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Biomedical subjects

T Hess

Publications and source records attributed to T Hess.

At least 127 records · Page 7Linked to original sources
PubMed1983

Digitoxin intoxication with severe thrombocytopenia: reversal by digoxin-specific antibodies.

As a result of overdosage a 77-year-old patient with heart disease developed digitoxin intoxication, associated with arrhythmias, extracardiac symptoms of intoxication and severe thrombocytopenia. Treatment with digoxin-specific antibody fragments relieved the signs and symptoms of intoxication within a few hours. The rise in platelet count from the pretreatment value of 26 000/mm3 to 47 000 within 12 h and to over 60 000/mm3 within 16 h of starting the antibody infusion may also be attributed to the treatment with antibodies. Such a rapid recovery from digitoxin-induced thrombocytopenia has not hitherto been described. Digoxin-specific antibodies, obtained by immunization of sheep with a digoxin-albumin conjugate, were used to treat intoxication with digitoxin, since cross-reaction had been demonstrated in vitro and in animal experiments. The present paper briefly discusses the mode of action and the general problems relating to the antibody therapy of digitalis poisoning.

Aged↗
PubMed1983

Digoxin-specific antibody fragments and a calcium antagonist for reversal of digoxin-induced mesenteric vasoconstriction.

The effect of digoxin-specific antibody fragments on glycoside-induced mesenteric vasoconstriction were investigated. Digoxin caused a sustained contraction of strips of isolated feline mesenteric artery lasting for several hours, while in anaesthetized cats it produced a significant decrease in blood flow and increase in resistance in the mesenteric artery. In-vitro, digoxin's contractile effect was inhibited by 'prophylactic' addition of antibody to the organ bath, but the clinical use for prophylaxis is not a practical proposition. When the antibodies were added with the contraction of the arterial strip in response to digoxin already established, the tone of the preparation decreased significantly over 3 h, but the effect of the glycoside was not fully reversible. In-vivo, control animals not treated with antibodies developed arrhythmias, mesenteric blood flow fell by more than 50% and resistance increased by more than 80% relative to the initial values. These animals died of ventricular fibrillation before the end of the experiment. Animals treated with digoxin-specific antibody fragments after receiving digoxin injections showed no further decrease in mesenteric blood flow and 90 min after the last dose of digoxin, the flow was recovering and mesenteric resistance decreasing. Furthermore, all the animals that had received antibodies remained in sinus rhythm to the end of the experiment. In view of the latent period to onset of action of the antibodies, valuable time may be lost in impaired mesenteric blood flow. To bridge the gap or, indeed, as primary treatment, calcium antagonists merit consideration; in our experiments mesenteric vasoconstriction was abolished within a few minutes by application of the dihydropyridine calcium antagonist 4-(2,1,3-benzo-oxadiazol-4-yl)-2,6-dimethyl-1,4-dihydropyridine-3,5-dicarboxylic aid, diethyl ester (PY 108-068).

Anesthesia↗
PubMed1983

Tomoscintigraphic assessment of myocardial metabolic heterogenity.

I-123-omega-heptadecanoic acid (HDA) was evaluated for myocardial scanning in 59 healthy volunteers and 133 patients, using a 7-pinhole collimator. Early (uptake) and late (retention) images were compared visually. Regional HDA elimination was also followed semiquantitatively based on the calculation of a retention-over-uptake ratio, R(phi), derived from the maximal counts/pixel in 60 midventricular slice sectors. The healthy heart concentrated HDA homogeneously in all segments with no difference between early and late images. The minimal R(phi), taken as representative of that myocardium with the best function, was unchanged after maximal ergometer stress and with dipyramidole-induced hyperperfusion. A circumscribed decreased HDA uptake is the clear-cut criterion for an abnormal finding. HDA tomography of the myocardium had an 86% sensitivity for myocardial infarcts (MIs) up to 4 wk old, and 83% for myocardial scars (MSs). Comparing early and late tomograms, we find a cool-warm sequence more often with acute and subacute MIs. A cool-cool or a cold-cold sequence dominated with MSs. HDA tomoscintigraphy cannot replace TI-201 for the evaluation of regional coronary reserve in coronary heart disease.

Adult↗
PubMed1982

[Ventricle rupture in myocardial infarction].

22 patients with rupture of the heart after myocardial infarction in the years 1974-1978 were compared with a matched sample of other patients with infarction. No increase in rupture rate was observed under present-day intensive care methods over the time period, nor did early heparin administration in one of the institutions involve increased risk of subsequent rupture.

Aged↗
PubMed1982

[Drug side effects as the probable cause of death. Results of the Berne Comprehensive Hospital Drug Monitoring Program].

During the years 1974-1980, 19 of 17,285 inpatients of the divisions of internal medicine of two teaching hospitals showed a probable or definite adverse drug reaction (ADR) which was considered to be a major cause of death. In 7 patients the decisive ADR occurred during the hospital stay. The overall mortality from ADR is 0.040%. For each therapeutic group of drugs the following rate of drug-related death was calculated: for anticoagulants 0.047% (3/6378 inpatients), for cardiac glycosides 0.016% (1/6368), for analgesic/antirheumatic drugs 0.014% (1/7112) and for cytostatic drugs 0.38% (2/531). In 12 patients the ADR was already present on hospital admission.

Aged↗
PubMed1982

[Bioavailability of digoxin and beta-methyl-digoxin in patients with liver and gastro-intestinal diseases ].

The bioavailability of digoxin and beta-methyl-digoxin (BMD) was tested with a single dose on the grounds of peak serum concentration, tmax, area under the serum concentration-time curve and the cumulative 24 hour urinary excretion on one group of patients with liver disease (n = 20) and one with gastrointestinal disease (n = 10). Despite the smaller dose (0.5 mg BMD against 0.75 mg digoxin), peak serum concentration was significantly higher with BMD in both groups and was also reached earlier than with digoxin. The extent of absorption was also higher in both groups with BMD than with digoxin. A comparison of the results on hand with the results obtained in corresponding tests on healthy persons showed no significant differences with BMD. The excellent bioavailability of BMD was therefore also proved on patients with gastrointestinal diseases, whereas with digoxin the absorption in these patients was retarded, compared with healthy persons, but the extent of absorption was not reduced either. In gastrointestinal diseases with unknown conditions of absorption, the better bioavailability of BMD is probably of advantage, when compared with digoxin. According to medical literature, t/2 of BMD may be prolonged in liver diseases, so that in such cases the dose of BMD has to be adjusted or the use of digoxin is recommended.

Adult↗
PubMed1982

Suicidal digoxin poisoning: conventional treatment and antibody therapy.

A 66-year-old mand suffering from severe coronary heart disease took digoxin with suicidal intent an was treated for the ensuing complete atrioventricular block with digoxin-specific antibody fragments. Two and a half hours after intravenous infusion of the antibody fragments, the signs of intoxication passed off, and atrial fibrillation with a normal ventricular rate was reinstated. Antibody therapy is capable of permanently abolishing the signs of symptoms of digitalis poisoning after a matter of hours. Such a rapid or complete response cannot be achieved by any conventional form of treatment. This advantage must be weighed against the risks (immunologic reactions, loss of the therapeutic effect of the cardiac glycoside if an overdose of antibody is given). Moreover, antibody therapy does not take effect immediately, as is understandable in view of the mechanism of action. It should therefore be instituted in good time in potentially life-threatening cases of intoxication.

Aged↗
PubMed1981

[Biological availability of digoxin and beta-methyl-digoxin administered in the fasting state or after meals].

Ten healthy volunteers were given 0.75 mg digoxin and 0.5 mg beta-methyl-digoxin (BMD) in tablet form in the fasting state or after breakfast. Serum concentrations and 24-hour urine excretion of glycoside were measured by radioimmunoassay. Neither the mean area under the serum concentration curve nor the mean cumulative urinary excretion was significantly changed by postprandial administration. Peak serum concentrations were higher when the subjects took the tablets while fasting than when they took them postprandially, but the difference was significant only for BMD. After BMD in the fed state the peak serum concentration was reached earlier and with less variation than after digoxin, but -- as after administration in the fasting state -- the differences were not significant. The peak serum concentration and the time when it is achieved are, as parameters for the rate of absorption, only of secondary importance for treatment with cardiac glycosides in medical practice. They suggest faster absorption of BMD compared with digoxin. Both the glycosides can be given equally well before, during or after food, a fact which facilitates prescription.

Adult↗
PubMed1981

[Underdosing and overdosing with digitalis].

Incorrect dosage of digitalis occurs frequently and is due in most cases to relative over- or underdosage. The narrow therapeutic range of all cardiac glycosides and the lack of an ideal preparation form the basis, and noncompliance of the ill-informed patient as well as the changing digitalis requirement from patient to patient, and even in the same patient, are the most frequent causes of dosage errors. Important guidelines for the dosage of digoxin and digitoxin (renal failure, diseases of the liver and gastrointestinal tract, body weight, age, electrolyte disorders, hypoxia, thyroid dysfunction and drug interactions) are discussed. Symptoms, signs and treatment of underdigitalization and digitalis intoxication, a frequent and often lethal complication, are reviewed.

Angina Pectoris↗
PubMed1981

[Features and treatment of heart failure in old age].

Heart failure is a syndrome with many causes and well known symptoms, which are mentioned in the introduction. In aged people coronary and hypertensive cardiopathy are the main causes of heart failure, and only rarely do senile changes of the heart play a role. A causal therapy cannot be performed in most cases since in old age several heart diseases and concommittant affections are combined. A well aimed treatment of the diseases that cause and promote heart failure is crucial for the further course. The symptomatic treatment combines general measures, pharmacotherapy with digitalis and diuretics. Special aspects of the administration of glycosides in old age are treated in detail, and the use of continuous therapy is discussed. Diuretics as well as digitalis should be adapted to the single case. For the time being the treatment with vasodilating drugs must be restricted to special clinical situations and selected cases.

Aged↗
PubMed1980

The effectiveness of digoxin-specific F(ab')2-antibody fragments in the treatment of digitoxin poisoning: experimental investigations in the cat.

In animal experiments heterologous digoxin-specific F(ab')2 antibody fragments have been found to be effective for the treatment of arrhythmias induced by toxic doses of digoxin. So far they have been successfully employed in three patients suffering from digoxin poisoning. The present study was undertaken to test whether these antibodies are also effective in the treatment of digitoxin poisoning. Ventricular tachycardia, induced in digitalized cats by intravenous injections of digitoxin, was fatal in four out of five controls. However, sinus rhythm was reinstated in all the animals treated with digoxin-specific F(ab')2 after onset of the arrhythmia. Cross-reactivity between the antibodies used and digitoxin, while slight in vitro, is, nevertheless, sufficient to justify their clinical use in cases of digitoxin poisoning.

Animals↗
PubMed1980

[The treatment of digitalis poisoning with antibiotics (author's transl)].

Digitalis intoxication occurs frequently and proves fatal in 5-10% of all cases. Treatment is limited to symptomatic measures. Glycoside-specific antibodies offer a new way of treatment of digitalis intoxication. In our experiments with cats, they were found to be highly effective in reversing digoxin-induced arrhythmias. Specific antibodies have previously been employed in a patient with suicidal digoxin intoxication. We report a case of nonsuicidal Lanatosid-C intoxication treated with F(ab')2-fragments of digoxin-specific antibodies from the sheep. The treatment was successful and without side-effects. Serum concentration of free digoxin and total digoxin measured during and after treatment showed a decrease of free and a sharp raise in total digoxin. For clinical use, antibody fragments are superior to intact antibodies. Problems and possible indications concerning the treatment of digitalis intoxication with antibodies are briefly discussed.

Animals↗
PubMed1979

[Antibody treatment of digoxin intoxication in a patient with renal failure (author's transl)].

A 72-year-old man with coronary heart disease and renal failure required hospitalization because of digoxin intoxication with severe arrhythmias and generalised heart failure. The intoxication was successfully treated and sinus rhythm rapidly restored after administration of heterologous digoxin-specific F(ab')2 antibody fragments. There were no side-effects and the heart failure improved after treatment.

Aged↗