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Biomedical subjects

L Hess

Publications and source records attributed to L Hess.

At least 19 recordsLinked to original sources
PubMed2001

[An uncommon cause of severe soft tissue bleeding during phenprocoumon treatment].

HISTORY AND ADMISSION FINDINGS: A 66-year-old patient presented to our clinic with extensive left arm and left flank haematomas, anaemia, a prolonged activated partial thromboplastin time (aPTT), and reduced factor IX activity 6 weeks after prosthetic mechanical aortic valve implantation. INVESTIGATION: Treatment with both vitamin K and a single injection of factor IX concentrate led to normalization of the activated partial thromboplastin time and factor IX activity, which remained constant for several days. No acquired factor IX inhibitor was detectable. Analysis of exon 2 of the factor IX gene revealed a C-->T mutation in codon 10 of the propeptide region, resulting in the substitution of alanine by valine. Echocardiography revealed a significant paravalvular leak. TREATMENT AND COURSE: The substitution of valine for alanine in the factor IX propeptide leads to an impaired affinity of factor IX to the vitamin K-carboxylase complex. In this situation, treatment with coumarin derivatives can profoundly reduce factor IX activity and result in severe bleeding episodes. This patient was re-exposed to warfarin under close hematological monitoring. After 4 days factor IX activity had decreased to 15%, which was associated with an increase of the aPTT and a mild decrease of the prothrombin time. Due to rapid progression of the paravalvular leak and almost impossible long-term orale anticoagulation with coumarin derivatives, we recommended replacement of the prosthetic mechanical valve with a biological device. CONCLUSION: The development of severe bleeding in the context of initiating warfarin therapy raises the suspicion of a factor IX propeptide mutation. The initial screening test is the activated partial thromboplastin time, which is elevated in the presence of the mutation. If concomitantly diminished factor IX activity is found the factor IX propeptide mutation should be excluded. Use of lifelong coumarin derivatives is contraindicated in patients with this mutation. However, a general screening of the activated partial thromboplastin time after coumarin initiation is not justified by cost/benefit analysis.

Aged↗
PubMed2001

Pain status of patients with severe haemophilic arthropathy.

Patients with severe haemophilia A growing up before the establishment of prophylactic treatment frequently developed significant haemarthropathies. The goal of the following study was to clarify the role of haemarthropathic pain for haemophilic patients. Furthermore, we aimed to determine to what degree daily activities are influenced by the impairment and which therapeutic modalities are used in pain management. Using a questionnaire we consulted 71 haemophiliacs concerning their complaints and how they were treated in 1999 (average age 43 years; range 21-63 years). The pain in the large joints and spine and the effect of specific treatment was estimated by a visual analogue scale. On average, there were four joints with major pain and 0.5 with minor pain. The most frequent sources of pain were the ankle joints (45%), followed by the knee (39%), spine (14%) and elbow (7%). Fifty percent of all patients complained of pain throughout the day if no treatment was applied. In 29% of patients, pain persisted after application of factor VIII (FVIII), while 12% claimed that pain still remained after use of FVIII and pain killers. Restriction in activities of daily life was reported by 89% of the group and 85% reported on an impact of pain on their mood. Patients primarily used FVIII to decrease pain, followed in frequency by use of anti-inflammatory drugs, orthopaedic footwear, liniments and bandages. Haemophilic patients with haemarthropathy are chronic pain patients. By means of the questionnaire, it is possible to reveal the 'silent' sufferers. Sufficient pain treatment is essential so as to increase the patient's quality of life and avoid inadvertent abnormal postures possibly resulting in increased loading of joints and subsequent bleeding episodes.

Activities of Daily Living↗
PubMed2001

Soft-tissue angioleiomyoma of the hand as a rare differential diagnosis of haemophilic pseudotumour.

The benign vascular tumours known as angioleiomyomas, which originate from smooth muscle cells of arterial or venous walls are rare, particularly in the region of the hand. Frequently, the diagnosis is only made after surgical extirpation and histological assessment. The occurrence of an angioleiomyoma in a haemophiliac has not yet been reported, to our knowledge. A 62-year-old patient with a haemophilia B complained of increasing pain in the vicinity of the soft tissue covering the carpo-metacarpophalangeal joint of his left palm. In the T1-weighted magnetic resonance images a hypointense well-demarcated mass was found, showing a homogeneous enhancement after intravenous application of contrast medium. T2-weighted images showed a hyperintense signal. Based on clinical and radiographic findings, the tumour was initially thought to be a haemophilic pseudotumour arising from a prior local haematoma. Intraoperatively, the mass was found to be solid, and histological assessment diagnosed an angioleiomyoma, without signs of malignant transformation. Descriptions of the clinical symptoms of angioleiomyoma in an extremity vary considerably in the literature. Although rare, the vascular leiomyoma should therefore be contemplated in the differential diagnosis in patients with a solid nodular lesion of unclear aetiology in arms or legs. Especially in a haemophiliac patient, the growth can easily be mistaken for a pseudotumour because of its clinical and radiological similarities.

Angiomyoma↗
PubMed2000

Influence of self-measurement of blood pressure on the responder rate in hypertensive patients treated with losartan: results of the SVATCH Study. Standard vs Automatic Treatment Control of COSAAR in Hypertension.

Home measurement of blood pressure (BP) can improve compliance. The aim of this study was to evaluate if the efficacy of losartan in hypertension could be enhanced by providing patients with a device for home BP measurement. In this open, randomised, prospective, multi-centre study in 244 Swiss practices, patients with mild-to-moderate hypertension were randomised to a group receiving a home BP measuring device (OMRON) (group 2), or to a group where this device was not provided (group 1). After 8 weeks of treatment with losartan, the responder rates between subjects performing home measurement of BP were compared with those without self-measurement, whereby exclusively sphygmomanometric office BP values were considered. A total of 622 subjects completed the study. Treatment with losartan significantly reduced diastolic (DBP) and systolic BP (SBP) (P < 0.0001). Overall, the group with home BP measurement showed an increased responder rate (DBP < or =90 mm Hg) by 6.4% (59.8% vs 66.2%; 0.05 < P < 0.1). This difference was mainly due to female patients (64.1% vs 73.2%), where it reached statistical significance (P < 0.01). Pretreated patients showed a 9.0% improvement of response in the home measurement group as well (0.05 < P < 0.1). The responder rate in newly treated subjects was relatively high, reaching 79.5% (DBP < or =90 mm Hg or reduction > or =10 mm Hg DBP from baseline). However, home measurement did not significantly improve BP control in these new patients (81.4% vs 77.7%). Overall, home measurement can lead to a slight improvement of BP control. This improvement was most evident in females, reaching significance.

Administration, Oral↗
PubMed2000

Intra-articular hyaluronic acid in the treatment of haemophilic arthropathy of the knee. Clinical, radiological and sonographical assessment.

Hyaluronic acid has been used successfully in the treatment of osteoarthritis since 1989. There is no experience in haemophiliacs in larger study groups. In a prospective study, 20 patients (21 knees) with haemophilic arthropathy of the knee received 20 mg hyaluronic acid by intra-articular injection for 5 consecutive weeks. Assessment included clinical scores, X-ray, magnetic resonance imaging (MRI) and biomechanical motion analysis before and 3 months after the first injection. The score of the WFH advisory committee and the Aichroth score for special evaluation of the knee were used. After an average period of 26 months, the World Federation of Hemophilia (WFH) score, the Aichroth score and the visual analogue scale were evaluated again. All patients had pain caused by their arthropathy, nine of them had positive antibodies to human immunodeficiency virus, and 15 had chronic hepatitis C. The mean WFH score was 8.1 points, the Petterson score was 7.3 points and the Aichroth score was 38 points (maximum 55 points). The WFH score decreased to 7.3 points, the Aichroth score improved to 40 points and the subjective assessment measured with a visual analogue scale improved from 5.3 to 3.7 points. No differences from MRI controls were detected. After 3 months, 14 of 20 patients improved subjectively, particularly in longer walking distance, stair-climbing or initial pain. These positive aspects were limited by arthropathy in adjacent joints. After 26 months 10 patients still are benefiting for up to 31 months follow-up. The average WFH score was 7.3 points, the Aichroth score 39 points, the visual analogue scale 4.0 points. We recommend hyaluronic acid for haemophilic arthropathy of the knee when regular conservative therapy has failed and operative treatment is not feasible.

Activities of Daily Living↗
PubMed2000

NovoSeven in immune tolerance therapy.

The development of inhibitors in haemophilia patients is one of the most serious challenges to effective treatment. The effect of factor (F) concentrate and treatment regimen on titre levels was studied in nine patients with haemophilia A or B and inhibitors. Patients with haemophilia A were subdivided into those treated with recombinant activated factor VII (rFVIIa) on demand or those treated prophylactically with activated prothrombin complex concentrate (aPCC) and rFVIIa. A third group comprised haemophilia B patients receiving rFVIIa prophylaxis and on-demand aPCC or rFVIIa. On-demand therapy with rFVIIa proved to be effective and safe treatment for acute bleeding episodes in haemophilic patients. In group 1, inhibitor titres decreased markedly 0.5-21 months prior to immune tolerance therapy (ITT) and remained low for a further 1-19 months. However, use of rFVIIa instead of aPCC as prophylactic treatment in group 2 patients undergoing ITT failed to show favourable results for rFVIIa. This may be due to the short half-life of rFVIIa (2.3-2.9 h). The data presented suggest that exclusive use of rFVIIa in acute bleeding episodes prior to commencing ITT is an effective method of decreasing inhibitor titre, thereby optimizing conditions for ITT.

Adolescent↗
PubMed2000

Antibodies to factor VIII in hemophilia A patients.

Inhibitor development represents the main complication in the treatment of haemophilia A. The risk of inhibitor formation is in part genetically determined by the type of the underlying factor VIII gene lesion but environmental factors may also play an important role. Due to the lack of efficiency of factor VIII in these patients other therapeutic agents must be used for the treatment of bleedings, however, none is as effective as factor VIII in a non-inhibitor patient. Therefore, the eridication of the inhibitor through immune tolerance therapy is the treatment of choice. Centralized national and international immune tolerance registries have collected the results and show cost effectiveness of this treatment.

Factor VIII↗
PubMed1998

Results of a job analysis of psychologists working in state hospitals.

The graduate training of psychologists should prepare them for central roles in state hospitals, especially roles involving direct patient care and supervision of colleagues. To what extent do actual job practices match graduate preparation? To find out, 55 psychologists from 12 state hospitals in the Midwest were surveyed regarding their educational backgrounds and time currently spent in various job activities. Results indicated that paperwork consumes more time than any other activity, followed by therapeutic services, psychological assessment, supervision, and case management. Almost 50% of the sample was trained under a cognitive-behavioral orientation; however, more than 60% of survey participants now practice according to eclectic models. These results imply that psychologists in these settings may not be utilized to their full potential because of a variety of organizational constraints.

Administrative Personnel↗
PubMed1998

An ecological model for school-based mental health services for urban low-income aggressive children.

An ecological model for school-based mental health services that targets urban low-income aggressive children--a highly vulnerable and underserved population--is presented. The goals of the model are to increase children's and teachers' involvement in the delivery of services and to increase the integration of these services into existing school resources and activities. The model proposes that mental health service providers work in collaboration with teachers to deliver services that (1) can be managed by existing school resources and personnel, (2) are related to empirically based factors associated with reduced aggression and increased social functioning, and (3) are group administered to increase the number of children served and to reduce stigmatization associated with mental health services. The model is individualized and flexible by acknowledging that contexts for aggression differ across classrooms and children and by providing services specific to those contexts. Two studies are presented illustrating the application of this model to decrease aggression and increase academic engagement in low-income urban public schools.

Achievement↗
PubMed1998

Immune tolerance induction: a role for recombinant activated factor VII (rFVIIa)?

The development of factor VIII (FVIII) and FIX inhibitors is one of the most serious complications of repeated transfusions in patients with haemophilia. Management of patients with haemophilia with inhibitors must be separated into 2 concepts: the control of acute bleeding episodes and, in the long term, the treatment of the inhibitor itself. This paper will discuss both aspects of the management of these patients, focusing in particular on the therapeutic options available for the treatment of bleeding episodes during immune tolerance induction (ITI) therapy. The second part of the paper will review the management and outcomes of 10 patients with severe haemophilia in whom recombinant activated FVII (rFVIIa: NovoSeven, Novo Nordisk, Bagsvaerd, Denmark) has been used to treat bleeding episodes in the Haemophilia Centre at Bonn University; 6 patients were treated with rFVIIa for bleeding episodes while undergoing ITI. The results obtained demonstrate that rFVIIa is a safe and effective treatment for bleeding episodes and haemostatic cover for surgical procedures in patients with inhibitors. Inhibitor titres were not boosted in patients with haemophilia and inhibitors on treatment with rFVIIa. Therefore, rFVIIa is also a suitable treatment for bleeding episodes or control of haemostasis during surgery in patients prior to initiation of ITI therapy.

Antibodies↗
PubMed1998

[Modern cardiac anesthesia].

Contemporary cardioanaesthesia is based on the use of opioid effects, whereby their dosage is steadily decreased. This calls for supplementation of anaesthesia by further pharmacological preparations which ensure adequate anaesthesia. Despite great efforts, neither, substances available at present nor their combinations are sufficient to suppress surgical stress completely. The authors attempt therefore selective influencing of the sympathetic nerve. In this respect preparations which stimulate sympathetic alpha2 receptors seem promising. The general trend of contemporary cardioanaesthesia is an effort to reduce the time spent by patients in the intensive care unit to a minimum. The motivation are in the first place economic reasons.

Anesthesia↗
PubMed1995

[The fist detection of Giardia spp. in horses in the Czech Republic].

The first occurrence of Giardia spp. in horses in the Czech Republic is reported. During preventive examination of 360 five-month up to 14-year horses from various parts of the region of Central Bohemia carried out from January 1993 to June 1994 in the parasitological laboratory of the State Veterinary Institute in Prague, the Giardia cysts were detected in the excrements of 18 (5%) horses, mostly 2-4 years of age, and in two foals 3 and 6 weeks old. During the period between March 1993 and June 1994, systematic and repeated observation was aimed at a group of 38 racing horses two up to four years of age from two studs in the surroundings of Prague. In one of these studs Giardia spp. cysts were found in 7 horses (35%) out of a total of 20 animals. During bacteriological examination of horses infected with Giardia carried out parallely, only in one animal pathogenic bacteria Rhodococcus equi and Streptococcus equi subsp. zooepidemicus were detected in the excrements. After the application of Entizole (following discontinuation of the preparation on days 4 and 50), however, the result of bacteriological examination was negative. The size of cysts (n = 100) was 12.8-16.0 x 9.6-11.2 microns (with the mean of 14.6 x 9.9 microns) there was no finding of free trophozoites of Giardia in the horse excrements examined. On the basis of morphological characteristics of the protozoon cysts and of the structure of median bodies (following excystation of the Giardia cysts in vitro), the intestinal flagellate found in horses can be included into the morphological group of G. intestinalis.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

[5 years' experience with conscious sedation with midazolam (Dormicum Roche) in stomatology].

The authors used Midazolam in dental treatment of 225 patients of both sexes (ASA I-IV). 25 patients suffering from heart diseases (ASA III-IV) were ECG monitored during the treatment. Midazolam with the biological half-life of 0.5-1.5 hours was successfully used for premedication of dental out-patients. The used doses had no significant influence on hemodynamic and respiratory values. Specific antagonist Flumazenil reduced the period of psychological recovery of the patients and thus made it possible for the patients to be dismissed within 30 minutes after the dental treatment if accompanied.

Adolescent↗
PubMed1992

Analgosedation raises baroreflex sensitivity in acute myocardial ischaemia.

Acute local myocardial ischaemia is associated with a decrease in baroreflex sensitivity while electrical instability (vulnerability) of ventricles increases. Co-administration of a benzodiazepine and a potent analgesic (analgosedation) has been found to raise both baroreflex sensitivity and ventricular fibrillation threshold. Pharmacological modulation of neurovegetative ionization of the heart in the early phase of ischaemia is a promising method for preventing sudden coronary death.

Animals↗
PubMed1991

Prevention of sudden coronary death.

The following results were obtained in an experimental study in the dogs in general pentobarbital anaesthesia: Lidocaine type antiarrhythmics (lidocaine, Xylocaine ASTRA, Ethmozin USSR) administered shortly before artery ligation have a pro-fibrillation effect. This effect is indirectly proportional to the ischaemic focus development. A 3rd-generation beta blocker with intrinsic sympathetic activity (celiprolol, Selectol Chemie-Linz) had the same electrostabilizing effect on the ventricles in the acute phase of ischaemia as a 1st-generation beta blocker (metipranolol, Trimepranol SPOFA). The 3rd-generation blocker, however, stopped short of provoking a drop in the heart rate invariably associated with the 1st-generation beta blocker. The analgesic fentanyl (G. Richter) in combination with benzodiazepine (m,idazolam, Dormicum Hoffmann-La Roche) inducs analgosedation. In this way the dose of the analgetic can be reduced and yet the analgesia and electrostability of the heart remain the same. Due to the lower dose of the analgesic there is a lesser decrease in the heart rate and blood pressure. Analgosedation can be discontinued by administering an antagonist-agonist of benzodiazepines (flumazenil, Anexate Hoffmann-La Roche) or an antagonist of potent analgesics (butorphanol, Beforal SPOFA) without the risk of eliminating, at the same time, the electrostabilizing effect of analgosedation on the ischaemically damaged ventricles of the heart. For the prevention of sudden coronary death due to ventricular fibrillation in the acute phase of local myocardial ischaemia we can, on the basis of our experimental results, recommend analgosedation and the use of beta blockers with intristic sympathetic action. The use of lidocaine antiarrhythmics may lead to a reduction in the electric stability of the heart ventricles the ischaemic focus is developing under a certain "critical" blood level of the antiarrhythmics.

Adrenergic beta-Antagonists↗
PubMed1991

Analgosedation-enhanced baroreflex sensitivity in acute local myocardial ischaemia.

In acute local myocardial ischaemia produced in mongrel dogs, the sensitivity of baroreflex decreased as electrical instability (vulnerability) of cardiac ventricles increased. Simultaneous administration of a benzodiazepine and a powerful analgesic (analgosedation) augmented both baroreflex sensitivity and ventricular fibrillation threshold. Modulation of neurovegetative activation of the heart by drugs in the early stage of ischaemia holds promise as a potential technique of sudden coronary death prevention.

Animals↗
PubMed1991

[Anesthesia in dogs with the combination preparation Tilest 500].

Tilest 500 contains tiletamine and the water-soluble benzodiazepine zolazepam in the ratio 1:1. The drug was administered intramuscularly in ten dogs at a dosage of 10 mg/kg bwt of tiletamine and 10 mg/kg bwt of zolazepam and tested for its effects on hemodynamics, respiration, and the antagonistic effect of flumazenil. Initial effects occurred quickly, analgesia and muscle relaxation were excellent 10 minutes after administration. There was a highly significant increase in heart rate and a slight decrease in both mean arterial blood pressure and arterial pO2. In a second group of ten dogs the interventricular paraconal branch of the left coronary artery was ligated which induced local myocardial ischemia. Here Tilest 500 showed electrostabilizing and antifibrillatory properties even in the presence of severe arrhythmias. The benzodiazepine compound of this drug combination can be antagonized by flumazenil. To avoid excitatory reactions flumazenil should not be injected earlier than 45 to 60 minutes after administration of Tilest 500.

Analgesia↗