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Biomedical subjects

W Mohl

Publications and source records attributed to W Mohl.

72 records · Page 4Linked to original sources
PubMed1984

[Dermatoglyphics in families with Potter type III polycystic kidney degeneration].

Several dermatoglyphic studies of patients suffering from genetically determined disorders which are not manifest at birth, indicate an early direct or indirect influence of the causative factors on the formation of dermatoglyphics. On the basis of these observations the present study gives an analysis of the quantitative and qualitative dermatoglyphic characteristics of fingers, palms and soles, as well as body and head measurements and morphological traits of the head and face of nine patients with adult polycystic kidney disease (APCD) type III and of their first and second degree relatives. No malformations nor any significant variation of these variables were observed, i.e. no differences were recorded between patients and controls or patients and their healthy relatives. Yet some interesting trends appeared in dermatoglyphic ridge counts when special methods for intrafamilial comparison were applied. Thus, APCD type III ridge counts on fingers and palms were somewhat lower when plotted against their mid-parent values than those of their healthy sibs. Nevertheless, only studies of additional family material may permit the conclusion that such a constellation is due to type III APCD, and not merely a spurious finding.

Adult↗
PubMed1984

Reduction of infarct size induced by pressure-controlled intermittent coronary sinus occlusion.

The effect of pressure-controlled intermittent coronary sinus (CS) occlusion on myocardial infarction (MI) size was evaluated. A device for this purpose was developed that consisted of a balloon catheter and pump system that produced controlled, intermittent occlusion of the CS and used CS pressure as a feedback to determine the duration of occlusion. It was hypothesized that proper selection of occlusion and non-occlusion times would both facilitate improved retrograde flow to ischemic areas and allow for more complete venous washout of metabolites. In 13 treated dogs and 12 control dogs before treatment, myocardium at risk of MI was estimated by injection of technetium-labeled microspheres. Intermittent CS occlusion was then begun, 15 minutes after coronary artery occlusion, and continued until termination of the experiment 6 hours later. Postmortem determination of infarct size was performed using the triphenyltetrazolium chloride staining technique. Intermittent CS occlusion begun 15 minutes after coronary artery occlusion and continued for 6 hours resulted in a 45% average reduction in MI size (p less than 0.001). During CS occlusion, the sinus systolic mean pressure increased from 10 to 44 mm Hg, while the distal coronary artery mean pressure increased by an average of 36% (from 22 to 30 mm Hg, p less than 0.05). These results suggest intermittent occlusion may be an effective treatment for evolving MI. This therapy, used alone or combined with other therapies (e.g., administration of pharmacologic agents), appears to have great clinical potential.

Animals↗
PubMed1984

The development and rationale of pressure-controlled intermittent coronary sinus occlusion--a new approach to protect ischemic myocardium.

The early concept of global retroperfusion and arterialisation of the coronary sinus was discarded because of unacceptable damage to the myocardium, although many authors provided evidence on the improvement of cardiac function during ischemia. Furthermore, the exact mechanism of coronary sinus retroperfusion remained poorly understood. The lack of a strong physiological basis for retroperfusion as well as the development of coronary bypass grafting lessened interest in this revascularisation technique. Renewed interest in myocardial protection via the coronary sinus emerged because of a more aggressive therapy of acute myocardial ischemia. We developed a simple retroperfusion system conceptualized as a periodical occlusion of the coronary sinus and as a redistribution of venous flow to compromised areas during acute myocardial ischemia, sweeping out toxic substances and edema during coronary venous drainage. To allow sufficient filling of the infarcted area as well as venous drainage, the occlusion versus release phase is controlled by the coronary sinus pressure. This pressure-controlled intermittent coronary sinus occlusion (P-ICSO) represents a closed loop system and therefore guarantees optimal physiologic function of the system. This report explains the proposed nature of action of enhanced washout of myocardial edema induced by P-ICSO. Moreover, beneficial effects of P-ICSO observed during canine studies are summarized. It is concluded that this new simple retroperfusion technique has the clinical potential to serve as interim support to protect deprived myocardium until definite reperfusion is available.

Blood Pressure↗
PubMed1984

[Ergometry and long-term ECG for assessing bradycardiac and tachycardiac heart rhythm disorders in symptomatic patients over 70].

The usefulness of exercise testing and long term-ECG recording in old age was evaluated in a retrospective study. During a period of 24 months 317 long-term-ECGs in 195 patients greater than 70 years and 208 exercise tests in patients greater than 70 years were performed. The mean age of the patients was 73 +/- 3 years. Long-term ECG revealed a high incidence of supraventricular arrhythmias, while PVCs were found in only 28.7% of patients and PVCs greater than 30/h in only 7.3% of patients. Complex ventricular arrhythmias occurred in 25% of patients. Long-term ECG recording appeared to be of particular value in detecting abnormal regulation of heart rate and bradycardia, although symptom correlation with arrhythmias recorded was rare. Exercise testing revealed a higher incidence of PVCs with PVCs recorded in 67% of patients and PVCs greater than 2/min in 42% of patients. The incidence of complex ventricular arrhythmias was slightly greater compared to long-term recording with 29% of all patients. Exercise testing was particularly useful in detecting complex arrhythmias in patients with additional signs of myocardial ischemia (ST-segment depression and/or angina pectoris during increasing levels of exercise). Thus comparing both exercise testing and long-term ECG both appeared to be useful methods to uncover arrhythmias in symptomic patients older than 70 years and have to be considered as complementary tools. Exercise testing is particularly useful in recovering complex ventricular arrhythmias in patients with signs of myocardial ischemia during exercise. Long-term ECG on the other hand allows better recognition of bradycardias and conduction defects that may also be present and may contribute to the patients symptoms.

Aged↗
PubMed1982

Myocardial perfusion evaluated by contrast echocardiography. A preliminary report.

The usefulness of contrast echocardiography for demonstration of myocardial perfusion was studied on six mongrel dogs. Two contrast agents tested were: (1) 0.9 percent saline solution, and (2) CO2-enriched saline solution (containing 0.2 ml CO2/10 ml). Only the latter solution produced an elucidation of the myocardium and allowed an estimation of the distribution and flow velocity of the contrast agent, which was characterized using the following three parameters: (1) transmural flow time (0.13 +/- 0.02 s x +/- SEM); (2) circumferential flow time (1.43 +/- 0.31 s); and (3) persistence time (42.0 +/- 4.3 s). There were no serious side effects on hemodynamics or heart rhythm. Thus, contrast echocardiography offers the possibility of detecting and quantitating myocardial perfusion.

Animals↗
PubMed1982

[Experimental model for determination of an "in vivo" area at risk accounting for the quantity and distribution of collateral flow (author's transl)].

To determine the influence of interventions on infarct size numerous studies have attempted a comparison between treatment and control groups. This has been complicated by the great variability in the quantity of necrosis due to the differences in coronary bed size and collateral flow. An experimental model is presented in which it is possible to determine an "area at risk of infarction" at several time points during the evolution of the infarct. This model allows to estimate infarct size that may be expected under the present conditions, prior to interventions, early, in vivo and in the same experiment. It is possible to quantitate topographically changes in collateral flow and to investigate the effect of intervention in the same experiment. We found a correlation of life-threatening arrhythmias including ventricular fibrillation with the size of the "myocardium at risk of infarction" and with the size of the infarcts measured post mortem. Several beneficial interventions were studied.

Animals↗
PubMed1981

[Postoperative therapy by means of acute parenteral alimentation (APA) with high doses of insulin and glucose after open heart surgery (author's transl)].

Immediately after open heart operations (extracorporeal circulation) 22 patients were investigated in 2 groups at the intensive care unit. Whereas the control group received Ringer lactate as postoperative infusion (RL-group), the 2nd group was given 50% glucose (0.5 g/kg/h) and insulin (250 U/1,000 cc) (GI-group). In case of need (blood glucose level) additional insulin up to 200 U/h, maximum 800 U/10 h, was supplied. On the 1st postoperative day 500 ml 10% crystalline amino acid solution was added. Before the start of postoperative infusion therapy postoperative serum insulin levels were low in spite of considerably elevated blood glucose levels (glucose utilisation disorder, insulin suppression). In contrast with the RL-group there was in the GI-group a significant decrease of FFA-serum level and cAMP serum level which developed during the infusion. Urine output and urinary glucose excretion was nearly equal in both groups. Urinary potassium excretion in the GI-group remained significantly one third lower than that of the RL-group, in spite of the potassium supply to the GI-group being nearly twice and serum potassium level approximately equal. Urinary sodium excretion of GI-group on the other hand was approximately 15% higher than that of RL-group. In relation to preoperative values postoperative urinary N-excretion of the GI-group was unchanged, whereas in RL-group the postoperative N-excretion was significantly 30% increased; in postoperative alpha-amino-N-excretion there was only a small difference between the groups, which indicates an insulin-modifiable increase in protein breakdown rather than a decreased protein synthesis. According to the obviously improved situation in energetic considerations, cell membrane potential restoration and N-balance resp. protein synthesis in the insulin treated group, the question is discussed whether this therapy (APA) which shifts metabolism to an anabolic state, is of a certain value as a therapeutic measure in the postshock phase.

Adult↗
PubMed1979

[Mechanisms common to the development of malformation in congenital and sporadic forms of atrial septal defect (type II) (author's transl)].

Familial prevalence of some congenital cardiopathies leads to the conclusion that genetic factors might be involved. The case histories are presented of three families with atrial septal defect, Type II (ASD II) in which autosomal dominant inheritance was assumed on account of the pedigree analysis. Each family member was examined serologically, morphologically and morphometrically. One family was also tested for cytogenetic abnormalities. It is highly probable that the gene responsible for the defect is linked to the HLA system (Lod score = + 3.612) and is, therefore, located on the short arm of chromosome 6. The morphological examinations demonstrated uniformity of individual ear traits in related patients; moreover, the palmar dermatoglyphics showed a tendency to shortening of main line C, to ulnar and distal shifting of the carpal triradius and to an increase in hypothenar patterns. In addition a study was carried out of patients with apparently sporadic cardiopathy. A similar trend as to palmar configuration was observed. An attempt was made to connect known factors causing malformations with the results of this investigations.

Adolescent↗
PubMed1979

[Omphalocele and gastroschisis: clinical differences and surgical considerations. A ten year review (author's transl)].

31 infants with anterior abdominal wall defects were treated over the past 10 years. Despite the falling birth rate gastroschisis occurred almost twice as often as omphalocele (19 and 12 cases, respectively). The mortality rate of 71% in omphalocele were related to large defects, rupture of the sac and associated cardiac malformations. The 73% incidence of prematurity, additional malformations and sepsis contributed to the mortality rate of 58% in gastroschisis.

Abdominal Muscles↗
PubMed1978

[Results of operative treatment of artial septal defect in the adult (author's transl)].

55 of 59 patients with artial septal defect, who had been operated in adult age, were examined postoperatively. The mean time interval from the operation was 43,8 months. Two patients had died immediately after the operation; there were no late deaths. The majority of the reexamined subjects was free of symptoms, in no case was there congestive heart failure. Persistence of postoperative symptoms increased with increasing age at the time of operation, but only up to the fourth decade of life. In 26 cases hemodynamics were examined. Mean pulmonary arterial pressure was normal at rest and during a slight ergometric load. In 5 patients there was moderate pulmonary hypertension. In 8 subjects there was minimal, in one patient moderate increase of pulmonary vascular resistance. Heartsize in chest roentgenogramm was increased in about 25% of cases, in more than 50% the pulmonary vessels were accentuated. Irregularities of cardiac rhythm were not more frequent postoperatively, than they had been prior to surgery. However, surgery was followed by a marked decrease of right axis deviation and of EKG signs of right ventricular hypertrophy. Pulmonary function studies revealed a slight decrease of vital capacity and of maximal breathing capacity. These results are favourable compaired to medically treated groups of patients as described in the literature. It is concluded, that even in later adult age the atrial septal defect as a rule is an indication for surgery.

Adult↗
PubMed1978

[Sudden cardiac death in patients with pacemakers].

The risk of sudden death in our material, is 13.6% of all deaths. 2. In 5 patients (1.6%) death was caused by failure of the pacemaker (PM), or the electrode. 3. Patients with an asynchronous PM have no higher risk for sudden death, than patients with demand PM. 4. In 9 of 44 patients, a dysfunction of the PM or electrode, can not be excluded. Thus, it must be strictly advised in all patients with an implanted PM, that an autopsy and control of the explanted PM and electrode should be performed. 5. Patients who have a higher risk for sudden death (total AV-Block, Adams-Stokes-Attacks) should be kept hospitalized at least 4 weeks after implantation, controlled more frequently than others, and should be labelled as high risk patients in their PM passport. 6. Control of the resistance in the patients circuit can detect impending failure of the electrode and prevent life threatening complications.

Death, Sudden↗
PubMed1976

[A new design for a totally artificial heart: the ellipsoid heart (author's transl)].

Thromboembolic complications represent the main limiting factor in cardiac replacement by totally artificial hearts in calves at present. Thrombus formation within artificial hearts is caused by the appearance of stagnation areas. The ellipsoid heart eliminates stagnation areas by virtue of its production as a one-piece membrane. The heart is driven pneumatically and functions as a diaphragmatic blood pump. The stroke volume is 178 cm3 and the maximal cardiac output 15.8l/Min. Three acute experiments demonstrated a high degree of haemodynamic efficiency without compression of, or interference with surrounding structures, especially the inferior vena cava or the right atrium.

Animals↗
PubMedDate not supplied

Measurement of aortic flow velocity during transesophageal echocardiography in the transgastric five-chamber view.

Continuous-wave Doppler echocardiography of aortic flow velocity has a variety of clinical and research applications. Recently, continuous-wave Doppler echocardiography has been added to transesophageal echocardiographic systems. However, alignment of the Doppler beam with aortic flow is not possible with standard single and biplane views. A modified transesophageal echocardiographic view; the transgastric five-chamber (TG5C) view, allows for measurement of aortic flow velocity but its feasibility and accuracy in an unselected consecutive population have not yet been described. The feasibility of obtaining the TG5C view and measuring aortic flow velocity was assessed in 58 consecutive transesophageal echocardiographic investigations. The TG5C view was obtained in 97% and adequate Doppler flow velocity signals were obtained in 91% of patients. The accuracy of measurements was assessed in 24 patients in whom flow signals from both the TG5C and standard transthoracic views could be obtained. The correlation between TG5C and transthoracic views was excellent, with r values of 0.968 and 0.952 for peak aortic flow velocity and mean aortic flow velocity, respectively. Accurate aortic flow velocity measurements can be obtained in most patients during transesophageal echocardiography with the TG5C view. This view has great utility in a variety of situations in which adequate transthoracic imaging is not possible, especially the operating room and intensive care unit.

Adolescent↗
PubMedDate not supplied

Coronary perfusion pressure and inflow resistance have different influence on intramyocardial flows during coronary sinus interventions.

A mathematical model is used to represent the vascular bed of the left coronary circulation by an arterial, a capillary and a venous compartment. The model is first adjusted so as to reproduce arterial hemodynamics known from measurements during normal perfusion. Additionally, measurements under coronary sinus occlusion are used to assess the venous section of the model. While the calculated phasic shapes of epicardial flows are seen to agree with measurements, intramyocardial flows, which are inaccessable to measurement, are predicted from the model. The model is run under stepwise changes of coronary perfusion pressure and coronary artery resistance for both the normal state and coronary sinus occlusion. Intramyocardial flow between capillaries and veins, being the main determinant for a possible therapeutic effect of coronary sinus interventions, is estimated.

Animals↗