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Biomedical subjects

W Klein

Publications and source records attributed to W Klein.

At least 163 records · Page 9Linked to original sources
PubMed1996

Oral treatment of late Lyme borreliosis with a combination of roxithromycin and co-trimoxazole--a pilot study on 18 patients.

In this pilot trial, 18 patients participated in an investigation in which the combined therapy of co-trimoxazole and roxithromycin in late Lyme borreliosis was tested. The study has been performed as a result of earlier case reports in "The Lancet" where this combination has been used successfully in order to thwart late Lyme disease. The authors show that 76% of the patients recovered completely. In 2 patients, symptoms could be resolved with i.v. penicillin and 2 did not respond to any antibiotic therapy. These results show that oral therapy of co-trimoxazole and roxithromycin in combination provides similar results as i.v. antibiotics in earlier studies.

Administration, Oral↗
PubMed1996

[Current aspects of ACE inhibitor therapy from the cardiologic viewpoint].

From a cardiologist's view there are several established indications for the use of ACE-inhibitors like hypertension, heart failure and acute myocardial infarction. In other forms of coronary artery disease like stable and unstable angina and prevention of arteriosclerotic complications. ACE-inhibitors are under discussion. As antihypertensives ACE-inhibitors are about equally effective as calcium blockers, betablockers and diuretics without the negative effects on lipid metabolism and insulin sensitivity. Vascular and cardial remodelling are prevented with ACE-inhibitors at least to a certain degree. In heart failure ACE-inhibitors reduce morbidity and mortality, if left ventricular ejection fraction is reduced. In acute myocardial infarction ACE-inhibitors are indicated in overt heart failure, depressed left ventricular function and high-risk-patients. In silent ischaemia and secondary prevention ACE-inhibitors are under discussion.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1996

[Inhibition of the renin-angiotensin system: ACE inhibitors and angiotensin II receptor blockers].

The renin-angiotensin system (RAS) plays an important role in blood pressure regulation and fluid homeostasis in people with and without hypertension. The ACE-inhibitors were the first of the RAS blocking agents to have a wide clinical acceptance. Several trials demonstrated their usefulness in the treatment of essential hypertension, congestive heart failure, post myocardial infarction and diabetic renal disease. The recent development of selective angiotensin II type 1 receptor II blockers offers the compelling concept of interfering on the receptor level without disruption of the prostaglandin and bradykinin biosystems. Losartan, the prototype of orally active angiotensin II type 1 receptor antagonists, has been shown to be safe and effective in control of elevated blood pressure and improvement of the abnormal hemodynamics in the patient with congestive heart failure. These early encouraging results have to be confirmed by studies translating the circulatory benefits into augmented end-organ protection and prolongation of life.

Angiotensin Receptor Antagonists↗
PubMed1996

[Smoking behavior and views on the smoking topic in the Styrian population--results of a survey at the Graz autumn convention].

Cigarette smoking has been identified as a major risk factor for cardiovascular diseases apart from hypercholesterolemia and arterial hypertension. Diseases of the respiratory system and several neoplasms as well as complications of pregnancy are considered to be "smoking-related", too. In order to survey the smoking habits and views on smoking in the Styrian population, a questionnaire was issued to 1034 visitors of the Graz Autumn Fair 1992. Pleasure proved to be the main motivation for smoking both in men and in women, habit, addiction, stress and boredom being further motivations. Not only non-smokers, but also smokers were assessed to be aware of smoking being a health hazard. Prohibition of tobacco advertising was accepted most widely as a mean of anti-smoking campaign. About half the non-smokers are exposed to environmental tobacco smoke, at place of work more frequently than at home. Percentage of smokers differs with age and job classes, however, no geographical variations were found. Further anti-smoking measures should be considered. Smoking restrictions at place of work and in public could prevent passive smoking. Ban on advertising seems to be the most effective anti-smoking campaign.

Adolescent↗
PubMed1996

[ACE inhibitors with SH groups have no effect of ATP-dependent K channels--a dissertation].

ACE-inhibitors are used in the treatment of hypertension, and ischemic heart disease, chronic heart failure, cardiomyopathy and diabetic nephropathy. The effect of the ACE inhibitors is mainly due to the inhibition of the angiotensin converting-enzyme, but they also potentiate the effect of bradykinine. Sargent et al. have indicated, that SH-containing ACE-inhibitors show an effect on KATP-channel open probability in vascular smooth muscle. In our experiments, we used isolated bovine coronary arteries and guinea pig aortas, which were cut transversally and brought into Normal-Tyrode-solution. The vessels were precontracted with phenylephrine or U 46619, and after that a cumulative dose of the SH-containing ACE-inhibitors Captopril or Zofenopril was added to obtain a relaxation curve. In a second series we blocked the KATP-channels with glibenclamide to see if the relaxation could be attenuated. In bovine coronary arteries the relaxing effect of Captopril could not be attenuated by glibenclamide, a specific blocker of KATP-channels of vascular smooth muscle. In the guinea pig aorta, the relaxing effect of Zofenopril was also not effected by glibenclamide. The concentrations of Zofenopril were between 10(-7) and 10(-4) mol/l; the maximal effect could be seen at a concentration of 10(-5) mol/l. Experiments with the non SH-containing ACE-inhibitor Enalapril did also not show any statistically significant difference between the 2 groups of series. We conclude, that, in contrast to Sargent's conclusions, there is little or no effect on KATP-channels due to the presence of SH-groups.

Adenosine Triphosphate↗
PubMed1996

[Quality assurance in invasive and interventional cardiology in Austria in 1994. Commissioned by the Interventional Cardiology Working Group of the Austrian Cardiology Society].

A complete National Database is the prerequisite for quality control, quality management and improvement. In Austria, we have been reaching for this goal since more than three years. 21 094 diagnostic coronary angiographies (CA) and 4934 PTCAs were performed in all 27 centers (out of which 17 perform PTCA) in Austria during the year 1994. This is a reduction of 3.2% concerning CA and an 8.6% increase in PTCA compared to 1993. 48% of all PTCAs were done during the diagnostic study (CA), multivessel PTCA in 11%, direct PTCA for ongoing infarction in 2.3%. Concerning "new devices", 437 stents (182 during the year 1993) were implanted in 1994; also all 73 cases with rotablator, 105 with intracoronary ultrasound, and 26 directional coronary atherectomies (DCA) are documented. Hospital mortality after PTCA was 0.5% (unchanged from the years 1992 and 1993), emergency bypass surgery rate after PTCA was 1.2% (0.7% during the year 1993), and 1.4% of the patients suffered a myocardial infarction in the cathlab (1.2% during 1993). International comparison shows Austria among the top nations with 2637 CA and 617 PTCA per million inhabitants, corresponding to a ratio of 23% PTCA per 100 CA. Risk adjustment (exercise stress test pre PTCA documented in six cath-labs in 1993, compared to 11 in 1994. Type of stenosis (A, B, C) in five labs in 1993 and in 12 labs in 1994) and outcome control (exercise stress test 3 months after PTCA documented in five cath-labs in 1993, compared to 10 in 1994) are subject to constant improvement of our yearly monitor visits and feedback reaction. Austria is the only nation worldwide to support a complete national database with controlled numbers and parameters since more than 3 years, including yearly monitor visits (Internet address for the 1995 data: http@info.uibk.ac.at/gin/org/i_iik.stu/i_iik+ ++.htm) and feedback reports. We experienced no single negative reaction to our activities, but find them necessary for further quality management targets.

Angioplasty, Balloon, Coronary↗
PubMed1996

[Quality assurance in invasive and interventional cardiology in Austria for the 1995 calendar year].

A complete national database is the prerequisite for quality control, quality management and improvement. In Austria, we are reaching for this goal since more than 3 years. 23969 diagnostic coronary angiographies (CA) and 5898 PTCA were performed in all 25 adult-centers (out of which 18 perform PTCA) in Austria during the year 1995. This is an increase of 13.6% concerning CA and a 19.5% increase in PTCA compared to 1994. 50% of all PTCA were done during the diagnostic study (CA), direct PTCA for ongoing infarction in 2.8%. Concerning "new devices", 1572 stents (27% of the PTCA cases) were implanted in 1995. Hospital mortality after PTCA was 0.5% (unchanged to the years 1992 and 1993), emergency bypass surgery rate after PTCA was 0.8% (0.7% during the year 1993), and 1.3% of the patients suffered a myocardial infarction due to PTCA in the cath-lab (1.4% during 1994). International comparison shows Austria under the top nations with 2996 CA and 737 PTCA per million inhabitants, corresponding to a ratio of 41% PTCA and CABG per 100 CA. Out of 18 centers with PTCA-activity ischemia was proven to be present before PTCA in 2729 patients within 11 centers, primary-success-rate was documented in 14 centers concerning 3703 patients and a controlling exercise stress test within 3 months after PTCA was reported by 8 centers for 1555 patients. Local logbooks with continuous readings of complications, guidelines and monitor visits (audits) within all cath-labs in Austria turned out to be a better tool for quality control than computer-databases. But additional electronic databases will be necessary in the future. Austria is the only nation worldwide to support a complete national database with controlled numbers and parameters since more than three years, including complete yearly monitor visits and feedback reports. We experienced no single negative reaction to our activities, but find them necessary for further quality management targets.

Angioplasty, Balloon, Coronary↗
PubMed1995

[Thrombosis of a prosthetic mitral valve in the anticardiolipin syndrome].

A 40-year-old woman in whom the mitral valve had to be replaced with a prosthetic one (St. Jude's) had to be reoperated 8 months later because of endocarditis on the second prosthetic valve (Carbo-Medics). Four months later her general condition deteriorated progressively with cough and dyspnoea, requiring hospitalization. Auscultation revealed moist rales over both lung bases; heart sounds were distant but otherwise normal. The "international normalized ratio" was 2.5, while erythrocyte sedimentation rate, white cell count and C-reactive protein were normal. Transthoracic echocardiography demonstrated a hardly moving mitral valve prosthesis with an opening area of 0.8 cm. Subsequently this decreased further and measurement of the anticardiolipin antibody titre revealed an IgG fraction of 37.9 U/ml (normal up to 12 U/ml). Within 48 hours thrombolysis with streptokinase had increased the valve's opening area to 1.8 cm. The patient made an uneventful recovery under strict anticoagulation. This case illustrates that the anticardiolipin syndrome can be a cause of an otherwise unclear genesis.

Adult↗
PubMed1995

Heart rate deflection related to lactate performance curve and plasma catecholamine response during incremental cycle ergometer exercise.

The correlation between the behaviour of the heart rate/work performance (fc/W) curve and blood lactate ([la]b) and plasma adrenaline/noradrenaline concentrations ([A]/[NA]) during incremental cycle ergometer exercise was investigated. A group of 21 male sports students was divided into two groups: group I, with a clear deflection of the fc/W curve; group II, without or with an inverse deflection of the fc/W curve. The aerobic threshold (Thaer) and the lactate turn point (LTP) were defined. Between Thaer and maximal work performance (Wmax) the behaviour of the fc/W curve as well as the behaviour of [la-]b and [A]. [NA] were described mathematically. The fc, systolic blood pressure (BPs), W, [la-]b, [A] and [NA] at rest, Thaer, LTP, Wmax, after 3 and 6 min of recovery (Re3/Re6) were calculated. A significant difference between the two groups could only be detected for fc at LTP, Re3 and Re6 (P < 0.05). No significant correlation could be found between individual fc/W-behaviour and individual time course of [la-]b, [A] and [NA]. However, a significant correlation was visible between [la-]b/W-behaviour and individual catecholamine response. These results and the fact that the different flattening at the top of the fc/W curve was related to diminished stress-dependent myocardial function led us to the conclusion that it is possible that sympathetic drive is not directly involved in mechanisms of regulation between load dependent fc and myocardial function. In addition, individual fc/W behaviour was independent of BPs and Wmax, or individual conditions of energy supply.

Adult↗