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Biomedical subjects

W Klein

Publications and source records attributed to W Klein.

At least 289 records · Page 16Linked to original sources
PubMed1991

[Silent myocardial ischemia. Current concepts of prognosis and therapy].

Type-I-patients with silent myocardial ischemia (SMI) have a 2-4fold higher longterm-risk for coronary-events than healthy people. With increasing gravity and duration of ischemia type-II-patients have an increased event-risk. Reliable statements about prognosis of type-III-patients are very difficult. Therapy of SMI is equivalent to therapy of "loud" ischemia and comprises: 1) treatment of cardiovascular risk-factors (nicotine, arterial hypertension, hyperlipidemia, adiposis), 2) nitrates as effective straight at the coronary stenosis, 3) beta-blockers, which influence the circadian ischemic rhythm, 4) calcium-channel-blockers with especially for nifedipine little effect, 5) thrombocyte-aggregation inhibitors and 6) invasive therapeutical methods (percutaneous transluminal coronary angioplasty [PTCA] and aorto-coronary bypass grafting [ACBG]).

Angina Pectoris↗
PubMed1991

[Coronary artery anomalies in adulthood].

In a series of 3000 consecutive coronary angiographies carried out in adults (period October 1988 through February 1991) the incidence of coronary artery anomalies was investigated. Among these there were 7.2% of patients with left-, 3.8% with right-sided and 89% with bilateral coronary artery supply. 10 cases revealed a double left anterior descendent artery (LAD), whereas in 2 patients the left circumflex artery (CX) was missing. In approximately 1% of patients origin anomalies of coronary arteries were observed, above all of the right coronary artery (RCA). A pronounced kinking of the coronaries was seen in 22 cases (11 LAD, 11 RCA) and a bridging in 2.5% of patients (74 LAD, 1 CX, 1 RCA). Of the latter, there were 21 hemodynamic active stenoses (more than 75% diameter stenosis) of which in 12 cases this narrowing was the sole cause for the heart complaints. During the same period there were 8 patients with coronary anomalies leading to shunt development out of which a 30-year-old female revealed clinically a coronary steal phenomenon. Aneurysms of the coronary arteries were observed in 54 cases (2%) whether congenital or acquired could not be ascertained. In total, there were 194 coronary anomalies in the total series (6.5%) being clinical significant in 22 cases (0.7%).

Adult↗
PubMed1991

Sulfonylurea-metformin-combination versus sulfonylurea-insulin-combination in secondary failures of sulfonylurea monotherapy. Results of a prospective randomized study in 50 patients.

50 type II diabetics with secondary failure of a sulfonylurea (SU) treatment have been included in a randomised controlled trial by assigning them either to a Metformin + SU or insulin + SU treatment. At study entry the metabolic control of patients had to be insufficient, as demonstrated by increased fasting or postprandial plasma glucose levels (greater than 130 resp. greater than 180 mg/100 ml). The study lasted for a period of 12 months in which a Metformin treatment of 850, 1,700 or 2,550 mg/day or an insulin therapy of 12-40 IU was added to the existing maximal dose of SU. Both the Metformin and the insulin dosage were adapted to the response of metabolic control. Parameters of metabolic control and security were monitored regularly every two months. 16 patients in the Metformin + SU-group and 19 patients in the insulin + SU-group were observed for the total study period of 12 months. In both groups there was a similar development of metabolic parameters. Stimulated C-peptide reduced in both groups indicating an increase of peripheral insulin sensitivity under both treatment regimes.

Aged↗
PubMed1991

[An intraoperatively applicable roentgen grid for assessing alignment of the long bones].

An alignment grid is described which may used peroperatively in combination with a mobile image intensifier to accurately reduce long bone fractures or correct bony deformities. The device has been evaluated in use in over 50 patients. It has enabled reductions and corrections to be achieved with alignment accuracies of the order of two to three degrees form neutral. The device is cheap to manufacture and quick to use. It produces significant savings in operating time, radiation exposure to staff and revenue costs of X-ray film. The idea has now been extended to include assessments of the mechanical axis of the limb and limb length in complex limb reconstruction cases.

Achondroplasia↗
PubMed1991

[Traumatically-induced thrombosis of the distal ulnar artery. Case report and review of the literature].

The authors report on a patient who fell and struck his right hypothenar against a sharp edge. He had immediate pain and reduced circulation in his ring and little fingers. The neurological findings revealed paraesthesia in the two ulnar fingers and loss of abduction strength in the little finger. Treatment was at first conservative, but the symptoms persisted. Four weeks after injury, the patient was referred to our unit. Doppler ultrasound and angiography of the brachial artery were performed, showing an occlusion of the ulnar artery just distal to the space of Guyon. Operative revision was carried out and a 20 mm thrombus removed. Recovery was then uneventful, and all previous symptoms disappeared. A review of the literature is presented and typical symptoms, diagnostic and therapeutic approaches discussed. The need for an early diagnosis and operative revision is demonstrated.

Angiography↗
PubMed1991

[Current state of interventional measures in cardiology].

Interventional cardiology comprises all therapeutic heart procedures which are percutaneously performed via catheterization. Selected patients with severe mitral or aortic stenoses may be efficiently treated by percutaneous transluminal balloon valvuloplasty (PTBV). Percutaneous transluminal coronary angioplasty (PTCA) as a treatment of coronary artery disease has now been applied for more than 10 years, and the main problem appears to be the development of restenosis after 3 to 4 months. The efficacy of newer interventional techniques (the percutaneous transluminal laser ablation [PTCLA], the endatherectomy, rotational catheters, or the application of stents) is studied at present all over the world. The question is whether these procedures may reduce restenosis and increase success rate in patients at risk.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Correlation between late potentials, left ventricular function and coronary heart disease].

By signal averaging it is possible to registrate late, fragmented low amplitude signals (late potentials, LP's) from the bodysurface 26 patients (21 males, 5 females) with a mean age of 57 years were investigated by signal averaging, Holter-monitoring and cardiac catheterization. 11 patients had a dilative cardiomyopathy (group A), 10 patients a coronary heart disease (group B), 5 of them with an ejection fraction greater than 50%, 5 of them with a reduced ejection fraction, whereas the control-group with 5 patients (group C) showed no coronary stenosis or reduced ventricular function, 6 out of 11 patients with dilative cardiomyopathy showed LP's; all of these with Lown IVb had LP's. In 2 patients with coronary heart disease and good left ventricular function late potentials were found, and in all 5 patients with disturbed left ventricular function. The control-group revealed no late potentials although 4 patients had Lown IVa or more in Holter-ECG. In conclusion, late potentials show a good correlation to malignant ventricular ectopic beats in patients with dilative cardiomyopathy and coronary heart disease, especially when the left ventricular function is reduced.

Adult↗
PubMed1990

Anticardiolipin antibodies are no marker for survived myocardial infarction.

Antiphospholipid antibodies--both the lupus anticoagulant and anticardiolipin antibodies--are closely associated with arterial and venous thrombosis. In this prospective trial the IgM- and IgG-anticardiolipin antibodies in serum were determined in acute and chronic coronary artery disease. Seventy-four unselected males (34-87 years, mean 60) were included in the study. All patients underwent coronary angiography; infectious and autoimmune diseases were exclusion criteria. Sixteen patients had coronary artery disease (group A), 34 showed coronary stenoses with prior infarction (B), and 14 had survived an acute myocardial infarction (C), whereas 10 patients revealed no significant coronary narrowing (D; controls). The major risk factors were the same for all groups. Neither the IgM- nor the IgG-anticardiolipin antibody levels showed any significant difference in the four groups. The severity of coronary artery disease did not correlate to these antibodies. Furthermore, no correlation was found between elevated anticardiolipin antibodies and thrombocyte levels. Thus, a higher anticardiolipin level does not appear to be a marker for recurrent cardiovascular events.

Adult↗
PubMed1990

[The patient following PTCA].

Diagnostic measures after PTCA consist of history, clinical findings, after 3 months and thereafter in 6 months intervals as well as ergometry in case of recurrency of complaints of after 3 months and then in 6 months intervals. A thallium-scintigraphy is done eventually. A repetition of a coronarography is indicated only in cases of typical symptoms or registration of ischemia. Therapy consists of lifelong ASS and calcium channel blockers for 3 months and treatment of risk-factors. Repetition of a PTCA, atherectomy, stent-implantation, laser-angioplasty or bypass-surgery varies from case to case; the decision has to be made individually.

Angioplasty, Balloon, Coronary↗
PubMed1990

Galactosylceramide sulfotransferase, arylsulfatase A and cerebroside sulfatase activity in different regions of developing rat brain.

The in vivo metabolism of sulfatides was studied in spinal cord and cerebral cortex of developing rat pups. Developmental changes in the rate of sulfolipid synthesis were measured after the intraperitoneal injection of 35SO4(2-). We also measured the accumulation of sulfatides, as well as the profiles of cerebroside sulfotransferase, cerebroside sulfatase and arylsulfatase A in both brain regions as a function of postnatal development. The accumulation of sulfatides was higher in spinal cord than in cerebral cortex. In addition, sulfatide metabolism was more active in spinal cord. In both brain regions, the developmental pattern of 35SO4(2-) incorporation into sulfolipids was closely correlated to the activities of cerebroside sulfotransferase and of arylsulfatase A. The activity of these enzymes was initially low, increased during the period of active myelination and declined thereafter. However, the activity of cerebroside sulfatase, measured with its physiological substrate, [35S]sulfatide, increased during development and did not decline. An explanation for the difference between the developmental profiles of the arylsulfatase A and cerebroside sulfatase reactions (which are supposed to be catalysed by the same enzyme) is proposed.

Aging↗
PubMed1990

Coronary revascularization: influence on ventricular arrhythmias.

Myocardial ischemia may cause severe cardiac arrhythmias. In the present study, the influence of revascularization on ventricular arrhythmias was investigated. A total of 68 patients (61 male, 7 female; mean age 53 years) with coronary artery disease was divided into three groups: Group A (21 patients) underwent percutaneous transluminal coronary angioplasty (PTCA); Group B (37 patients) had coronary artery bypass grafting (CABG); and Group C were 10 patients who served as controls, who had simple coronary angiography. All patients had a Holter ECG on the day before angiography. PTCA patients and controls were restudied on the day after the procedure, while in Group B, Holter ECG was repeated three weeks after surgery. Groups A and B were again studied 18 months after the first Holter ECG. The PTCA group showed a slight reduction in complex arrhythmias immediately following PTCA, which increased again after 18 months; the CABG group, however, revealed a significant increase in complex arrhythmias three weeks after bypass surgery, but a decrease after 18 months. There was no significant change in the control group before or after angiography. Thus, successful revascularization has no influence on ventricular arrhythmias after 18 months.

Adult↗
PubMed1990

Different stereoselective effects of (R)- and (S)-propafenone: clinical pharmacologic, electrophysiologic, and radioligand binding studies.

Propafenone is a class 1c antiarrhythmic agent with moderate beta-blocking activity as a result of a structural similarity to beta-adrenoceptor antagonists. In a randomized, double-blind crossover exercise study, eight healthy volunteers were examined before and 2 1/2 hours after oral administration of 300 mg (R,S)-, 150 mg (R)-, and 150 mg (S)-propafenone hydrochloride. The mean rate pressure product was significantly reduced by (R,S)-propafenone hydrochloride (-5.2%; p = 0.045) and half-dosed (S)-propafenone hydrochloride (-5.9%; p = 0.013), whereas the (R)-enantiomer caused no significant changes. There was a significant difference between the effects of (R)- and (S)-propafenone (p = 0.033). In beta-adrenoceptor-binding inhibition experiments with (S)-(125I)iodocyanopindolol in a sarcolemma-enriched cardiac membrane preparation, the eudismic ratio of (S)- over (R)-propafenone was 54. On the spontaneously beating Langendorff-perfused guinea pig heart, 3 x 10(-6) mol/L of both (R)- and (S)-propafenone resulted in significant changes (p less than 0.01) on His bundle conduction (+79% +/- 27% and +69% +/- 9%), as well as comparable decreases in the maximal rate of pacing with 1:1 conduction of the atrial (-54% +/- 10% and -57% +/- 8%) and ventricular myocardium (-42% +/- 6% and -43% +/- 6%), indicating equal effects in sodium channel-dependent antiarrhythmic class 1 activity. Thus (R)- and (S)-propafenone exert different beta-blocking actions but equal effects on the sodium channel-dependent antiarrhythmic class 1 activity. More specific antiarrhythmic class 1 therapy with reduction of beta-blocking side effects may be attained with optically pure (R)-propafenone hydrochloride instead of the currently used racemic mixture.

Administration, Oral↗