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Biomedical subjects

W Grimm

Publications and source records attributed to W Grimm.

At least 19 recordsLinked to original sources
PubMed2003

[Helicobacter pylori infection in children and juveniles: an epidemiological study on prevalence, socio-economic factors and symptoms].

BACKGROUND AND OBJECTIVE: In view of numerous sequelae of a Helicobacter pylori (H.p.) infection and sparse epidemiological data on the infectious status of children and juveniles, a cross-sectional study was undertaken in schools of the Aschaffenburg area. Data were recorded on the number of H.p. infections in pupils aged 14-20 years, the possible influence of various socio-economic factors, and a possible association of the infection with upper abdominal symptoms. SUBJECTS AND METHODS: In 540 pupils of grade 2 (aged 7-9 years: primary school, n = 183) grade 7 (aged 11-15: primary and secondary schools, n = 177) and grade 12 (aged 16-20 years: vocational or grammar school: n = 180), the presence of H.p. was elucidated with the 13C-urea breath test. An anonymous questionnaire was used to ascertain socio-economic status and any symptoms. RESULTS: In 51 of the 540 pupils (9.4%) the test for H.p. was positive. The infectious state increased with age, but there was no significant difference between the various age groups. Ethnically German pupils were less often infected (7.1%) than those of foreign origin (28.2%). The number of persons in a household correlated with the H.p. status. Upper abdominal symptoms were more frequently reported by infected children and juveniles and were an independent risk factor for H.p. infection. CONCLUSION: This study highlights the importance of socio-economic factors and the possible association of upper abdominal pain with H.p infection.

Abdominal Pain↗
PubMed2003

[Continously increasing sensitivity in thyroid cancer aftercare in the course of three generations of thyroglobulin IMAs].

UNLABELLED: Aim of our study was to evaluate the increasing sensitivity within three generations of thyroglobulin (Tg) assays, which were available during the past decade, and its clinical impact for patients with differentiated thyroid carcinoma. METHODS: Determination of Tg using the IRMA introduced in 1989 (Dynotest Tg, Henning Berlin, Berlin; assay A) and 1994 (Selco Tg, Medipan Diagnostica, Selchow; assay B), as well as the IEMA available recently (Medizym Tg Rem, Medipan Diagnostica, Selchow; assay C). RESULTS: We found a close correlation between the measurable Tg values of assay A and B (r=0.985; p<0.001) as well as assay B and C (r=0.978; p<0.001). Assay B (lowest detection limit: 0.3 ng/ml) was more than twice as sensitive as assay A and did not show quite as many disturbances of recovery (in 0.5% versus 4% of our patients). Due to its strict calibration to the European reference preparation CRM 457, Tg values determined by assay C were in the mean 1.9-fold higher than by assay B. Thus, with its functional sensitivity of 0.03 ng/ml assay C is nearly 20-fold more sensitive than assay B. Whereas the proportion of measurable Tg values was only 22% in a selected group of patients (criterion of inclusion: Tg in assay B< or =1 ng/ml with TSH-suppressive conditions; n=317 serum samples from 103 patients), it was 68% in assay C, with good intraindividual reproducibility of these values in the course. CONCLUSION: The ultrasensitive assay C is especially suitable for the follow-up of treated thyroid cancer patients being considered as cured, and may shorten the time interval until the detection of a recurrence markedly: the gain of time calculated from the Tg courses in patients with a gradually progressive tumor relapse ranged from 5 to 15 months.

Biomarkers, Tumor↗
PubMed2002

[Amiodarone induced pulmonary toxicity].

BACKGROUND: Antiarrhythmic therapy with class III drug amiodarone (Cordarex(R)) for supraventricular and ventricular tachycardia is commonly used because of its high efficacy and absent negative inotropy. Pulmonary toxicity of amiodarone possibly leading to lung fibrosis is a rare, but severe side effect of chronic therapy. In contrast to patients with coronary artery disease, there are only a few data about pulmonary toxicity in patients with dilated cardiomyopathy. CASE REPORT: We report on two patients with dilated cardiomyopathy who received amiodarone because of symptomatic non-sustained or sustained ventricular tachycardia. After 6 weeks resp. 8 months of treatment with amiodarone both patients developed pulmonary toxicity. Other causes of pulmonary toxicity were ruled out by bronchoscopy, bronchoalveolar lavage and biopsy. Pulmonary function improved in both patients within some weeks after discontinuation of amiodarone. CONCLUSIONS: This report deals with two cases of amiodarone induced pulmonary toxicity in dilated cardiomyopathy leading to respiratory insufficiency. Pulmonary toxicity is a rare, but potentially lethal side effect of amiodarone. Reversibility of pulmonary changes in case of an early drug discontinuation is shown. Because of severe reduced left ventricular function in dilated cardiomyopathy, heart failure symptoms could conceal clinical signs of pulmonary amiodarone toxicity. Therefore, pulmonary function should be controlled periodically during amiodarone therapy including bronchoscopy, bronchoalveolar lavage, biopsy and measurement of diffusion capacity.

Adult↗
PubMed2001

[Prevention of atrial arrhythmias by pacing].

BACKGROUND: Atrial fibrillation is the most frequent arrhythmia. It can impair quality of life considerably. Due to thromboembolic complications it contributes to the patients' morbidity and mortality and to the costs for their medical treatment. PREVENTION: In chronic atrial fibrillation there is a need for adequate anticoagulation and heart rate control. In paroxysmal and intermittent atrial fibrillation it should be sought to prevent its progression to chronic atrial fibrillation. Since atrial fibrillation initiates negative processes of remodeling within the atrial myocardium, it has the tendency to perpetuate itself. From a theoretical point of view, it can be expected that all means which prevent episodes of atrial fibrillation or which terminate it immediately after its onset, are able to prevent or at least to delay the progression to chronic atrial fibrillation. Pharmacologic treatment is usually used to prevent recurrences of atrial fibrillation. Based on the actual data it can also be expected that pacemakers with special preventive pacing algorithms are able to reduce the atrial arrhythmic burden. Besides consequent overdrive pacing, more sophisticated algorithms like "suppression of premature atrial contractions", "post exercise response", "automatic rest rate" or "post mode-switch pacing" have been developed. They can be applied either alone or in combination with special lead positions (interatrial septal pacing or pacing of the triangle of Koch) or special stimulation configurations like dual site right atrial pacing or biatrial pacing. These pacing strategies cover the most relevant onset mechanisms of atrial fibrillation. Furthermore, there are algorithms to treat atrial tachyarrhythmias actively by antitachycardia pacing (ATP). First clinical results have shown that about 2/3 of the diagnosed atrial tachyarrhythmias could be terminated by these means immediately after their onset. ONGOING TRIALS: This article gives an overview over the principles of pacing in the management of atrial arrhythmias and ongoing clinical trials in this field. Before a definite judgement on the clinical relevance of these new preventive and therapeutic pacing strategies can be given, the results of these ongoing controlled clinical studies have to be analyzed.

Algorithms↗
PubMed2001

Reversal of tachycardia induced cardiomyopathy following ablation of repetitive monomorphic right ventricular outflow tract tachycardia.

Radiofrequency catheter ablation was performed in four adults with myocardial dysfunction related to repetitive monomorphic ventricular tachycardia (RMVT) originating in the right ventricular outflow tract. Serial echocardiographic assessment of left ventricular function before and after radiofrequency catheter ablation of RMVT showed complete reversal of left ventricular dysfunction without arrhythmia recurrence during 31+/-28 months follow-up.

Adult↗
PubMed2001

Varicella myocarditis in an adult.

A 24 year old male with varicella myocarditis was admitted with chest pain and fever up to 39 degrees C. The ECG showed J point and ST elevation in leads V2-V4, and inverted T waves in leads V5 and V6. Creatine kinase (CK) was raised to 435 U/l (CK-MB 36 U/l), troponin I was 63.4 microgram/l, and lactate dehydrogenase was 359 U/l, suggesting cardiac involvement of varicella infection. The left ventricle was dilated (58 mm) and left ventricular ejection fraction was globally reduced (ejection fraction 45%). Myocarditis was confirmed by endomyocardial biopsy. The patient was treated with specific varicella hyperimmunoglobulins, aciclovir, and a non-steroidal anti-inflammatory drug. During two months follow up the patient recovered completely. This case report is a reminder that a varicella infection can cause myocarditis in adults. Early diagnosis and appropriate treatment of this rare form of myocarditis may lead to complete recovery.

Adult↗
PubMed2001

Prognostic value of heart rate variability analysis in patients with carcinoid syndrome.

BACKGROUND/AIMS: Recently, a decrease in heart rate variability measures was found in patients with carcinoid syndrome suffering from carcinoid heart disease compared to those without cardiac involvement of carcinoid syndrome. The prognostic relevance of this finding, however, was not clear. PATIENTS AND METHODS: Therefore, 35 patients with carcinoid syndrome (21 men, age 56 +/- 11 years), all of them suffering from metastatic carcinoid tumors, were followed prospectively at our institution. Digital 24-hour Holter monitoring, echocardiography, and serum serotonin and urine 5-hydroxyindole acetic acid (5-HIAA) samplings were performed in all study patients at baseline. Indices of time domain heart rate variability obtained from Holter recordings included the standard deviation of all normal RR intervals (SDNN) representing overall variability, the square root of the mean of the squared differences between adjacent normal RR intervals (rMSSD), and the percentage of the number of pairs of adjacent normal RR intervals differing by >50 ms (pNN50), both indices reflecting predominantly vagal influences on heart rate. RESULTS: During a mean follow-up of 18 +/- 7 months, 15 of 35 patients with carcinoid syndrome (43%) died. Patients with cardiac manifestation of the carcinoid syndrome showed a tendency towards an increased mortality in comparison to patients without cardiac involvement (p = 0.09). Patients with the combination of decreased heart rate variability (SDNN <100 ms) and presence of carcinoid heart disease had a significant worse prognosis (p = 0.04) compared to patients without carcinoid heart disease and preserved heart rate variability (SDNN > or =100 ms). CONCLUSIONS: The presence of carcinoid heart disease in combination with decreased heart rate variability is associated with the most adverse prognosis in the setting of carcinoid syndrome.

Aged↗
PubMed2000

Outcome of patients with sleep apnea-associated severe bradyarrhythmias after continuous positive airway pressure therapy.

Twenty-nine patients in whom severe bradyarrhythmias occurred exclusively during obstructive sleep apnea and in whom advanced sinus node disease or atrioventricular conduction system dysfunction had been excluded by invasive electrophysiologic evaluation were prospectively followed on nasal continuous positive airway pressure. During 54 +/- 10 months follow-up, no syncope and no sudden deaths were observed, suggesting that patients with sleep apnea-associated bradyarrhythmias and a normal electrophysiologic study appear to have a favorable prognosis with continuous positive airway pressure.

Bradycardia↗
PubMed2000

Significance of accelerated idioventricular rhythm in idiopathic dilated cardiomyopathy.

Holter monitoring was performed in 202 patients with idiopathic dilated cardiomyopathy, which revealed accelerated idioventricular rhythm in 16 patients (8%) and nonsustained ventricular tachycardia in 70 patients (35%). During 32 +/- 15-month prospective follow-up, no significant difference was observed for major arrhythmic events and transplant-free survival between patients with and without accelerated idioventricular rhythm, whereas patients with nonsustained ventricular tachycardia had a significantly higher incidence of major arrhythmic events and a lower transplant-free survival rate.

Accelerated Idioventricular Rhythm↗
PubMed2000

Cardiac autonomic tone and its relation to nonsustained ventricular tachyarrhythmias in idiopathic dilated cardiomyopathy.

BACKGROUND: In contrast to postinfarct patients, little is known about cardiac autonomic tone and its relation to spontaneous ventricular tachyarrhythmias in idiopathic dilated cardiomyopathy (IDC). Both heart rate variability (HRV) and baroreflex sensitivity (BRS) are indices of autonomic innervation of the heart. HYPOTHESIS: The aim of the present study was to determine the relation between cardiac autonomic tone assessed by HRV and BRS and spontaneous nonsustained ventricular tachycardia (NSVT) on Holter in a large patient population with IDC. METHODS: 24-h digital Holter recordings including HRV analysis and BRS testing were prospectively performed in 137 patients with IDC and preserved sinus rhythm. Mean age was 48 +/- 12 years, and mean left ventricular (LV) ejection fraction was 32 +/- 9%. The HRV analysis on Holter included the mean RR interval (RRm), the standard deviation of all normal RR intervals (SDNN), the square root of the mean of the squared differences between adjacent normal RR intervals (rMSSD), and the proportion of adjacent normal RR intervals differing more than 50 ms (pNN50). Testing for BRS was performed noninvasively using the phenylephrine method. RESULTS: Of 137 study patients, 42 (31%) had spontaneous NSVT on 24-h Holter. Compared with patients without NSVT, patients with NSVT on Holter had a higher New York Heart Association (NYHA) functional class (NYHA III: 40 vs. 18%, p < 0.01), a lower ejection fraction (29 +/- 9 vs. 34 +/- 9%, p = 0.01), and an increased LV end-diastolic diameter (69 +/- 8 mm vs. 66 +/- 7 mm, p = 0.03). The HRV variables rMSSD, pNN50, RRm, and BRS did not differ significantly between patients with and without spontaneous NSVT. Only SDNN on Holter was slightly lower in patients with versus without NSVT (106 +/- 45 vs. 121 +/- 46 ms, p = 0.08). CONCLUSIONS: Patients with IDC and spontaneous NSVT on Holter are characterized by a higher NYHA functional class, a lower LV ejection fraction, an increased LV end-diastolic diameter, and a tendency toward a lower SDNN value compared with patients without NSVT. The remaining measures of HRV including rMSSD and pNN50 reflecting primarily tonic vagal activity, as well as BRS reflecting predominantly reflex vagal activity, were similar in patients with and without NSVT. The prognostic significance of these findings in patients with IDC is currently under investigation in the Marburg Cardiomyopathy Study (MACAS) at our institution.

Adolescent↗
PubMed2000

Prediction of major arrhythmic events and sudden cardiac death in dilated cardiomyopathy. The Marburg Cardiomyopathy Study design and description of baseline clinical characteristics.

The Marburg Cardiomyopathy Study (MACAS) is a prospective observational study designed to determine the value of the following potential non-invasive arrhythmia risk predictors in more than 200 patients with idiopathic dilated cardiomyopathy (IDC) over a 5-year follow-up period: New York Heart Association functional class, left ventricular end-diastolic diameter and ejection fraction, left bundle branch block and atrial fibrillation on ECG, QTc and JTc-dispersion on 12-lead ECG, abnormal time-domain analysis and spectral turbulence analysis of the signal-averaged ECG, ventricular arrhythmias and heart-rate variability on 24-hour Holter ECG, baroreflex sensitivity, and microvolt T wave alternans during exercise. This report describes the rationale of MACAS as well as the clinical characteristics of the first 236 patients enrolled between March 1996 and October 1999. The prognostic significance of the potential arrhythmia risk predictors in MACAS will be determined by multivariate Cox analysis at the end of 5-year follow-up. Primary endpoints are total mortality and major arrhythmic events defined as sustained ventricular tachycardia, ventricular fibrillation or sudden cardiac death. The results of MACAS will have important implications for the design of future studies evaluating the role of prophylactic defibrillator therapy in idiopathic dilated cardiomyopathy.

Adolescent↗
PubMed2000

[Correlation between cardiac autonomic activity and compromise of left ventricular function in dilated cardiomyopathy].

In recent years, evaluation of cardiac autonomic activity by means of heart rate variability (HRV) determination and baroreflex sensitivity (BRS) testing has become readily available. The results of the ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) study showed that both diminished HRV and baro-reflex sensitivity are associated with poor outcome in patients after myocardial infarction. In contrast to patients with coronary disease little information is available concerning cardiac autonomic activity in idiopathic dilated cardiomyopathy (IDC). Therefore, HRV and BRS were assessed in 160 patients with IDC and preserved sinus rhythm in order to investigate the relationship between HRV, BRS, and left ventricular ejection fraction. Time domain indices of HRV were computed from 24-hour digital Holter recordings. BRS testing was performed using the noninvasive phenylephrine method. Mean standard deviation of all normal RR intervals (SDNN) of the whole study population was 112 +/- 46 ms. A well preserved HRV (SDNN > 105 ms) was found in 74 patients (46%), a moderately decreased HRV (SDNN 70-105 ms) in 59 patients (37%), and a severely decreased HRV (SDNN < 70 ms) in 27 patients (17%). Mean BRS was 7.5 +/- 5.0 ms/mm Hg. A well preserved BRS (> 6 ms/mm Hg) was present in 78 patients (57%), a moderately decreased BRS (3-6 ms/mm Hg) was present in 38 patients (28%), and a severely decreased BRS (< 3 ms/mm Hg) in 21 patients (15%). There was only a weak correlation between SDNN and BRS (r = 0.19; p < 0.05). A weak correlation was found for SDNN and left ventricular ejection fraction (r = 0.29; p < 0.05). There was no significant correlation between BRS and left ventricular ejection fraction (r = 0.14). In summary, there was only a weak correlation between the HRV, BRS, and left ventricular ejection fraction in patients with IDC suggesting that these 3 variables may be independent predictors of sudden death in IDC. The relative prognostic value of these variables and other potential risk predictors including the presence of arrhythmias on Holter, microvolt T wave alternans, QTc dispersion, and signal-averaged ECG is currently under investigation in a large prospective observational study (Marburg Cardiomyopathy Study (MACAS)) during 5-year follow-up at our institution.

Adolescent↗