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Biomedical subjects

P Hanrath

Publications and source records attributed to P Hanrath.

At least 19 recordsLinked to original sources
PubMed1992

[Metal endoprostheses for endoscopic therapy in malignant bronchial tumors].

Self-expanding metal stents were implanted in the trachea or main bronchus in 12 patients (eleven men, one woman; mean age 60 +/- 8 years) with nonresectable bronchial carcinoma (n = 11) or tracheal metastasis of a hypernephroma (n = 1). They all had pulmonary complications caused by tumour stenoses (group I: severe dyspnoea [n = 6], group II: retention pneumonia [n = 4] or lung abscess [n = 2] after unsuccessful antibiotic treatment). The procedure was undertaken after local anaesthesia with a flexible bronchoscope (in the first three cases still with a rigid bronchoscope under general anaesthesia) under fluoroscopic control. Immediate reduction in dyspnoea occurred in five of the six patients in group I. In five of the six patients in group II antibiotics cured the infection after stent placement. The therapeutic effect was immediate in severe dyspnoea and retention of secretions. The clinical improvement lasted longer in patients with abscess and retention pneumonia than those with dyspnoea (41 +/- 16 vs. 26 +/- 10 days). If strict indications are observed in cases with malignant bronchial stenosis, implantation of self-expanding stents provides rapidly effective, well-tolerated palliation.

Aged↗
PubMed1992

[Physical exercise tolerance in chronic obstructive emphysematous bronchitis and coronary heart disease under antiobstructive therapy].

19 consecutive patients (18 men, one woman, mean age 61.4 [49-73]years) with chronic obstructive airways disease (bronchitis and emphysema) together with angiographically confirmed coronary heart disease were studied to investigate their cardiopulmonary exercise tolerance and the effects of bronchodilators on their myocardial ischaemia. Because they were receiving drug therapy for angina or because they had previously undergone aortocoronary bypass operation or balloon dilatation, the patients were symptom-free. In three cases slight ischaemia was demonstrable during maximal exertion. Aerobic and anaerobic exercise capacity was determined by spiroergometry after inhalation of salbutamol (S, 0.2 mg) alone or in combination with oxitropium bromide (O, 0.2 mg). The supplementary effect of oral theophylline (T, 15 mg/kg.day) was studied in 13 patients. In terms of maximal aerobic exercise tolerance the following improvements were noted: energy output (watts): S: + 6.3%; S and O: + 12.3% (P < 0.05); S, O and T: + 14.0% (P < 0.01). Oxygen uptake (ml/min): S: + 8.2% (P < 0.05); S and O: + 18.2% (P < 0.01); S, O and T: + 35.4% (P < 0.01). Maximum exercise capacity was not significantly improved, although maximum oxygen uptake was significantly increased by the two-drug combination by 16.9% (P < 0.05) and by the three-drug combination by 19.2% (P < 0.05). Maximum minute volume and tidal volume rose significantly, though respiratory rate was unchanged. Heart rate and blood pressure remained practically unaffected by the treatment, both at rest and during exertion. There was no evidence of significant aggravation of ventricular arrhythmias or of ischaemia during ergometric testing.

Albuterol↗
PubMed1992

Intravascular ultrasound to assess aortocoronary venous bypass grafts in vivo.

In 20 consecutive patients (18 men and 2 women, aged 42 to 72 years) undergoing repeat coronary angiography because of new onset of angina pectoris 4 months to 11 years (mean 53 months) after aortocoronary saphenous venous bypass operation, the graft to the left anterior descending (n = 12), left circumflex (n = 4) or right coronary (n = 2) artery, or a diagonal branch (n = 2) was studied by both intravascular ultrasound and angiography. Sonographic images were obtained using a 4.8Fr catheter with a crystal mechanically rotated at 900 rpm; quantitative coronary angiograms were recorded in biplane projections. In 18 patients, qualitatively as well as quantitatively evaluable images could be recorded; no complications occurred. The venous wall in general appeared to be homogenous; there were no separate layers identifiable. Simultaneous ultrasound and angiographic measurements were performed at a total of 75 sites (2 to 6 per bypass). In 4 of these patients (10 of 75 sites), neither intravascular ultrasound nor angiography revealed any pathologic changes; these bypasses were classified as normal. At the remaining 65 sites, arteriosclerotic lesions were detected in each case by ultrasound, but at only 33 sites by angiography. Median wall thickness was 0.59 mm (95% confidence interval 0.54 to 0.63) in normal grafts and 1.02 mm (0.99 to 1.07; p less than 0.001) in diseased grafts. The cross-sectional luminal area determined by ultrasound correlated well with the angiographic assessment (r = 0.90; p less than 0.001), but the measured values were significantly higher (17 +/- 4 vs 14 +/- 4 mm2; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Diagnostic value of transesophageal echocardiography in atrial septal aneurysm.

Transthoracic and transesophageal echocardiography was performed in 40 consecutive adult patients with an atrial septal aneurysm. In 11 (27%) of 40 patients transthoracic echocardiography failed to demonstrate the lesion and the diagnosis was established by the transesophageal approach only. Interatrial shunting, assessed by echocardiographic contrast study and/or color flow mapping, was detected in 13 (54%) of 24 patients on transthoracic imaging and in 29 (76%) of 38 patients during transesophageal echocardiography. Identification of multiple fenestrations (n = 9) and thrombi within the aneurysm (n = 2) could be achieved only by transesophageal ultrasound. A cerebrovascular event of suspected embolic origin occurred in 20 (50%) of 40 patients; 11 (55%) of the 20 patients had repeated cerebral events. Except for mitral valve prolapse in 2 patients and spontaneous left atrial contrast phenomenon in 1 patient no other potential cardiac source of embolism could be identified by transesophageal echocardiography. A marked thickening of the aneurysm was present in 14 (70%) of 20 patients with a cerebrovascular event versus only 4 (20%) of 20 patients without a cerebrovascular event (p less than 0.01). The mechanism of embolization may be both primary thrombus formation within the aneurysm and paradoxical embolization through an interatrial communication as suggested by the findings on transesophageal ultrasound in 2 patients. Although the patients of this study represent a highly selected group it may be concluded that atrial septal aneurysm is a cardiac abnormality with embolic potential. Transesophageal echocardiography has to be regarded the imaging method of choice for evaluation of this lesion.

Adult↗
PubMed1992

Transoesophageal stress echocardiography for pre-operative detection of patients at risk of intra-operative myocardial ischaemia.

Patients with coronary artery disease have an increased risk of developing intra-operative myocardial ischaemia and peri-operative myocardial infarction. Pre-operative identification of patients at risk of developing peri-operative myocardial ischaemia is often difficult or even impossible due to the inability of the patient to perform an exercise test. For those unable to perform physical exercise a system has recently been described combining transoesophageal echocardiography with simultaneous transoesophageal atrial pacing via the same probe to detect pacing-induced wall motion abnormalities, a sign of coronary artery disease. In a prospective study, 20 patients with clinically suspected coronary artery disease undergoing hip replacement were examined pre-operatively by transoesophageal stress echocardiography. During the subsequent operation the incidence of intra-operative ischaemia was evaluated again in all 20 patients by transoesophageal echocardiography. In eight of the 20 patients (40%) wall motion abnormalities could be induced by transoesophageal stress echocardiography pre-operatively. Intra-operative wall motion abnormalities occurred in six of these eight patients. In two patients with wall motion abnormalities induced by transoesophageal stress echocardiography no abnormalities occurred during surgery. However, in those in whom wall motion abnormalities did occur during operation they occurred in the same left ventricular segment as those initiated by stress echocardiography. None of the patients without pre-operatively inducible wall motion abnormality developed them during surgery. No patient developed a myocardial infarction intra- or post-operatively. Thus, preoperative transoesophageal stress echocardiography is a valuable technique for the detection of patients who may develop ischaemic wall motion abnormalities during surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Transoesophageal echocardiography in the diagnosis of cor triatriatum; incremental value of colour Doppler.

Cor triatriatum sinistrum is a rare congenital cardiac abnormality often accompanied by other malformations. Transthoracic echocardiography does not always define the membrane and associated abnormalities; so, transoesophageal colour Doppler echocardiography was used to visualize intra-atrial blood flow through the intra-atrial membrane in a patient in whom the membranous orifice could not be seen by precordial echocardiography. There was no anomalous pulmonary venous drainage or associated atrial septal defect.

Adult↗
PubMed1992

Initial experience with a multiplane transoesophageal echo-transducer: assessment of diagnostic potential.

BACKGROUND: the prototype of a transoesophageal echocardiographic transducer with a rotatable cross-sectional scanning plane underwent initial evaluation. METHODS: the 5 MHz, phased array, 64 element transducer is incorporated into a 16 by 11 by 40 mm echoscope tip. The instrument also has pulsed wave and colour flow Doppler capabilities. Exterior controls allow continuous mechanical rotation of the scanning plane from 0 degree, corresponding to the conventional transverse plane, through 180 degrees, thereby encompassing all possible planes. RESULTS: 103 patients underwent examination without complications; two additional patients were excluded because of difficulty in swallowing the probe. Advantages include precise alignment of aortic valve long- and short-axis views, long-axis views of the ascending aorta (mean visualized length: 6 cm), and full scanning of the entire circumference of the mitral valve and the left ventricle. Separation of paravalvular and transvalvular leakage in prosthetic valves is distinctly improved. CONCLUSION: multiplanar transoesophageal imaging is feasible and increases the diagnostic yield, especially in mitral and aortic pathology and in the assessment of left ventricular wall motion. Three-dimensional reconstruction is an attractive potential application.

Adult↗
PubMed1992

Endobronchial sonography: feasibility and preliminary results.

Endobronchial sonography, a new ultrasound technique, has been evaluated for the assessment of normal lungs and bronchial carcinomas. The procedure was performed with ultrasound catheters, which were introduced into central and peripheral bronchi through the operating channel of fibreoptic bronchoscopes. The bronchial wall is highly echogenic and laminated. The lung parenchyma appears echo rich and patchy. Pulmonary arteries can be identified by the pulsatile changes and floating echoes within the echo free lumen. Echo poor bronchial carcinomas were detected in 69 out of 74 patients with endoscopically visible tumours and in 19 out of 26 patients with peripheral carcinomas. The correct implantation of metallic stents was facilitated by endobronchial sonography in nine patients. The sonographic examination carried no particular risk and caused little discomfort.

Adult↗
PubMed1992

[Electrocardiographic diagnosis of acute graft rejection after heart transplantation].

In order to evaluate the diagnostic value of standard-ECG (ST-ECG) and precordial mapping-ECG with 63 unipolar leads (PM-ECG) for detection of acute cardiac allograft rejection, 15 patients (12 male, 3 female; age range 24-64 years) were studied. ST-ECG and PM-ECG were recorded along with 94 endomyocardial biopsies. Twenty-four acute rejections were detected histologically. Using the ST-ECG, a reduction of the QRS-amplitude-sum (lead I, II, III, V1 and V6) greater than or equal to 5% in comparison with the ECG obtained 1 week before was found to be the best diagnostic criterion (sensitivity 63%, specificity 74%, positive predictive value 48%, negative predictive value 85%). By analysing the PM-ECG a drop of the QRS-amplitude greater than or equal to 12% in greater than or equal to 14/63 precordial leads was determined to be the most reliable parameter (sensitivity 79%, specificity 71%, positive predictive value 49%, negative predictive value 91%). In contrast to the high sensitivity of PM-ECG, ST-ECG was less suitable for detection of acute rejection. However, taking into account the high negative predictive value of PM-ECG, acute rejection could be excluded with high probability, if the QRS-amplitudes of the PM-ECG remained stable. This may lead to a lower frequency of routinely performed endomyocardial biopsies.

Adult↗
PubMed1992

[Initial clinical trial of a multi-planar transesophageal echoscope].

The prototype of a multiplanar transesophageal echocardiographic transducer was evaluated clinically. This 5 MHz, phased array, 64-element transducer allows to continuously rotate the imaging plane from the transverse (0 degree) position to a maximal 180 degrees position, thus encompassing transverse, longitudinal, and every intermediate position. The transducer is incorporated in the echoscope tip measuring 16 by 11 by 40 mm. The shaft of the instrument is 110-cm long and has a 9-mm diameter. The instrument has pulsed wave, continuous wave, and color Doppler capabilities. 176 clinical patients were examined with the multiplane transducer. No complications occurred. Advantages of this transducer included: 1) comprehensive scanning of the whole mitral circumference and mitral valve; 2) quick and precise alignment of aortic valve long and short axis views, including long axis views of the ascending aorta, with a mean visualized length of 6 cm; 3) improved imaging and evaluation of transvalvular and paravalvular regurgitant jets in mitral and aortic valve prostheses; 4) complete evaluation of all left ventricular segments using multiple planes from transgastric and transesophageal transducer positions. An important potential application is three-dimensional reconstruction of cardiac structures and color Doppler jets.

Adult↗
PubMed1992

[Morphology of aortic isthmus stenosis--invasive study using intravascular ultrasound].

In patients with coarctation of the aorta, intravascular ultrasound can yield important additional diagnostic information concerning stenosis morphology and aortic wall structure that, thus far cannot be obtained with conventional angiography. For the first time, we were able to visualize, in vivo, the eccentric thickening of the posterior aortic wall, which is the typical morphological finding in patients with coarctation of the aorta, known from post mortem or intraoperative specimens. The additional information about stenosis morphology and aortic wall structure, obtained with intravascular ultrasound, is especially valuable for the newer interventional therapy of balloon angioplasty. With intravascular ultrasound, not only the direct quantitative assessment of the aortic cross-sectional luminal area, but also the immediate visualization of local dissections and aneurysms is possible. Using special angioplasty catheters with integrated ultrasonic crystals (which are currently under manufacturing development), a step-wise dilation with immediate evaluation of the therapeutical success may improve the short- and long-term results of balloon angioplasty. At present, intravascular ultrasound is still only an additional diagnostic tool. If it is combined with interventional balloon angioplasty, however, it could gain increasing clinical importance for the treatment of aortic coarctation in the near future.

Aorta, Thoracic↗
PubMed1991

[A iatrogenic arteriovenous fistula following laminectomy. A rare differential diagnosis of heart failure].

An abdominal murmur was first heard in a now 46-year-old man four years after laminectomy at the age of 21. Signs of right heart failure and, ultimately, of global heart failure developed progressively and increasingly 20 years later. Echocardiography demonstrated enlargement of the right heart cavities, and atrial fibrillation was diagnosed. Cardiac catheterization revealed the typical picture of high output failure (cardiac output 13.9 l/min). Intra-arterial subtraction angiography demonstrated a fistula between the left iliac artery and vein. After operative closure of the fistula the signs of heart failure disappeared. Six months later a residual but insignificant fistula was still present, as well as persistent atrial fibrillation. Medical treatment having failed cardioversion successfully re-established sinus rhythm and the patient became symptom-free. Arteriovenous fistula after laminectomy is a rare cause of heart failure and often diagnosed very late. The prognosis is good once the fistula has been closed.

Arteriovenous Fistula↗
PubMed1991

Distinct down-regulation of cardiac beta 1- and beta 2-adrenoceptors in different human heart diseases.

Cardiac beta-adrenoceptor density and beta 1- and beta 2-subtype distribution were examined in human left ventricular myocardium from transplant donors serving as controls and from patients with mitral valve stenosis, aortic valve stenosis, idiopathic dilated cardiomyopathy, and ischaemic cardiomyopathy respectively. The total beta-adrenoceptor density was similar in transplant donors and patients with moderate heart failure (NYHA II-III) due to mitral valve stenosis, but was markedly reduced in all forms of severe heart failure (NYHA III-IV) studied. A reduction of both beta 1- and beta 2-adrenoceptors was found in patients with severe heart failure due to mitral valve stenosis or ischaemic cardiomyopathy. In contrast, a selective down-regulation of beta 1-adrenoceptors with unchanged beta 2-adrenoceptors and hence a relative increase in the latter was observed in idiopathic dilated cardiomyopathy and aortic valve stenosis. It is concluded that the extent of total beta-adrenoceptor down-regulation is related to the degree of heart failure. Selective loss of beta 1-adrenoceptors is not specific for idiopathic dilated cardiomyopathy but also occurs in aortic valve stenosis. Changes in beta 1- and beta 2-subtype distribution are rather related to the aetiology than to the clinical degree of heart failure.

Adult↗