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W Klein

Publications and source records attributed to W Klein.

At least 19 recordsLinked to original sources
PubMed2000

Segmental degradation of left ventricular wall motion after persistent coronary fistula in a posttransplantation patient: a case report and short review of literature.

A 50-year-old man received an orthotopic heart transplant because of severe coronary heart disease and congestive heart failure. Two years after the transplantation, a continuous murmur occurred at the left sternal edge after repeated endomyocardial biopsies. Echocardiography and coronary angiography revealed a dilated left anterior descending artery with a fistula to the right ventricle. The circumflex was large with an equally postero-lateral branch, and the right coronary artery was rather small with collaterals to the distal part of the left anterior descending branch. The patient had refused any intervention to close the fistula. The left ventricular levogram was normal. Two years later, in a follow-up angiogram, the left ventricular ejection fraction had decreased as a result of hypo- and akinesis of the apex and posterior wall. We suggest that this local wall motion disturbance derives from a steal phenomenon rather than being a sequela of rejection. The decrease in left ventricular ejection fraction was associated with shortness of breath upon moderate exercise. Standard heart failure medication relieved the patient's symptoms. The observation of local wall motion disturbances in this case, as well as conflicting views in the literature, raises the question whether postbiopsy coronary fistulas in transplant patients should be closed.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2000

Reduction techniques in distal radius fractures.

External skeletal fixation is an important minimal invasive procedure in the management of fractures at the distal end of the radius. Attention to detail is important not only in the recognition of indications and function of the external fixator but also in its specific application. To improve anatomical restoration (e.g. palmar tilt) multi-planar ligamentotaxis is recommended. The demonstrated dynamic fixator is easy to apply and the double ball joint facilitates reduction after mounting by multi-planar ligamentotaxis. This transarticular unilateral external fixation system permits restoration of anatomy with the wrist in neutral or extension, thereby allowing full flexion of the metacarpophalangeal joints, with fingers and wrist extensor tendons relatively relaxed. Multi-planar ligamentotaxis, combined with a limited approach for supplementary procedures (fixation of articular fragments and/or bone grafting) and with early wrist motion, offers an encouraging treatment option in the management of unstable distal radial fractures by providing better anatomical restoration, especially of the palmar tilt and reduces the risk of wrist and finger stiffness.

Adult↗
PubMed2000

Results of transarticular fixator application in distal radius fractures.

From January 1989 until October 1993, 102 patients with 103 distal radius fractures were included in a prospective study with the Pennig wrist fixator (Orthofix, Srl, Italy). 90.5% of these patients were reviewed with a minimum follow-up of 12 months. Using the functional outcome score according to Gartland and Werley, we obtained 41% excellent, 46% good, 10% fair and 3% poor results. Additional procedures such as K-wires, bone grafting or radio-ulnar stabilizations were carried out in 61% of cases. The complications included five fixator displacements, four of which happened with the prototype used until the first half of 1990. Two major pin-track-infections required surgical intervention, three patients in the beginning of the series encountered irritations of the superficial radial nerve, one pin cut out of the second metacarpal bone and one patient sustained algodystrophy. The results show the significance of an anatomical reduction, the restoration of the radial length seems to be of special importance to obtain good functional outcome. This can not always be achieved with the fixator alone; often additional procedures are required in order to obtain an anatomical joint reconstruction. The advantage of this fixator lies in its lightweight and small-size design as well as in its easy application technique and the possibility to carry out the reduction after mounting the fixator with the double ball joint centered on the fracture level and the carpus.

Adolescent↗
PubMed1999

Short- and long-term outcomes of Wiktor stent implantation at low versus high pressures. Austrian Wiktor Stent Study Group.

A prospective, randomized, multicenter trial was conducted to evaluate whether high-pressure postdilation of the Wiktor stent provides short- and long-term benefits compared with the conventional low-pressure implantation technique. From June 1995 through May 1996, 181 patients were randomly assigned to either low-pressure (6 to 12 atm, group A, n = 94) Wiktor stent placement or to high-pressure postdilation (> or = 13 atm, group B, n = 87) after stent deployment. All patients were followed up clinically for 7 +/- 3 months, with an angiographic follow-up in 154 patients (85%). After stent implantation, neither minimal lumen diameter (MLD) nor percent diameter stenosis (%DS) differed significantly between the 2 groups (MLD, 2.8 +/- 0.5 vs 2.9 +/- 0.5 mm; %DS, 17 +/- 8% vs 16 +/- 9% for groups A and B, respectively). However, a trend toward a larger mean lumen diameter within the stent was observed in group B (3.3 +/- 0.6 vs 3.5 +/- 0.5 mm for groups A and B, respectively; difference between means 0.14 mm, 95% confidence interval -0.01 to 0.29, p = 0.08). Angiographic follow-up revealed similar MLD and %DS in both treatment groups (MLD, 2.1 +/- 0.7 vs 2.2 +/- 0.8 mm; %DS, 31 +/- 17% vs 30 +/- 24% for groups A and B, respectively, p = NS). Acute stent thrombosis occurred in 2 patients (1%) (1 patient in each group), and subacute thrombosis in 1 patient (0.6%) in group A. There was 1 death in group A, and target lesion restenosis (> or = 50% DS) was observed in 15% of patients with no differences between the groups. In conclusion, this study demonstrated favorable short- and long-term results of Wiktor stent implantation. Despite a trend toward additional initial lumen gain by high-pressure postdilation, this did not translate into a measurable improvement in long-term outcome.

Aged↗
PubMed1999

[Secondary prevention following coronary intervention. Survey of 13 intervention centers in Austria].

Risk factor control has been shown to reduce the incidence of coronary events in patients with or without preceding infarction. Secondary prevention should therefore be borne in mind by every cardiologist. In order to test this concept and/or to promote secondary prevention in our country, the following survey was conducted by our working group for epidemiology and prevention. All interventional centres of the country (7 million inhabitants) were asked to report relevant data of 50 consecutive patients with PTCA in a structured questionnaire. Thirteen centres responded and we report the data of 650 patients. The mean proportion of women was 28%, the mean age 61.1 years and the mean stent rate 49.8%. The indications for PTCA varied widely: stable angina 10-74%, unstable angina 10-86%, primary PTCA 0-22%. The risk factor history was distributed as follows: diabetes 12-46% (mean 22.3%), hypertension 32-68% (mean 54.2%), current smoking 6-56% (mean 21.9%), and total cholesterol (TChol) > 200 mg/dl: 30-78% (mean 60.3%). Current lipid values were available for T chol. in 44-100% (mean 84.5%) and for LDL in 4-100% (mean 67.1%). Dietary counselling by a dietician was done in 4-100% of patients (mean 35.6%) Information concerning the hazards of smoking was given to 25-100% (mean 83.6%) of current smokers. Drug treatment at hospital discharge was as follows: 84-100% (mean 93.1%) received ASA, 24-74% (mean 49.8%) ticlopidine, 6-84% (mean 53.3%) nitrates, 34-82% (mean 60.2%) beta blockers, 10-70% (mean 39.5%) ACE inhibitors, 4-74% (mean 4 7.2%) lipid lowering drugs, 7-48% (mean 17.8%) calcium antagonists, 0-12% (mean 6.1%) digitalis and 0-28% (mean 13.6%) diuretics. Follow-up data were collected in 4 centres at 6 months post discharge and were available for 174 patients. Here we found an increase in the prescription of calcium antagonists, digitalis and statins. The following conclusions were drawn at a conference in which all centres participated: lipid values should be available for each patient at PTCA, dietary counselling should be initiated for every patient during hospitalisation (and continued by the family physician) and the national cardiac society should promote guidelines for the use of drugs in which the variation in use is too wide at present. It should be ensured that these guidelines are implemented not only in patients after AMI but also in those after PTCA.

Adrenergic beta-Antagonists↗
PubMed1999

Management strategies in unstable coronary artery disease--current problems and future directions. The UCAD Council.

Unstable coronary artery disease continues to pose a major challenge to clinicians. The advent of new therapies, such as percutaneous transluminal coronary angioplasty, low-molecular-weight heparins, and glycoprotein IIb/IIIa inhibitors, provides new management options for this indication but also raises new questions with regard to optimal management. Prospective randomized trials with well-defined, long-term outcome measures and a means of identifying which patients will derive most benefit from each treatment, together with a means of rapid and clear dissemination of study results and implications, are required in order to advance the management of unstable coronary artery disease.

Angina, Unstable↗
PubMed1999

Subclinical health effects of environmental pesticide contamination in a developing country: cholinesterase depression in children.

The effect of exposure to pesticides among children in a Nicaraguan community in the path of rain water runoff from a large crop-dusting airport was evaluated by measuring plasma cholinesterase. Mean cholinesterase activity in 17 children in the path of runoff was 2.4 international units/ml blood/min, lower than the 2.9 IU/ml/min measured in a group of 43 children from an unexposed community (difference=0.49 IU/ml/min; 95% C.I. 0.24, 0.76). Six (35%) of the 17 exposed children had abnormally low cholinesterase levels. A possible explanation for this physiological effect of exposure to pesticides is the dermal absorption which may have occurred among children playing barefoot in puddles grossly contaminated by runoff from the airport. Drinking water from a well in the exposed community demonstrated low level residues of cholinesterase-inhibiting pesticides, although contamination with toxaphene (not a cholinesterase inhibitor) exceeded by over 8-fold the United States Environmental Protection Agency maximum permissible concentration in drinking water. The difficulty in measuring health effects resulting from environmental pesticide contamination, and in controlling exposure resulting from the rapidly increasing use of pesticides, is a growing problem for developing countries like Nicaragua.

Child↗
PubMed1999

Metabolism of trans fatty acids by hepatocytes.

The present work was undertaken to study the metabolism of fatty acids with trans double bonds by rat hepatocytes. In liver mitochondria, elaidoyl-CoA was a poorer substrate for carnitine palmitoyltransferase I (CPT-I) than oleoyl-CoA. Likewise, incubation of hepatocytes with oleic acid produced a more pronounced stimulation of CPT-I than incubation with trans fatty acids. This was not due to a differential effect of cis and trans fatty acids on acetyl-CoA carboxylase (ACC) activity and malonyl-CoA levels. Elaidic acid was metabolized by hepatocytes at a higher rate than oleic acid. Surprisingly, compared to oleic acid, elaidic acid was a better substrate for mitochondrial and, especially, peroxisomal oxidation, but a poorer substrate for cellular and very low density lipoprotein triacylglycerol synthesis. Results thus show that trans fatty acids are preferentially oxidized by hepatic peroxisomes, and that the ACC/malonyl-CoA/CPT-I system for coordinate control of fatty acid metabolism is not responsible for the distinct hepatic utilization of cis and trans fatty acids.

Acetyl-CoA Carboxylase↗
PubMed1999

The effects of eccentric head positions on leftward and rightward turns of a handle-bar.

We explored the structural constraints on concurrent movements and/or positions of the head and a steering device by means of a reaction-time task. In the first experiment, subjects had to respond rapidly to an imperative stimulus by way of rotating a handle-bar to the left or to the right and back to the central position while they maintained a left or right eccentric position of the head. Latency of the handle-bar responses did not depend on whether their initial directions were toward the eccentric head position or in the opposite direction, but kinematic characteristics did: iso-directional movements were of larger amplitude and longer duration until peak excursion. In the second experiment, the imperative stimuli for handle-bar rotations were presented at variable intervals after the head had been moved from the central to one of the eccentric positions and before its predictable return movement. Kinematic characteristics of the handle-bar rotations depended on the left and right eccentric head positions in the same way as in Experiment 1, but now iso-directional movements had a longer reaction time than movements in the direction of the forthcoming return movement of the head. These findings suggest that specifications of head-movement directions facilitate concurrent specifications of handle-bar rotations in the same direction and inhibit specifications of handle-bar rotations in the opposite direction, consistent with the notion of cross-talk during motor programming.

Adult↗
PubMed1999

[Behavioral pattern and behavioral characteristics of children in two pediatric clinics].

OBJECTIVES: To describe systematically patterns of behavior of children and parents in pediatric hospitals. METHODS: A questionnaire to systematically rate behavior of children and parents was administered by nurses to two independent samples in two different pediatric hospitals. At the von Haunersches Kinderspital, Klinikum Innenstadt of the Ludwig-Maximilian-University of Munich, 659 children were rated, at the Pediatric Hospital of the University of Freiburg, 484 children. Latent class analysis grouped children/parents according to similar patterns of behavior. RESULTS: In Munich a five-class model is most appropriate to classify children/parent behavior, in Freiburg a six-class model best first the data. Four classes in Munich and in Freiburg display nearly identical profiles. Three of them describe inconspicuous behavior of children in different age groups, whereas the fourth group describes disturbed children. These four groups classify 87% of the children in Munich and 73% of those in Freiburg. In Munich 25% of the children are rated as disturbed, as opposed to 39% in Freiburg. CONCLUSIONS: The questionnaire is suitable for everyday clinical practice. Results of both samples mostly correspond. Remaining differences are caused by type of hospital (pediatrics vs. pediatric surgery) and by the differing depth of nurses' rater training.

Child↗
PubMed1999

Effects of intensified lifestyle modification on the need for further revascularization after coronary angioplasty.

BACKGROUND: In patients with coronary artery disease (CAD), a rate of restenosis as high as 50% is observed after percutaneous transluminal coronary angioplasty (PTCA). Frequently, this results in further revascularization procedures. Lifestyle intervention has been shown to slow the progression of CAD and to reduce cardiovascular events after myocardial infarction. However, no information exists whether such treatment influences the rate of restenosis in patients with CAD. The present study was performed to investigate the effects of an intensified lifestyle intervention on the need for further revascularization procedures in patients with established CAD after successful PTCA. DESIGN: A total of 60 patients were included and randomized to either conventional treatment by cardiologists and general practitioners or additional intensified lifestyle intervention in a diabetes and metabolism outpatient clinic for 12 months. The mean observation time after successful PTCA was 26 months. The primary outcome variable was the need for further revascularization procedures because of clinical restenosis. Secondary outcome variables were lifestyle-related measures. RESULTS: Intervention resulted in a reduction in body weight and blood pressure, and in increased physical activity. Furthermore, nutritional habits were changed towards less fat intake, and body composition changed towards a higher proportion of fat-free mass. The need for further revascularization procedures was reduced from a total of 14 out of 32 in the conventionally treated group to 3 out of 28 in the intervention group. This resulted in an event-free survival probability of 0.89 in the intervention group and 0.57 in the control group (P = 0.0055, log rank) with a resulting relative risk of 0.26 (95% CI 0.09-0.74). CONCLUSION: In conclusion, our data strongly suggest that intensified lifestyle modification is able to reduce the need for further revascularization procedures after PTCA in patients with CAD.

Angina Pectoris↗
PubMed1999

Inhibition of phosphatidylcholine and phosphatidylethanolamine biosynthesis in rat-2 fibroblasts by cell-permeable ceramides.

Phospholipids and sphingolipids are important precursors of lipid-derived second messengers such as diacylglycerol and ceramide, which participate in several signal transduction pathways and in that way mediate the effects of various agonists. The cross-talk between glycerophospholipid and sphingolipid metabolism was investigated by examining the effects of cell-permeable ceramides on phosphatidylcholine (PtdCho) and phosphatidylethanolamine (PtdEtn) synthesis in Rat-2 fibroblasts. Addition of short-chain C6-ceramide to the cells resulted in a dose- and time-dependent inhibition of the CDP-pathways for PtdCho and PtdEtn synthesis. Treatment of cells for 4 h with 50 microM C6-ceramide caused an 83% and a 56% decrease in incorporation of radiolabelled choline and ethanolamine into PtdCho and PtdEtn, respectively. Exposure of the cells for longer time-periods (>/= 16 h) to 50 microM C6-ceramide resulted in apoptosis. The structural analogue dihydro-C6-ceramide did not affect PtdCho and PtdEtn synthesis. In pulse-chase experiments, radioactive choline and ethanolamine accumulated in CDP-choline and CDP-ethanolamine under the influence of C6-ceramide, suggesting that synthesis of both PtdCho and PtdEtn were inhibited at the final step in the CDP-pathways. Indeed, cholinephosphotransferase and ethanolaminephosphotransferase activities in membrane fractions from C6-ceramide-treated cells were reduced by 64% and 43%, respectively, when compared with control cells. No changes in diacylglycerol mass levels or synthesis of diacylglycerol from radiolabelled palmitate were observed. It was concluded that C6-ceramide affected glycerophospholipid synthesis predominantly by inhibition of the step in the CDP-pathways catalysed by cholinephosphotransferase and ethanolaminephosphotransferase.

Animals↗
PubMed1999

Decreased melatonin synthesis in patients with coronary artery disease.

AIMS: Decreased night-time plasma levels of melatonin were recently reported in patients with coronary artery disease, and it was postulated that melatonin production may be impaired, due to a lack of synthesizing enzymes. However, since artefacts possibly influencing the release pattern were not taken into account, this interpretation was strongly criticized. We therefore carefully investigated night-time melatonin production in patients with coronary artery disease using an appropriate experimental approach. Furthermore, we examined the effect of beta-blockers, a frequently used drug in coronary artery disease therapy. METHODS AND RESULTS: Forty-eight male patients with angiographically documented severe coronary artery disease, 24 of them taking beta-blockers daily in therapeutic dosages, were included. Eighteen age-matched men, with no evidence of coronary sclerosis, served as controls. To determine melatonin production, 6-sulfatoxymelatonin (aMT6s) was measured radioimmunologically from overnight urine. Urinary aMT6s concentration was significantly decreased in patients, and beta-blocker treatment did not further suppress melatonin production. CONCLUSIONS: The data obtained using this investigative approach provide clearcut evidence that melatonin production in patients with coronary artery disease is decreased. Whether a decreased melatonin level may be a predisposing factor for coronary artery disease, or whether the occurrence of coronary artery disease decreases melatonin synthesis remains to be determined.

Adrenergic beta-Antagonists↗
PubMed1999

Structural constraints on the coordination of concurrent rotations of the head and a steering device.

Concurrent movements of different effectors are subject to structural constraints that facilitate certain patterns of coordination but impede others. The constraints for concurrent rotations of the head and a bimanually operated steering device were explored in two experiments. To indicate structural constraints, the difference between concurrent periodic rotations in same and different directions with respect to the variable error of synchronization was used. The first experiment showed less error for rotations in same directions than for rotations in opposite directions. In the second experiment, the same result was obtained with a horizontal and a backward-tilted steering wheel. Adding gaze shifts to head oscillations increased the accuracy of synchronization but did not affect the difference between both coordination patterns. In contrast to the synchronization of head and steering device, the variable error of synchronization of gaze and steering wheel did not differ between both modes of coordination; the error was again reduced when head oscillations were added to the saccades between eccentric fixation targets. This suggests space related (or allocentric) constraints, which most likely originate from concurrent specifications of movement directions in coupled spatiotopic maps so that the specification of rotations in the same direction is facilitated in comparison to rotations in opposite directions.

Adult↗
PubMed1999

Cold shock response of Bacillus subtilis: isoleucine-dependent switch in the fatty acid branching pattern for membrane adaptation to low temperatures.

Bacillus subtilis has developed sophisticated mechanisms to withstand fluctuations in temperature. Membrane fatty acids are the major determinants for a sufficiently fluid membrane state to ensure the membrane's function at all temperatures. The fatty acid profile of B. subtilis is characterized by a high content of branched fatty acids irrespective of the growth medium. Here, we report on the importance of isoleucine for B. subtilis to survive cold shock from 37 to 15 degrees C. Cold shock experiments with strain JH642 revealed a cold-protective function for all intermediates of anteiso-branched fatty acid biosynthesis. Metabolites related to iso-branched or straight-chain fatty acid biosynthesis were not protective. Fatty acid profiles of different B. subtilis wild-type strains proved the altered branching pattern by an increase in the anteiso-branched fatty acid content and a concomitant decrease of iso-branched species during cold shock. There were no significant changes in the fatty acid saturation or acyl chain length. The cold-sensitive phenotype of isoleucine-deficient strains in the absence of isoleucine correlated with their inability to synthesize more anteiso-branched fatty acids, as shown by the fatty acid profile. The switch to a fatty acid profile dominated by anteiso-C(15:0) and C(17:0) at low temperatures and the cold-sensitive phenotype of isoleucine-deficient strains in the absence of isoleucine focused our attention on the critical role of anteiso-branched fatty acids in the growth of B. subtilis in the cold.

Adaptation, Physiological↗