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Biomedical subjects

M Hülsmann

Publications and source records attributed to M Hülsmann.

At least 55 records · Page 3Linked to original sources
PubMed1997

Efficacy, cleaning ability and safety of different devices for gutta-percha removal in root canal retreatment.

The purpose of this study was to evaluate the efficacy, cleaning ability and safety of five different devices and techniques to remove gutta-percha root canal fillings. One hundred and twenty extracted single-rooted anterior and premolar teeth were enlarged to ISO size 35 and obturated with laterally condensed gutta-percha using AH 26 as the sealer. Removal of gutta-percha was performed with the following devices and techniques: (a) Gates-Glidden and Hedstrom files, (b) only Hedstrom files, (c) Hedstrom files and chloroform, (d) the Endotec and Hedstrom files, and (e) the XGP drill and Hedstrom files. The following data were recorded: time taken to reach the desired working length, time required for the removal of the gutta-percha, and the amount of material extruded apically. The teeth were split longitudinally and photographed. Cleanliness of the root canal walls was scored using the projected slides with a total magnification of approximately 70x. The fastest technique to reach the working length was using the XGP drill (e), followed by the Gates-Glidden drills (a), Hedstrom files and chloroform (c), and the Endotec device (d). The use of Hedstrom files (b) without any additional support proved to be most time-consuming. Differences were statistically significant (U-test, P > 0.05) between the rotary devices and the manual techniques. Time for complete removal of gutta-percha was again shortest with the XGP drills (e), followed by the Gates-Glidden burs (a), the Endotec device (d), Hedstrom files with chloroform (c), and Hedstrom files alone (b). The XGP burs and the Gates-Glidden drills worked significantly faster than the other techniques. The amount of debris and filling material extruded apically in most cases did not exceed 0.1 mg. No significant differences could be detected between the groups (U-test, P > 0.05). Root canal cleanliness proved best following the use of Hedstrom files without additional support (b) and the Gates-Glidden drills (a), followed by Hedstrom files in combination with chloroform (c), the XGP-gutta-percha remover (e), and the Endotec device (d). When using the XGP two instrument fractures occurred in the apical parts of the root canals preventing further instrumentation to the apical foramen. When using the Gates-Glidden burs four instrument fractures occurred, but all fragments could be removed with forceps immediately. The results suggest that the XGP gutta-percha remover and the Gates-Glidden drills are efficient and time saving devices to remove gutta-percha but include a certain risk of instrument breakage and may leave some filling material inside the root canal. The best root canal cleanliness was achieved with Hedstrom files alone which, on the other hand, were shown to be the most time-consuming.

Evaluation Studies as Topic↗
PubMed1997

Dens invaginatus: aetiology, classification, prevalence, diagnosis, and treatment considerations.

Dens invaginatus is a malformation of teeth probably resulting from an infolding of the dental papilla during tooth development. Affected teeth show a deep infolding of enamel and dentine starting from the foramen coecum or even the tip of the cusps, and which may extend deep into the root. Teeth most affected are maxillary lateral incisors and bilateral occurrence is not uncommon. The malformation shows a broad spectrum of morphologic variations and frequently results in early pulp necrosis. Root canal therapy may present severe problems because of the complex anatomy of the teeth. Aetiology, prevalence, classification, and therapeutic considerations including root canal therapy, apical surgery and prevention of pulpal involvement are reviewed.

Austria↗
PubMed1997

Prostaglandin E1--bridge to cardiac transplantation. Technique, dosage, results.

BACKGROUND: Heart transplantation candidates who remain severely symptomatic despite therapy are normally hospitalized. Continuous infusion of intravenous drugs from a portable pump may allow such patients to live a fairly active life until a donor heart is found. AIM: To investigate in an open pilot study if heart transplantation can be safely accomplished if these patients are continuously bridged with various regimens including inotropic support with low-dose dobutamine in conjunction with dopamine and prostaglandin E1. METHODS: We report on 5 years' experience with prostaglandin E1, a potent vasodilator with proven efficacy in severe heart failure when coupled with catecholamines. From 1990 to 1995 54 heart transplantation candidates were bridged with prostaglandin E1 in addition to dobutamine 5 micrograms.kg-1. min-1 and dopamine 3 micrograms.kg-1 min-1 (group A; n = 32) or in addition to 3 micrograms.kg-1 min-1 dopamine alone (group B; n = 22), and 11 heart transplantation candidates were bridged with dobutamine 5 micrograms.kg-1. min-1 and dopamine 3 micrograms.kg-1 min-1 only (group C; n = 11). In an initial dose-ranging test, prostaglandin E1 was uptitrated to side effect limit (29 +/- 1 ng.kg-1.min-1). Haemodynamics, except for stroke volume index, were similar in all patients at baseline and a sufficient haemodynamic response (20% increase in stroke volume) was observed during the acute study. Fifty percent of the peak dose was used for initiating chronic therapy; the dose of prostaglandin E1 was further reduced if side effects recurred. RESULTS: Twenty-nine (54%) patients in groups A and B and six in group C could be discharged home with chronic therapy via a Hickman catheter connected to a portable pump. After 4 weeks in six patients in group A and in 13 patients in group B, when prostaglandin E1 had been reduced from 15 +/- 2 ng.kg-1.min-1 to 8 +/- 1 ng.kg-1 min-1 increases in cardiac index and decreases in systemic vascular resistance were sustained, and a permanent decrease in pulmonary vascular resistance index was observed in group B. Intravenous therapy was changed in nine patients (3/1/5) because of side effects and worsening heart failure. Prostaglandin E1 was withdrawn in three of these patients because of an increase in serum creatinine (3 mg.100 ml-1), and in one because of noncompliance. In total, there were 17 cardiac deaths (9/6/2), 42 heart transplants (22/14/6) and six (1/2/3) weaned survivors (including one non-cardiac death) in this study. Overall outcome was similar in groups A and B, but distribution after 2 months appeared to be different (P < 0.05) based on more transplantations in group A. CONCLUSION: We concluded that chronic infusions with prostaglandin E1 at reduced dosages is a feasible and safe therapeutic adjunct to bridge end-stage heart failure patients and may yield desirable effects in a subset of patients in the absence of inotropic support by dobutamine.

Alprostadil↗
PubMed1997

Hemisection and vital treatment of a fused tooth--literature review and case report.

Fusion and gemination of permanent teeth are developmental anomalies of the dental hard tissues which may require endodontic and surgical treatment for functional, orthodontic or aesthetic reasons. Following a review of the dental literature on tooth fusion and gemination, a case of fusion of a maxillary central incisor and a supernumerary tooth and its endodontic and surgical treatment is presented.

Child↗
PubMed1997

Hemodynamic and neurohumoral effects of long-term prostaglandin E1 infusions in outpatients with severe congestive heart failure.

BACKGROUND: Prostaglandins of the E type are potent endogenous vasodilators that also interfere with the activity of the sympathetic nervous system. Thus treating patients with end-stage heart failure with prostaglandin E1 (PGE1) infusions seems to accord well with the hypothesis that neurohumoral imbalance rather than hemodynamic derangements should be the priority in the treatment of heart failure. METHODS: We sought to investigate neurohumoral in addition to hemodynamic changes during long-term PGE1 infusion and determined plasma renin activity, atrial natriuretic peptide, norepinephrine, and big endothelin plasma levels in 13 male patients with heart failure whose symptoms remained severe in spite of optimized oral therapy with digitalis, nitrates, furosemide (185 +/- 72 mg/d) and enalapril (33 +/- 3 mg/d). PGE1 infusion rate was started with 2.5 ng/kg/min and stepwise increased to the maximum tolerated dose (26 +/- 4 ng/kg/min), which was halved for continuous infusion through the following 12 hours and further stepwise reduced to an average dose of 8 +/- 1 ng/kg/min. Right heart catheterization was performed for acute hemodynamic studies and after 4 weeks. All patients were discharged with a catheter that was connected to a portable pump for home therapy. RESULTS: Acute effects of PGE1 were reductions in systemic blood pressure, (p < 0.05), right atrial pressure (p < 0.001), pulmonary artery pressure (p < 0.05), pulmonary capillary wedge pressure (p < 0.01), systemic and pulmonary vascular resistance index (both p < 0.01) and an increase in cardiac and stroke volume index (both p < 0.001) without a change in heart rate. After 4 weeks a persistent increase from baseline in cardiac index (from 1.9 +/- 0.1 to 2.5 +/- 0.2 L/min/m2; p < 0.01) and in pulmonary vascular resistance index (from 479 +/- 50 to 331 +/- 29 dynes x sec/cm5 x m2; p < 0.05) was observed. Atrial natriuretic peptide (p < 0.05) decreased, and norepinephrine and big endothelin showed a tendency to a lower level. Concomitantly, New York Heart Association functional class changed (p = 0.0001), with one patient's condition remaining class IV, the conditions of seven patients decreasing to class II, and the conditions of five patients decreasing to class III. CONCLUSION: Thus long-term parenteral home therapy with PGE1 infusions in patients with severe end-stage heart failure elicited beneficial clinical and hemodynamic effects without activating neurohumoral counterregulatory systems.

Alprostadil↗
PubMed1997

Prostaglandin E1 infusion compared with prostacyclin infusion in patients with refractory heart failure: effects on hemodynamics and neurohumoral variables.

Prostaglandin E1 or prostacyclin were randomly infused in 18 patients with severe chronic heart failure who did not respond to oral treatment. Maximally tolerated dosages of both agents increased cardiac index; however, only prostacyclin decreased mean arterial pressure and increased plasma norepinephrine significantly. Twelve hours after 50% peak dose reduction, atrial natriuretic peptide levels, right atrial pressure, mean pulmonary artery pressure, and mean arterial pressure continued to decrease with prostaglandin E1, whereas the increase in cardiac index was sustained; in contrast, at 50% prostacyclin dose reduction, cardiac index decreased toward baseline, suggesting that, with reduced dosages for chronic infusions, desired hemodynamic changes seem to be sustained with prostaglandin E1 only.

Alprostadil↗
PubMed1996

Prognostic impact of big endothelin-1 plasma concentrations compared with invasive hemodynamic evaluation in severe heart failure.

OBJECTIVES: This study sought to test the hypothesis that big endothelin-1 plasma levels in advanced heart failure are related to survival. BACKGROUND: In heart failure, production of the potent vasoconstrictor endothelin-1 is increased. Because elevation of immunoreactive endothelin-1 in severe heart failure is primarily related to the precursor "big" endothelin-1, increased big endothelin-1 levels may be associated with a poor prognosis. METHODS: Plasma big endothelin-1 concentrations, in addition to 16 clinical, hemodynamic and neurohumoral variables, were obtained from 113 patients (mean age -=/[SEM] 53 +/- 1 years) with left ventricular ejection fraction <20% and were related to 1-year mortality by a stepwise Cox regression multivariate analysis. RESULTS: Plasma big endothelin-1 concentrations were significantly higher in patients with moderate and severe heart failure than in those with mild heart failure (4.5 +/- 0.4 and 6.0 +/- 0.1 vs. 2.7 +/- 0.1 fmol/ml, p = 0.0001, respectively) and lower in 58 one-year survivors than in 29 nonsurvivors (2.6 +/- 0.1 vs. 5.9 +/- .04 fmol/ml, p = 0.0001) and 26 heart transplant recipients. By univariate analysis, big endothelin-1 plasma concentrations (p < 0.0001), functional class, daily furosemide dose, left ventricular ejection fraction, most hemodynamic variables and plasma atrial natriuretic peptide, sodium renin activity and aldosterone levels were all related to mortality, but only functional class provided additional prognostic information when big endothelin-1 plasma levels were entered into the multivariate model. CONCLUSIONS: In advanced heart failure, plasma big endothelin-1 is strongly related to survival and appears to predict 1-year mortality better than hemodynamic variables and levels of atrial natriuretic peptide, an established neurohumoral prognostic marker in chronic heart failure.

Adult↗
PubMed1996

Severe dens invaginatus malformation: report of two cases.

Two cases of severe dens invaginatus malformation of teeth are presented. In the first case apical abscess formation occurred before root end closure. In the second case the dysmorphic tooth form may be considered a possible cause of retarded eruption.

Child↗
PubMed1996

Effects of two different enalapril dosages on clinical, haemodynamic and neurohumoral response of patients with severe congestive heart failure.

Angiotensin converting enzyme inhibitors improve symptoms and prolong life in congestive heart failure, but the dose in the individual patient is uncertain. A randomized, 48-week, double-blind study was performed to investigate the safety and efficacy of 'high' in comparison to continued 'low' angiotensin converting enzyme inhibitor therapy in severe heart failure. Eighty-three patients (56 +/- 1.1 years; 69 men, 14 women) in New York Heart Association functional class III/IV on digoxin, furosemide and 'low' angiotensin converting enzyme inhibitors (captopril < or = 50 mg.day-1 or enalapril < or = 10 mg.day-1) were included. After a > or = 14 day run-in on 10 mg.day-1 enalapril, digitalis and furosemide, right heart catheterization at rest and exercise was performed. All patients presented with atrial pressure > 10 mmHg and/or pulmonary artery pressure > 35 mmHg, and/or cardiac index < 2.5 l.min-1.m-2 at rest. Patients then received enalapril 5 mg twice daily (n = 42), or 20 mg twice daily (n = 41) in random order. Thus, patients randomized to low doses of enalapril actually had no change in therapy from baseline to 48 weeks. Forty-three patients (52%) completed the study, 19 patients on the low dose and 24 patients on the high dose. Both dosages equally influenced survival with 15 (18%) deaths, eight on low dose and seven on high dose. After 48 weeks, functional capacity by New York Heart Association class improved more on the high dose than on the low dose (P = 0.04). In contrast, alterations in invasive haemodynamic variables at rest and exercise as well as maximal exercise capacity were comparable in both groups. Diastolic blood pressure decreased and the change between both groups was statistically significant (P = 0.01). Changes in plasma creatinine levels did not differ between high and low dose treatment and no patients had to be withdrawn because of deterioration in kidney function. With regard to neurohumoral activity, a tendency to a discrepant response to both treatments was observed with a blunted increase in noradrenaline on high versus low enalapril dose. Thus, high-dose enalapril treatment proved superior to low dose as regards symptomatology in severe heart failure after long-term treatment, despite similar effects on haemodynamics and on maximal exercise capacity.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

Acceptance of a pump-driven infusion therapy with prostaglandin E1 as a bridge to heart transplantation.

Ambulatory pump-driven intravenous infusions are a novel and - compared with hospitalization-cost-effective procedure to bridge refractory heart failure patients to cardiac transplantation. In the present study 13 patients received chronic infusions with prostaglandin E1 alone or in conjunction with catecholamines and the acceptance of this bridging therapy was investigated over a period of seven weeks. Prostaglandin E1 was uptitrated from 2.5 ng/kg/min to a maximum of 40 ng/kg/min, according to individual tolerance. 50% of the maximum tolerated dose of prostaglandin E1 was used for chronic infusion with a further dose reduction if side effects occurred. Altogether 8 patients who completed the therapy were analysed; of the remaining 5 three patients had a heart transplant, one patient died and one patient did not comply with the protocol. The drugs were administered by an automatic portable pump, which was connected to a subcutaneous tunneled catheter. During hospitalization patients and their relatives were instructed how to prepare drug solutions and to handle the infusion system. Patients' perceptions were investigated by visual analog scale questionnaires (rating scale zero to ten) before, and at weekly intervals during bridging therapy. Initial acceptance was documented as belief in therapy (9.4 +/- 1.2 SD), absence of fear of handling the pump (8.9 +/- 1.2 SD) and confidence of receiving help of close relatives (8.7 +/- 1.8 SD). During the observation period there were no statistically significant differences compared with this favorable starting position and no significant disruption of life style occurred. Pain in the joints-a prostaglandin E1-associated side effect-increased significantly (p < 0.05) at week 5, but returned to baseline levels during the following two weeks. At study end patients confirmed that they would repeat the experience (7.6 +/- 1.4 SD) and advise other patients to undergo this form of therapy (8.2 +/- 1.9 SD). Thus, this pilot study suggests that ambulatory pump-driven intravenous infusion therapy comprising prostaglandin E1 and catecholamines is acceptable to patients as a bridge to heart transplantation and that there should be no major difficulties regarding compliance.

Adult↗
PubMed1995

Sudden death and staged therapy for hemodynamic stabilization in patients enrolled in a heart transplantation program.

To investigate the impact of staged therapy for advanced heart failure on therapeutic endpoints, 236 consecutive patients (coronary artery disease/dilated cardiomyopathy in 61/175 patients, left ventricular ejection fraction 14% +/- 5%, New York Heart Association Class II/III/IV in 102/79/55 patients, respectively) with advanced heart failure were prospectively followed. One hundred thirty-seven patients enrolled from January 1989 to December 1991 were treated conventionally with digoxin, furosemide, and low dose angiotension converting enzyme (ACE) inhibition. Patients refractory to this therapy underwent urgent heart transplantation. Ninety-nine patients enrolled from January 1992 to August 1993 underwent staged therapy: stage 1: maximal tolerated ACE inhibition; stage 2: therapy with PGE1 for pre- and afterload reduction to achieve hemodynamic stabilization; or stage 3: refractory patients bridged to heart transplantation with continuous outpatient dobutamine. Sudden death was defined as death within 1 hour of symptoms if heart failure symptoms remained stable over the previous 7 days. Conventionally treated patients were followed for 10 +/- 9 months; patients who underwent staged therapy for 9 +/- 5 months. In the group of patients that underwent standard therapy, 39 of 137 (28%) patients died: 5 (13%) deaths occurred suddenly, and death due to progressive pump failure occurred in the remaining 34 (87%) patients. In the group of patients that underwent staged therapy, 25 of 99 (25%) patients died: 13 (52%) deaths occurred suddenly, and 12 (48%) deaths occurred due to progressive pump failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Alprostadil↗
PubMed1995

Incidence of pseudoaneurysm after diagnostic and therapeutic angiography.

PURPOSE: To investigate prospectively with color flow duplex (CFD) sonography the incidence of pseudoaneurysm or arteriovenous fistula (AVF) after transfemoral arterial catheterization with angiography, percutaneous transluminal angioplasty (PTA), or local lysis (LL). MATERIALS AND METHODS: CFD sonography was used to examine the puncture site in 565 consecutive patients who had undergone PTA, LL, or angiography (581 procedures). RESULTS: The incidence of pseudoaneurysm in the first 300 procedures in which standard compression was used was 14.0% overall, 27.0% after LL with antegrade-puncture PTA, 18.5% after antegrade-puncture PTA, 9.3% after retrograde-puncture PTA, and 1.2% after angiography. To decrease the high incidence, in the next 281 procedures manual compression was continued for at least 5 minutes after local bleeding had stopped. This significantly reduced the incidence to 1.1% overall, 8.0% after LL in combination with PTA, 0.9% after antegrade PTA alone, 0.9% after retrograde PTA, and 0% after angiography (P < .01). CONCLUSION: The incidence of pseudoaneurysm after transfemoral arterial catheterization depends on the type of intervention. The main risk factor is too brief a period of manual compression.

Adult↗
PubMed1995

[Dens invaginatus--its etiology, incidence and clinical characteristics (I). A review].

Dens invaginatus is a rare malformation of teeth, showing a broad spectrum of morphological variations. A genetical determination cannot be excluded. The incidence of dental invaginations cannot be determined exactly, the data from different investigations range from 0.25% to 10%. The majority of epidemiological studies present an incidence of more than 2%. Most affected are maxillary lateral incisors, bilateral occurrence is not uncommon (43%). The aetiology of dens invaginatus is still not entirely known. Most probably the invagination has its origin in a deep folding of the foramen caecum during tooth development which in some cases may even result in a second apical foramen. The invagination presents a predisposition for carious lesions, often resulting in early pulp necrosis and apical periodontitis. Endodontic therapy may present several complications due to complex morphology of the root canal system of teeth with invaginations. The paper reviews the different theories on the aetiology of dens invaginatus, classifications, incidence and clinical aspects of this malformation.

Dens in Dente↗
PubMed1994

Removal of fractured instruments using a combined automated/ultrasonic technique.

Removal of fractured instruments is one of the most difficult operative procedures in endodontics. Although a number of different devices and techniques have been developed, none are successful in all cases. An additional technique using an automated device (Canal Finder System) for bypassing and an ultrasonic device for loosening and retrieval of fractured instruments is presented. The rationale for this technique is described and illustrated by two clinical cases.

Adult↗
PubMed1994

Retreatment decision making by a group of general dental practitioners in Germany.

The aim of this study was to evaluate whether retreatment of root fillings was judged necessary or not and which kind of retreatment was preferred among a group of general dental practitioners in Germany. A questionnaire comprising 19 cases of endodontically treated teeth with different case histories and several treatment options was sent to all general practitioners in Göttingen (Germany). The cases included teeth with periapical radiolucencies, pain, apical resorption, under- and overfilling, and unfilled root canals. Results obtained from 43 questionnaires returned indicate that non-intervention or further radiographic monitoring were preferred by the majority of general practitioners in 10 of 19 cases, even in the presence of periapical pathosis. Only five cases were judged to require conservative endodontic retreatment and, in four cases, root resection. The results revealed large inter- and intraindividual discrepancies in the estimation of endodontic retreatment need.

Adult↗
PubMed1993

Comparison of root canal preparation using different automated devices and hand instrumentation.

The pre- and postinstrumentation degree of curvatures in curved mesial root canals of mandibular molars were compared after preparation with eight automated devices and hand instrumentation. The straightening of the root canal was measured before preparation and after preparation to size 25 and 35. Procedural mistakes such as loss of working length or file fractures were also recorded. Following preparation to ISO 25, only the Endoplaner and the Canal Finder system showed significantly more straightening than hand instrumentation. After preparation to ISO 35, the Endoplaner and the Intra-Endo 3-LDSY showed significantly more straightening than hand instrumentation. Mecasonic, Excalibur, and the Canal Finder system also straightened the root canal more than hand instruments, but the results did not differ significantly. The best results with only moderate straightening and few cases of loss of working length were obtained by the Endolift and Giromatic handpieces, which both were comparable to hand instrumentation.

Dental Cavity Preparation↗