Biomedical subjects
Publications and source records attributed to M Welsch.
A 83-year-old patient had been treated for pityriasis rubra pilaris with 70 mg etretinate daily. He developed acute renal impairment, with creatinine levels reaching 73 mg/l on day 7. After discontinuation of etretinate, all biological changes were reversible. Although renal impairment is not considered as retinoid side effect, the chronology of renal changes is very suggestive of etretinate responsibility.
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A randomised, double-blind, double-placebo trial compared the efficacy and safety/acceptability of sustained release verapamil and of captopril in two parallel groups of patients with mild to moderate hypertension. After a 2 week placebo period, 45 patients were randomised into 2 groups, the 1st group (n = 22) given sustained release verapamil (240 mg/24 h) as a single morning dose and the second (n = 23) captopril 25 (50 mg/24 h) as two daily divided doses. Treatment was given for 75 days, with the possibility of a combination of sustained release verapamil + captopril from day 45 onwards if diastolic blood pressure remained at 95 mmHg or more. After 45 days of treatment, the reduction in supine diastolic blood pressure did not differ significantly in the 2 groups (-10.4 mmHg in the sustained release verapamil group and -9.7 mmHg in the captopril), with 68.2 per cent responders to sustained release verapamil and 52.2 per cent in the captopril group. After 75 days of treatment, once again there was no significant difference in efficacy between the two groups: -14 mmHg for diastolic pressure and 80 per cent responders in patients treated with sustained release verapamil, -11.3 mmHg and 62.5 per cent responders in the captopril group. The percentage of responders was 58.3 per cent in the group treated with the combination of sustained release verapamil + captopril from day 45 onwards. The number of patients showing evidence of clinical or electrocardiographic adverse reactions was not significantly different: 20.7 per cent in the sustained release verapamil group and 34.8 per cent in the captopril group.(ABSTRACT TRUNCATED AT 250 WORDS)
In private practice mild or moderate arterial hypertension is controlled primarily to prevent the development of a severe, organ-damaging hypertensive disease. The general practitioner's approach to management proceeds in 3 steps. 1) He must decide to initiate a treatment after obtaining sufficient evidence that the hypertension is permanent and after starting to correct the associated risk factors. 2) He must select a single-drug initial treatment among the four families of antihypertensive medications, viz.: diuretics, beta-blockers, angiotensin-converting enzyme inhibitors and calcium antagonists. The selection is based on the information available concerning the benefit/risk ratio of the preferred drug, its interactions with the pathologies that are often associated with hypertension, and its acceptability. Finding for each patient the optimal dosage with maximum effectiveness and minimum undesirable side-effects is of prime importance. 3) If this initial treatment fails, the practitioner must first make sure that his prescription was optimal in dosage and compliance. If this was the case, he must make a choice between another single-drug therapy and a combination therapy, using by preference two synergistic drugs in low doses.
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The effects of scopolamine, an anticholinergic drug, of trimipramine, a tricyclic antidepressant with both anticholinergic and sedative properties, of diazepam and a placebo, on explicit memory and repetition priming were assessed using a free-recall task and a word-stem completion task. Forty-eight healthy volunteers took part in this double-blind study. Diazepam provoked a dissociation between free recall, which was profoundly impaired, and word completion, which was spared. No significant changes in memory performances were observed in the scopolamine group; however, a significant correlation between explicit and implicit memory performances was observed in this group. At the low dose used, the effects of trimipramine on memory were mild. The results suggest that the cholinergic system is involved in the priming effect.
In the present study, we investigated the protective effect of nimodipine against postischemic neuronal damage in the rat and considered the question of whether this histologic finding coincides with an improvement of cerebral circulation. Male Wistar rats were subjected to 10 minutes of forebrain ischemia by clamping both common carotid arteries and lowering blood pressure to 40 mm Hg. Histologic evaluation was performed 7 days after ischemia. Local cerebral blood flow was determined with the 14C-iodoantipyrine technique in anatomically defined areas of the brain, including hippocampus. Preischemic application of nimodipine (3.0 mg/kg p.o.) significantly reduced the percentage of damaged neurons in hippocampal CA1 subfield from 78 +/- 4% in controls to 59 +/- 6% in treated rats (mean +/- SEM; p less than 0.05, Mann-Whitney U test). After 10, 60, and 180 minutes of recirculation no differences in local cerebral blood flow between control and drug-treated animals were observed. Our results demonstrate that nimodipine reduces ischemia-induced neuronal damage in rat hippocampus. We did not consider increased cerebral blood flow in the hypoperfusion state in the applied experimental design since improvement of cerebral blood flow seems to bear little relation to the neuroprotective activity of nimodipine.
The hypothesis has been tested that an unusual maternal acetylator phenotype can predispose to congenital malformations in the fetus. The acetylator phenotype of normal caucasian control women and of mothers of malformed children was established by measuring urinary sulphadimidine and its acetylated metabolite. A further control group was the fathers of the malformed newborn. The malformations studied were facial-cleft, spina-bifida and congenital heart disease. The acetylator phenotype was shown not be modified by pregnancy. 49 of 100 (49%) control women were rapid acetylators. Amongst the 108 mothers of malformed babies, 56 (52.8%) were slow acetylators and 52 (47.2%) were fast acetylators, 42 out of 83 (50.5%) of the fathers of malformed were slow acetylators and 41 (49.5%) were fast acetylators. Thus, the acetylator phenotype of the mothers of malformed children is no different from the acetylator phenotype of controls.
Ways of improving sensitivity of the radioreceptor assay to determine the plasma levels of dihydropyridine calcium antagonists were investigated. Extraction of the drug from plasma with organic solvent was found to enhance the sensitivity of the assay (method 1). Alternatively, the inhibitory effect observed when plasma is added directly to the binding assay can be counteracted by increasing the amount of membranes in the assay (method 2). Plasma levels after single oral doses of nitrendipine and nicardipine were followed with method 1. Plasma levels of isradipine were measured with methods 1 and 2 and by mass fragmentography. The data confirm that nitrendipine plasma level kinetics vary widely from patient to patient, whereas for nicardipine the drug level profile is more homogeneous. The similarity of the data obtained from the radioreceptor assay and from mass fragmentography suggests the absence of any active metabolite of isradipine.
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Fever, anemia, pulmonary infiltrates and weight loss occurred in a 47-year-old man four weeks after a gastric operation. On echocardiography and cardiac catheterization an atrial myxoma was revealed. In removing the myxoma the tricuspid valve apparatus was destroyed, requiring insertion of a bio-prosthetic valve (Hancock). Signs of infection persisted post-operatively, together with complete A-V block and panuveitis. The Candida IGM titer was markedly increased and histological examination of the thrombus revealed massive fungal infection. Recurrent fever and massive vegetation on the prosthetic valve necessitated removal of the prosthetic valve under antimycotic treatment, which also cleared the pulmonary lesions. The patient's general condition improved. Right-heart failure was controllable by drugs.
Two groups of patients with either psychophysiologic disorders or organic diseases were examined four weeks prior to an in-patient rehabilitation treatment, at the beginning and at the end of the rehabilitation, and six months thereafter. Data were collected through questionnaires assessing personality dimensions, physical complaints, hypochondriac behaviour, mood, disease concepts, living habits, and socio-economic as well as medical data. The groups were comparable according to a wealth of socio-economic and medical data but differed in extraversion, emotional lability, physical complaints, mood, disease concepts, and performance during ergometric exercise. Even before treatment there were changes in some variables between the examination at home and the examination at the onset of the treatment. Many short-term and long-term positive treatment effects could be observed but some adverse trends also emerged. Changes in personality dimensions, mood, and disease concepts revealed differential trends for both groups. The results are discussed in the context of the illness behaviour concept.
At the beginning and at the end of inpatient cardiac rehabilitation, 105 male cardiac patients were examined with a newly designed questionnaire for life satisfaction assessment (Fragebogen zur Lebenszufriedenheit-FLZ). Data collection moreover included the Freiburg Personality Inventory, the Freiburg Somatic Complaints Lists, an adjective list assessing current mood, questionnaires on anamnestic data, treatment expectancies and life habits, as well as medical data. Significant correlations found between the FLZ and subjective or objective criteria of rehabilitation outcome indicate the importance of life satisfaction, with more content patients showing better outcomes. No mean value differences were found in respect of medical data, less content patients, however, reported more previous hospital stays and rehabilitation treatments. Also, there is a tendency for physician to discharge these patients as "unfit for work". 83 of these 105 patients participated in the follow-up study twelve months later. Life satisfaction is now lower, somatic complaints and emotional lability have increased. 90 percent of the patients with high life satisfaction, but only 66 percent of those with low life satisfaction, are back at work on follow-up. Fitness for work at follow-up, though primarily related to the rating given at the end of inpatient cardiac rehabilitation, is influenced to a high degree by non-medical factors. The results obtained underline the significance of patient illness behaviour, and point to a need for further improving individual psychological counseling during cardiac rehabilitation.
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From 1962 to 1984, 2460 prosthetic valve implantations in the heart were performed at the Department of Surgery of the University of Heidelberg. In addition to 2291 primary surgical interventions, 169 re-interventions were carried out. 153 emergency operations were necessary. The frequency rate of operations increased continuously; 52% of the operations were performed at the aortic valve and 37% at the mitral valve. In 9% of the cases, two valves had to be replaced, and in 2% even three valve prostheses were implanted. The indications for re-intervention included prosthetic thromboses, paravalvular leakages and prosthetic valve endocarditis. The situations requiring emergency intervention differed from case to case. Early mortality, which had been initially high, could be considerably reduced due to increased experience in surgical technique, anaesthesia, intensive care and improved myocardial protection. The extent and quality of medical postoperative care will determine the success of medical rehabilitation and hence the future professional activity of the patient.
Embolization of pacemaker electrode fragments into the pulmonary circulation is a rare complication following transvenous pacemaker implantation. One such case is reported here. In a 67-year-old patient, a battery pocket infection developed after transvenous pacemaker implantation and subsequent surgical revision. After removal of the pacemaker and ventricular pacing lead, the atrial lead broke within the superior vena cava when prolonged traction was applied after frustrating attempts to extract the electrode. Attempts to extract the fragment transvenously using endoscopic forceps were unsuccessful. Due to firm fixation of the electrode by extensive fibrous scar tissue in the atrial wall, a further attempt to remove the retained electrode fragment by atriotomy also failed. On the first postoperative day, the fragment migrated to the left pulmonary artery, from where it was successfully extracted by means of a Dormier basket.
In a prospective, randomized study of 20 patients undergoing elective open-heart surgery, up to c. one-third of the total intraoperative and postoperative transfusion requirement could be provided by autologous centrifuged blood. Retransfusion of washed, packed red blood cells freed from cellular debris, heparin and activated clotting factors significantly reduced blood loss during and after surgery. The cell separator is a valuable aid in autotransfusion technique.