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Biomedical subjects

M Pichler

Publications and source records attributed to M Pichler.

At least 55 records · Page 3Linked to original sources
PubMed1985

Tracer elimination in I-123-heptadecanoic acid: half-life, component ratio and circumferential washout profiles in patients with cardiac disease.

Sixty patients with different cardiac diseases and healthy volunteers were given omega-I-123-heptadecanoic acid (HDA) intravenously. Tracer kinetics were followed for 90 min, and tracer elimination curves were obtained regionally. In addition, circumferential washout profiles were evaluated for 26 patients and interpolative as well as constant background subtraction was performed for comparison in selected patients. Rest and stress radionuclide ventriculography allowed formation of a group with normal ventricular function (control group); the remaining patients had an abnormal ventricular function at rest or under stress. Regions of patients in the control group were significantly different (P less than 0.005) from regions of patients with CHD or CMP with regard to the initial half-life or the component ratio between a fast and a slow component (Ca/Cb). Regions of patients after MI without exercise-induced angina did not differ strikingly from control regions. Circumferential washout analysis showed homogeneous tracer kinetics in healthy subjects, bus some individuals showed increasing regional activity, mainly by late activity uptake of the stomach. Dynamic heart scintigraphy with HDA is an additional nuclear cardiologic tool that makes possible the classification of patients with myocardial disease and abnormal ventricular function already under resting conditions. Initial half-life allows reasonable discrimination between different severely diseased patient groups; expansion of acquisition time to 90 min refines biexponential tracer analysis which, by means of an altered component ratio Ca/Cb, may allow better clinical judgement of the individual patient. Circumferential washout analysis and interpolative background correction lead to a better specificity of examination.

Adult↗
PubMed1984

Scintigraphic left ventricular function during exercise in elderly patients with coronary artery disease.

Left ventricular performance at rest and during supine symptom-limited exercise was determined by radionuclide ventriculography (RNV) in 65 subjects of the age of 65 years or older. Eleven subjects had no evidence of coronary artery disease (CAD) by history or submaximal stress ECG. In this control group left ventricular ejection fraction (LV-EF) increased from 0.62 +/- 0.09 (mean +/- SD) to 0.69 +/- 0.08 with a further increase in regional wall motion. There were 10 patients with a history of hypertension or atypical angina without infarction. Left ventricular ejection fraction (LVEF) at rest was 0.65 +/- 0.11 and showed no significant increase during exercise (mean exercise tolerance: 73 +/- 33W). Nineteen patients had an anterior infarction. LVEF at rest was 0.44 +/- 0.16 and as a group showed no change during exercise (mean exercise tolerance: 70 +/- 23W). Only two of 19 patients showed an increase of LVEF greater than 0.10. There were 19 patients with inferior infarction. LVEF at rest was 0.49 +/- 0.08 and showed also no significant change during exercise (mean exercise tolerance: 80 +/- 25W). Four of 19 patients showed an increase of LVEF in response to exercise. The five patients with two or more infarctions showed a markedly decreased resting LVEF of 0.28 +/- 0.11 with a further decline (0.22 +/- 0.09) during exercise (mean exercise tolerance: 45 +/- 32W). Therefore, age by itself does not significantly impair left ventricular ejection fraction at rest and during exercise. RNV appears as a valuable method in evaluating left ventricular performance of older patients with a similar response to exercise as in younger persons without or with comparable disease.

Aged↗
PubMed1983

[Effect of nifedipine on hemodynamics in precapillary pulmonary hypertension at rest and during exertion].

The effect of sublingual nifedipine (20 mg) on haemodynamics at rest and during bicycle ergometry in supine position was assessed in 22 patients with precapillary pulmonary hypertension (obstructive form: n = 17, restrictive form: n = 2, combined obstructive-restrictive: n = 3). At rest nifedipine resulted in an increase of cardiac frequency from 85 to 89/min, during exercise from 109 to 120/min (P less than 0.05). Concomitantly the mean arterial blood pressure decreased significantly both at rest and during exercise. The mean pulmonary arterial pressure showed significant reduction from 42.9 to 36.2 mm Hg (P less than 0.0005) only during exercise. The total body vascular resistance at rest decreased by 21% (P less than 0.005), during exercise by 15% (P less than 0.1). Pulmonary arteriolar resistance at rest decreased by 9%, during maximum loading by 34% from 312 to 215 dyn X s X cm-5 (P less than 0.05). Nifedipine was shown to be a suitable agent for lowering right ventricular afterload in secondary pulmonary hypertension due to chronic lung disease. The beneficial effect at rest depends on the extent of the pulmonary arteriolar resistance and the mean pulmonary arterial pressure. However, during exercise conditions it can be observed in the majority of patients (93%). Due to the variable response haemodynamic assessment is required prior to routine use in order to establish patients with optimal response.

Adult↗
PubMed1983

Effects of nitroprusside-induced reduction of elevated preload and afterload on global and regional ventricular function in acute myocardial infarction.

To evaluate the effects of nitroprusside infusion on left and right ventricular ejection fractions and left ventricular regional wall motion, radionuclide ventriculography with simultaneous hemodynamic assessment was performed before and during nitroprusside infusion in 20 patients with acute myocardial infarction complicated by left ventricular failure and/or systemic arterial hypertension. Nitroprusside produced significant reductions in pulmonary capillary wedge pressure (21 +/- 6 to 13 +/- 5 mm Hg; -38%; p less than 0.001), mean arterial pressure (107 +/- 19 to 90 +/- 13 mm Hg; -15.9%; p less than 0.001), left ventricular end-diastolic volume index (84 +/- 28 to 75 +/- 23 ml/m2; -10.7%; p less than 0.001), and right ventricular end-diastolic volume index (77 +/- 30 to 67 +/- 27 ml/m2; -13.0% p less than 0.007), and significant increases in left ventricular ejection fraction (0.32 +/- 0.12 to 0.37 +/- 0.13; +15.6%; p less than 0.0001), right ventricular ejection fraction (0.37 +/- 0.11 to 0.45 +/- 0.14; +21.6%; p less than 0.001), and stroke volume index (25 +/- 7 to 27 +/- 7 ml/beat m2; +8.0%; p less than 0.03). These beneficial changes in global ventricular performance were accompanied by no change in the regional contractile function of 90% of the abnormally contracting infarct-related left ventricular segments and improved regional wall motion of 34% of noninfarcted but abnormally contracting left ventricular segments. We conclude that nitroprusside-induced reduction of elevated preload and afterload in acute myocardial infarction results in salutary effects on global ventricular function and improved regional function of noninfarcted left ventricular segments but with less prominent effects on regional function of infarcted segments.

Adult↗
PubMed1983

Wall motion abnormalities and electrocardiographic changes in acute transmural myocardial infarction: implications of reciprocal ST segment depression.

Left ventricular ejection fraction and regional wall motion were assessed by multigated equilibrium radionuclide ventriculography within 24 hours of onset of first acute transmural myocardial infarction (MI) in 32 patients. Abnormal left ventricular wall motion was noted in all 16 patients with anterior infarction and in 14 of 16 (87.5%) patients with inferior infarction. Regional wall motion abnormalities frequently included areas adjacent to and remote from those predicted by the ECG location of ST elevation and pathologic Q waves. Such remote wall motion abnormalities were associated with reciprocal ST segment depression in 17 of 18 (94%) patients, and conversely reciprocal ST segment depressions were associated with remote wall motion abnormalities in 17 of 24 (71%) patients. The left ventricular ejection fraction was lower in patients with a reciprocal ST segment depression compared to those without (anterior MI 0.29 +/- 0.07 vs 0.43 +/- 0.08, p less than 0.01; inferior MI 0.45 +/- 0.11 vs 0.63 +/- 0.06, p less than 0.001). In addition, the peak MB-CK levels were higher in patients with compared to those without reciprocal ST segment depression (anterior MI 268 +/- 183 vs 102 +/- 60, p less than 0.05; inferior MI 186 +/- 120 vs 67 +/- 20, p less than 0.05). Thirteen of 18 (72%) patients with reciprocal ST segment depression compared to 4 of 13 (31%) patients without reciprocal ST segment depression had a complicated clinical course during their hospital stay. These observation suggest that global left ventricular dysfunction in first acute transmural MI is greater when reciprocal ST segment depression is present on the 12-lead ECG.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Plasma concentration of cutaneously applied trinitroglycerin.

The absorption of trinitroglycerin ointment was studied on ten test persons over a 12-h period. The first plasma concentrations above the minimally detectable levels were found from the 10th min on. A first peak of absorption is measureable at 30 min. The inter- and intraindividual variations in the degree of absorption are most probably due to variability of absorption and various bioavailability. The absorption process can be substantiated during the entire time in which the ointment daub is in place. Typical trinitroglycerin effects such as reduction of blood pressure, elevation of heart rate, and increase in headaches were observed in healthy volunteers.

Administration, Topical↗
PubMed1982

Radionuclide assessment of sequential changes in left and right ventricular function following first acute transmural myocardial infarction.

The purpose of this study was to define the sequential changes in left and right ventricular ejection fraction (LVEF, RVEF) and regional LV wall motion following first transmural acute myocardial infarction (AMI). Fifty-four patients with either anterior (n = 28) or inferior (n = 26) infarction underwent radionuclide ventriculography (RNV) within 48 hours of onset of chest pain (study 1), between days 3 and 6 (study 2), and again between days 7 and 25 (study 3). Twenty-six of the patients with anterior MI (93%) had initial LVEF less than 0.54, compared with 13 of 26 patients (50%) with inferior MI (p less than 0.01). Eleven of 26 patients (42.3%) with inferior MI had initial RVEF less than 0.39, compared with 8 of 27 patients (29.6%) with anterior MI (p less than 0.01). There were no overall significant serial changes in mean LVEF or mean RVEF in patients with either anterior or inferior MI. From study 1 to study 2, LVEF did not change in 24 patients (44%), improved in 13 (24%), and worsened in 17 (31%). From study 1 to study 3, LVEF remained unchanged in 15 patients (35%), improved in 17 (39%), and worsened in 11 (26%). From study 1 to study 2, RVEF did not change in 25 of 51 patients (49%), improved in 17 (31%), and worsened in 9 (17%). From study 1 to study 3, RVEF remained unchanged in 14 (38%), improved in 18 (48%), and worsened in five (14%). Changes in EF tended to occur early in the hospital course, with little subsequent changes. Serial changes in EF could not be predicted by clinical or demographic variables or by location of infarction. Significant changes in LVEF typically occurred without concurrent change in regional LV wall motion, suggesting alteration in ventricular loading rather than change in intrinsic myocardial performance. Initial depression of LVEF correlated with in-hospital mortality as well as with development of congestive heart failure and conduction defects. However, sequential changes in LVEF did not correlate with short-term prognosis. We conclude that sequential changes in LVEF and RVEF occur frequently following AMI, appear to reflect ventricular loading conditions rather than intrinsic change in myocardial performance, and do not correlate well with short-term prognosis.

Adult↗
PubMed1981

[Hypernatraemic hyperosmolar syndrome (author's transl)].

Between 1972 and 1979 34 patients with severe hypernatraemia (serum sodium larger than or equal to 160 mmol/l) were admitted to the intensive care unit. Among these there were 45% of neuropsychiatric patients with reduced consciousness. Maximal serum sodium concentration was 168 (160--204) mmol/l, maximum serum osmolality 391 (340--520) mosm/kg H2O. Treatment consisted of infusion of hypotonic solutions and potassium substitution. Fluid balance was positive (5,9 during 43 hours) until normal serum sodium concentrations had been reached. The mortality of 77% was exclusively due to the underlying diseases.

Adolescent↗
PubMed1981

[Acute leukemia associated with lactic acidosis].

The clinical course and metabolic disturbances in three patients with acute leukemia and severe lactic acidosis (lactic acid concentrations 11.2, 17.0 and 21.0 mmol/l) are described. Circulatory failure could be ruled out as a possible cause of elevated lactic acid. Clinical findings included somnolence, hyperventilation and diffuse abdominal pain. In patients with malignant disease, a number of factors may contribute to elevated lactic acid levels. However, in our cases the excessive lactic acidosis was due to increased production of lactic acid by the leukemic cells, together with impaired hepatic metabolization. The diminished hepatic gluconeogenesis is also documented by a severe hypoglycemia in our patients. The essential step in treatment is early diagnosis of this syndrome and prompt initiation of cytotoxic medication.

Acidosis↗
PubMed1981

[Infection in patients with hepatic coma (author's transl)].

66 patients with hepatic coma were treated from 1972 to 1979 in the intensive care unit. Incidence and etiology of bacterial infections in these patients were evaluated retrospectively. Bacterial cultures were positive in a high proportion of the cases investigated as compared to the situation on a normal ward. Bacterial cultures were performed in 51 patients (77.3%); cultures from 35 patients were positive. Gramnegative bacteria accounted for 56.4%, grampositive bacteria for 34.8% and candida albicans for 8.8% of all the cases. It is pointed out, that invasive diagnostic and therapeutic manoeuvers in intensive care patients carry a high risk of infection.

Adolescent↗
PubMed1980

[Haemodynamic effects after application of nitroglycerin sublingually or as ointment in patients with left ventricular heart failure (author's transl)].

The haemodynamic effects of a 2% nitroglycerin ointment and of sublingual nitroglycerin in patients with left ventricular heart failure were investigated. The well-known pulmonary blood pressure and pulmonary wedge-pressure lowering effect were observed with both forms of administration. Differences exist between onset and duration of the haemodynamic effects. With sublingual administration of nitroglycerin the peak effect was seen after 5 minutes, whilst the pulmonary blood pressure rose again 30 minutes later. After application of nitroglycerin ointment a peak effect was seen 30 minutes later and the effects were sustained for 3 to 6 hours.

Administration, Oral↗
PubMed1980

Analysis of cardiac kinetics: use of a new photo-optic technique.

The photokymograph (PKG) is a new noninvasive instrument that can record segmental myocardial wall motion from self-illuminated images such as are produce; by fluoroscopy, cine ventriculography, two-dimensional sonography, and 99mTc scintigraphy. The PKG can be calibrated to provide amplitude of myocardial tissue motion. The recordings of segmental wall motion obtained closely resemble those recorded by established techniques, both during control state and during ischemic episodes. Regression analysis was performed to compare PKG recordings with frame by frame analysis of left ventriculograms (0.98) and with M-mode echo derived from two-dimensional images (r = 0.97). The PKG has some distinct advantages over existing techniques used to analyze segmental wall motion: it is inexpensive, usable simultaneously over multiple areas, analyzes individual beats, and is not restricted to any particular myocardial wall or any particular angle of motion.

Echocardiography↗