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Biomedical subjects

P Probst

Publications and source records attributed to P Probst.

At least 109 records · Page 6Linked to original sources
PubMed1984

[Diagnosis of syncopes in suspected arrhythmias].

Several mechanisms lead to attacks with unsuspected sudden and intermittent loss of consciousness. A major cause for such syncopes are arrhythmias. Only in rare cases it is possible to register an ECG during a typical attack despite many newer methods as long-term ECG (LT-ECG), exercise stress test and electrophysiologic investigations. LT-ECG does not record the ECG only during symptomatic periods (syncopes, dizziness, palpitations etc), but also registers asymptomatic AR, which can be precursors of SY. Carotid sinus massage is a valuable tool for the detection of a cardio-inhibitory Carotid-Sinus-Syndrome, which can be treated with PM-implantation. Exercise stress testing induces ventricular arrhythmias, which also indicates AR as underlying cause for SY. Using the invasive electrophysiologic investigation methods the importance measuring supraventricular parameters (SNRT, SA-, AH-interval) or parameters of the AV-nodal conduction (AH-, HV-interval) decreased in contrast to the ventricular stimulation techniques. With these invasive procedures ventricular tachycardias, ventricular flutter or fibrillation can be induced in selected patients, which indicates also a possible arrhythmogenic substrate for SY. In a suspected arrhythmogenic genesis of SY it has to be recommended to perform LT-ECG, carotid sinus massage, exercise stress testing and -- in selected patients -- electrophysiological investigations in addition to the routine-ECG to exclude or confirm arrhythmias as possible substrate for SY.

Arrhythmias, Cardiac↗
PubMed1984

[Thyroid functional parameters during anti-arrhythmia therapy with amiodarone].

Thyroid function was investigated in 41 patients on chronic treatment with amiodarone. 27% of the patients had elevated total thyroxine levels together with elevated free thyroxine levels. Thyrotropin (TSH) secretion was completely suppressed in 15% of the patients. Elevated free or total thyroxine levels were frequently observed together with normal TSH secretion, although 5 of the 6 patients with suppressed TSH had markedly elevated levels. Triiodothyronine (T3) levels were low normal or below the normal range in all patients but one. This was the only patient who apparently developed amiodarone-induced hyperthyroidism. The clinical symptoms of this patient were equivocal. Thyroid function parameters including T3 levels returned to normal only 3 months after withdrawal of the drug. The patient did not need any thyrostatic treatment. The duration of treatment with amiodarone did not influence thyroid hormone concentrations, although there was an insignificant trend of increasing total thyroxine levels after a year of treatment. There was, moreover, no significant influence of the dose (200-500 mg orally/day) of amiodarone on thyroid hormone levels. Our results show that the usual screening parameters of thyroid function, namely total and free thyroxine serum concentrations, are not reliable in patients on chronic amiodarone treatment. The incidence of amiodarone-induced hypothyroidism was 2.4%. We did not observe an amiodarone-induced hypothyroidism, although there was one patient with increased TSH levels but normal T3 and thyroxine levels.

Adolescent↗
PubMed1984

[Preoperative x-ray computed tomography in cancer of the kidney].

The authors emphasise the importance of computed tomography in the detection, diagnosis and pre-treatment staging of cancer of the kidney. In a series of 82 cases, the diagnosis was made on the basis of ultrasonography combined with computed tomography in 55% of their last 44 cases. They stress the decreasing value of intravenous urography, which was used to detect the lesion in 68% of their first 38 patients and which was used in only 41% of the last 44 cases. Computed tomography is an essential step in the pre-treatment staging of cancer of the kidney. The real local extension of the tumour was correctly diagnosed by the CT scan in 79% of cases. Under-estimation of the degree of invasion of adjacent organs was observed in 3 cases and multiple tumours in the one kidney were misdiagnosed in one case (4 errors: 5%). Over-estimation was more common, affecting 13 out of 82 cases (16%). The CT scan was found to be reliable in the detection of lymph node invasion in 62 cases (76%) and inaccurate in 24% of cases (14 over-estimations (17% of cases) and 6 under-estimations (7%]. There is therefore an excessively high false positive rate in the detection of lymph node involvement. The CT scan is not reliable in this area. Staging of venous involvement was correct in 68% of cases. Three of the 17 cases of venous invasion were recognised by the CT scan. Overall, a large lymph node on the CT scan does not signify a neoplastic node and a normal-sized node does not signify a disease-free node.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1984

[Computer tomography of mycotic aortic aneurysm].

The CT findings in 2 patients with mycotic aortic aneurysms are presented. CT was helpful in establishing the diagnosis by detecting the presence of aneurysms surrounded by an abscess and reactive enlargement of the lymph nodes. CT should be the first investigation for patients with suspected aortic aneurysms and with fever of unknown origin.

Aneurysm, Infected↗
PubMed1983

Electrophysiologic findings in carotid sinus massage.

Thirty patients with carotid sinus syndrome were electrophysiologically studied. In 14 patients carotid sinus massage was performed during atrial and ventricular stimulation, and the conduction times were measured. The AH-time was prolonged by more than 120 ms in 6 patients (20%); the HV-time was prolonged in 6 patients by more than 55 ms (20%); 5 patients had bundle branch block (16.7%); The sinus node recovery time was prolonged in 7 out of 27 patients (26%). Ten patients (33%) did not have additional electrophysiologic abnormalities. There was a predominance of carotid sinus syndrome on the right side. During carotid sinus massage there was a significant increase of the AH-time, but there were no significant changes of the HV-time or the width of the QRS-complexes. Twenty-one patients developed an atrial asystole and 9 patients an atrial bradycardia and an additional AV-block. There was a longer AH-time and a longer prolongation of the AH-time in the patients who developed an AV-block. Twelve out of 14 patients (85.7%) developed an AV-block during carotid sinus massage and atrial pacing. During ventricular pacing 5 of 14 patients (35.7%) revealed a complete retrograde block before carotid sinus massage and 5 of the remaining 9 patients developed a total retrograde block during carotid sinus massage. Consequently, in 71.4% of the patients with carotid sinus syndrome complete retrograde conduction block and atrial asystole can be expected during attacks of ventricular asystole and simultaneous ventricular pacing. In conclusion, there is a high incidence of additional disturbances of the sinus node function and AV-conduction in patients with carotid sinus syndrome. AAI pacemakers are contraindicated due to the common development of additional AV-block during carotid sinus massage. Physiologic pacing might contribute to better hemodynamics, particularly in patients with the mixed type of carotid sinus syndrome.

Adult↗
PubMed1983

Postoperative evaluation of composite aortic grafts: comparison of angiography and CT.

Postoperative angiography and computerised tomography were performed in 10 patients 8 to 57 months after surgical repair (nine composite, one distal graft) of aneurysms of the thoracic aorta (six dissecting, four true aneurysms). Angiography and angio-CT showed chronic dissection of the distal aorta in five of six patients with dissecting aneurysms and detected a pseudoaneurysm originating from the distal suture line in another patient. CT may serve as an initial procedure for postoperative examinations after surgery of aortic aneurysms to demonstrate the state of the false lumen and the formation of pseudoaneurysms. The coronary arteries and aortic valve function have to be evaluated by angiography.

Adult↗
PubMed1983

Patency after femoral angioplasty: correlation of angiographic appearance with clinical findings.

Fifty-seven patients (34 men and 23 women) underwent percutaneous angioplasty (PTA) of the superficial femoral artery. Follow-up angiography revealed restenoses/reocclusions in 23 patients (relapsing group) and a patent, previously-dilated segment in 34 cases (patent group). These two groups were compared retrospectively regarding their clinical and angiographic state at the time of PTA. The lengths and types of the dilated arterial lesions were similar for both groups. However, the patients in the relapsing group were older as an average, showed significantly more advanced arteriosclerotic disease of their outflow tracts, and were predominantly female. For the relapsing group, a smaller lumen had been attained and a significantly higher brachiopedal pressure difference remained after PTA as opposed to the patients of the patent group. Of the patients with clinical signs of relapse, 28% still had patency of previously dilated segments at follow-up angiography. The true patency rate of dilated arterial segments presumably is higher than what is expected from follow-up examinations using clinical methods alone.

Adult↗
PubMed1983

Obstructive uropathy: frusemide test and analysis of renographic curve patterns.

49 patients with clinically proven uropathy and 14 others suffering from nephropathy underwent quantitative 131I-OIHA renography, combined with a frusemide provocation test. In significant obstruction, diuresis reaction was typically less than 5% (predictive value of a positive test 76%). The renographic curves, derived from the renal cortex and from the pyelon were diverging, with the pelvic curve showing a continuous rise (predictive value of a positive test for the curve pattern analysis 92%). Non-obstructive dilatation of the urinary system was characterized by a high diuresis index (greater than 15%) (predictive value 82%). The curve pattern was plateau-like before and showed a converging course of cortical and pelvic activity spontaneously, at least after diuresis provocation (predictive value 75%). Nephropathy alone could exceptionally mimick both significant obstruction and non-obstructive dilatation. Qualitative renographic curve analysis combined with diuresis provocation renders a higher diagnostic yield regarding the dynamic state of questionable uropathy than either test alone.

Adolescent↗
PubMed1983

[Emission-computed tomography of the myocardium with the 7-pinhole collimator].

89 patients (78 with coronary artery disease, 11 normals) were studied comparatively with T1-201 planar myocardial scintigraphy and 7-pinhole emission tomography with a mobile gamma-camera. In 46 patients stress studies were performed, the other studies were performed as resting protocols. In 13 patients a correlation of scintigraphically determined infarct size calculated from the T1-201 tomograms with CK and CK-MB values (maximum values) in the acute infarction period was performed. 17 patients having undergone intracoronary streptolysis were studied to investigate the effect of this intervention. In patients without previous myocardial infarction (n = 35) sensitivity of 7-pinhole tomography was significantly superior over planar reading of images (83% for qualitative evaluation, 91% for quantitative analysis). In patients with previous myocardial infarction (n = 26) comparative sensitivities were not significantly different, although slightly higher, nevertheless the fraction of questionable findings was reduced from 9 to 4%, furthermore in 31% an additional information concerning size or localization could be obtained from the tomograms. Predictive diagnostic accuracy was highest for quantitative 7-pinhole tomography (91%) but not significantly different from qualitative tomography but higher than for planar imaging. Specificities of all methods were comparable. In patients during the acute phase of myocardial infarction a significant correlation (r = 0.76 for CK, r = 0.78 for CK-MB, p less than 0.01) was obtained with enzymatic markers of infarct size. In the group after intracoronary streptolysis 7-pinhole tomography was able to demonstrate a quantitative reduction of thallium infarct size in patients after successful lysis (23.5% vs 48.7%, p less than 0.01) although absolute quantitation is not possible with thallium-201 due to inherent biological limitations. Emission tomography using 7-pinhole collimation leads to an improvement of diagnostic accuracy in all patients with reversible ischemia and helps for better delineation of size and localization of infarct areas and could help in the assessment of interventional effects, as after intracoronary streptolysis.

Adult↗
PubMed1983

[Computer tomography-guided puncture of the retroperitoneal space].

A CT-guided fine-needle puncture was performed in 42 patients with renal or retroperitoneal space-occupying growths identified by means of computed tomography. In 18 out of 24 patients (75%), CT-guided fine-needle puncture enabled verification of malignant neoplasias, relapses and metastases by means of identification of malignant cells. In 9 out of 13 patients suspected of retroperitoneal abscess, fine-needle puncture helped to establish the diagnosis by a positive bacteriological finding. In 5 cases, CT-guided anterograde pyelography and percutaneous nephrostomy were effected after puncture of the renal pelvis by means of sonography had failed. CT-guided puncture should be used as an additional or complementary examination over and above computed tomography alone whenever a space-occupying growth is present the aetiology of which remains unclear. CT-guided puncture is indicated on principle in retroperitoneal space-occupying growths which cannot be properly defined by sonography.

Abscess↗
PubMed1982

[Prognostic factors in percutaneous transluminal dilatation of the renal arteries in renovascular hypertension].

In 59 percutaneous transluminal dilatations (PTD) the coaxial double catheter system was chiefly used, and only in one case was the axillary approach necessary. Clinically relevant complications were 1 dissection of the dilated renal artery (re-dilated successfully) and 2 hemorrhages at the femoral puncture site (1 surgical repair). In 32 patients (follow-up 2-52 months, mean 20 months) blood pressure was lowered from 187/108 to 150/91 mm Hg despite reduced antihypertensive therapy (p less than 0.001). Out of 15 patients with atherosclerotic stenoses blood pressure was normalized by PTD in 2 cases (unilateral) and improved in another 8 cases. Out of 11 patients with fibromuscular dysplasia blood pressure was normalized in 7 cases (all unilateral), improved in 3 and unchanged in 1 (bilateral). Among 6 patients with miscellaneous disease (vasculitis, renal insufficiency) only 2 were improved. Thus, PTD of renal arteries is a useful alternative in the management of renovascular hypertension, mainly in patients with fibromuscular dysplasia, unilateral stenosis and elevated renal vein renin ratio. Long-term results are comparable to the surgical results. However, since no surgical dissection is necessary, morbidity is low and long and costly hospital stays can be avoided. The procedure can be repeated in relapsing cases. For rare complications a vascular surgery team should be available.

Adult↗
PubMed1982

Tardokinesia: definition and clinical occurrence.

Tardokinesia is an abnormal slowness of contraction of a region of the left ventricular (LV) wall. This concept was stated in quantitative terms and used for analyzing LV regional wall motion. Forty-four consecutive patients from the case stream of the Cardiovascular Radiology Service were chosen, and their cine left ventriculograms were studied. A polar grid of thirty radii, at twelve degree increments, was superimposed on the tracing of each ventricle. The wall motion was measured at thirty points, and the location, speed, and acceleration of each point in each cine was calculated. Two cases of tardokinesia were found. Tardokinesia might be a sensitive or early indicator of ischemic heart disease.

Adult↗
PubMed1982

Induction of ventricular tachycardia by pacemaker programming.

The induction of ventricular tachycardia or ventricular fibrillation by competitive pacing, especially in the setting of acute myocardial ischemia, is well known. A case of ventricular tachycardia induced by a multiprogrammable unipolar cathodal ventricular pacemaker is reported. The arrhythmia was caused by reprogramming, which necessitates a short switch to fixed rate pacing in this model (Spectrax 5985 SX). This potential hazard is not well established in patients with unipolar pacemakers. The use of the magnet as one of the preconditions for reprogramming should be avoided in future pacemakers.

Bradycardia↗
PubMed1982

Lasting improvement of renovascular hypertension by transluminal dilatation of atherosclerotic and nonatherosclerotic renal artery stenoses. A follow-up study.

Sixteen consecutive patients with renovascular hypertension were treated by transluminal dilatation and observed during 6 - 39 months (mean 21.8 months). Poststenotic renal artery pressure increased (p less than 0.001) and the renal arteries were patent on angiograms taken immediately after dilatation. In 13 patients, angiography was repeated 2 - 9 months later; at that time the selective renal vein renin ratio had decreased (p less than 0.001). At the end of the follow-up, blood pressure was improved or normal in 14 cases. One of the eight patients with atherosclerosis was normotensive without treatment, compared with five of six patients with fibromuscular dysplasia (p less than 0.05). The results in two cases with vasculitis are uncertain. The four patients with relapses, one after intimal catheter dissection, were treated successfully by redilatation. Thus, renovascular hypertension can be improved by transluminal dilatation in patients with atherosclerosis and in patients with fibromuscular dysplasia with lasting success and a low morbidity rate.

Adult↗