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Biomedical subjects

W Hemmer

Publications and source records attributed to W Hemmer.

At least 91 records · Page 5Linked to original sources
PubMed1993

Brain-type creatine kinase in photoreceptor cell outer segments: role of a phosphocreatine circuit in outer segment energy metabolism and phototransduction.

Different isoforms of creatine kinase, an important enzyme of vertebrate energy metabolism, were localized in bovine photoreceptor cells, with particular emphasis on the identification and quantification of the brain-type isoform within the outer segment compartment. Using immunofluorescence and immunoelectron microscopy, brain-type creatine kinase was shown to be present in bovine photoreceptor cell outer and inner segments. The presence of this isoenzyme in rod outer segments was additionally confirmed by immunoblotting and immunolabeling of isolated rod outer segments. The content of creatine kinase in rod outer segments was quantified by measuring creatine kinase activity after membrane disruption with detergent. The ATP regeneration potential provided by the creatine kinase in isolated, washed bovine rod outer segments was 1.2 +/- (0.4) i.u. mg-1 rhodopsin. This value was calculated to be at least an order of magnitude larger than that necessary to replenish the energy required for cGMP resynthesis in rod outer segments, and high enough to regenerate the entire ATP pool of rod outer segments within the time span of a photic cycle. A mitochondrial creatine kinase isoenzyme was located within the ellipsoid portions of bovine rod and cone inner segments by immunofluorescence microscopy and, using immunogold staining, was specifically localized in the mitochondria clustered within bovine rod and cone inner segments. These results suggest that vertebrate photoreceptor cells contain a functional phosphocreatine circuit. Outer segment creatine kinase may play an important role in phototransduction by providing energy for the visual cycle, maintaining high local ATP/ADP ratios and consuming protons produced by enzymes located in the outer segment.

Adenosine Triphosphate↗
PubMed1993

[Myocardial revascularization with a free skeletal muscle transplant--a functional analysis of angiogenesis].

In order to evaluate the functional aspect of myocardial neovascularization after grafting a free skeletal muscle flap onto the heart in the dog with an arterial anastomosis to the internal mammary artery (IMA), a gradual occlusion of the left anterior descending coronary (LAD) was induced. This was achieved implanting an Ameroidconstrictor on the LAD, that due to its hygroscopical material induces a gradual coronary occlusion. The occlusion of the LAD was angiographically confirmed in vivo. In one dog the selective angiographical demonstration of the IMA anastomosed to the graft was achieved. This showed retrograde filling of the LAD occluded by the Ameroidconstrictor. These findings were confirmed in all dogs by a microvascular corrosion cast preparation of the vasculature induced from the graft, that was differentiated from the coronaries by a different coloured casting material. The occluded LAD was filled in all preparations by the casting material applied into the IMA. Thus, grafting of a free skeletal muscle flap anastomosed to the IMA onto the dog's heart produces a functional myocardial neovascularization.

Animals↗
PubMed1992

Direct current application: easy induction of ventricular fibrillation for the determination of the defibrillation threshold in patients with implantable cardioverter defibrillators.

For the determination of the defibrillation threshold, the induction of ventricular fibrillation is mandatory. However, in severely damaged hearts it is sometimes difficult to induce ventricular fibrillation by rapid stimulation or alternating current. Only rapid nonclinical ventricular tachycardias may result, and their cardioversion threshold may be different from the defibrillation threshold. Therefore, it was the purpose of this study to test the potential of direct current (DC) application to rapidly induce ventricular fibrillation in patients with an implanted cardioverter defibrillator. The defibrillation threshold had to be determined in 13 patients (9 with coronary heart disease, 4 with dilative cardiomyopathy, ejection fraction 35%) during and 2 weeks after the implantation of a cardioverter defibrillator. DC was applied 37 times by a commercially available 9-V DC battery via a bipolar catheter for about 3 seconds. Ventricular fibrillation was induced 23 times (62%) and rapid nonclinical ventricular tachycardias were induced six times (16%). In one patient clinical ventricular tachycardia was observed. In seven instances (19%) sinus rhythm remained. In 12 of the 13 patients, ventricular fibrillation could be induced by DC. Thus, the induction of ventricular fibrillation by DC application may serve as an additional tool to induce ventricular fibrillation, determining the defibrillation threshold in implantable cardioverter defibrillator patients.

Cardiac Catheterization↗
PubMed1991

Identification of creatine kinase isoenzymes in the guinea-pig. Presence of mitochondrial creatine kinase in smooth muscle.

Isoenzymes of creatine kinase (CK, EC 2.7.3.2) in guinea-pig smooth, cardiac and skeletal muscles as well as in brain were analyzed by cellulose acetate electrophoresis and FPLC gel permeation chromatography. In crude tissue extracts of smooth muscles brain type BB-CK and the hybrid form MB-CK were detected, but in enriched mitochondrial fractions from different guinea-pig smooth muscles, mitochondrial type Mi-CK was unambiguously identified. Smooth muscle Mi-CK displayed the same electrophoretic mobility as Mi-CK from brain, which migrates slower than cardiac Mi-CK. Identical to parallel experiments with Mi-CK from cardiac muscle and brain, smooth muscle Mi-CK could be resolved into dimeric and octameric species, the latter being remarkably stable. In contrast to guinea-pig smooth muscles, Mi-CK was not detected in chicken gizzard tissue extracts nor in enriched mitochondrial fractions thereof. The presence of Mi-CK, predominantly in octameric form, in guinea-pig smooth muscles, but not in chicken gizzard, may represent a clue for the different physiological properties of these muscles and may provide the molecular basis for the dependence of the PCr production on oxidative metabolism observed in the guinea-pig taenia caeci.

Animals↗
PubMed1991

What's the price to be paid for rate response: AV sequential versus ventricular pacing?

The purpose of this study was to compare the effects of atrioventricular (AV) sequential and ventricular pacing at rest and during exercise on parameters of left ventricular performance. Twenty-five patients were studied by means of first pass radionuclide angiography. Pacing rates increased significantly (P less than 0.001) during exercise in both pacing modes, resulting in a significant increase in the cardiac index (P less than 0.001). Pulmonary transit times decreased significantly (P less than 0.001) during exercise in both pacing modes with a significantly shorter pulmonary transit time for AV sequential pacing at rest (P less than 0.01) and during exercise (P less than 0.05), indicating impaired left ventricular function in ventricular pacing. Regional left ventricular wall movement deteriorated significantly during exercise in both pacing modes (P less than 0.02), with a significantly worse performance during ventricular pacing at rest (P less than 0.05) and during exercise (P less than 0.05). Therefore, the price to be paid for rate response is a deterioration of regional wall movement. An additional loss of AV synchrony worsens the situation. It is concluded that rate modulated pacing requires preservation of AV coordination to optimize left ventricular performance.

Arrhythmia, Sinus↗
PubMed1990

Phosphorylation of chicken brain-type creatine kinase affects a physiologically important kinetic parameter and gives rise to protein microheterogeneity in vivo.

In addition to the two monomer subunits of chicken brain-type creatine kinase (B-CK, EC, 2.7.3.2), termed Bb (basic) and Ba (acidic), another subspecies called Bb* was identified by chromatofocussing in the presence of 8 M urea (Quest et al., ). The latter low abundance protein species, isolated from tissue extracts, comigrated on 2D-gels with three minor species (Bb1-3), initially identified in immunoprecipitated, [35S]methionine labeled in vitro translation products of cDNA coding for the basic monomer Bb. During in vitro translation experiments in the presence of [32P]-gamma-ATP, Bb1-3 were labeled while phosphatase treatment eliminated these minor species. It is concluded that Bb* is identical to Bb1-3 and represents phosphorylated derivatives of Bb. B-CK dimer populations from different tissues were separated by ion-exchange chromatography and the Km values of the resulting fractions were determined under phospho-creatine (CP)-limiting conditions. In fractions containing only Bb and Bb* two kinetically different enzyme species were detected (Km values for CP = 1.6 mM and 0.8 mM), while fractions containing B-CK dimers composed of the major Ba and Bb monomers, but no Bb*, were homogeneous in this respect (Km for CP = 1.6 mM). Phosphorylation of Bb to yield Bb* is concluded to reduce the Km of B-CK dimers for CP by about 50%. This Km shift is within the range of CP concentrations found in tissues expressing the B-CK isoform and may therefore be of physiological relevance.

Animals↗
PubMed1987

[Presentation of a survey scale for neuro-rehabilitation--with a general discussion of current rehabilitation scales].

Presented is a newly developed rehabilitation survey scale for the field of neuro-rehabilitation, in which levels of functioning relative to ten specific and four global functions are documented at set intervalls by means of a five-grade rating scale. Additionally, numerous symptoms or associated phenomena are recorded ungraded. Used in the clinical setting, this scale affords a quick overview of the rehabilitation profile, with relatively little time and effort being required. Scientific evaluation may uncover information on the impact the disorders of specific functions have on global functions, which is relevant primarily in the social context. Also, the scale may be applied in the framework of larger-scale comparative studies. Dealt with in an extensive discussion, our newly presented scale may be accorded a number of advantages over currently used scales, which warrant its introduction. It is the outcome of many years of developmental work and pertaining reliability verifications.

Activities of Daily Living↗
PubMed1986

[Improved regional myocardial function after aortocoronary bypass surgery noninvasive studies using the first-pass technic].

50 patients after coronary artery bypass grafting were matched with 50 not-operated patients. After a follow-up period of four years they were investigated by first pass radionuclide angiography. Revascularized myocardial areas showed significantly higher regional ejection fraction during exercise and in territories with prior myocardial infarction. The results proved the hemodynamic benefits of coronary artery bypass grafting even in territories with poor myocardial function.

Angina Pectoris↗
PubMed1986

Surgical treatment of aneurysms of the ascending aorta. Twelve years' experience in 66 patients.

This study presents the results in 66 patients undergoing surgery for concomitant supracoronary vascular interposition and valve replacement carried out at the Department of Cardiac Surgery of the University of Munich, West-Germany, over a period of 12 years (from July 1, 1973 to June 30, 1985) using a technique similar to that described by Wheat. Forty-seven percent of the cases were true aneurysms and 20% chronic dissections. Thirty-three percent of patients had acute dissections. Early mortality was 16% in the total patient population, 9% in the group having true aneurysm and 32% in the group having acute dissection. No early death was observed in association with chronic dissections. The actuarial one-year survival rate in patients with true aneurysm or chronic dissection was 83.6%, and 54.1% in patients with acute dissection. The corresponding 4-year survival rates were 76.4% and 54.1%, respectively. The average improvement according to the New York Heart Association classification was 1.5 grades. These results confirm that the operative approach to ascending aortic aneurysms is superior to medical treatment, with the operative method involving vascular graft without concomitant aortic valve replacement as well as the method described by Wheat having both proved successful.

Acute Disease↗
PubMed1986

Complications in dual chamber pacing: a six-year experience.

In a six-year period (1980-1985), 345 dual chamber pacing systems were implanted in our hospital. Intraoperative complications were rare (n = 5/345 = 1.4%). 25 patients (7%) have died, 11 (3%) were lost to follow-up. A total of 39 patients (13%) showed minor problems, which could be overcome by reprogramming. Another 48 complications (15%) required reoperation. Nearly 70% of those reoperations (n = 31/48) were caused by a malfunction of the atrial lead. This high complication rate of 9% related to all implanted atrial leads could be reduced in the last three years to 2%. We could maintain a dual chamber stimulation mode (DDD, DDI, DVI, VDD) in 396 patients (99%). We conclude that improvements in lead design, pulse generator's programmability, and surgical experience have reduced complication rates to acceptable low values. Meanwhile, dual chamber pacing can be considered as safe as single chamber pacemaker therapy.

Adolescent↗
PubMed1986

What is the most appropriate stimulation mode in patients with sinus node dysfunction?

Sinus node disease (SND) has caused many controversies about the appropriate stimulation mode. We compared the advantages and disadvantages of VVI, AAI, DDD, and DDI mode. In an additional study, left ventricular function at rest (R) and during exercise (E) was investigated in dual chamber and ventricular stimulation mode with a stimulation rate of 70 ppm (R) and 110 ppm (E). A total of 223 patients (pts) was investigated (67 AAI, 87 VVI, 69 DDI). Hemodynamic disadvantages in VVI mode resulted in a 55% actuarial incidence of atrial fibrillation after five years. In AAI mode, we found another 25% complication rate due to impaired AV conduction (n = 9) or a bradyarrhythmia (n = 6) with slow ventricular response. DDI mode implies the possibility of sustaining a pacemaker mediated tachycardia. Single ventricular stimulation with a high stimulation rate (110 ppm) under E showed a worse left ventricular performance as compared to dual chamber stimulation. DDI mode shows none of the aforementioned disadvantages. To sum it up: Until a dual chamber rate responsive pacemaker becomes available, the DDI mode represents the best stimulation mode for patients with a SND.

Atrial Fibrillation↗
PubMed1985

Late (11 to 19 years) assessment of hemodynamic and prosthetic valve function in patients with Starr Edwards ball valves: a non-invasive study utilizing 99m-technetium pertechnetate scintigraphy.

This is an account of 2 groups of 10 patients each who received Starr Edwards ball valves in either the mitral (M) or aortic (A) position on average 14.7 +/- 3 or 14.9 +/- 2.4 years ago, respectively. Non-invasive scintigraphic studies were performed using the first pass of 18 to 20 mCi 99 m-Technetium Pertechnetate. Enddiastolic and endsystolic volumes were found elevated at rest: (M) EDV 135 +/- 50 ml, ESV 63 +/- 30 ml; (A) EDV 163 +/- 41 ml, ESV 69 +/- 25 ml. The response to maximum exercise--during which the heart rate increased from 85 +/- 23 min-1 to 133 +/- 33 min-1--was abnormal, since none of the volumes changed significantly. During exercise, therefore, the increase of the cardiac output was totally heart rate dependent: (M) 6.1 +/- 2.3 to 9.3 +/- 2.3 l/min; (A) 7.0 +/- 1.9 to 10.9 +/- 3.1 l/min. The dynamics of the rapid diastolic filling rate of the left ventricle (RFR) and the mean pulmonary transit time (MTT) served as functional parameters of the Starr Edwards ball valves in the mitral position. The rapid filling rate increased from 205 +/- 98 to 321 +/- 58 ml/sec, whereas MTT decreased from 7.4 +/- 1.4 to 5.4 +/- 2.1 sec. In patients with aortic valve replacement the left ventricular ejection rate was assessed, it rose from 233 +/- 80 to 459 +/- 232 ml/sec. The significant changes of the parameters proved that the Starr Edwards ball valve mechanism functions satisfactorily 11 to 19 years post-operatively.

Aortic Valve Insufficiency↗
PubMed1983

[Advantages in the therapy of bradycardiac rhythm disorders by physiologic pacemaker systems].

A review of the recent development in cardiac pacing is given, based on the experience of the Department for Cardiac Surgery of the University of Munich. Meanwhile the frequency of physiological pacemaker systems has increased to more than 30 percent of all implantations. Basical informations about physiological stimulation, indications, techniques of implantation--particularly via the subclavian vein and patient's follow-up--are discussed.

Bradycardia↗