Biomedical subjects
Publications and source records attributed to R Hofstetter.
On the chest X-ray of a 15-year-old patient, a round, egg-shell-like calcification was seen in projection into the left heart border. This finding was caused by a calcified coronary aneurysm following Kawasaki's disease. Although this has been described as a typical change, it is rarely found in daily clinical routine.
New Image Teen Theatre combines peer education and theatre in an informative and entertaining package. This study was undertaken to assess the effectiveness of New Image Teen Theatre on altering teenagers' attitudes, knowledge, and intentions regarding sexual behavior. A total of 143 adolescents between the ages of 13 and 19 viewed the performance. The performance focused on the prevention of pregnancy, AIDS, and STDs and included content aimed at increasing communication. Teen participants completed pretest and posttest questionnaires. Almost half of the adolescents reported having engaged in sexual intercourse. About one third of the sexually active reported never using birth control, and only 21% reported consistent use of condoms. These results confirm adolescents' risk for pregnancy, STDs, and AIDS in particular. Following the performance, the teens reported significantly more willingness to discuss sexual issues with others, significantly greater intention to use birth control (for sexually active teens), and demonstrated significantly greater sexual knowledge. Furthermore, they indicated that they had experienced more positive emotions than negative emotions while viewing the production. Results suggest that theatre education may set the stage for more comprehensive interventions designed to prevent pregnancy, STDs, and AIDS.
Infants with critical aortic stenosis may have global or regional left ventricular contraction abnormalities. In order to evaluate the clinical significance of these contraction abnormalities, we examined the systolic left ventricular function before and after aortic valvotomy in 16 infants operated on between 1980 and 1987. Left ventricular free wall and septal motion were studied by cross sectional echocardiography using the apical 4-chamber view. Enddiastolic and endsystolic left ventricular frames were digitized. The relative systolic reduction of the total left ventricular area (reflecting ejection fraction) as well as of 5 left ventricular sectors (reflecting regional wall motion) was calculated and compared to previously established normal values. Before valvotomy, 8 infants had normal and the other 8 impaired left ventricular systolic wall motion. These latter infants showed hypokinesia of the apex and/or the posterolateral left ventricular wall resulting in a decreased systolic reduction of the total left ventricular area. Four of these infants had evidence of myocardial infarction on intraoperative inspection. Early after operation, the systolic reduction of the total left ventricular area was normal in all infants, and the left ventricular apex and poster-lateral wall were either normo- or hyperkinetic. Follow-up studies of all infants more than 10 months and of 7 infants more than 3 years after operation showed that the left ventricular systolic wall motion remained normal in all, irrespective of whether it was normal or abnormal preoperatively. This study suggests that left ventricular contraction abnormalities in infants with critical aortic stenosis may be reversible and thus do not constitute a contraindication against aortic valvotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
Thirty-six clinically diagnosed and pathologically confirmed Alzheimer's disease (AD) patients included 13 with cortical and subcortical Lewy bodies (LBs). The patients with LBs appeared to constitute a distinct neuropathologic and clinical subset of AD, the Lewy body variant (LBV). The LBV group showed gross pallor of the substantia nigra, greater neuron loss in the locus ceruleus, substantia nigra, and substantia innominata, lower neocortical ChAT levels, and fewer midfrontal tangles than did the pure AD group, along with a high incidence of medial temporal lobe spongiform vacuolization. Analysis of neuropsychological tests from 9 LBV subjects and 9 AD patients matched for age and degree of dementia revealed greater deficits in attention, fluency, and visuospatial processing in the LBV group. Similar comparisons of neurologic examinations showed a significant increase in masked facies; in addition there was an increase in essential tremor, bradykinesia, mild neck rigidity, and slowing of rapid alternating movements in the LBV group. Extremity rigidity, flexed posture, resting tremor, or other classic parkinsonian features were not characteristic of the LBV patient. In some cases, it may be possible to diagnose LBV premortem on the basis of the clinical and neuropsychological features.
In 10 boys with coronary aneurysms following Kawasaki syndrome echocardiography was performed and compared to angiography with respect to its reliability in detecting coronary aneurysms. All patients had central aneurysms of the left coronary artery which were visualized by echocardiography. In contrast, only two of six central aneurysms of the right coronary artery were detected echocardiographically. None of four leftsided and five rightsided peripheral coronary aneurysms were seen by echocardiography. There was no correlation between severity of coronary lesions and the score of Asai and Kusakawa estimating the risk of aneurysms on clinical grounds. Regression of coronary aneurysms was observed in seven, persistence in two, and progression in one patient, respectively, within 7-27 months. All children are doing well without clinical evidence of myocardial ischemia. We conclude from our experience that involvement of coronary arteries is unlikely if the central parts of the left coronary artery, which can be well visualized by echocardiography, are inconspicuous. In case echocardiography suggests a coronary aneurysm we recommend angiographic investigation in order to visualize the peripheral coronary arteries.
Balloon valvuloplasty (BVP) of pulmonary stenosis (PST) was performed in 305 infants and children in 20 heart centres of the Federal Republic of Germany. 273 patients suffered from isolated PST. Their age ranged from 3 days to 18 years (mean = 5.85 +/- 4.82 years), their weight from 2.9 to 60 kg. The pressure gradient was measured invasively in the sedated or anaesthetized child, partly by CW Doppler. BVP was performed by mono- or trefoil catheters, mostly oversized. As a result, mean pressure gradient fell from 71.7 +/- 32 mmHg before to 31.8 +/- 25 mmHg immediately after BVP (P less than 0.0001). The gradient was reduced by less than 30% in 13% of the patients, by 30-49% in 23%, and by greater than or equal to 50% in 64%. Among 33 patients with a gradient reduction of less than 30%, nine were aged less than 1 year, nine had dysplastic valves, and nine had a short-term infundibular reaction and good late results. Gradient reduction was not improved with oversized balloons and was independent of the initial gradient. Follow-up for a mean 11.2 +/- 8 months showed a further slight improvement, probably due to regression of infundibular hypertrophy. In the whole group we observed infundibular reaction in 12%, serious complications with one late death in 4%. From the start, BVP proved to be a secure and effective tool for elimination of pulmonary stenosis.
We determined the end-diastolic and end-systolic diameters of the aortic root, ascending aorta, aortic arch, pulmonary trunk, and right pulmonary artery in infants and children with congenital heart disease by means of two-dimensional echocardiography. These measurements were compared to those obtained by angiocardiography in the same patients. We found an excellent correlation (r = 0.94 to 0.99) with a slope near to 1. In a second study, we measured echocardiographically the end-systolic diameters of the aortic root, ascending aorta, aortic arch, pulmonary trunk and right pulmonary artery in 87 healthy newborns, infants, children and adolescents and correlated these measurements with the body weight. We found a nonlinear correlation with the diameters being best described as a function of the natural logarithm of the body weight. We determined normal ranges containing 90% of all future normal observations with a confidence of 90%. These normal ranges may serve as basis for comparison of measurements of the same diameters in children with heart disease.
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Since the introduction of echocardiography into paediatrics by Lundström at the end of the 1960's, this noninvasive technique has come a long way. The original m-mode technique was followed by sector-echocardiography, which permits two-dimensional visualization of the heart. By this means cardiac and great vessel anatomy can be studied in real time. Even complex congenital heart defects can be analyzed and, in contrast to angiocardiography, the atrioventricular valves are well visualized. The addition of doppler-echocardiography enables one to examine direction and velocity of blood flow, which helps to reveal shunts within the heart and between the great vessels as to detect valvular stenosis and insufficiency. The principal advantage of echocardiography lies in this ability to rapidly diagnose congenital and acquired heart disease without harm to the patient. In addition, size and dynamics of the cardiac chambers and the great vessels including valves can be adequately studied.
A male newborn infant with hypoplastic left heart and transposition of the great arteries died on the second day of life. The haemodynamic consequences of this malformation are considerably different from those of ordinary hypoplastic left heart syndrome because of pulmonary rather than aortic atresia. In the absence of cross sectional echocardiographic equipment, cardiac catheterisation with angiography is necessary to delineate the anatomical picture. These two conditions have not apparently been reported before in association.
The sympathomimetic substance oxedrine (Sympatol) influences, by means of its affinity to alpha- and beta-receptors, cardiac performance and peripheral vascular tone. We studied in 12 healthy male volunteers the influence of intravenous oxedrine on left ventricular contractility parameters as estimated by TM-echocardiography, on cardiac index as well as on arterial blood pressure and peripheral vascular resistance. Under continuous intravenous infusion of 4 mg/min oxedrine the systolic and mean arterial blood pressure increased significantly (p less than 0.005) while the diastolic pressure and heart rate remained unchanged. The cardiac index increased (p less than 0.001) and the peripheral vascular resistance decreased significantly (p less than 0.01). The echocardiographically determined left ventricular contractility parameters, i.e. systolic shortening fraction (SF) as well as maximal velocity of shortening of the left ventricular diameter (VCFmin) also increased significantly (p less than 0.001 and 0.005, resp.). An increase in left ventricular contractility and cardiac index with concomitant decrease of peripheral vascular resistance and without increase in heart rate implies an economical increase in cardiac performance under intravenous infusion of oxedrine.
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In the first part of the study we examined silicone rubber left ventricular casts of children and adolescents by cross-sectional echocardiography using the so-called two-chamber and four-chamber apical views. Left ventricular volumes calculated from the echocardiographic left ventricular silhouettes correlated very well (r = 0.99) with the titrated cast volumes. In the second part of the study we compared in 30 infants, children, and adolescents left ventricular volumes as calculated from the two-chamber and four-chamber apical echocardiographic views with those obtained from the frontal projection of the left ventricular cineangiogram. Volumes calculated from the apical four-chamber view showed an acceptable correlation with those determined by angiography (r = 0.96 for enddiastolic and r = 0.90 for endsystolic volume). Underestimation of left ventricular enddiastolic volume by echocardiography was corrected by a factor of 1.33; no correction factor was necessary for the endsystolic volume. The correlation between the endsystolic volumes obtained by echocardiographic two-chamber view and by cineangiography was poor. Finally, in 51 infants, children, and adolescents without heart disease we determined left ventricular volumes and derived variables by cross-sectional echocardiography, using the previously established correction factor for the calculation of enddiastolic volumes. Both enddiastolic and endsystolic volumes were found to correlate linearly to body surface area.
From November 1977 to January 1981, 10 consecutive patients underwent intracardiac repair of the complete atrioventricular canal at our institution. Ages ranged from 14 months to 4.5 years (mean age 20 months). Four patients were predominantly of type A, while 6 were predominantly of type C according to Rastelli's classification. Three patients had associated cardiac anomalies (2 tetralogy of Fallot and one parachute mitral valve). Standard repair and correction of the associated anomalies were performed under cold cardioplegic cardiac arrest and deep hypothermia with low-flow perfusion or circulatory arrest. Two patients died early postoperatively in severe renal failure and one died 6.5 months postoperatively in cardiac failure due to progressive mitral valve incompetence. One patient, with parachute mitral valve, was reoperated and the mitral valve was replaced because of persistent mitral insufficiency. The patients were followed up for a period of 4 to 35 months (mean 14 months) with a total of 112 patient months. The result of the operation was very good and all patients with retarded growth curve preoperatively showed a marked acceleration of their growth curve after operation. The operative results in this group of patients are independent of age and weight at the time of operation but appear to be influenced by associated cardiac anomalies and by the quality and quantity of atrioventricular valve tissue available for reconstruction.
There are few echocardiographic studies which examine ventricular cavity and wall dimensions as well as ventricular function in normal newborn infants. We investigated the M-mode echocardiograms of 60 normal newborn infants aged 3 to 6 days using computer analysis. Using the same method, we examined in addition left ventricular cavity dimensions and contractility variables of 15 healthy newborn infants sequentially during the first hour of life. The left and right ventricular diameters, their systolic shortening fraction and maximal rate of change, as well as the thickness of the interventricular septum and the left ventricular posterior wall were found to be comparable to previously published values. In addition, we found that the left ventricular end-diastolic diameter and the systolic shortening fraction of the left ventricular diameter increase significantly during the first hour of life. This increase is probably because of the postnatal increase in left ventricular volume and pressure work.
The aortico-left ventricular tunnel (AOLVT) is a rare abnormal communication between the ascending aorta and the left ventricle. The pathogenetic mechanism of this congenital anomaly is not completely understood. In addition to our 3 observations, 28 cases have been reported to date. In most cases the first symptoms appeared in early infancy. Clinical presentation and hemodynamics are identical to those of an aortic valve insufficiency. The correct diagnosis can be established by echocardiographic and angiocardiographic methods. Since the aortico-left ventricular tunnel is associated with congestive heart failure in infancy, in most cases surgical intervention is indicated in early childhood. The method of choice for surgical correction is a patch closure of the aortic orifice of the tunnel.
One-dimensional (time-motion) echocardiography allows easy manual determination of the systolic shortening fraction SF of the left-ventricular diameter. Using a computer it is, in addition, possible to calculate the maximal normalized velocity of shortening and lengthening of the left-ventricular diameter VCFmin and VCFmax. We compared these left-ventricular parameters in 20 children with left-ventricular myocardial disease with those of a control group of 146 healthy children and adolescents. SF, VCFmin and VCFmax are decreased in the children with left-ventricular myocardial disease. VCFmin and VCFmax are heart rate- and therefore also age-dependent. Both parameters are suitable for recognition of decreased left-ventricular contractility although there is some overlap with the normal values. SF is independent of age and heart rate, thus mean and limits of normal are equal for infants, children and adolescents. In all 20 children with left-ventricular myocardial disease, SF lies below the 2-SD limit of the normal control group. It is concluded that SF, which can be easily and manually determined by one-dimensional echocardiography, is well suited for the differentiation of children with normal and decreased left-ventricular contractility. For routine diagnostic purposes, computer-assisted calculation of VCFmin and VCFmax does not give additional information.
We report on 8 children with a right aortic arch and a retrooesophageal component of the upper descending aorta. The chest roentgenogram shows a right aortic arch and the oesophagogram a broad posterior indentation of the oesophagus in every case. Aortography was performed in 5 cases: in 2 children, the branches of the right aortic arch originate in a mirror image relationship to normal, in the other 3 children, the left subclavian artery originates as 4th branch from a retrooesophageal diverticulum of the upper descending aorta. Three children have an acyanotic congenital cardiac defect. Four of the children are asymptomatic while 3 have exertional dyspnoe and one suffers from dysphagia and frequent bronchitis. The symptoms are caused by compression of the oesophagus and the trachea by the right aortic arch, the retrooesophageal diverticulum and the patent or atretic ductus arteriosus originating from the latter. Only one child had to be operated for severe symptoms. There is a significant difference between the right aortic arch with or without a retrooesophageal component. The former mostly occurs alone and sometimes causes clinically significant oesophago-tracheal compression, while the latter is almost always combined with a cyanotic cardiac defect (tetralogy of Fallot, truncus arteriosus) but practically never causes a compression.