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Biomedical subjects

R Erbel

Publications and source records attributed to R Erbel.

At least 469 records · Page 26Linked to original sources
PubMed1989

Additive effects of enoximone and nitroprusside in unstable chronic heart failure.

In the present study, the safety and efficacy of the combined administration of intravenous nitroprusside and oral enoximone, an experimental compound with phosphodiesterase inhibitory properties, were evaluated. Ten patients with unstable chronic heart failure maintained on digitalis and diuretics were selected to receive enoximone because of their poor response to intravenous nitroprusside. For a mean peak dose of 115 micrograms min-1 nitroprusside, cardiac index increased from 1.8 +/- 0.4 to 2.0 +/- 0.4 l min-1 m-2, while pulmonary artery diastolic pressure and mean right atrial pressure decreased from 29 +/- 6 to 24 +/- 5 and from 15 +/- 6 to 11 +/- 3 mmHg respectively; mean arterial pressure and heart rate were unchanged. The addition of 1.6 mg kg-1 oral enoximone t.i.d. to nitroprusside resulted in a substantial improvement of cardiac function: cardiac index increased further to 2.8 +/- 0.5 l min-1 m-2 (P less than 0.001), pulmonary artery diastolic pressure and right atrial pressure decreased to 18 +/- 5 and 7 +/- 3 mmHg (P less than 0.01), respectively, while mean arterial pressure rose from 90 +/- 11 mmHg to 95 +/- 0 mmHg (P less than 0.05); heart rate was unchanged. The salutary haemodynamic response to combined nitroprusside-enoximone therapy persisted for more than 32 h, and cardiac performance remained improved on enoximone for a further 8 h despite the discontinuation of nitroprusside. No serious side-effects or changes in the arrhythmia profile were observed. The addition of oral enoximone to nitroprusside has beneficial haemodynamic effects in unstable chronic heart failure.

Aged↗
PubMed1989

Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

Follow-up of 18 patients with aortic dissection (five with type I, one with type II, 11 with type III dissection according to DeBakey) by transesophageal, two-dimensional and color-coded Doppler echocardiography showed a persistence of the false lumen in five of seven patients (71%) after surgery and in nine of 11 patients (82%) after medical therapy. In two patients treated with surgery, the dissected part of the aorta had been resected, whereas in two patients treated medically, a progressive and complete obliteration of the false lumen was observed. In the false lumen, thrombus formation was absent in four, localized in four, and progressive in six patients. Flow within the false lumen could be registered in 14 patients, and two distinct flow patterns were differentiated (laminar biphasic flow or slowly circulating flow). Persisting intimal tears were visualized by two-dimensional echocardiography in four patients, whereas color-coded Doppler showed an additional one to three intimal tears in the descending aorta in 10 patients. Flow across these intimal tears was biphasic in 75% of patients; that is, systolic flow was directed from the true to the false lumen with diastolic flow reversal. Unidirectional flow was detected in 25% of the communications, directed in 20% from the true to the false lumen, serving as an entry only and in one (5%) as reentry only. Additional information concerning complications like extension of the dissection (one of 18 patients), localized dilatation of the regurgitation (three of 18 patients) were detected by this method. Concerning the morphologic findings and the detection of flow characteristics, the transesophageal approach was superior to conventional echocardiography especially in the descending thoracic aorta. Thus, transesophageal two-dimensional and color-coded Doppler echocardiography seems to be an ideal method not only for the easy detection of aortic dissection but also for follow-up.

Adult↗
PubMed1989

Urgent indications for surgery in primary or secondary cardiac neoplasm.

Ten patients underwent resection of primary or secondary cardiac tumor. Two-dimensional transthoracic echocardiography per se accurately located the endoluminal cardiac mass in nine patients, and transesophageal echocardiography demonstrated a right atrial tumor in the tenth case. The indications for urgent surgery included prior embolic events (3 cases), syncopal attacks (2) or echocardiographic evidence of a multilobulated mass (2 cases). The operative strategy was standardized for atrial tumors, but for malignant myocardial neoplasm both the anatomic site and the extent of tumor growth determined the surgical procedure. Histologic examination showed myxoma in seven cases, fibroma in one and metastases of malignant melanoma in two cases. The course after resection of endoluminal benign tumor was uneventful apart from transient atrial fibrillation in four cases. Follow-up echocardiography (after 4-28 months) showed no recurrent growth. In both cases of intracardiac metastases there was recurrence within 6 to 8 months after resection of the growth.

Adult↗
PubMed1989

Long-term enoximone therapy in unstable chronic heart failure.

Long-term safety and efficacy of oral enoximone were evaluated in 32 patients with unstable chronic heart failure despite digitalis, diuretics, and vasodilator therapy. Oral enoximone, 75-150 mg t.i.d. was given for an average of 32 weeks. At baseline, 21 patients were in NYHA functional class IV, 10 patients in class III, and 1 patient in class II. Within 12 weeks, 14 of 20 patients surviving for more than 26 weeks had improved by at least one functional class. Hemodynamic data showed an 18% increase of cardiac index and a 34% decrease of diastolic pulmonary artery pressure. Echocardiographic recordings revealed an increase of fractional shortening from 13.9 +/- 7 to 15.6 +/- 5% after 12 weeks and 20.3 +/- 5% after 26 weeks. The 1-year survival rate was 40%. Sudden death occurred in three patients and pump failure in 11 patients. No serious side effects were reported. Holter monitoring did not show a significant proarrhythmic drug effect. Thus, long-term enoximone therapy is safe and produces sustained clinical and functional improvement in unstable chronic heart failure. However, overall survival appears not to be influenced in this patient group.

Adult↗
PubMed1989

[Balloon dilatation and coronary vascular stent implantation].

To avoid acute complications and restenosis after percutaneous transluminal coronary angioplasty coronary stents were developed. For the first time three flexible Palmaz-Schatz stents were implanted after application and fixation by balloon inflation in two patients with severe lesions of the left anterior descending coronary artery. The vessels showed larger diameters with smoother surface and smaller gradients compared to balloon angioplasty as related to a blockade of the elastic properties of the vessel and suggested fixation of intima or media dissection. The implantation of the coronary stents was without complications. The control after 24 h showed an open vessel with unchanged diameter. The patients with the proximal lesion of the left anterior descending coronary artery six months later showed no restenosis and no luminal narrowing. The recanalized left anterior descending coronary artery, which was dilated, received two stents and was reoccluded after six months. Meanwhile, up to four stents were implanted successfully in an additional four patients with open vessels as the 24-h-control. Based on this and previous work the implantation of coronary stents seems to open a new dimension for percutaneous transluminal coronary angioplasty because vessel occlusions can be prevented. Whether or not the restenosis rate can be reduced has to be demonstrated in additional studies.

Adult↗
PubMed1989

[Functional evaluation of the left ventricle using 2-dimensional and color-coded Doppler echocardiography].

A new parameter for the evaluation of left ventricular function based on color-coded Doppler echocardiography is described. From an apical transducer position the maximal diastolic inflow area across the mitral valve into the left ventricle is registered. A ratio of this area to the left ventricular area in the same plane and frame is calculated. These parameters are evaluated in 17 normal controls and 31 patients with dilatative cardiomyopathy. Additionally, the left ventricular volumes and the ejection fraction are calculated from two-dimensional echocardiography using a disc method. The maximal inflow area is correlated with the stroke volume (r = 0.69, y = 7.0 + 8.6x) and the ratio to the ejection fraction (r = 0.99, y = 0.65 + 0.98 x). The intraobserver-correlation for the maximal diastolic inflow area was r = 0.95, y = 5.5 + 0.79 x and the interobserver-correlation r = 0.89, y = 7.7 + 0.8 x. Finally, the gain dependency of the maximal diastolic inflow area was tested. By increasing the gain at low levels a steep linear increase was noted; at higher gain levels a plateau phase was observed where measurements could be performed.

Adult↗
PubMed1989

[Possibilities and limits of 2-dimensional echocardiography in quantitative image analysis].

By two-dimensional echocardiography left ventricular volumes can be measured and ejection fraction can be calculated. But volume and ejection fraction determination are combined with a systematic underestimation despite high correlation in comparison to "true volume", whereas cineventriculography systematically overestimates true volume. This echocardiographic methodological problem is related not only to tangential scanning but also to low lateral resolution yielding a reduced endocardial border delineation. Meanwhile, advanced transducer technology and digital imaging techniques with zoom and cineloop possibilities have improved endocardial border detection. In comparison to cineventriculography, volume determination by two-dimensional echocardiography has improved significantly in comparison to results in 1983; this improvement was mainly due to a better determination of endsystolic volume. Similarly, left ventricular contrast echocardiography using color coding with statistical analysis of digitized images enhanced the accuracy of analysis of global and regional left ventricular function. Transesophageal echocardiography will be used when there is reduced image quality of transthoracic echocardiography, for example, in obese patients or those with pulmonary emphysema or mechanical ventilation. Transthoracic echocardiography has become a routine method for assessing global and regional left ventricular function. Echoventriculography can be used in patients with renal insufficiency, anaphylactic reaction to contrast medium, and poor left ventricular function.

Algorithms↗
PubMed1989

[The status of echocardiography imaging].

After several decades of gradual technical improvement of echocardiographic imaging, these methods have now attained a level of performance that is not so much dictated by technical limitations as it is determined by constraints imposed by the underlying physical principles. Image quality of echocardiographic imagers is discussed in terms of the spatial, temporal, and graylevel resolution provided. The level of technical performance obtained recently improves essentially the clinical value of echocardiography. Application of contrast material requires new techniques of image display such as color superposition imaging. Image quality in Doppler or color flow imaging is essentially described in terms of spatial, temporal, and velocity resolution. Phantom studies are proposed for routine testing of the image quality provided by clinical echocardiographic instruments. We mention some expected developments concerning archival image storage and the integration of echocardiograms into cardiological databases or complete departmental information systems.

Echocardiography↗
PubMed1989

[Right heart ventriculography using Gelifundol].

Forty patients (14 women, 26 men, mean age 58 years) with suspected anomaly of the right heart and suspected tricuspid insufficiency or atrial septal defect were given four injections of Gelifundol in five-minute intervals via the right cubital vein. Before, during, and after each injection an echocardiogram was obtained (four-chamber-view). One subcostal view was recorded. Contrast echocardiograms were analyzed according to a subjective score scheme by two independent observers and by video-intensitometry. After injection of contrast medium no patient showed ECG changes, nor did any patient report side effects after the injection of Gelifundol. Concerning the subjective parameters there were no significant differences between both observers. Score points varied between 5.2 to 5.5, intensitometric maxima lay between 54.6 and 58.0 relative intensity units, and the half-time of the intensity maximum (T1/2) varied between 7.2 s and 8.1 s. There were no statistical differences between the two observers. In all patients a diagnotic improvement could be achieved. A tricuspid insufficiency which was not diagnosed in the native echocardiogram could be diagnosed in 13 patients with Gelfundol. Thus, Gelifundol seems well suited for the assessment of right ventricular lesions in man.

Adolescent↗
PubMed1989

[Detection of bone marrow embolism in femoral intramedullary nailing using transesophageal echocardiography].

Cardiopulmonary complications are known in intramedullary nailing, especially of the femur. Transesophageal echocardiography now allow intraoperative detection of embolized bone-marrow, recognizable as reflecting particles in the right atrium. In intramedullary nailing of a femoral fracture with a closed distal fragment bone-marrow embolism was detectable in the right atrium during reaming of the medullary canal. This technique should permit further research on the pathophysiology of pulmonary alterations during intramedullary nailing and also testing the effectiveness of pressure-relief in the medullary canal as proposed by drilling a bone-hole.

Adult↗
PubMed1989

[Influence of angiotensin-induced change in afterload on hemodynamics in mitral valve insufficiency. A 2-dimensional and color-coded Doppler echocardiography study].

This study assesses the consequences of angiotensin I-induced afterload-stress on mitral regurgitation by two-dimensional and color-coded Doppler echocardiography. During continuous intravenous infusion of angiotensin I in increasing doses of 0.5, 2, and 4 micrograms/min, blood pressure increased significantly from 119 +/- 7/73 +/- 3 mm Hg up to 145 +/- 8/91 +/- 4 mm Hg (+22% resp. +25%; p less than 0.0001 resp. p less than 0.0001). Heart rate did not change significantly (84 +/- 2 min-1 resp. 88 +/- 4 min-1). The enddiastolic volume index, determined by two-dimensional echocardiography, did not change significantly (104 +/- 10 ml/m2 resp. 112 +/- 3 ml/m2), the endsystolic volume index increased from 57 +/- 10 ml/m2 to 75 +/- 13 ml/m2 (+32%; p less than 0.01), the ejection fraction fell from 47 +/- 4% to 36 +/- 4% (p less than 0.001). In the RAO-equivalent view the maximal jet-length, determined by color-coded Doppler echocardiography, increased from 2.6 +/- 0.2 cm to 3.9 +/- 0.3 cm (+50%; p less than 0.001), the maximal jet-area rose from 3.4 +/- 0.6 cm2 to 7.0 +/- 1.0 cm2 (+106%; p less than 0.001); in the parasternal long axis view the maximal jet-length increased from 2.3 +/- 0.2 cm to 3.5 +/- 0.3 cm (+52%; p less than 0.001), the maximal jet-area from 2.6 +/- 0.5 cm2 to 4.9 +/- 0.8 cm2 (+89%; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1988

Recombinant single-chain urokinase-type plasminogen activator during acute myocardial infarction.

Recombinant single-chain urokinase-type plasminogen activator was intravenously administered in 2 different doses in 24 patients with acute myocardial infarction and angiographically proved occlusion of the infarct-related artery. Patients with first infarction without contraindications of thrombolysis were treated within the first 4 hours after the onset of symptoms. Group A (12 patients) received 20 mg of rscu-PA as a bolus followed by 60 mg infused over 1 hour and group B received 10 mg as a bolus and 30 mg as infusion. The 2 groups showed no significant difference in age, sex, height, weight, time between onset of symptoms and start of therapy, peak values and course of infarct-related enzymes. Time to reperfusion was 43 minutes in group A versus 67 minutes in group B (p less than 0.005). The rate of reperfusion 90 minutes after start of treatment was 91% in group A and 50% in group B (p less than 0.001). Plasma levels of fibrinogen, plasminogen and alpha-2-antiplasmin did not differ significantly in both groups. Systemic lytic state (fibrinogen less than 100 mg/dl) occurred in 33% of group A and in 9% of group B. Intravenous infusion of 80 mg (but not 40 mg) of rscu-PA led to reperfusion of the occluded coronary artery in nearly all patients. Approximately one-third of the patients treated with this dose demonstrated systemic lysis.

Adult↗