Biomedical subjects

S Kissler

Publications and source records attributed to S Kissler.

21 records · Page 2Linked to original sources

PubMed1996

Evaluation of post-myocardial infarction regional and global left ventricular function by monoplane ventriculography: superiority of right versus left anterior oblique projection at any infarct location.

OBJECTIVES: To study the significance of serial quantitative regional wall motion analysis, volumes, and ejection fraction findings as well as their prognostic implications derived from cineventriculography in 30 degrees right anterior oblique (RAO) projection in comparison with 60 degrees left anterior oblique (LAO) projection in post-myocardial infarction patients. Ventriculographic left ventricular parameters are accepted surrogates of mortality in myocardial infarction. Nowadays, in contrast to a biplanar approach in most institutions and clinical trials, the investigation is reduced to monoplanar ventriculography. However, it is not known whether the relevance of the two established projections might differ in different infarct topographies. DESIGN AND METHODS: Two hundred and six consecutive patients with acute myocardial infarction (infarct duration < 6 h) were treated with streptokinase (group I, n = 103) and allocated randomly additional percutaneous transluminal coronary angioplasty (group II, n = 103). Biplanar cineventriculography studies were performed at the acute stage, before discharge, and 6 months after discharge from hospital. RESULTS: Regional wall motion analysis (using an algorithm of fixed radiants) documented larger hypokinetic areas and intensities on RAO than it did on LAO projections, whereby infarct size and its improvement (stunned myocardium) was displayed more comprehensively, and a higher predictive power for survival (P = 0.0002 versus NS) was shown in anterior and inferior infarcts. No advantage of the LAO projection could be detected for evaluation of lateral infarcts due to circumflex coronary artery thrombosis either. The predictive power of the global function (ejection fraction; the algorithm of disc summation method) established by RAO projection (P = 0.007) was superior to that of LAO projection (P = 0.03). Enlargement of volumes (left ventricular remodeling) could be documented significantly only by the RAO projection; the LAO projection failed to do so. Groups I and II did not differ in any respect. CONCLUSIONS: The RAO projection has excellent diagnostic and predictive power at any infarct location. In contrast, additional LAO projection provides little information that cannot be obtained reliably from the RAO projection.

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

[Disturbed utero-tubal transport in hysterosalpingoscintigraphy as a predictive functional test for IVF therapy].

Hysterosalpingoscintigraphy (HSSG) is a simple method to evaluate the transport function of uterus and fallopian tubes. There is a quick uptake of radionuclides into the uterus and a transport to the side bearing the dominant follicle in 70 % of the patients in the late follicular phase of the cycle. Uptake and transport of the immotile radionuclides imitate the directed sperm transport through the female genital tract at the time of ovulation. 214 of 796 infertility patients with proven patency of fallopian tubes (27 %) showed only an uptake of the particles without a transport towards the fallopian tubes (negative HSSG). In these patients no spontaneous pregnancy occurred and pregnancy rate remained low by the means of timed intercourse or insemination. Indeed, the pregnancy rate (8.4 %) was significantly lower compared with the patients who became pregnant by timed intercourse, insemination or spontaneously and had a positive HSSG before (15 %; p=0.001). However, the pregnancy rate that could only be achieved by methods of ART was significantly higher in the group of patients with negative HSSG (57 % vs. 25 %, p=0.05). Our data suggest that HSSG is a new method to evaluate the integrity of the inner genital tract's transport function, especially in patients suffering from idiopathic infertility. Impaired transport function (negative HSSG) should be considered as an indication for IVF-treatment.

Fallopian Tubes↗

PubMedDate not supplied

Sperm transport in the human female genital tract and its modulation by oxytocin as assessed by hysterosalpingoscintigraphy, hysterotonography, electrohysterography and Doppler sonography.

The transport function of the uterus and oviducts and its modulation by oxytocin has been examined using hysterosalpingoscintigraphy, recording of intrauterine pressure, electrohysterography and Doppler sonography of the Fallopian tubes. After application to the posterior vaginal fornix, a rapid (within minutes) uptake of the labelled particles into the uterus was observed during the follicular and during the luteal phase of the cycle in all patients. Transport into the oviducts, however, could only be demonstrated during the follicular phase. Transport was directed predominantly into the tube ipsilateral to the ovary bearing the dominant follicle; the contralateral oviduct appeared to be functionally closed. The proportion of patients exhibiting ipsilateral transport did increase concomitant with the increase of the diameter of the dominant follicle. That ipsilateral transport has biological significance is suggested by the observation that the pregnancy rate following spontaneous intercourse or insemination was significantly higher in those women in whom ipsilateral transport could be demonstrated than in those who failed to exhibit lateralization. Oxytocin administration was followed by a dramatic increase in the amount of material transported to the ipsilateral tube, as demonstrated by radionuclide imaging and by Doppler sonography following instillation of ultrasound contrast medium. Continuous recording of intrauterine pressure before and after oxytocin administration did show an increase in basal tonus and amplitude of contractions and a reversal of the pressure gradient from a fundo-cervical to a cervico-fundal direction. These actions of oxytocin were accompanied by an increase in amplitude of potentials recorded by electrohysterography. These data support the view that uterus and Fallopian tubes represent a functional unit that is acting as a peristaltic pump and that the increasing activity of this pump during the follicular phase of the menstrual cycle is reflected by an increased transport into the oviduct ipsilateral to the ovary bearing the dominant follicle. In addition, they strongly suggest a critical role of oxytocin in this process. Failure of this mechanism appears to be a cause of subfertility or infertility, as indicated by the low pregnancy rate following intrauterine insemination or normal intercourse in the presence of patent Fallopian tubes. It may be regarded as a new nosological entity for which we propose the term tubal transport disorder (TTD). Since pregnancy rate of such patients is normal when treated with in-vitro fertilization (IVF), hysterosalpingoscintigraphy seems to be useful for the choice of treatment modalities in patients with patent Fallopian tubes suffering from infertility.

Adult↗