[The disease picture of acute toxic epidermolsis in children caused by drug intolerance. Report on 4 personal cases].
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Adrenocorticotropic Hormone↗
Biomedical subjects
W Kasper
Publications and source records attributed to W Kasper.
Vulnerability of the right ventricle to cathodal, anodal, and bipolar stimulation at double diastolic threshold strength.
UNLABELLED: The repetitive ventricular response (RVR) to three stimulation techniques (bipolar, cathodal and anodal) was investigated in 35 patients. 26 patients suffered from coronary heart disease and 9 patients from dilative cardiomyopathy. The stimulation study was performed at a ventricular driving rate of 120/min with one and two premature ventricular extrastimuli. We used rectangular impulses of 1.8 ms duration at double diastolic threshold strength. RVR was scored as follows: 0: no RVR, 1: one nonstimulated RVR, 2: two nonstimulated RVR, 3: three nonstimulated RVR, 4: four to ten nonstimulated RVR, 5: more than ten nonstimulated RVR lasting less than 2 minutes, 6: sustained ventricular tachycardia or ventricular fibrillation. We found that with unipolar anodal stimulation the diastolic threshold was significantly greater and the effective refractory period of the right ventricle was significantly shorter as compared to the other stimulation techniques. Between the three different electrode configurations there were no significant differences concerning the number of consecutive ventricular depolarizations following premature stimulation. CONCLUSION: the phenomenon of RVR is not influenced by the stimulation technique (bipolar, cathodal and anodal) at double diastolic threshold.
Adult↗
Combined thallium 201/technetium 99m-labeled pyrophosphate tomography for identification of the "culprit" vessel in acute myocardial infarction.
BACKGROUND: Many previous investigations have used the presence of transient ischemic 201Tl perfusion defect to localize coronary artery stenosis. This study reports the results of 201Tl tomography alone and combined 201Tl/99mTc-labeled pyrophosphate (99mTc PYP) tomography employed to identify the infarct-related vessel in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: All short-axis images were evaluated by dividing each left ventricular slice into eight equal sectors. In addition, for combined 201Tl/99mTc PYP tomography, two sectors were added to evaluate involvement of the right ventricle. In a preevaluation phase of the study, the sectors were assigned to the supplying coronary arteries in 75 patients with single chronic myocardial infarction related to the left anterior descending coronary artery (LAD), left circumflex artery (LCX), or right coronary artery (RCA). In this pilot phase, 201Tl tomograms were reviewed in conjunction with the angiographic data. This assignment was then tested prospectively in 117 patients with AMI. As confirmed by angiography, the AMI was related to the LAC, LCX, and RCA in 54, 17, and 46 patients, respectively. Sensitivity and specificity for 99mTc PYP accumulation on combined 201Tl/99mTc PYP tomography were 98% a nd 100% for the LAD, 88% and 99% for the LCX, and 98% and 96% for the RCA, respectively. For 201Tl tomography, sensitivity and specificity for identification of the culprit vessel were 94% and 89% for the LAD, 82% and 91% for the LCX, and 72% and 96% for the RCA, respectively. CONCLUSION: This prospective study demonstrates that combined 201Tl/99mTc PYP tomography is highly accurate for identification of the infarct-related artery in AMI, even in patients with multivessel disease. Positive contrast visualization of myocardial necrosis in both the left and right ventricle allows for reliable differentiation between AMI related to the LCX or RCA territory. In comparison, for 201Tl tomography the sensitivity to detect the culprit vessel, particularly the LCX and RCA, appears to be lower than for 201Tl 99mTc PYP imaging, particularly in patients with prior infarction or right dominant coronary artery.
Coronary Vessels↗
Electrophysiological actions of lorcainide in patients with cardiac disease.
Lorcainide is a new antiarrhythmic agent which effectively suppresses ventricular premature contractions. Its electrophysiological actions were studied in 15 cardiac patients with and without cardiac conduction abnormalities. In a dose of 2 mg/kg body weight, lorcainide decreased the sinus cycle length (SCL) and increased the corrected sinus node recovery time. The intra-atrial, atrioventricular (AV), and intraventricular conduction times were prolonged. A third-degree AV block developed in 2 patients with pre-existing conduction abnormalities. QRS widening showed that intramyocardial conduction was also affected. The effective refractory period of the atrioventricular node (ERP-AVN) was shortened, whereas the effect on the functional refractory period of the AVN was variable. The decrease in SCL and ERP-AVN may be due to a possible anticholinergic effect of the drug. The accessory pathway was blocked in 3 patients with a Wolff-Parkinson-White syndrome. The ERP of the ventricle was slightly prolonged. The electrophysiological profile of the drug, i.e., slowing of conduction velocity throughout the heart combined with shortening of SCL and ERP-AVN, differs from other antiarrhythmic agents.
Acetanilides↗
Clinical electrophysiological properties of N-allyl-clonidine (ST 567) in man.
The electrophysiological properties of N-allyl-clonidine (ST 567) were studied in 18 patients. Four of these patients were pretreated with intravenous propranolol, 0.2 mg/kg, and atropine, 0.04 mg/kg, to induce autonomic blockade. ST 567 produces a sustained bradycardiac effect at a dose of 40 mg, i.v., in patients without (group I) and with (group II) autonomic blockade. The mean increase in Group I was 23% and in group II, 42%. The sinus node recovery time increased in both groups, from 1,151 +/- 73 to 1,310 +/- 81 msec in group I, and from 995 +/- 145 to 1,599 +/- 248 msec (means +/- SEM) in group II. The corrected sinus node recovery time was unaffected by ST 567 in Group I and increased from 165 +/- 50 to 427 +/- 117 msec in group II. The sinoatrial conduction time was unaffected by ST 567 in group I. The effective refractory period of the right atrium, the atrioventricular node and the right ventricle, as well as the functional refractory period of the atrioventricular node, were unaffected by ST 567 in patients without autonomic blockade. Intra-atrial, atrioventricular, and intraventricular conduction were also not altered by this drug. Thus, the electrophysiological profile of ST 567 differs from other bradycardia-inducing agents such as beta-blockers or calcium antagonists.
Adult↗
Pharmacokinetic and pharmacodynamic properties of alinidine in man.
The elimination kinetics of alinidine and the changes in heart rate and blood pressure were determined in five health subjects following intravenous and oral administration of single doses of 40 mg alinidine. The plasma concentration after the intravenous injection declined at least biexponentially with time, with mean half-lives of 0.6 +/- 0.15 h and 3.9 +/- 0.28 h for the distribution and the elimination phase, respectively. The mean total clearance amounted to 40.3 +/- 8.9 L/h and the renal clearance to 33.6 +/- 12.3 L/h. The bioavailability following oral administration was nearly complete (0.92 +/- 0.06). Alinidine produced a modest bradycardia effect in healthy subjects. The maximal decrease in the heart rate was 19.2 +/- 7.7% (p less than 0.05) and 14.2 +/- 8.1% (p less than 0.05) following intravenous and oral administration, respectively. Time intervals in surface electrocardiogram (duration of the P- wave, PG time, QRS duration, and QTc) were not significantly altered by alinidine after both routes of administration. There was also a slight but consistent decrease in the systolic blood pressure (3-8%) after both routes of administration, whereas the diastolic blood pressure remained unchanged.
Adult↗
Vascular tumor in the heart.
A rare case of a vascular tumor originating from the uterus growing up in the inferior vena cava into the right heart with clinical signs of tricuspid insufficiency is reported. Although this vascular tumor primarily showed no signs of malignancy, consequent re-evaluation seems to be necessary in order to detect possible tumor recurrence in time.
Adult↗