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Biomedical subjects

P Held

Publications and source records attributed to P Held.

At least 109 records · Page 6Linked to original sources
PubMed1991

Enalaprilat in acute myocardial infarction: tolerability and effects on the renin-angiotensin system.

We treated 48 patients with intravenous enalaprilat within 24 hours from the onset of acute myocardial infarction. Concomitant therapy included thrombolytic treatment (29), intravenous metoprolol (34), intravenous nitroglycerin (16) and intravenous furosemide (15). The first 40 patients included had systolic blood pressure at baseline greater than or equal to 110 mmHg. Intravenous bolus injections of 0.2-1.2 mg (mean 1.0 mg) enalaprilat in one hour were given to 20 patients and an intravenous infusion of 1 mg over two hours was administered to another 20 patients, as well as to a separate group of 8 patients with systolic blood pressure between 100-109 mmHg at baseline. The infusion was stopped in five cases when the systolic blood pressure fell below 100 and 90 mmHg, respectively, in the two infusion groups. No hypotensive reactions were symptomatic. Blood pressure decreased from a mean of 134/82, 131/79 and 106/72 mmHg to a minimum of 117/71, 118/73 and 97/63 mmHg, respectively, in the three groups. Almost complete suppression of plasma angiotensin converting enzyme activity was achieved within 30 minutes. No significant changes were found in plasma levels of angiotensin II, renin activity or atrial natriuretic peptide between baseline and 24 hours. Treatment was continued with oral enalapril 2.5-10 mg/day, which was generally well tolerated. We conclude that intravenous and oral enalapril added to conventional therapy in the early phase of acute myocardial infarction is well tolerated in selected patients, but should be carefully titrated.

Aged↗
PubMed1991

[Use of the 3D procedure in nuclear magnetic resonance tomography in ENT diagnostics].

The use of 3D-gradient-echo sequences improved the diagnosis of malignant tumors of the skull base, the nasopharynx, the nasal cavities, the paranasal sinuses and the upper parts of the parapharyngeal space with relation to the skull base. Therefore the tumor extent and infiltration may be better appreciated than in conventional 2D-spin-echo or gradient echo sequences. Using this method, the examinations of 22 patients with carcinomas could be compared. Precise tumor delineation was achieved in six of these patients when compared with surgical and histological findings. The 3D sequences most frequently used were FLASH 40 degrees with TR of 40 ms and the shortest TE (5 to 6 ms). 3D turbo-FLASH (MPRage) with Gad-DTPA was applied in order to shorten the acquisition time by half and especially to reduce motion artefacts.

Follow-Up Studies↗
PubMed1991

[Tumors of the oropharynx, hypopharynx and larynx--diagnosis with magnetic resonance imaging].

312 patients with neoplasms of the oropharynx, hypopharynx and larynx--301 of these suffered from malignancies--were examined with use of magnetic resonance imaging (MRI) and--in most cases--with computed tomography (CT) for comparison. MRI yielded better results than CT in the case of oropharyngeal tumors. With regard to hypopharyngeal tumors, however, slight discrepancies in the diagnostic capacities of both methods were observed. MRI afforded a clearer tumor definition through sagittal and coronal slice orientations. In the case of laryngeal neoplasms in the glottic region, CT is currently superior to MRI. This could change in the future as a result of improvement in signal behavior of the 2D gradient echo (2D GE) sequences and of the use of phonation studies (Turbo-FLASH). MRI, on the other hand, is superior to CT in the definition of sub-, supra- and panglottic tumors.

Carcinoma↗
PubMed1991

[MRT of orofacial tumors--initial clinical experiences with turbo-flash intensity studies].

We examined 36 patients with carcinomas of the tongue and the floor of the mouth. In 11 cases, a clear definition of the tumor extent was not possible using T2 w. spin echo sequences and T1 w. spin echo and gradient echo sequences after injection of contrast material. This delineation was attained with Turbo-FLASH intensity-vs-time studies (Gad-DTPA). The time of acquisition of each measurement was about 1 sec. At the end of injection of Gad-DTPA, 30 measurements with a delay of 1 sec between two measurements were performed. Using this technique, a marginal zone at the boundary of the tumor of very high signal intensity was visible within first minute after Gadolinium injection. This method is not required in the case of clearly hypointense (majority of the tumors) or hyperintense (minority) lesions on T1 w. Gadolinium-enhanced SE or GE images.

Aged↗
PubMed1990

Pharmacokinetic and pharmacodynamic properties of atenolol in acute myocardial infarction.

A commonly used combined intravenous (i.v.) and oral dose regimen of atenolol was evaluated in 21 patients with acute myocardial infarction (MI). Atenolol 5-10 mg was administered i.v. and was followed by 50 mg twice daily during the first 24 h. Starting on the second day, 100 mg was administered as a single dose. Dose adjustments were made as necessary. The i.v. dose resulted in a rapid plasma peak concentration, but absorption of the first oral dose appeared to be delayed. The half-life (t1/2) was significantly prolonged on day 2 as compared with day 6, but the tmax, Cmax, and area under the curve (AUC) were all comparable to what has been reported in patients without MI. The change in heart rate (HR) or blood pressure (BP) was not related to the initial plasma level of atenolol. The interindividual variation was large, but most patients obtained plasma levels of atenolol which in studies of other diseases have been shown to be effective.

Adult↗
PubMed1990

Routine medical management of acute myocardial infarction. Lessons from overviews of recent randomized controlled trials.

In recent years, several large randomized trials have clarified the role of various interventions in acute myocardial infarction. There is clear evidence that thrombolytic therapy, aspirin, and beta-blockers reduce mortality. Both aspirin and beta-blockers also reduce reinfarction and stroke. Of the thrombolytic agents, comparative trials have established that tissue plasminogen activator and streptokinase have similar effects on mortality, morbidity, and left ventricular function. There appears to be an increased risk of cerebral hemorrhage with tissue plasminogen activator. The benefits of heparin in conjunction with aspirin and a thrombolytic agent are unclear and, at best, are likely to be modest. Heparin increases the risk of hemorrhagic complications twofold. Although trials of vasodilators conducted before the widespread use of thrombolytic therapy and aspirin have been promising, newer trials are needed to evaluate their effects among patients receiving these agents. The aggregate of all trials of the routine use of calcium antagonists or antiarrhythmic agents indicates that these agents do not improve survival.

Adrenergic beta-Antagonists↗
PubMed1990

[ACE inhibitors in the treatment of heart failure].

Cardiac insufficiency is a clinical syndrome which presents several distinctive findings but is nevertheless difficult to define both clinically and in the scientific literature. In this article we maintain that cardiac insufficiency is a clinical condition characterized by symptomatic fluid retention on a cardiac basis, combined with signs of impaired pumping in the form of reduced capacity and/or other organic effects such as reduced renal function. The renin-angiotensin system is of cardinal importance once cardiac insufficiency is established and ACE inhibition is of essential significance for the treatment. It is not yet clear whether it is possible to prevent the onset of cardiac insufficiency in patients at high risk thereof. Current studies may answer this question.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1990

[Chloroma in the blastic crisis of chronic myeloid leukemia--MR tomography findings].

Granulocytic sarcomas are rare manifestations of diseases of the white corpuscles. The incidence of this type of disease is not yet known because it is so rare. We observed two patients, who had had a chronic myeloid leukemia for several years, and in whom such a tumor occurred during the development of a blastomatous crisis. Both patients were examined by MRI. With this method it is possible to depict changes of the bone marrow as well as extramedullary lesions. MRI is a highly sensitive, but a less specific method.

Adult↗
PubMed1989

Behavioral and autonomic responses to peer separation in pigtail macaque monkey infants.

Brief maternal separations of young nonhuman primates have been used extensively to study the behavior and physiology of attachment, loss, and bereavement. The physiological responses to the loss of alternative attachment figures, such as peers, is less well documented in nonhuman primates. This study examined both autonomic and behavioral responses of peer-reared pigtail macaque infants to separation. Eight infants were removed from their mothers at birth and reared in four peer pairs. At 6 months of age, each monkey was implanted with a multichannel biotelemetry device which transmitted heartrate, body temperature, EEG, EMG, and EOG. Blood was collected twice weekly for immunological assessment. Behavioral and physiological data, including sleep, were collected for 1 week of baseline, 2 weeks of separation, and 1 week of reunion. Behavioral and physiological results indicated agitation but not depression following separation from their peer attachment figures. We found reduced mitogenic responses to pokeweed consequent to peer separation, suggestive of altered B-cell function. REM variables were the only sleep measures affected by the separation, and were suggestive of agitation but not depression.

Animals↗
PubMed1989

[CT and MRT of vertebral hemangiomas].

A retrospective comparative study of CT and MRI was carried out involving 38 vertebral haemangiomas; this revealed a typical signal pattern on MRI from benign lesions. It consists of a hyper-intense signal from the bone marrow affecting the T1/T2 sequences; this may be focal or involve the entire vertebral body. These characteristic signals were compared with CT images of the spine. The areas of bone that produce the high intensity signals on MRI appear on CT as spongy patterns with hypertrophic trabeculae surrounding mostly areas with negative absorption values. An analysis of the changes in the spongiosa has revealed three clearly defined types. The signals derived from haemangiomas extending beyond the bone have an intensity of normal spongiosa; this corresponds with an absence of fat, as demonstrated by CT. Extra-osseous components have low intensity T1 signals that increase in T2 sequences.

Adult↗
PubMed1989

Early intravenous beta-blockade in acute myocardial infarction.

The clinical effects of early intravenous beta-blockade followed by short-term oral treatment in acute myocardial infarction (MI) have been studied in 30 randomized trials totaling almost 28,000 patients. This treatment reduces the incidence of infarction by 10-15% in patients with threatened MI, reduces infarct size by 20-30%; reduces the incidence of nonfatal reinfarction, nonfatal cardiac arrest and mortality each by about 15%. Treatment has to start within 12 h of the onset of symptoms to be able to reduce measures of infarct size and infarct development. If patients are carefully selected serious side effects are rare and reversible. Based on the different presumed mechanisms of benefit it would be reasonable to expect the combination of i.v. beta-blockade and other therapies of proven benefit to be more beneficial than either class of agent used alone.

Adrenergic beta-Antagonists↗