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Biomedical subjects

T Risler

Publications and source records attributed to T Risler.

At least 109 records · Page 6Linked to original sources
PubMed1991

[Low-dose enalapril in severe chronic heart failure].

In a prospective, controlled trial, the clinical course of 40 patients with severe chronic heart failure (NYHA III-IV) was followed for 1 year. In addition to digitalis and diuretics, 20 patients were treated with low-dose enalapril (5 mg/d; group E), while the previous therapy including conventional vasodilators was continued in the other 20 patients (group K). After 1 year in group E, the functional degree of heart failure decreased significantly compared to group K (p less than 0.02): 65% of group E patients improved by at least one NYHA functional class vs only 5% in group K. Parallel to the clinical changes in group E, cardiac size decreased significantly compared to group K, when measured as either a decrease in the cardiac thoracic ratio of the chest x-ray from 0.55 +/- 0.07 to 0.52 +/- 0.11 (p less than 0.02) or in the echocardiographically determined left ventricular end-diastolic diameter from 72 +/- 9 to 65 +/- 7 mm (p less than 0.01). Severe side effects or complications occurred in 15% of the patients in group E and in 10% of group K, showing no significant difference between the two groups. During the 1-year observation period, two patients died in group E, and nine patients died in group K, resulting in a significantly (p less than 0.025) different mortality rate of 10% in group E compared to 45% in group K. Thus, additional treatment with low dose enalapril had lasting favorable influences on the clinical course of patients with severe chronic heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Low-dose enalapril as additional medication in severe chronic heart failure].

A prospective, randomized efficacy study of low-dose enalapril was undertaken in 38 outpatients (24 men, 14 women; mean age 58 [41-69] years) with chronic heart failure (NYHA functional class III-IV). All patients were pretreated with digitalis and diuretics, some also with conventional vasodilators. 19 patients (group E) received in addition to their previous medication, 5 mg enalapril daily, while the other 19 (group K) continued with their previous therapy. Three months later, 15 patients in group E improved by at least one NYHA functional class and none died (P less than 0.02). Four patients in group K died and only one patient improved by one class. After three months, left ventricular ejection fraction was significantly higher (P less than 0.0001) in group E (39 +/- 19%) compared to group K (30 +/- 14%). In group E, plasma aldosterone concentration decreased significantly (P less than 0.0001) by 33.4 +/- 6.5 ng/dl, while in group K no significant change occurred (delta 1.1 +/- 1.2 ng/dl). Thus, low-dose enalapril in addition to conventional therapy may improve the clinical status of patients in severe chronic heart failure. This improvement is associated with an increase in left ventricular ejection fraction and reduction in secondary hyperaldosteronism.

Chi-Square Distribution↗
PubMed1990

Renal effects of the new calcium channel blocking drug isradipine.

The acute effect of a single oral dose of isradipine 5 mg on blood pressure, renal haemodynamics, electrolyte excretion and plasma renin activity was studied in 10 healthy males. Isradipine did not produce a significant change in systolic or diastolic blood pressure, and glomerular filtration rate, renal plasma flow, renal vascular resistance, and urinary albumin excretion remained constant. There was a marked natriuretic and diuretic effect about 1-3 h after isradipine. Plasma renin activity showed a slight, insignificant increase 1 h after dosing. Uric acid clearance and beta 2-microglobulin excretion showed no significant changes, despite an increase in sodium clearance, suggesting an additional mechanism of action other than the proximal tubular natriuretic effect of isradipine in normotensive volunteers.

Administration, Oral↗
PubMed1990

Association of glomerular and interstitial mononuclear leukocytes with different forms of glomerulonephritis.

Immunophenotyping of mononuclear leukocytes was performed in renal tissue obtained from 69 patients with different forms of glomerulonephritis (GN) and from ten donors' kidneys for transplantation used as controls. A panel of monoclonal antibodies was used in the immunoperoxidase technique on frozen sections to define B- and T-lymphocyte subpopulations, NK cells and monocytes/macrophages, as well as the expression of HLA class II antigens-DQ, -DR and -DP. Quantification of labelled leukocytes revealed a significant increase of CD4+ and CD8+ T-cells in glomeruli of rapidly progressive glomerulonephritis, membranoproliferative glomerulonephritis and even of focal gomerulosclerosis. The number of glomerular monocytes/macrophages was significantly increased only in rapidly progressive glomerulonephritis, whereas in membranoproliferative glomerulonephritis it was decreased. No differences to normal tissue were detected in glomeruli for all other types of inflammatory cells. Interstitial cells were mostly T-lymphocytes in all forms of glomerulonephritis. In all groups the CD4+/CD8+ ratio was somewhat greater than 1 and even about 2 in rapidly progressive glomerulonephritis. Only in particular case was this ratio inversed. High expression of HLA class II antigens was observed on interstitial mononuclear leukocytes, as a sign of their activation. The excess of HLA-DQ-positive cells over the sum of CD14+ and CD20+ cells provides evidence not only for presence of activated T-lymphocytes but perhaps also for accumulation of renal dendritic cells in the interstitium in glomerulonephritis associated with interstitial infiltration.

Antibodies, Monoclonal↗
PubMed1990

Regulation of plasma aldosterone during hemodialysis.

In order to clarify the influence of serum potassium, serum sodium and plasma angiotensin II concentrations on aldosterone release during hemodialysis (HD), six chronic hemodialysis patients were studied during HD with varying dialysate sodium concentrations and different buffers. Plasma aldosterone concentrations were higher during acetate than bicarbonate HD, during low sodium compared to high sodium HD, and were correlated inversely to serum sodium concentrations. The decline in plasma aldosterone concentrations during HD paralleled the decrease in serum potassium concentrations, and plasma aldosterone concentrations were correlated with serum potassium concentrations. In addition, plasma aldosterone and plasma angiotensin II concentrations were correlated significantly. It is proposed that serum potassium and the renin-angiotensin system are the main factors of aldosterone release during hemodialysis, while serum sodium per se seems to be of less importance. The dialysate buffer employed also plays a role in aldosterone regulation (via the renin-angiotensin system).

Acetates↗
PubMed1989

Low-dose enalapril in severe chronic heart failure.

In a 3-month prospective, single-blind, controlled trial, 38 patients in New York Heart Association functional class III-IV were assigned to group E (n = 19): enalapril 5 mg/day in addition to the previous therapy with digitalis and diuretics, or group C (n = 19): continuation of the previous therapy. In group E, 79% of the patients improved by at least one NYHA functional class after 3 months. In group C, the functional class did not change and four patients died. The echocardiographically determined end-diastolic diameter of the left ventricle decreased in group E from 72 +/- 8 mm to 63 +/- 6 mm (p less than 0.001), and the scintigraphically determined ejection fraction of the left ventricle increased from 33 +/- 18% to 40 +/- 19% (p less than 0.002). In contrast, no significant change was found in group C. Plasma-renin activity increased in group E from 8.2 +/- 1.8 ng/ml h to 29.7 +/- 14 ng/ml h (p less than 0.001), and plasma aldosterone decreased from 47.7 +/- 7.6 ng/dl to 19.9 +/- 4.8 ng/dl (p less than 0.01). In group C no significant change occurred. Comparing the actual changes (deltas) of the NYHA functional class (p less than 0.02), end-diastolic diameter and ejection fraction of the left ventricle, plasma-renin activity, and plasma aldosterone (p less than 0.0001), a significant difference between the two groups was found. Thus, low-dose enalapril resulted in a significant improvement of the NYHA functional class in patients with severe chronic heart failure, accompanied by an improvement in left ventricular function and a decrease in secondary aldosteronism.

Aged↗
PubMed1989

Expression of HLA-DQ, -DR, and -DP antigens in normal kidney and glomerulonephritis.

Expression of the defined subtypes of HLA-class II antigens DQ, DR, DP, as well as of a putatively new HLA-class II determinant DY was evaluated with specific monoclonal antibodies on frozen sections of 15 normal kidneys, as well as of renal tissue of 65 patients with different forms of glomerulonephritis (GN). In normal kidney HLA-DR and/or -DY versus DQ or DP antigens were shown to be differentially expressed on subpopulations of glomerular and interstitial cells, as well as vascular endothelia. Normal proximal tubular epithelia lacked HLA-DQ and -DP antigens, but carried -DY and variably -DR products constitutively. In comparison, aberrant presence of HLA-DQ and/or -DP antigens was found on proximal tubular cells in the majority of patients with rapidly progressive (RPGN), membranoproliferative GN (MPGN), or focal glomerular sclerosis (FGS), but more rarely observed in other forms of proliferative or non-proliferative GN. In addition all cases with RPGN revealed reduction of HLA-DQ, -DR, -DP or -DY+ glomerular cells. Decline of HLA-DP and/or -DR+ glomerular cells was variably seen in mesangioproliferative glomerulonephritis (MesPGN) and MPGN, whereas in FGS HLA-DQ antigens appeared to be increased in glomeruli. HLA-DQ, -DR, -DY+ interstitial cellular infiltrates were present in RPGN, FGS and MPGN and only occasionally occurred in other forms of GN. Altered renal expression of HLA-class II antigens may indicate specific sites of immunologically-mediated kidney injuries in GN.

Antibodies, Monoclonal↗
PubMed1989

Multifactorial genesis of enhanced platelet aggregability in patients with nephrotic syndrome.

Platelet aggregation, beta-thromboglobulin (beta-TG) and platelet factor 4 (PF 4) release and thromboxane B2 (TxB2) formation in stimulated platelet-rich plasma were investigated in 13 patients with nephrotic syndrome who had normal serum creatinine levels (creatinine clearance greater than 70 ml/min/1.73 m2). In contrast to 13 sex- and age-matched controls, spontaneous platelet aggregation only occurred in patients with nephrotic syndrome with correlation to serum albumin and plasma fibrinogen levels. The EC50 (estimated concentration of aggregating agent to cause half maximum velocity of primary aggregation) for ADP and collagen and threshold concentration of arachidonic acid (threshold AA) were decreased in patients with nephrotic syndrome, reflecting a hyperaggregable state. In patients with nephrotic syndrome EC50 ADP values were significantly correlated to serum albumin, serum cholesterol and plasma fibrinogen, however, EC50 collagen or threshold AA did not correlate to these parameters. Plasma beta-TG levels were increased in patients, whereas plasma PF 4 levels were not significantly changed in patients compared to controls. In vitro TxB2 formation was elevated in patients only after stimulation with AA. Nevertheless, after stimulation with collagen and ADP, TxB2 formation was unchanged in patients compared to controls. Platelet hyperaggregability in nephrotic patients was confirmed in our study. However, unchanged thromboxane B2 formation after collagen stimulus as well as missing correlations between EC50 collagen or threshold AA and serum albumin were contradictory to the hypothesis that enhanced AA availability due to hypoalbuminemia is responsible for platelet hyperaggregability. Platelet hyperaggregability in terms of EC50 ADP being associated with serum albumin levels as well as to serum cholesterol and plasma fibrinogen indicate a multifactorial genesis.

Female↗
PubMed1988

[Significance of ultrasonics in the placement of a central venous catheter].

An ultrasound investigation was undertaken of the neck region of 42 patients with normal neck anatomy in order to determine whether the results of ultrasound-gained topographical data provided pointers to the choice of entry site to the internal jugular vein (IJV). In addition, the IJV was punctured under ultrasound control in 23 patients in an intensive care unit in whom there was a problem of increased bleeding tendency, anatomical difficulty or previously failed "blind" puncture. In all of them a central venous catheter was placed without complication by the Seldinger technique via the primary chosen point for puncture. An approach through the sternocleidomastoid muscle, between the cricoid level and the "central" place of puncture between the two bellies of the sternocleidomastoid muscle proved to be the most satisfactory compromise between easy application of the ultrasound head, large vein diameter and reduction of any risk of mistakenly puncturing artery or pleura. This approach has to be varied according to the ultrasound findings. It is concluded from this experience that ultrasound is suitable for the placement of central venous catheters. But since the equipment is bulky it cannot be used in an emergency.

Adult↗