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Biomedical subjects

K Ulm

Publications and source records attributed to K Ulm.

At least 91 records · Page 5Linked to original sources
PubMed1987

[Diagnosis of pulmonary hypertension using pulsed Doppler cardiography].

The accuracy of pulsed Doppler cardiography in predicting pulmonary hypertension was assessed in 70 patients (aged 16-72 years) with varying cardiac disease, who had undergone catheterization. Doppler velocity traces were recorded from four sampling sites in the pulmonary outflow tract and from the tricuspid valve. These results were compared to the invasive data. An inverse correlation (r = -0.77) was found between acceleration time (onset of RV ejection to peak pulmonary velocity) and mean pulmonary arterial pressure, with the sampling site in the centre of the pulmonary valves or of the RV outflow tract (r = -0.71). Acceleration time was inversely related to patient age but was not dependent on heart rate or on cardiac output. The sensitivity of the acceleration time was 85-91% for the diagnosis of moderate or severe pulmonary hypertension, and the predictive value was greater than 90%. The following measurements were less helpful in diagnosing pulmonary hypertension: peak velocity of pulmonary arterial blood flow, its mean acceleration, RV isovolumic relaxation time and the qualitative sign of a presystolic pulmonary flow wave induced by atrial contraction. A reversal of systolic flow at the level of the pulmonic valves, measured as time of forward flow in percent of RV ejection time, was found only in patients with moderate or severe pulmonary hypertension. This was a sensitive marker of an elevated pulmonary arterial resistance (greater than or equal to 95%), the mechanism of which is not yet fully understood.

Adolescent↗
PubMed1987

[Heart valve replacement in patients over age 60: analysis of the peri- and postoperative course compared to patients under age 60].

During recent years, advances in cardiology and cardiac surgery have led to an increased number of older patients submitted for heart valve replacement. The following retrospective study analyses perioperative risk and long-term prognosis of 168 patients older than 60 years of age, compared with 942 patients younger than 60 years of age with heart valve replacement. There was no significant difference in 7-year actuarial survival, late mortality, late complications and postoperative functional improvement for both groups. However, early mortality was higher in patients over 60 years of age than in the group of patients under 60 years (7.9% vs. 4.5% from 1980-85, p less than 0.05), especially when multivalvular replacement was performed or the patients were in preoperative functional class NYHA IV. The results indicate that in patients over 60 years of age, heart valve replacement can be performed with a good long-term prognosis and a marked improvement in the quality of life. Early mortality can be reduced to an acceptable rate if the patient is operated in time.

Adolescent↗
PubMed1986

[Decrease in immunoreactivity in melanoma. Analysis of DNCB tests in the literature].

It is generally accepted that cell mediated immunity is impaired in melanoma patients. Several studies, however, could not confirm this thesis, especially in early malignancy. Therefore, it was the aim of our study to evaluate the results of the DNCB skin tests in melanoma patients of the literature. DNCB sensitization lineally decreased with increasing tumor progression. The difference of the sensitization rates between controls and stage I patients and between melanoma stage I and stage II was significant (p less than 0.001). The difference between stage II patients and stage III melanoma was apparent; statistical analysis, however, could not be done, because the results of three out of six evaluated studies where contradictory. The results confirm the thesis of impaired delayed type immunity in the course of tumor progression and support the therapeutic approaches of immune modulation in tumor patients: BCG vaccination, DNCB sensitization, interferon application.

Dinitrochlorobenzene↗
PubMed1986

[Occupational cancer study of asbestos: possibilities and limits of epidemiologic studies on the causes of death in West Germany].

The study is based on 3990 men and women exposed to asbestos dust for at least three years at their place of work, and prospectively and epidemiologically examined since 1 January, 1977. By 31 December, 1983, 336 had been registered as having died. Calculation of standard mortality rates indicates that the incidence of malignant tumour as cause of death was much higher than in the general population of the FRG, that of fatal mesothelioma about 100 times as high. Standard mortality rate for lung cancer was increased by 48% and 175%, respectively, depending on whether exposure to asbestos dust had ended after (subgroup I) or before (subgroup II) 1 January, 1972. Proportional mortality rate of 43% of tumours at all locations, with about 14% lung cancer and about 9% fatal mesothelioma cases in subgroup II, approaches the internationally recognized frequency of asbestos-associated tumours.

Adult↗
PubMed1986

Mortality rates in the Federal Republic of Germany following previous occupational exposure to asbestos dust.

In 1972, a procedure was introduced by the Industrial Injuries Insurance Institutes (Berufsgenossenschaften) of the Federal Republic of Germany, which is to be used by the special occupational health service for employees exposed to asbestos dust. Since 1 January 1972, occupational health examinations are performed when exposure to asbestos dust has been of at least 3 years' duration. On 1 January 1977, a prospective cohort study was started with employees formerly exposed to asbestos dust whilst working for companies manufacturing or using asbestos. Data on these persons are collected in the Central Register of Employees Exposed to Asbestos Dust of the Industrial Injuries Insurance Institutes. A total of 3,070 male and female employees in whom asbestos exposure terminated after 1 January 1972 formed subcohort I of the study. For comparison, 665 persons whose exposure terminated before 1 January 1972 served as subcohort II. In addition to several other inclusion criteria, each individual's permission was required before personal data could be evaluated. Of the subjects in the two subcohorts, 185 and 71, respectively, had died by 31 December 1982. Tumours were more frequently than this cause of death is expected in the general population. In addition to a high incidence of mesothelioma, the standard mortality rate was especially increased for lung cancer. The proportional mortality rates of about 40% for tumours of all sites (with about 17% lung cancer and 8% mesothelioma) especially in subcohort II, seemed to be comparable to the international figures for epidemiological mortality.

Asbestos↗
PubMed1986

Negative inotropic effects of tetrodotoxin and seven class 1 antiarrhythmic drugs in relation to sodium channel blockade.

The negative inotropic effect and the effect on action potential configuration were investigated for TTX and 7 class 1 antiarrhythmic drugs (aprindine, AR-LH 31, CCI 22277, disopyramide, mexiletine, quinidine and sparteine) in the isolated guinea-pig papillary muscle contracting at 1 Hz. The ratio of the molar concentration producing 50% reduction of Vmax to that reducing force of contraction by 50% ranged from 0.23 (sparteine) to 2.2 (disopyramide) showing that some of the drugs were more potent Na channel blockers than negative inotropic agents, while the reverse was true for others. With the exceptions of sparteine and AR-LH 31, all the drugs produced a larger negative inotropic effect than TTX at concentrations equieffective in reducing Vmax. Thus, blockade of Na channels can account for only part of the negative inotropic effect of aprindine, CCI 22277, disopyramide, mexiletine and quinidine. Even sparteine and AR-LH 31 showed a negative inotropic property independent of Na channel blockade because, unlike TTX and like all other agents, they retained their negative inotropic activity after inactivation of Na channels by elevated extracellular K concentration (24 mmol/l). Relative negative inotropic effects of lorcainide, Org 6001 and propafenone were similar at 5.9 and 24 mmol/l (K)o. In contrast, the -log molar IC50(Fc) of flecainide, prajmalium bitartrate and tocainide was significantly decreased (by 0.35 to 0.81 log units) if Na channels were inactivated by K depolarization. Ouabain-sensitive Na,K-ATPase was not inhibited by sparteine, while mexiletine and AR-LH 31 produced partial inhibition (each at 1 mmol/l). We conclude that the negative inotropic effect of class 1 antiarrhythmic drugs represents the sum of their Na channel blocking and additional drug-dependent inotropic properties. Quinidine, aprindine and mexiletine appear to be combined Na channel and Ca channel inhibiting agents thus causing a larger negative inotropic effect than TTX. However, a superimposed positive inotropic mechanism may also be operative in some antiarrhythmic drugs (sparteine, AR-LH 31, high concentrations of mexiletine).

Action Potentials↗
PubMed1986

[Tumor-associated antigens and fibrin derivatives as reaction products of ovarian cancer].

The detection of tumour-associated antigens in blood, ascites fluid, and tissue by the use of monoclonal antibodies establishes new aspects for the course control of ovarian cancer therapy and the evaluation of tumour-associated fibrinolysis. Monoclonal antibodies to the cross-linking site of fibrin derivatives in an enzyme immunoassay (D-dimer-ELISA) allow to compare quantitative results of fibrinolysis products with different tumour markers and the clinical tumour situation. In a prospective follow-up-study in 102 patients with epithelial ovarian carcinoma Ca 125, D-dimer, TPA, Ca 19-9, and CEA were investigated as tumour markers. Specificity (control group 61 gynaecologic patients with benign diseases) and sensitivity were compared in sensitivity-specificity diagrams (receiver operating characteristic curves) for different clinical tumour situations (preoperative, S0-S3). Applying a limit value of normal range, indicated in parentheses, the specificity of Ca 125 (greater than 65 mu/ml) amounts to 100%, D-dimer (greater than 700 ng/ml) 100%, TPA (greater than 120 mu/ml) 90%, CEA (greater than 5 ng/ml) 96%, Ca 19-9 (greater than 37 mu/ml) 98%. In the same sequence, sensitivity values came to 91%, 82%, 65%, 8% and 19% in manifest tumour situations. Antigen-concentration levels and frequency of pathological values depend on the degree of tumour disease. The results of seroimmunodiagnostic methods correlate with the clinical tumour situation: In 11 of 12 cases clinical tumour progression or relapse were accompanied by increasing concentrations of Ca 125 and D-dimer. In 21 cases of second-look laparotomies, tumour marker values in the normal range were often found not to be conclusive for diagnosing a tumour-free situation. The predictive value for true negative results amounted to only 18%. Immunohistochemical investigations and plasma-ascites diffusion ratios of antigens indicate that enrichment occurs in ascites. Fibrin deposition often surrounds tumour plugs and is found in interstitional tissue, whereas Ca 125 is expressed mainly at tumour cell surface. The histochemical image reflects fibrin as a tumour surrounding antigen and Ca 125 as a tumour-originated antigen. Clinical relevant serodiagnostic methods for ovarian cancer are brought about by the monoclonal detection of the investigated antigens.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

Mitral valve closure and left ventricular filling time in patients with VDD pacemakers. Assessment of the onset of left ventricular systole and the end of diastole.

The effect of mitral valve closure on left ventricular filling time and its relation to the onset of systole were assessed from mitral valve echocardiograms and simultaneous apex cardiograms in 21 normal subjects, 11 patients with left bundle branch block, and 19 patients with VDD pacemakers programmed for atrioventricular intervals of 50, 150, and 250 ms. The interval between the electrocardiograph Q wave and the apex cardiogram upstroke was similar in normal subjects and patients with left bundle branch block, but was significantly longer in patients with VDD pacemakers at all atrioventricular intervals. Similarly there was little difference in the time interval between the Q wave and mitral valve closure in normal individuals and patients with left bundle branch block but this was considerably delayed in VDD pacemaker patients with the atrioventricular interval set at 50 ms. With increasing atrioventricular intervals the mitral valve closed significantly earlier, whereas the onset of left ventricular systole and the timing of mitral valve opening remained unchanged. Thus as a result of earlier mitral valve closure left ventricular filling time decreased progressively as the atrioventricular interval was increased. Since the onset of left ventricular systole, with respect to left ventricular stimulation, is considerably delayed in VDD pacemaker patients a short atrioventricular interval is required in these patients to maintain the normal time relations between atrial and ventricular contraction and hence maximise left ventricular filling.

Adult↗
PubMed1986

Does transurethral resection of prostatic carcinoma promote tumor spread?

122 patients with prostatic carcinoma treated by radiation therapy were reviewed. An actuarial analysis was done on survival comparing patients treated by transurethral resection (TURP) prior to radiation to those diagnosed by needle biopsy. Survival rates were not significantly different between groups. TURP was also without effect on interval free of distant or local recurrence. Survival and time to distant or local recurrence were analyzed by tumor stage and grade. A multivariate analysis with the Cox model was made by which the effects of TURP and tumor grade and stage were examined simultaneously. TURP was without effect on survival rates and interval to distant or local recurrence after adjustments had been made for the effects of stage and grade.

Actuarial Analysis↗
PubMed1986

[New statistical criteria for validation of the antiarrhythmic effects by acute oral testing].

There are no reliable criteria for the evaluation of acute effects after oral application of a high single dose of an antiarrhythmic agent from the analysis of data of 46 patients with frequent complex VPBs suffering from severe organic heart disease (19 CHD, 27 COCM), we developed a new statistical model. Our calculations were based on nine 10 h Holter ECGs (2 controls, 1 placebo test, 6 class 1 antiarrhythmic agent tests) and two 24 h Holter ECGs (1 control, 1 while on chronic treatment) recorded in each patient. Usually reductions in VPB frequency caused by the medication occurred within 1 hour after application and lasted greater than or equal to 4 hours. The VPB reduction in the course of time was assessed by the parameters r and R (r = VPB reduction of the 4 h interval in comparison to the last hour before application, R = VPB reduction of the 4 h interval in comparison with an analogous interval of a control day). Values of r and R greater than or equal to -50% were never observed simultaneously. In contrast, the majority of all patients developed r and R values greater than or equal to -50% after application of an antiarrhythmic agent, and were classified as responders. As shown at a Holter control after 1 week of chronic treatment, the predictive value of a positive test result was good.

Administration, Oral↗
PubMed1986

[Analysis of the accuracy of the Holter system ICR 6201-G3].

UNLABELLED: The accuracy of the Holter System ICR 6201-G3 was investigated by evaluation of 32 Holter recordings taken randomly from the hospital's ECG laboratory. All events were classified into true positive, false positive and false negative diagnoses. Sensitivity (S) and predictive accuracy (PA) were calculated. RESULTS: QRS complexes: S 99.9%, PA 99.9%; supraventricular premature beats: S 98.3%, PA 81.1%; single ventricular premature beats: S 96.8%, PA 97.4%; ventricular couplets: S 96.4%, PA 95.6%; ventricular salvos: S 98.6%, PA 90.8%; pauses: S 100%, PA 91.7%. It is concluded that despite a relatively good overall accuracy of automatic arrhythmia detection, on account of the lower accuracy in the evaluation of all clinically important arrhythmias and of the markedly worse accuracy in some instances, a fully automatic use of the system cannot be recommended. Repetitive ventricular arrhythmias and asystolies must be controlled by hand.

Arrhythmias, Cardiac↗
PubMed1985

Survival and follow-up after pacemaker implantation: a comparison of patients with sick sinus syndrome, complete heart block, and atrial fibrillation.

The number of patients receiving cardiac pacemakers for sick sinus syndrome (SSS) has increased considerably in recent years. The literature has suggested that patients with sick sinus syndrome have a shorter life expectancy with pacemaker therapy than patients with total heart block or atrial fibrillation. We studied the survival rate of 1,049 patients with complete heart block, 592 with sick sinus syndrome and 447 with atrial fibrillation. After 10 years we found a survival rate of 54.5% for patients paced for SSS, 34.4% for those with complete heart block, and 24.7% for those with atrial fibrillation (statistical significance: SSS--heart block: p less than 0.05; SSS--atrial fibrillation: p less than 0.01; heart block--atrial fibrillation: NS). Considering the calculated survival rates of a comparable normal population (i.e., 56.5%; 41.2%; 47.8%), the differences in survival expectancy are even more pronounced (SSS-normal: NS; heart block-normal p less than 0.05; atrial fibrillation-normal: p less than 0.05). For patients with sick sinus syndrome, the life expectancy parallels that of the general population, while that of patients with complete heart block or atrial fibrillation have a life expectancy that is considerably lower.

Adolescent↗
PubMed1985

Cytotoxicity of the alkyl-linked lipoidal amine 4-aminomethyl-1-[2,3-(di-n-decyloxy)-n-propyl]-4-phenylpiperidine (CP-46,665) in cells from human tumors and leukemias.

The alkyl-linked lipoidal amine 4-aminomethyl-1-[2,3-(di-n-decyloxy)-n-propyl]-4-phenylpiperidine (CP-46,665) inhibited the in vitro incorporation of tritiated thymidine into blasts of eight leukemias and cells of nine different solid tumors of human origin. This activity was well correlated with trypan blue dye exclusion, which was tested to assess cell membrane damage. Scanning electron microscopy revealed loss of cell surface features and severe cell membrane destruction after incubation with CP-46,665. These effects on thymidine uptake and single cell viability were accompanied by a clear loss of the reproductive capacities of human tumor and leukemic cells as measured in a human tumor stem cell assay after incubation with CP-46,665. The above-mentioned cytostatic and cytotoxic effects of CP-46,665 were dependent on dosage and incubation time. Destruction of leukemic blasts was often completed with greater than or equal to 5 micrograms/ml after an incubation of greater than or equal to 48 hr or greater than or equal to 10 micrograms/ml after an incubation of greater than or equal to 24 hr. Cells from solid tumors usually required a slightly higher drug concentration and longer incubation period for maximum killing. The alkyl-linked lipoidal amine CP-46,665 often showed considerably greater efficacy than did the alkyl-linked phospholipid rac-1-O-octadecyl-2-O-methylglycero-3-phosphocholine tested in comparison. In contrast to both drugs, 2-lysophosphatidylcholine showed only minor activity within the same dose range.

Adjuvants, Immunologic↗
PubMed1985

[Secondary pauses following high frequency atrial stimulation: incidence and possible underlying mechanisms].

Atrial pacing up to 250 bpm was performed in 88 patients with suspected sick sinus syndrome or syncopes of unknown origin. Measurements were done on the first five return cycles. According to cSNRTmax they were divided in 3 groups (group 1 less than 525 ms, group 2 greater than or equal to 525 ms less than 1000 ms, group 3 greater than or equal to 1000 ms). The return cycle pattern (PSM) was calculated (mean + standard deviation of PSI 1-PS15 at each pacing rate). A "normal" PSM with long PSI1 and gradual shortening of the subsequent cycles was found only at low pacing rates in group 1 and group 2. At higher rates, the PSI1 shortened and PSI2 lengthened, resulting in frequent secondary pauses (SP). Atrial pacing up to 400 bpm was performed in 20 open chest dogs. SP were frequently obtained at pacing rates above 300 bpm. Intravenous application of propranolol and atropine did not diminish SP, neither did bilateral vagotomy. Additional subthreshold stimuli, as well as stimulation with large interpolar distance did not influence the PSM of SP at high frequencies. Simultaneous stimulation of right atrium and right ventricle had no significant effects on SP. Pacemaker shifts occurring frequently after high rate pacing were not necessarily accompanied by SP. The velocity of activation spread over the sinoatrial region was significantly slower in cases of postpacing beats preceding a SP. It was concluded that the PSM of SP provoked by high rate atrial pacing is neither caused by local release of neurotransmitters nor by pacing induced changes of the autonomic tone nor by pacemaker shifts.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

[Cardiac arrhythmias and their clinical significance in mitral valve prolapse].

Among 160 patients with mitral-valve prolapse but no other illness there were 118 with cardiac arrhythmias. 30 had frequent or multifocal ventricular premature systoles, 21 had coupled ventricular extrasystoles, and seven had ventricular tachycardia. In six patients the prematurity index was under 1. Supraventricular premature systoles were registered in 56 patients, with seven each having paroxysmal atrial tachycardia and paroxysmal atrial flutter or fibrillation. Ventricular arrhythmias were significantly more frequent in late-systolic prolapse and with positive auscultation findings (systolic click or systolic murmur). Long-term ECG monitoring was more valuable than an exercise ECG. About half the patients with frequent arrhythmias had palpitations and rapid heart action. Coupled ventricular premature systoles and ventricular tachycardias, as well as R-on-T were relatively rare; our findings thus tend to suggest a relatively favourable prognosis for these arrhythmias.

Adolescent↗
PubMed1984

[The effect of amiodarone on thyroid gland function].

Plasma concentrations of T4, FT4, T3, rT3 and TBG, as well as of TSH before and after stimulation with TRH were studied in 25 patients, who had been treated with amiodarone for up to nine years. At the beginning of therapy, all the parameters mentioned above were found to be in the normal range in all patients. After two months of therapy, T4 had increased from 100 nmol/l +/- 24 nmol/l to 155 nmol/l +/- 32 nmol/l (p less than 0.01), and FT4 from 22 pmol/l +/- 10.5 pmol/l to 32 pmol/l +/- 8 pmol/l (p less than 0.01). T3 had decreased to the lower normal range (n.s.). TBG showed no significant changes. The TRH-tests had been normal in the beginning, but they remained positive in only 20% of the cases. At the end of the study, rT3 exceeded the normal range in all 25 patients. Two patients developed definite hyperthyroidism with elevations of T3 up to 4.7 nmol/l and 7.5 nmol/l, respectively. In one of them, we decided to discontinue amiodarone. Testing of thyroid function under antithyroid drug therapy revealed a hyperfunctioning autonomous adenoma, which was successfully eliminated by radioactive iodine therapy. In the other patient, it was not possible to withdraw amiodarone, so we initiated long-term treatment with antithyroid drugs. Our data support the assumption that amiodarone causes an impairment of the peripheral conversion of T4 to T3. As a result, one finds elevated serum concentrations of T4, which, in combination with the mainly negative TRH-test, must not be interpreted as proof of a hyperthyroid metabolic state being present. Hyperthyroidism is confirmed only if serum concentrations of T3 are also elevated.

Adolescent↗