage kidney disease undergoing chronic maintenance dialysis (HD) are a high risk group for sudden death due to cardiovascular complications. It was the aim of the study to investigate the quantity and quality of arrhythmias during HD and between two consecutive HD (interval, I) with regard to the reproducibility of the expected results. 15 patients (8 males, 7 females) underwent continuous Holter monitoring (LT-ECG) under ambulatory conditions over 96 h including two HD ( HD1 + HD2 ) and two intervals (I1 + I2). The LT-ECG recordings were analysed with the computer assisted ' Multipass -Scanning' system with regard to heart rate (HR), supraventricular premature beats (SPB), ventricular ectopics (PVC) and malignant ventricular arrhythmias. RESULTS: The HR demonstrated a typical, well-known circadian pattern with remarkable increase of the HR during each HD. Except for rare, single SPB and/or PVC, no supraventricular or ventricular arrhythmias could be detected reproducibly. Single PVC occurred in patients with a lower potassium value. No malignant ventricular arrhythmias were found. In comparison to previously published studies, which demonstrated a high incidence of malignant ventricular arrhythmias, these conflicting results were due to differences in patients' recruitment (underlying disease, age, etc.), the performance of HD (duration, ion concentration of the dialysate etc.), serum potassium levels and drug medication (digitalis, quinidine). In summary, chronic HD per se did not enhance the risk of malignant arrhythmias in patients with end-stage kidney disease.

Adolescent↗
PubMed1983

Electrophysiologic findings in carotid sinus massage.

Thirty patients with carotid sinus syndrome were electrophysiologically studied. In 14 patients carotid sinus massage was performed during atrial and ventricular stimulation, and the conduction times were measured. The AH-time was prolonged by more than 120 ms in 6 patients (20%); the HV-time was prolonged in 6 patients by more than 55 ms (20%); 5 patients had bundle branch block (16.7%); The sinus node recovery time was prolonged in 7 out of 27 patients (26%). Ten patients (33%) did not have additional electrophysiologic abnormalities. There was a predominance of carotid sinus syndrome on the right side. During carotid sinus massage there was a significant increase of the AH-time, but there were no significant changes of the HV-time or the width of the QRS-complexes. Twenty-one patients developed an atrial asystole and 9 patients an atrial bradycardia and an additional AV-block. There was a longer AH-time and a longer prolongation of the AH-time in the patients who developed an AV-block. Twelve out of 14 patients (85.7%) developed an AV-block during carotid sinus massage and atrial pacing. During ventricular pacing 5 of 14 patients (35.7%) revealed a complete retrograde block before carotid sinus massage and 5 of the remaining 9 patients developed a total retrograde block during carotid sinus massage. Consequently, in 71.4% of the patients with carotid sinus syndrome complete retrograde conduction block and atrial asystole can be expected during attacks of ventricular asystole and simultaneous ventricular pacing. In conclusion, there is a high incidence of additional disturbances of the sinus node function and AV-conduction in patients with carotid sinus syndrome. AAI pacemakers are contraindicated due to the common development of additional AV-block during carotid sinus massage. Physiologic pacing might contribute to better hemodynamics, particularly in patients with the mixed type of carotid sinus syndrome.

Adult↗