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Biomedical subjects

B Hesse

Publications and source records attributed to B Hesse.

At least 55 records · Page 3Linked to original sources
PubMed1998

Pulmonary function after treatment for acute lymphoblastic leukaemia in childhood.

The aim of this study was to examine pulmonary function after acute lymphoblastic leukaemia in childhood and identify risk factors for reduced pulmonary function. We studied a population-based cohort of 94 survivors of acute lymphoblastic leukaemia in childhood who were in first remission after treatment without spinal irradiation or bone marrow transplantation. Pulmonary function test results were compared with reference values for our laboratory, based on 348 healthy subjects who had never smoked from a local population study. A median of 8 years after cessation of therapy (range 1-18 years) the participants had a slight, subclinical, restrictive ventilatory insufficiency and reduced transfer factor and transfer coefficient. The changes in lung function were related to younger age at treatment and to more dose-intensive treatment protocols that specified more use of cranial irradiation and higher cumulative doses of anthracyclines, cytosine arabinoside and intravenous cyclophosphamide than previous protocols. We conclude that, 8 years after treatment without bone marrow transplantation or spinal irradiation, survivors of childhood acute lymphoblastic leukaemia in first remission were without pulmonary symptoms but had signs of slight restrictive pulmonary disease including reduced transfer factor. The increased dose intensity of many recent protocols for childhood acute lymphoblastic leukaemia may lead to increased late pulmonary toxicity.

Adolescent↗
PubMed1998

The diagnostic value of oesophageal radionuclide transit in patients admitted for but without acute myocardial infarction.

The use of radionuclide transit (RT) as a screening test for chest pain of oesophageal origin has been debated. The aim of this study was to determine the value of RT as a screening test for oesophageal disorders in comparison with oesophageal manometry in patients admitted with acute chest pain but without acute myocardial infarction (non-AMI patients), and to assess the frequency of oesophageal disease present in these patients. A total of 222 non-AMI patients entered the study. An extensive examination programme comprised noninvasive cardiac studies, pulmonary studies, a careful physical examination of the musculoskeletal system, and oesophago-gastric examinations including endoscopy, pH monitoring of the oesophagus and a Bernstein test. In 91% of the patients one or more diagnoses were obtained. Based on clinical and laboratory data a 'consensus' diagnosis was made. With manometry as the reference RT had a poor sensitivity (35%) but an acceptable specificity (82%). With the consensus diagnosis as the gold standard the sensitivities of both manometry and RT were poor (29%), whereas the specificity of RT, but not of manometry, was very high (97%). Gastrointestinal diagnoses were found in 57% of the patients. In conclusion, none of the applied oesophageal examinations are valuable as single screening tests. Both RT and manometry have low sensitivities. RT may be used as a cheap, noninvasive and rapid supplementary examination. When positive, it strongly supports further invasive studies of the oesophagus in non-AMI patients with unexplained chest pain.

Chest Pain↗
PubMed1998

Serial changes in atrial natriuretic peptide and endothelin-1 concentrations. Their relationships to the cardiac performance of patients hospitalized for acute myocardial infarction.

AIM: The study was designed to assess temporal changes in atrial natriuretic peptide (ANP) and endothelin-1 (ET) concentrations in patients hospitalized for acute myocardial infarction (AMI) and their relationships to cardiac performance determined by radionuclide ventriculography. PATIENTS AND METHODS: 20 patients with first AMI were studied. Blood samples were drawn within the first 4-18 h, after 18-24 h, and on days 2, 3 and 6. Plasma concentrations of ANP and ET were measured in blood samples taken simultaneously. Radionuclide ventriculography was performed on the day of discharge to determine left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic volume index, end-systolic volume index and left-ventricular stroke volume index. RESULTS: Median concentrations of ET decreased from 2.15 pmol/l on admission to 1.45 pmol/l at discharge (32%, p < 0.001). Median ANP rose from 29 to 79 pg/ml (172%, p < 0.001). The increment in ANP and the decrease in ET concentrations from admission to discharge was inversely correlated (r = -0.81, p < 0.005). ANP was inversely correlated to LVEF (r = -0.82, p < 0.001) and to the end-systolic volume index at discharge (r = -0.73, p < 0.003). CONCLUSION: Dynamic and inverse fluctuations in ET and ANP occur within the 1st week of AMI. The magnitude of endocrine activation in the ANP-ET system seems to reflect an impairment in the left-ventricular systolic performance.

Atrial Natriuretic Factor↗
PubMed1997

[The long-term prognosis of patients with acute chest pain of various origins].

A total of 204 patients with acute chest pain, but without myocardial infarction (non-AMI) were included. In 56 a definite diagnosis was obtained within 24-48 hours of admission. The remaining 148 patients underwent a comprehensive examination program. Ischaemic heart disease (IHD) was diagnosed in 64 patients, 81 had gastro-oesophageal disorders, 58 chest wall disorders, nine pericarditis, five pulmonary embolism, four pneumonia/pleuritis, three pulmonary cancer, two dissecting aortic aneurysm, one aortic stenosis and one herpes zoster. During 33 months of follow-up, 31 of the 64 patients with IHD had a cardiac event (cardiac deaths, non-fatal AMI, bypass surgery or PTCA) whereas only three events occurred among the 140 patients without IHD (p < 0.00001). However, the frequency of readmissions and of recurrent episodes of chest pain were similar in the three major diagnostic groups (NS). It is concluded that the high risk subset of a non-AMI population can be identified by means of non-invasive cardiac examination. The remainder who have other diagnoses are at low risk. However, the morbidity is high with frequent readmissions and recurrent episodes of chest pain, and the need for development of strategies with regard to diagnosis and treatment of these patients is emphasized.

Acute Disease↗
PubMed1997

Myocardial sestamibi single-photon emission tomography: variations in reference values with gender, age and rest versus stress?

Reference data files support the evaluation of myocardial perfusion single-photon emission tomography (SPET). The aim of this study was to create a large reference data base for technetium-99m sestamibi SPET, age and gender matched to the general patient population. One hundred and twenty-eight healthy volunteers (76 males and 52 females) with a likelihood of coronary artery disease of less than 5% underwent rest and maximal exercise 99mTc-sestamibi SPET with a 2-day protocol and 180 degrees elliptical rotation. The normalized activity values of 99mTc-sestamibi in the inferior wall differed significantly between men and women. Age variations were found for men in the anterior wall. Normalized activity values in all four walls were strikingly similar during rest and stress. Our results suggest that the use of reference files in 99mTc-sestamibi SPET requires a gender- and, for males, possibly an age-matched reference population. Different reference files at rest and during stress might not be necessary.

Adult↗
PubMed1997

Radionuclide tracers in the evaluation of resting myocardial ischaemia and viability.

Of all the tracer techniques currently available for the detection of myocardial viability, it is the classic pattern of fluorine-18 deoxyglucose-perfusion mismatch that is clearest from the conceptual point of view and consistently gives good predictive values. Measurements of absolute rates of glucose uptake depend on the much criticized lumped constant, never validated for myocardial ischaemia, and may provide little additional information or may even be confusing because of the bi-directional changes in glucose uptake in response to increasing ischaemia. Labelled nitroimidazole compounds are currently of interest because they are "ischaemia-avid" and because they can be imaged by a gamma camera. Nevertheless, much more work is required to show whether retention of nitroimidazole in ischaemic tissue may reflect viability.

Animals↗
PubMed1997

Technetium-99m sestamibi and tetrofosmin myocardial single-photon emission tomography: can we use the same reference data base?

The aim of this study was to compare technetium-99m labelled tetrofosmin and sestamibi myocardial perfusion single-photon emission tomography (SPET) with one common sestamibi reference file for bull's eye imaging, with quantitation of the extent and severity of perfusion defects. Twenty patients suspected or known to have coronary artery disease participated in the study. Patients first underwent routine sestamibi myocardial SPET over 2 days, receiving doses of 400-600 MBq at stress and 600-800 MBq at rest. Then within the same week a 1-day tetrofosmin myocardial SPET study was performed, with a dose of 300 MBq at stress, followed 2.5 h later by a dose of 750 MBq at rest. Bull's eye images were generated for visual evaluation. Black-out defects according to the Cequal software analysis were only recorded if they comprised more than 10 pixels in men and 20 in women. According to the Cequal program, extent score and severity scores were expressed as number of pixels and deviations below reference limits. Five patients had normal myocardial SPET imaging with both radiotracers, while 15 had reversible, irreversible or partially reversible defects. The concordance of the results was high. The only two significant differences were that one patient had a reversible defect which appeared to be located in different myocardial regions (LAD vs RCA), and another patient had a defect that was partially reversible with sestamibi but irreversible with tetrofosmin. The results showed very high correlation coefficients for the extent and severity scores (linear correlation coefficient values of 0.99 and 0.94, respectively). In conclusion, it appears that changing between sestamibi and tetrofosmin has little influence on the interpretation of bull's eye images from the data file of a common reference population using one of the tracers.

Coronary Disease↗
PubMed1997

The occurrence of false-positive technetium-99m sestamibi bull's eye defects in different reference databases. A study of an age- and gender-stratified healthy population.

Myocardial perfusion single-photon emission tomographic (SPET) imaging has been shown to be sensitive in the detection of coronary artery disease (CAD), whereas its specificity has been suboptimal. The aim of the present study was to study the frequency of abnormal bull's eye perfusion defects in a large age-stratified group of healthy subjects undergoing myocardial SPET assessed by comparison with two existing commercially available reference databases. One hundred and twenty-eight healthy volunteers (76 males and 52 females) with a less than 5% likelihood of CAD underwent rest and exercise technetium-99m sestamibi SPET. The false-positive response rate, defined as a significant reversible defect, was 12% when compared to the CEqual database and 29% when compared to the Cedars-Sinai database. With the CEqual program, rest defects occurred in 12% of the subjects. Defects occurred more often in women than in men, but the difference did not attain statistical significance. Significant defects were most frequent in the inferior wall and in women in the anterior wall as well. The distribution of defects was independent of age. Our results suggest that the specificity of 99mTc-sestamibi myocardial SPET using commercially available reference files is suboptimal. The risk of obtaining a false-positive test result in subjects undergoing 99mTc-sestamibi myocardial SPET with a very low likelihood of CAD was higher than anticipated. With both reference files false-positive test results were most frequently observed in the inferior wall. Our data suggest that commercial reference files for myocardial SPET need to be optimised, and should be used with caution. The use of attenuation correction may prove to be a major step forward.

Adult↗
PubMed1997

Scintigraphic assessment of focal platelet accumulations following infrainguinal bypass surgery in humans.

Enothelial injury is assumed to be of pathogenetic significance in the development of graft stenoses, which remain a major cause of failure of peripheral bypasses. The aim of this study was to assess endothelial injury related to infrainguinal bypass surgery by indium-111 platelet scintigraphy. In 28 patients undergoing in situ vein (n = 24), composite vein-polytetrafluoroethylene (PTFE) (n = 1) or PTFE (n = 3) bypass surgery, assumed vascular injuries were recorded intraoperatively. Autologous indium-111-labelled platelets were injected into the inflow artery immediately after restoration of flow in the graft. Platelet deposition was assessed by gamma-camera images of thigh and crus obtained 4 and/or 24 h after surgery. Areas of focally increased activity were recorded and graded as moderate or intense. In the 24 vein bypasses, a median of two (range 0-5) areas of focally increased radioactivity were seen at the proximal anastomosis (n = 21), in the body of the graft (n = 20) or at the distal anastomosis (n = 9). The activity was moderate in 27 cases and intense in 23 cases. Scintigraphic evidence of focal platelet aggregation in vein grafts was not correlated with preoperative antiplatelet therapy or vein graft diameter. Only 2 of the 20 intragraft platelet depositions occurred in areas where intra-operative vascular injury was suspected. In the composite graft and the PTFE grafts, diffuse activity was observed throughout the entire bypass. In conclusion, focal activity accumulations, suggesting localized endothelial injury, were observed in the majority of in situ vein bypasses, in particular at the sites of the anastomoses. Prosthetic bypasses were characterized by diffuse platelet aggregation.

Aged↗
PubMed1997

Published models and local data can bridge the gap between reference values of lung function for children and adults.

The aim of this study was to create reference equations for pulmonary function tests (PFTs) that span the age range from childhood to young adulthood. PFT results (forced vital capacity (FVC), forced expiratory volume in one second (FEV1), ratio of FEV1 to FVC (FEV1/FVC), total lung capacity (TLC), transfer factor) of 348 healthy 13-24 yr old Caucasian never-smokers from a local population study were compared with 13 selected sets of published reference equations. Predicted and observed PFT results differed significantly for 63 of 92 reference equations tested, and most equations accounted poorly for the increase in PFT variables which takes place during adolescence. We selected the equations with the best fit and adjusted their parameters, so that the level and variance of predicted values agreed with the local data. For subjects older than 18 yrs, we selected the European Community for Steel and Coal (ECSC) equations. For subjects younger than 18 yrs, we chose European summary equations for FVC, FEV1, and FEV1/FVC, and recent British equations for TLC and transfer factor. The customized reference equations are the best available (maximum likelihood) for analysing PFTs of patients tested in our laboratory. Our approach can be used whenever generally accepted reference equations are lacking and a local sample of normal subjects is available.

Adolescent↗
PubMed1996

Risk factors for development of asthma in children and adolescents: findings from a longitudinal population study.

BACKGROUND: The prevalence of asthma appears to be on the increase, and risk factors are not well established. To investigate risk factors for the development of asthma, a population sample of children and adolescents, aged 7-17 years at enrolment, were studied in 1986. Initial examinations were repeated at follow-up in 1992; complete data was available for 408 subjects (199 males). METHODS: Obtained case histories were used to assess the presence of asthma; pulmonary function, skin prick test reactivity, total serum IgE and bronchial responsiveness to inhaled histamine were measured using standard techniques. RESULTS: The 12-month period prevalence of asthma increased significantly from the first to the second examination in both males (P < 0.001) and females (P < 0.001), whereas the number of subjects with a positive histamine challenge test declined in both sexes, although this was only statistically significant in males (P < 0.001). The prevalence of a positive skin prick test was higher at the second examination (26% and 44%, respectively, P < 0.001); the proportion of subjects with a positive skin reaction to house dust mite (HDM pos) increased from 14% to 26%. Bronchial hyper-responsiveness to inhaled histamine (BHR), HDM allergy, a history of wheezy bronchitis and symptoms of asthma at first examination were more prevalent among subjects reporting asthma at the second examination than among subjects without respiratory symptoms. Confining the analysis to subjects without a history of asthma at the first examination showed that asymptomatic BHR ¿Odds ratio [OR] 3.8 [95% confidence interval (CI) 2.5-5.1], P = 0.0002¿, HDM pos [OR 2.6 (95% CI 1.9-3.3), P = 0.005], a history of wheezy bronchitis before the age of 2 years [OR 3.8 (95% CI 2.4-5.2), P = 0.006] and a history of rhinitis and/or eczema [OR 2.8 (95% CI 1.7-3.9), P = 0.007] at first examination were associated with an increased risk for development of symptomatic asthma at some point between the two examinations. No significant relationship could be demonstrated between smoking (passive or active) and the risk for development of asthmatic symptoms. CONCLUSIONS: In conclusion, this longitudinal population study showed an increase in the 12-month period prevalence of asthma with sensitization to HDM and asymptomatic BHR as important risk factors for development of asthma; the temporal relationship between sensitization to HDM and presence of airway abnormalities needs to be explored further.

Adolescent↗
PubMed1996

The diagnoses of patients admitted with acute chest pain but without myocardial infarction.

OBJECTIVE: The purpose of this study was to describe the frequencies of various diagnoses in patients admitted with acute chest pain, but without acute myocardial infarction, and to evaluate a non-invasive screening programme for these patients. PATIENTS: A total of 204 consecutive non-acute myocardial infarction patients were included. Fifty-six had a definite diagnosis within 48 h, whereas 148 patients underwent an examination programme including pulmonary scintigraphy, echocardiography, exercise electrocardiography, myocardial scintigraphy, Holter monitoring, hyperventilation test, oesophago-gastro-duodenoscopy, 3 h monitoring of oesophageal pH, oesophageal manometry, Bernstein test, physical examination of the chest wall and thoracic spine, bronchial histamine provocation test and ultrasonic examination of the abdomen. RESULTS: According to predefined criteria, 186 patients (91%) had at least one diagnosis, 144 had one, whereas 39 had two, and three patients had three diagnoses. In 18 patients no diagnosis was obtained. The diagnoses belonged mainly to three groups: (1) ischaemic heart disease (n = 64); (2) gastro-oesophageal diseases (n = 85); (3) chest-wall syndromes (n = 58). Less frequent diagnoses included pulmonary embolism, pleuritis/pneumonia, lung cancer, aortic stenosis, aortic aneurysm and herpes zoster. CONCLUSIONS: The high risk subset of a non-acute myocardial infarction population can be identified by means of a clinical evaluation and non-invasive cardiac examinations. Among the remainder, pulmonary embolism, gastro-oesophageal diseases and chest-wall syndromes should be paid special attention. A careful physical examination of the chest wall and upper endoscopy seems to be the most cost-beneficial examination to employ in this subset.

Acute Disease↗
PubMed1996

Lung function after allogeneic bone marrow transplantation for leukaemia or lymphoma.

Longitudinal data were analysed on the lung function of 25 of 29 survivors of childhood leukaemia or lymphoma, who had been conditioned with cyclophosphamide and total body irradiation before allogeneic bone marrow transplantation, to test whether children are particularly vulnerable to pulmonary damage after transplantation. None developed chronic graft-versus-host disease. Transfer factor and lung volumes were reduced immediately after bone marrow transplantation, but increased during the following years. However, at the last follow up, 4-13 years (median 8) after transplantation, patients had significantly reduced transfer factor, total lung capacity, and forced vital capacity (-1.0, -1.2, and -0.8 SD score, respectively), and increased ratio of forced expiratory volume in one second to forced vital capacity (+0.9 SD score). None of the patients had pulmonary symptoms, and changes were unrelated to their age at bone marrow transplantation. In conclusion, patients had subclinical restrictive pulmonary disease at a median of eight years after total body irradiation and allogeneic bone marrow transplantation.

Adolescent↗
PubMed1995

[Evaluation and utilization of complementary medical procedures--a survey of 793 physicians in general practice and the clinic].

It is well known that complementary medicine is demanded by numerous patients and used by many doctors. In a representative postal survey of 793 female and male doctors working in practices and hospitals in the town and in the district of Kassel we could confirm the wide distribution of these procedures, especially as far as doctors in practice are concerned. It was the special interest of our study to analyse the motives for the use and the indications and to ask for a detailed and differential assessment of 18 complementary techniques.

Adult↗
PubMed1994

[Positron emission tomography. A new measurement method for imaging of regional and biochemical parameters].

Positron emission tomography (PET) is a method for quantitative imaging of regional physiological and biochemical parameters. Positron emitting radioactive isotopes can be produced by a cyclotron, eg. the biologically important carbon (11C), oxygen (15O), and nitrogen (13N) elements. With the tomographic principle of the PET scanner the quantitative distribution of the administered isotopes can be determined and images can be provided as well as dynamic information on blood flow, metabolism and receptor function. In neurology PET has been used for investigations on numerous physiological processes in the brain: circulation, metabolism and receptor studies. In Parkinson's disease PET studies have been able to localize the pathology specifically, and in early stroke PET technique can outline focal areas with living but non-functioning cells, and this could make it possible to intervene in this early state. With positron emission tomography a quantitative evaluation of myocardial blood flow, glucose and fatty acid metabolism can be made as well as combined assessments of blood flow and metabolism. Combined studies of blood flow and metabolism can determine whether myocardial segments with abnormal motility consist of necrotic or viable tissue, thereby delineating effects of revascularisation. In the future it will probably be possible to characterize the myocardial receptor status in different cardiac diseases. The PET technique is used in oncology for clinical as well as more basic research on tumor perfusion and metabolism. Further, tumor uptake of positron labelled cytotoxic drugs might predict the clinical benefit of treatment.

Brain↗
PubMed1994

Endothelin release and enhanced regional myocardial ischemia induced by cold-air inhalation in patients with stable angina.

This study was designed to determine the influence of cold-air inhalation on regional myocardial perfusion in patients with ischemic heart disease. A selected group of vasoactive hormones was measured to investigate their possible roles as ischemic agents. Ten men who had recently had a myocardial infarction and anginal symptoms and with verified pathologic ST deviations during a preceding exercise test volunteered to participate in this randomized cross-over study. Two identical exercise tests were performed on different days; one with inhalation of cold (-22 degrees C) air and the other one with inhalation of thermoneutral air (22 degrees C). Scintigraphic imaging (single-photon emission computed tomography) of regional myocardial blood flow was performed with technetium 99m isonitrile flowtracer and a Bull's eye visual display with calculation of the scintigraphic ischemic severity score. The score was significantly higher during exercise with inhalation of cold air as compared to exercise with inhalation of thermoneutral air. Furthermore, only with cold-air inhalation did arterial plasma endothelin concentration increase significantly from rest to exercise and correlate with the change of ischemic severity score. In contrast, no change was observed under thermoneutral conditions. There was no significant difference between peak values of heart rate, systolic blood pressure, adrenaline, and noradrenaline concentrations in the two situations. We conclude that inhalation of cold air during exercise increases the degree of regional myocardial ischemia and that this is not caused by an increased myocardial oxygen demand. We suggest that cold air directly influences the vasomotor tone of the myocardial resistance vessels and that endothelin may be involved in the ischemic response.

Adult↗