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Biomedical subjects

W Rudolph

Publications and source records attributed to W Rudolph.

At least 91 records · Page 5Linked to original sources
PubMed1984

[Anti-ischemic effect of 8 mg molsidomin in retard form].

Studies of the efficacy of molsidomine, previously performed on our service, demonstrated that a clear antianginal effect in the longterm treatment of angina pectoris could only be achieved with a regimen of the standard 2 mg dose when given six times daily. Consequently, since a mode of administration with a longer duration of action was implicitly desirable, the present study, carried out in eleven patients with coronary artery disease and stable, exertional angina pectoris, was undertaken to assess the antiischemic effects of 8 mg molsidomine in sustained-release form as compared with the standard 2 mg formulation according to a double-blind, randomized, crossover, placebo-controlled protocol. Additionally, plasma concentrations of molsidomine were determined to elucidate the bioavailability as well as possible correlations between plasma concentrations and antiischemic effect. As compared with placebo, after administration of 8 mg molsidomine sustained-release there were reduction in the ST-segment depression at one, three, five and eight hours of 74% (p less than 0.001), 61% (p less than 0.001), 44% (p less than 0.025), and 31% (p less than 0.01), respectively; after 2 mg molsidomine, 74% (p less than 0.001), 37% (p less than 0.025), 7% (ns) and 6% (ns), respectively. Analysis of the response of the ST-segment in the individual patients showed an unequivocal antiischemic effect with a reduction in ST-segment depression of at least 1 mm after 8 mg molsidomine sustained-release at the specified points in time in ten, five, six and four patients, respectively, and after 2 mg molsidomine in nine, five, one and no patients, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1984

[Development of tolerance with regard to the anti-ischemic effect of isosorbide dinitrate in regular multiple daily administration].

In previous studies it had been shown that during longterm treatment of coronary artery disease with isosorbide dinitrate (ISDN) in sustained-release form, there was no reduction in exercise-induced ST-segment depression, no decrease in the rate of anginal attacks or nitrate consumption and no changes in blood pressure or heart rate [1, 4]. To determine to what extent tolerance development is a fundamental property of longterm administration of ISDN, this study, carried out according to a randomized, double-blind, cross-over, placebo-controlled protocol (Figure 1), was undertaken. The anti-ischemic effects of 40 mg ISDN were analyzed after acute administration and during longterm treatment with 40 mg four times daily in eleven patients with stable angina pectoris and reproducible ST-segment depression. Additionally, the influence of this therapy on the anti-ischemic effects of 0.8 mg sublingually-administered nitroglycerin (GTN) was assessed in ten of the eleven patients. On acute administration, 40 mg ISDN led to a reduction in ST-segment depression at one hour from 2.05 to 0.18 mm (p less than 0.01), and at six hours from 2.35 to 1.20 mm (p less than 0.01) (Figure 2, Table 1). During chronic treatment, statistically significant changes were no longer detectable. In eight of the eleven patients there was a complete loss of effects; in the remaining three, a marked attenuation was observed (Figure 3). Acute administration of 40 mg ISDN resulted in plasma concentrations of 221 ng/ml 5-ISMN, 53 ng/ml 2-ISMN and 23 ng/ml ISDN (Figure 6, Table 2).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1984

[Comparison of the anti-ischemia effect of nisoldipine and verapamil. Double-blind randomized cross-over and placebo-controlled acute and long-term study].

Nisoldipine (Bay K5552), a newly-developed dehydropyridine derivative with calcium antagonistic properties, was found to have a duration of action twice as long as its parent compound, nifedipine, in laboratory experiments. To evaluate the anti-ischemic potency and duration of action, the effects of 10 mg nisoldipine after acute administration and at the end of three weeks of treatment with 10 mg twice daily were compared with those of 120 mg verapamil three times daily in a double-blind, randomized, crossover, placebo-controlled study. In twelve patients with angiographically-documented coronary artery disease and stable exertional angina pectoris, bicycle ergometry was performed before and at three and seven hours after medication on the first and 21st days of the three respective treatment phases. The control value at 8 a.m. on the 21st day corresponded with the ten-hour value on the 20th day of treatment. Between the three treatment phases, there was a one-week wash-out period during which the patients received placebo three times daily. At the time of the ergometric studies, blood was drawn for determination of verapamil plasma concentrations and, additionally, each patient recorded anginal attacks and nitrate consumption. Analysis was carried out for ST-segment depression in each patient at the highest comparable workload achieved in all treatment phases, the time to onset of 1 mm ST-segment depression as well as the response of the heart rate, systolic arterial blood pressure and the heart rate-blood pressure double-product both at rest and during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1984

Symptoms, exercise capacity and exercise hemodynamics: interrelationships and their role in quantification of the valvular lesion.

To compare the symptoms with the objectively-determined exercise capacity, the symptoms as well as the exercise capacity with the exercise hemodynamics and the symptoms, exercise capacity and exercise hemodynamics with the severity of the valvular lesion, in 154 patients with aortic regurgitation, mitral regurgitation, aortic stenosis or mitral stenosis, the symptoms were classified according to the New York Heart Association and the exercise capacity was determined by means of bicycle ergometry with simultaneous measurement of heart rate, blood pressure, pulmonary artery pressure, cardiac output and the left ventricular ejection fraction. Among the parameters studied, no relationships could be established; to a certain degree, the exercise hemodynamics correlated with the severity of the valvular lesion in that a markedly pathologic response was associated with the presence of a high-grade valvular lesion. Since the symptoms were not indicative of the exercise capacity, nor the symptoms or the exercise capacity of either the exercise hemodynamics, the exercise ejection fraction or the severity of the valvular lesion, the symptoms and the exercise capacity should be evaluated on the basis of the exercise hemodynamics before they are taken into consideration for meaningful decision-making processes such as establishment of the indication for surgery.

Adolescent↗
PubMed1984

[Doppler-echocardiographic determination of the degree of severity of mitral stenosis].

The assessment of severity of mitral stenosis is generally based on the mitral valve orifice area as calculated by the Gorlin formula from the invasively-measured pressure gradient and flow across the valve. As an additional reference for evaluating severity, the hemodynamically-determined pressure half-time has been suggested; that is, the time required for the peak gradient across the stenotic valve to drop to one-half of its original value. Since the pressure gradient and the velocity of flow in the region of the stenosis are related to each other as described in the Bernoulli equation and, since the velocity of flow can be analyzed with Doppler echocardiography, the possibility is afforded for noninvasive determination of both the pressure gradient and the pressure half-time. From the Doppler echocardiographically determined pressure half-time, the mitral valve orifice area can be calculated. This study, in a relatively large population of patients with mitral stenosis, was undertaken to compare the pressure half-times obtained from Doppler echocardiography with the valve orifice areas derived from hemodynamic measurement, to analyze the relationship between the two latter parameters and to evaluate the relevance of the newly-developed method. In Doppler echocardiography, the frequency shift of emitted sound reflected from moving blood cells is measured. The velocity of blood flow is proportional to the frequency shift delta f.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Sudden heart death.

Explore the source record for details and available documents.

Arrhythmias, Cardiac↗
PubMed1984

[Torsten-Sjögren syndrome].

The Torsten -Sjögren-syndrome is the combination of hereditary cataract associated with impaired central nervous coordination, mental retardation and hyperaminoacidurea . This recessive inheritable disease is due to an alteration of the aminoacidmetabolism also present in the not manifestly affected parents. In addition, the presented case exhibited an anal atresia with perinatal fistula. The pediatric and ophthalmologic aids have been started early. According to the etiology a genetic counceling is necessary.

Amino Acid Metabolism, Inborn Errors↗
PubMed1983

Effect of postextrasystolic potentiation on amplitude and timing of regional left ventricular wall motion in ischaemic heart disease.

In order to investigate the effects of postextrasystolic potentiation on left ventricular wall motion, the left ventriculograms of 30 patients were digitised frame by frame and regional movement demonstrated by contour displays. Postextrasystolic potentiation caused significant increases in end-diastolic volume, ejection fraction, and peak ejection and filling rates. The amplitude of normally moving segments increased by 5.7 +/- 2.3 mm, regardless of initial amplitude. Hypokinetic segments moved normally if the initial amplitude was greater than 5 mm, and there was a reduced or absent response if 4 mm or less. Four specific abnormalities of timing of motion were studied during isovolumic contraction, early ejection, and isovolumic relaxation. Their timing and extent were all unaffected in postextrasystolic beats. These results thus give no evidence for the entity "reversible asynergy". Rather, they suggest that the response of local wall motion to postextrasystolic potentiation depends only on basal amplitude and increased volume change in postextrasystolic beats.

Cardiac Complexes, Premature↗
PubMed1983

Tolerance development during isosorbide dinitrate treatment: can it be circumvented?

Based on studies carried out according to randomized, double-blind, crossover, placebo-controlled protocols, analysis was performed to assess the antiischemic effects of (a) 40 mg ISDN, both after acute administration and during long-term treatment with four doses daily, (b) treatment with 20 mg ISDN twice daily (at 8 a.m. and 1 p.m.), and (c) 0.8 mg sublingually administered NTG during treatment with 40 mg ISDN four times daily. After acute administration of 40 mg ISDN there was a reduction in ST-segment depression from 2.05 to 0.18 mm (p less than 0.01). During chronic treatment, statistically-significant changes were no longer detectable. Sublingual administration of 0.8 mg NTG led to a reduction of ST-segment depression during the acute phase of ISDN from 1.20 to 0.15 mm (-87%; p less than 0.01) and during chronic treatment from 1.90 to 0.90 mm (-53%; p less than 0.01). Accordingly, as compared with changes induced in the acute and placebo phases, the effectiveness of NTG during chronic ISDN treatment was diminished. After acute administration of 20 mg ISDN, ST-segment depression was reduced from 2.15 to 0.40 mm (p less than 0.01) and to a comparable degree during long-term twice-daily treatment, from 2.25 to 0.40 mm (p less than 0.01). There was a significant reduction in the rate of anginal attacks and nitrate consumption. Thus, with respect to the anti-ischemic effectiveness of ISDN, tolerance development is incurred during repeated administration. Concomitantly, the effectiveness of NTG is not essentially negated, but rather diminished.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Trials as Topic↗
PubMed1983

[Detection and evaluation of infectious endocarditis].

Based on the findings of 50 patients with infective endocarditis, 37 affecting the aortic, six the mitral and seven both the aortic and mitral valves, in addition to analysis of predisposing factors, prominent signs and symptoms distinctive for the clinical entity were assessed (Tables 1 to 3). Preexistent conditions such as aortic valve lesions including bicuspid aortic valve as well as mitral valve lesions including mitral valve prolapse were proven in 66%. Factors which may have compromised host defense mechanisms such as cachexia and chronic alcohol or intravenous drug abuse were present in isolated cases. In 38% of the patients, a diagnostic or therapeutic manipulation, suspected to have given rise to the bacteremia, antedated the onset of endocarditis. Malaise, fatigue and chills were the most frequent symptoms (Table 4). Fever and cardiac murmurs were observed in all patients, anemia and bacteremia in 74% of the patients, respectively (Tables 4 to 6). In blood cultures, the most common microorganisms were found to be hemolytic and nonhemolytic streptococci accounting for 65% of positive findings, followed by enterococci and gram-negative bacteria each with 14% respectively (Table 6). Congestive heart failure predominated among cardiac complications with its occurrence in 84% of the patients. Valvular ring or myocardial abscess, aortic or sinus of Valsalva aneurysm, occasionally with perforation, were found in 24% of our patients. Coronary embolism was documented in 6%; infection-associated pericarditis was observed only rarely (Table 7). Extracardiac complications involved the skin, central nervous system, spleen and kidneys, respectively, in 20 to 30% of the patients. Complications afflicting the eyes, lungs, gastrointestinal tract and the musculo-skeletal system were seen with a lesser frequency of 0 to 12% (Table 8). The diagnosis of infective endocarditis, rendered highly-probable by the constellation of fever, cardiac murmur, bacteremia and anemia, necessitates, however, confirmation through cardiac examinations. In this respect, electrocardiographic and radiologic findings are of limited value, although they may be useful in the detection of cardiac complications. In 6% of the patients, positive criteria for myocardial infarction were indicative of coronary embolism and, i 30%, atrioventricular or fascicular block suggested the presence of abscess formation (Table 9). As radiologic evidence of heart failure, 74% of the patients were found to have pulmonary vascular congestion (Table 10).(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1982

[Exercise testing in the assessment of ventricular arrhythmias (author's transl)].

During exercise, ventricular arrhythmias may be observed in 50% of healthy subjects and up to 85% of patients with heart disease. For the quantitative as well as qualitative assessment of ventricular arrhythmias, continuous ECG (Holter) monitoring is superior to the Exercise ECG. Both methods together render a 10% increase in sensitivity over that achieved through the use of one method only. In patients with repeated ventricular tachycardias, assessment through electrical stimulation is more preferable than the use of the exercise ECG or continuous ECG monitoring. In patients with coronary artery disease, ventricular arrhythmias during exercise, depending on their incidence and complexity, may indicate a two to eight-fold increase in the likelihood of cardiac death. The reproducibility of ventricular arrhythmias during repeated exercise testing is reported between 30 and 77%. Thus, in the individual patient, the complete absence of an exercise-induced arrhythmia during treatment does not permit differentiation between therapeutic effect and spontaneous variability. Accordingly, the exercise ECG is generally not an adequate method for assessment of antiarrhythmic treatment.

Arrhythmias, Cardiac↗