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Biomedical subjects

M Pfisterer

Publications and source records attributed to M Pfisterer.

At least 199 records · Page 11Linked to original sources
PubMed1979

[Diagnosis of coronary artery disease: value and limitations of non-invasive methods. (Ecg, thallium perfusion scintigraphy, radionuclide angiography) (author's transl)].

In order to compare the three non-invasive exercise tests Ecg, Thallium myocardial perfusion imaging and radionuclide angiography in the diagnosis of coronary artery disease, the results of these tests in a consecutive series of 30 patients and 14 controls were analyzed. In all 88 symptom-limited exercise tests a significantly higher double product (heart rate x systolic blood pressure, mm Hg/min) was reached on a treadmill test (for Ecg and Thallium scintigraphy) as compared to the supine bicycle ergometer exercise (for radionuclide angiography: 243.1 +/- 61.1 vs. 215.2 +/- 46.5 x 10(2) (p less than 0.01). Considering all 132 diagnostic tests the overall sensitivity for rest/exercise Ecg was 67%, for Thallium scans 77%, for both combined 83% and for the ejection fraction response to exercise determined by radionuclide angiography 97%. If only the exercise response was considered, the corresponding sensitivity values were 60% (Ecg), 47% (Thallium scans), 70% (both tests combined) and 97% (radionuclide angiography). The specificity for coronary artery disease was determined to be 79% for Ecg, 86% for Thallium scintigraphy, 64% for Ecg/Thallium scans and 71% for radionuclide angiography. The most common reason for a false-positive result in all tests was found to be the diagnosis of cardiomyopathy, whereas most false-negative results were seen in patients with single vessel right coronary artery disease. Based on these results, the clinical implications of the three non-invasive tests in the diagnosis of coronary artery disease are discussed.

Adult↗
PubMed1978

[Diagnostic value of the myocardium-specific isoenzyme creatinephosphokinase (CK-MB)].

In 150 ambulatory and 155 hospitalized patients the normal values for creatine phosphokinase (CK) and the isoenzyme CK-MB were determined using a simple test with inhibiting antibodies. In a series of 100 consecutive patients hospitalized for chest pain, CK-MB was measured over a 72-hour period in 6- to 12-hourly intervals. The results were compared to the clinical findings, ECG, total CK and SGOT. In addition, CK-MB was determined after elective DC countershock and intramuscular injections (12 patients in each group). Normal values for CK-MB were found to be less than or equal to 10 U/1 in all patients, whereas the values for total CK turned out to be male less than 125 U/1, female less than 100 U/1 in ambulatory patients and less than 50 U/1 in hospitalized patients. In 68 of the 100 patients hospitalized for chest pain, acute myocardial infarction was found. The specificity of CK-MB in patients with transmural infarction was calculated as 100%, and the sensitivity as 97%. After DC countershock and intramuscular injections, CK was markedly elevated whereas CK-MB only rose after cardioversion. We conclude that CK-MB may be of considerable value for the differential diagnosis of elevated total CK activities of unknown origin. It is a very specific and a sensitive parameter for the diagnosis and exclusion of acute myocardial infarction.

Creatine Kinase↗
PubMed1977

[Hypersensitive carotid sinus reflex in older patients. Incidence and significance for the diagnosis of sick sinus node].

Carotid sinus massage was performed in 100 consecutive patients over the age of 50 years: 63 showed a normal reaction and sinus bradycardia occurred in 12, whereas sinus arrest was registered in 22 and total AV block in 3. With atrial pacing only 2 patients with sick sinus syndrome could be detected. Intravenous administration of atropine did not help to identify them. We conclude that in 1/4 to 1/3 of these elderly people the sinus node reacts in a hypersensitive manner to carotid sinus massage, but this does not imply the diagnosis of sick sinus syndrome.

Aged↗
PubMed1977

[Early mobilisation after myocardial infarction. A prospective and controlled study (author's transl)].

Early mobilisation after acute myocardial infarction is said to increase the risk of ventricular aneurysm and -rupture, reinfarction, sudden death, and heart failure. In order to evaluate these possible negative effects, we run a prospective and controlled study: 2 X 100 consecutive patients with acute myocardial infarction were mobilized conventionally (A) and according to an early mobilisation programme (B) respectively-the two groups were comparable according to age, sex, CHD-history, infarction transmural/non transmural and coronary prognostic index (Norris). There was a significant reduction in the average hospital stay from 31.4 days in group A to 25.8 in group B. The patients were followed up for 32 (A) and 46 days (B) respectively. In the early mobilized group we found no increased risk for heart failure, reinfarction, or sudden death. On the other side, early mobilisation has many psychological, oeconomic and social advantages for patients and hospital.

Early Ambulation↗
PubMed1976

[Exercise hemodynamics and renin before and after acute beta block in patients with essential hypertension].

Hemodynamic and renin studies at rest and during graded upright ergometry were performed in 21 patients with essential hypertension before and after propranolol. Beta-adrenergic receptor blockade reduced exercise-stimulated cardiac and renin responses significantly more when compared with the corresponding effects at rest. Propranolol increased peripheral resistance at rest but not during exercise. The degree of the individual hemodynamic changes after propranolol correlated better with the corresponding control values than with age or renin. A direct relationship between the percent reduction of heart rate and renin responses after acute beta-blockade indicates a parallel suppression of cardiac and renal receptor functions.

Adrenergic beta-Antagonists↗
PubMed1976

[Hemodynamic changes under metoprolol compared to propranolol in hypertensive patients].

The effect of the new beta-receptor-blocking drug metoprolol on hemodynamics and plasma renin activity was studied at rest and during exercise. 5 patients with essential hypertension were investigated before, 4 weeks after and 8 weeks after oral treatment (3 X 50 mg day). The results were compared to data of 5 patients under propranolol matched according to age, arterial blood pressure, and renin concentration. Metoprolol leads to a significant fall in renin and heart rate, whereas cardiac index is depressed only during exercise. Peripheral resistance remains unchanged and left ventricular filling pressure rises slightly. This results in a slight fall in arterial blood pressure. In comparison with propranolol the hemodynamic and renin patterns under metoprolol are similar, the only difference being the slighter fall in blood pressure due to a less depressed cardiac index.

Adult↗
PubMed1976

Haemodynamic responses to exercise and acute beta-receptor blockade in renin sub-types of essential hypertension.

1. Haemodynamic and renin responses to dynamic exercise before and after intravenous beta-adrenoreceptor blockade with propranolol were compared in twenty-one patients with essential hypertension and either high (n = 7), normal (n = 7) or low plasma renin activity (n = 7). 2. Renin and heart-rate responses to exercise and beta-receptor blockade diminished from high-renin to normal and to low-renin patients, effects which were blunted with increasing age. 3. Among the renin groups cardiac output, stroke volume, diastolic pulmonary artery pressure, systemic pressure and peripheral vascular resistance as well as their changes produced by exercise and acute beta-receptor blockade were not significantly different. 4. Long-term anti-hypertensive propranolol effects correlated with pre-treatment renin status, renin stimulation and its suppression by acute beta-receptor blockade as well as with the exercise tachycardia and the patient's age. 5. The results suggest different adrenergic control mechanisms in renin sub-types of essential hypertension, age being a modulating factor.

Adult↗
PubMed1975

[Epidemiology and clinical aspects of infectious endocarditis].

There has been a change in the epidemiological, etiological and clinical pattern of infective endocarditis. This changing pattern has been substantiated by comparison of 156 cases of infective endocarditis seen over the period 1947-1957 (period I) and 227 cases treated during the period 1961-1974 (period II). Epidemiologically the pathomorphosis consists in a slight decline in "medical" cases, contrasted with a marked increase of--predominantly acute--cases after cardiac surgery. Etiologically the change is characterized mainly by a reduction of streptococci (61%/33%) and a much higher incidence of virulent organisms, especially staphylococci (3%/21%), as the infective agent. With regard to the clinical picture of infective endocarditis, the changing pattern is apparent in an increase in atypical and misleading features and an often oligosymptomatic presentation. In period II the classical signs were more often absent. The difference in the course of infective endocarditis consists in a higher hospital mortality during period II. In this period the main cause of death was refractory heart failure, often provoked by acute rupture of the aortic valve. The factors which may be responsible for this change and the clinical implications are discussed. The difficulties in early diagnosis and the role of misleading symptoms of this still "malignant" disease are outlined. Special interest is focused on the diagnostic problems involved in recognizing acute endocarditis, right-heart endocarditis and acute rupture of the aortic valve.

Adult↗
PubMed1975

Antihypertensive beta blocking action as related to renin and age: a pharmacologic tool to identify pathogenetic mechanisms in essential hypertension.

Three hundred fifteen patients with essential hypertension were classified according to low (18 percent), normal (59 percent) or high (23 percent) renin-sodium index. The proportion of patients with low renin hypertension progressively increased with increasing age and blood pressure, there being no difference between the sexes. Two high renin groups emerged: a younger group with early moderate hypertension, and an older group with severe hypertension consequent to possibly ischemic renal disease. Long-term beta blocking monotherapy in 137 patients resulted in a reduction of idastolic pressure to 95 mm Hg or less in 65 percent: 85 percent in those with high and 73 percent in those with normal renin activity; pressure was reduced to this level in only 1 of 24 patients (4 percent) with a low renin index. Antihypertensive efficacy was also related to age, since diastolic pressure was normalized in 80 percent of patients under age 40 years, in 50 percent of those aged 40 to 60 years, but in only 20 percent of those over age 60 years. Age may heolp in patient selection but is no substitute for the more reliable renin index, especially in patients over age 40 years, or with high pressure. Using studiew with propranolol as a standard, similar renin responses were obtained with two cardioselective beta1 type blocking drugs, atenolol and metoprolol, as well as with two nonselective beta2+1 receptor antagonists, LL21945 exhibiting prolonged receptor affinity and oxprenolol in slow release form. These long-acting drugs, which proved effective in single daily doses, could be of value in improving patient compliance...

Adrenergic beta-Antagonists↗
PubMed1975

[Test for the determination of physical fitness 3 weeks after myocardial infarction].

In a consecutive group of 125 patients three weeks after myocardial infarction an ergometer bicycle test was performed in order to obtain an objective assesment of the physical fitness. The patients were exercised on 3 different workloads during a total time of six minutes. It was attempted to reach the training heart rate which was calculated from the resting heart rate plus 60% of the maximum increase, the maximal heart rate being "215-age in years". The Physical Work Capacity (PWC) was compared with the fitness of on age correlated control group. We could show that the PWC at hospital discharge, i.e. 3 weeks after myocardial infarction, was 79.6 +/- 23% of the normal value. Three weeks later it had improved by another 9%. A positive correlation with the CPJ of Norris and with the degree of physical activity prior to the acute illness could be demonstrated.

Adult↗
PubMedDate not supplied

Influence of dietary (n-3)-polyunsaturated fatty acids on leukotriene B4 and prostaglandin E2 synthesis and course of experimental tuberculosis in guinea pigs.

In the present study eicosanoid synthesis was studied in macrophages of guinea pigs fed different amounts of (n-6)- and (n-3)-polyunsaturated fatty acids (PUFA). Three groups of weanling guinea pigs were fed by isocaloric diets differing only in their contents of PUFA: controls with 2.8 Cal% of linoleic acid (LA; 18:2(n-6)); (n-6)-rich fed animals with 15.4 Cal% of LA; and (n-3)-rich fed animals with 10.1 Cal% of LA, 1.4 Cal% of eicosapentaenoic acid (20:5(n-3)) and docosahexaenoic acid (22:6(n-3)). After 13 weeks half the number of animals from each group was infected i.m. by 180 colony forming units of Mycobacterium tuberculosis strain H37Rv. Seven weeks after infection the release of leukotriene (LT)B4 and prostaglandin (PG)E2 was quantified in calcium ionophore stimulated whole blood, peritoneal macrophage cultures and alveolar macrophages by immunoassays after high performance liquid chromatography. Synthesis of LTB4 and PGE2 was found to be reduced in (n-3)-rich fed guinea pigs (p < 0.05), and equivalent between controls and (n-6)-rich fed animals. Controls and (n-6)-rich fed animals showed the same mycobacterial counts in the spleen whereas (n-3)-rich fed guinea pigs demonstrated an increased number of mycobacteria (p < 0.05). Our results demonstrate that an increased dietary intake of (n-3)-PUFA suppress LTB4 and PGE2 synthesis. The increased number of M. tuberculosis found in the spleens of (n-3)-rich fed animals could represent persistence of the experimental infection. It may be speculated that a functional relationship exists between the two findings.

Animals↗
PubMedDate not supplied

Acute hemodynamic effects of bufuralol: a beta-adrenoceptor blocking drug with vasodilatory effects.

Simultaneous hemodynamic and equilibrium radionuclide function measurements were performed at rest and during exercise before and 75 min after oral administration of 30 mg bufuralol, a nonselective beta-adrenoceptor blocking drug, in 10 patients with stable angina pectoris. Acute beta-blockade with bufuralol resulted in a reduction of exercise-stimulated heart rate, Systolic blood pressure, and cardiac index. There was, however, also a fall in diastolic blood pressure and end-diastolic volume index, and an improved global left ventricular ejection fraction, without a change in total vascular resistance, suggesting an acute vasodilator effect. regional analysis revealed that this beneficial effect was particularly present in ischemic segments of the left ventricular wall where regional function increased. Thus, bufuralol is a beta-adrenoceptor blocking agent with additional peripheral vasodilating properties.

Adrenergic beta-Antagonists↗