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Biomedical subjects

W Kasper

Publications and source records attributed to W Kasper.

At least 163 records · Page 9Linked to original sources
PubMed1982

[Suprasternal M-mode echocardiography in the diagnosis of cardiovascular diseases in adults].

The study describes the technique and standardized evaluation of suprasternal M-mode echocardiography. The day-to-day variability of suprasternal echoparameters was tested in 7 subjects studied on five consecutive days. The variation coefficient found ranged from 3.5 to 6%. The interobserver variability were tested by evaluation of 127 suprasternal echocardiograms from two investigators independently. Absolute values differed slightly in only 2 out of 8 parameters between both investigators by about 0.8 and 6.3%. 349 consecutive patients were subsequently studied with the suprasternal notch technique. The clinical diagnosis of these patients were as follows: 35 normal subjects, 122 patients with coronary heart disease, 155 patients with valvular heart disease, 33 patients with dilative and 4 with hypertrophic cardiomyopathy. The feasibility to record the aortic arch amounted to 68%, the right pulmonary artery was visualized in 85%, and the left atrium was seen in 75% of the patients studied. The echographic parameters correlated to body size, weight and body surface area. It could be demonstrated that also hemodynamic changes caused variations of these echographic parameters. The different clinical entities did not differ from each other with respect to these suprasternal echoparameters for those in whom the pulmonary artery pressure was within normal range. The size of the pulmonary artery and of the left atrium was found increased in those patients with an elevated pulmonary artery pressure. The suprasternal approach seems to be a useful completion of the echocardiographic technique and should be applied routinely.

Aorta↗
PubMed1981

[Validity of echocardiography in non-invasive diagnosis of acute pulmonary embolism (author's transl)].

M-mode echocardiography was used in 66 consecutive patients with a clinical suspicion of acute pulmonary embolism. It could be ascertained in 30 patients using pulmonary angiography and in 19 using lung scintigraphy. When pulmonary embolism had effects on haemodynamics, an end-diastolically enlarged right ventricle, a diminished left ventricle, reduced closing velocity of the anterior mitral valve cusp and paradox septum movement were seen in precordial echocardiography (n = 18). The relation of end-diastolic diameter of the right ventricle to the left ventricle correlated with the angiographic severity of pulmonary embolism (r = 0.78). In patients with acute pulmonary embolism and pulmonary hypertension a significant enlargement of the right pulmonary artery was found in the suprasternal beam direction when compared with patients without pulmonary hypertension (14.7 +/- 2.2 mm/m2 body surface vs 11.0 +/- 1.2 mm/m2 body surface; P less than 0.01). The index width of the right pulmonary artery of all patients correlated with the mean pulmonary artery pressure (r = 0.84). In one patient a thrombus in the right pulmonary artery could be demonstrated by suprasternal echocardiography. Haemodynamically effective pulmonary embolisations in patients without cardiopulmonary history can be diagnosed using echocardiography.

Adult↗
PubMed1981

[Listeria monocytogenes meningitis (author's transl)].

Listeria monocytogenes meningitis was observed in a 24-year-old obese patient. Morphology and serology of CSF bacterial isolates indicated beta-haemolytic streptococci group B first. However, further differentiation permitted certain classification as Listeria monocytogenes serovar 4b. Treatment with erythromycin (2 g/d) and gentamicin (40 mg t.i.d.) led to rapid improvement of clinical symptoms.

Adult↗
PubMed1981

Separation of left atrium from right pulmonary artery: a new echocardiographic sign of pericardial effusion.

We report a new echocardiographic sign of pericardial effusion in patients with pericardial effusion examined by the suprasternal approach. In normal individuals the right pulmonary artery is closely connected with the superior wall of the left atrium. A separation of these structures is only to be noticed during atrial contraction. In 12 of 17 patients with a pericardial effusion observed a separation of the left atrium from the right pulmonary artery ranging from 3 to 20 mm throughout the cardial cycle. We suggest that this echo-free zone represents fluid in the transverse pericardial sinus which is located between the two structures. In five patients with a small pericardial effusion (less than 400 ml) this observation could not be made.

Diagnosis, Differential↗
PubMed1981

Pharmacokinetics of the enantiomers of acenocoumarol in man.

1 The pharmacokinetics of R(+)-, S(-)- and R,S(+/-)-acenocoumarol were studied in healthy volunteers after administration of single oral and intravenous doses. 2 After both oral and i.v. administration of either enantiomer in a dose of 0.25 mg/kg, the concentrations of R(+) found in the plasma were much higher than those of S(-). This indicates that the observed differences are not related to stereoselective absorption. 3 After intravenous administration of 25 mg of each enantiomer and the racemate, the total plasma clearance of S(-) was about 10 times that of R(+). The clearance of the racemate was between that of the enantiomers. 4 The apparent elimination half-life of S(-) was much shorter than those of R(+) and the racemate, which were similar. 5 The apparent volume of distribution VdSS of S(-) acenocoumarol was 1.5 to 2 times that of R(+). 6 Measurements of the extent of binding to serum proteins, made in vitro at much higher concentrations than those observed in vivo, revealed no differences between the two enantiomers and the racemate. 7 The results indicate that the greater anticoagulant potency of R(+) compared with S(-) acenocoumarol can be explained mainly by stereoselective differences in their metabolic clearance.

Acenocoumarol↗
PubMed1981

Posterior aortic wall motion and left atrial volume changes.

The motion characteristic of the posterior aortic wall has been used in precordial M-mode echocardiography as a parameter of cardiac function. However, the determinants of this characteristic motion pattern of the aorta are still unknown. In this study the posterior aortic wall motion was studied angiographically as it is related to left atrial volume changes. 21 patients with various heart diseases served as the study group. 18 patients were in sinus rhythm, 3 patients in atrial fibrillation. We found an excellent agreement between left atrial volume changes and the movement of the posterior aortic wall. The correlation coefficient between both parameters ranged from .73 to .95 irrespective of the underlying heart disease and heart rhythm. From this study one can conclude that left atrial volume changes are reflected by the motion of the posterior aortic wall.

Adult↗
PubMed1981

[Posterior aortic wall motion in mitral valve disease (author's transl)].

The posterior aortic wall motion was studied in 60 patients, 39 patients with mitral valve disease and 21 normals. The motion of the posterior aortic wall was measured by using the amplitude of the posterior aortic wall motion from the beginning of left ventricular contraction to aortic valve closure and an atrial filling and emptying index. The latter two indices were used, because left atrial volume changes were reflected by the motion of the posterior aortic wall. It could be demonstrated that normals differed in their motion pattern of the posterior aortic wall to those with mitral valve disease. Furthermore, patients with mitral stenosis, mitral insufficiency and mixed mitral valve disease could be differentiated from each other in terms of these indices and an atrial filling-emptying ratio. Thus careful inspection of the posterior aortic wall motion by precordial echocardiography can be used as a parameter of mitral valve function.

Adult↗
PubMed1980

Undersensing of demand pacemakers in acute myocardial infarction.

Trasient asynchronous pacing due to abnormal sensing function is reported in two patients with inserted demand pacemakers during the early phase of acute myocardial infarction. The hazards of the pacemaker induced parasystole with R on T phenomenon in conditions of enhanced electrical instability could be successfully overcome applying overdrive suppression of the inserted pacing system by external chest wall stimulation.

Acute Disease↗
PubMed1980

Wall motion characteristic of the right pulmonary artery in the suprasternal echocardiogram.

This study describes the motion pattern of the right pulmonary artery (RPA) as it can be assessed from the suprasternal echocardiogram. The motion characteristic of the RPA is dependent on hemodynamic factors within the lumen of the RPA and those within the left atrium and the aortic arch. During atrial contraction the superior wall of the left atrium separates from the inferior wall of the RPA (IWRPA) and produces an "a" dip in the wall motion of the IWRPA. During isovolumic contraction the RPA is shifted upward (IC point). The incisura in the pulmonary artery pressure curve reflecting pulmonic valve closure can be seen by a sudden decrease in the diameter of the RPA (PC point). In conditions coinciding with pulmonary arterial hypertension, the overall diameter of the RPA increases, and the IC and PC points are flattened or even absent. Thus, changes in hemodynamics caused by pulmonary or cardiac disease may be analyzed noninvasively on the basis of altered wall motion of the RPA.

Adult↗
PubMed1980

Haemodynamic effects of a single intravenous dose of lorcainide in patients with heart disease.

The cardiovascular effects of a single i.v. dose (2 mg/kg over 5 min) of lorcainide were studied in 14 patients with heart disease. In the haemodynamic part of the study (6 patients), the aortic and pulmonary systolic, diastolic and mean pressures, left ventricular systolic and end-diastolic pressures, cardiac output and the rate of rise of left ventricular pressure were measured before and for 30 min after administration of the drug. Lorcainide produced a slight and short-lasting decrease in the aortic and pulmonary systolic pressures, and all other pressure values remained unchanged. The cardiac output and systemic vascular resistance were not altered by lorcainide. It consistently depressed the rate of rise of left ventricular pressure (maximum mean decrease 19%). In the angiographic part of the study (8 patients), the ejection fraction and the mean velocity of circumferential fiber shortening were measured before and 5 min after lorcainide. In all but one patient, lorcainide decreased the ejection fraction (mean decrease 11.6%), and the mean velocity of circumferential fiber shortening was uniformly diminished by lorcainide (mean decrease 29.7%). Thus, lorcainide moderately impaired myocardial performance in patients with normal and reduced left ventricular function without producing hypotensive side effects.

Adult↗
PubMed1980

Echocardiographic control of Swan-Ganz catheters.

In 68 patients, subxiphoidal, percordial, and suprasternal echocardiography was used to trace the Swan-Ganz catheter during its passage to the pulmonary artery and to localize its position. The localization of the catheter could be exactly identified in 62 out of 68 patients in whom we managed to obtain a suprasternal echocardiogram. In one patient, the catheter was found (by chest x-ray film) in the left pulmonary artery (LPA) and was regarded to be in the right pulmonary artery according to suprasternal echocardiography. In two patients, the catheter could not be localized by suprasternal echocardiography although it was positioned in the LPA. In three patients, the catheters could not be advanced to the pulmonary circulation and were visualized within the right ventricular cavity by precordial and subxihpoid echocardiogarphy. Thus, echocardiography, particularly the suprasternal approach, has proven a safe, reliable, and easy way for position control of Swan-Ganz catheters.

Catheterization↗
PubMed1980

Antiarrhythmic effect of lorcainide during chronic treatment.

The effect of oral N-(4-chlorophenyl)-N-[1-(1-methylethyl)-4-piperidinyl]benzene acetamide (lorcainide) was studied in 12 patients with frequent and stable ventricular arrhythmias resistant to a number of other antiarrhythmic agents. Ambulatory electrocardiograms were obtained before and during treatment with lorcainide and in some patients after discontinuation of the drug. Lorcainide suppressed ventricular premature contractions by more than 90% in all but one patient. The daily doses were 200 mg (N = 8), 300 mg (N = 1), 400 mg (N = 1)and 600 mg (N = 2). Plasma concentrations of lorcainide and of the dealkylated metabolite ranged from 0.13 to 0.27 microgram/ml and 0.25 to 0.95 microgram/ml, respectively. Side effects such as insomnia and excessive perspiration were seen in 7 and 3 patients, respectively. Lorcainide is an effective antiarrhythmic agent against ventricular arrhythmias otherwise difficult to treat.

Adult↗