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Biomedical subjects

C Friedland

Publications and source records attributed to C Friedland.

18 recordsLinked to original sources
PubMedDate not supplied

[Out-patient palliative care of children with cancer and their families].

Pediatric palliative care is still in its beginning. Most children with life-threatening disorders succumb with incomplete symptom control under in-patient conditions. Due to the limited number of patients and large hospital-home distances the realization of out-patient concepts of palliative care especially for children and adolescents with cancer is purposeful and beneficial. In a pilot project such an a aforementioned concept of pediatric palliative care proved successfully working despite insufficient conditions. Guidelines of pediatric palliative care are to be defined at short notice in order to ascertain autonomy and mobility of patients aiming at highest possible quality of life. The recently initiated program of integrating ambulatory and in-patient care within the regulations set forth in Germany's last health care system reform offers the chance of palliative home care of children in their terminal phase of life.

Adolescent↗
PubMedDate not supplied

Ceftriaxone alone or in Combination with Teicoplanin in the Management of Febrile Episodes in Neutropenic Children and Adolescents with Cancer on an Outpatient Base.

STUDY OBJECTIVE: This study prospectively investigated the outpatient once daily therapy with ceftriaxone alone or if necessary in combination with teicoplanin, in the treatment of infections in children and adolescents with chemotherapy-induced neutropenia or aplastic anemia. PATIENTS: 42 patients 1-22 years of age suffering from solid tumors, hematological and oncological diseases, with clinical signs of infection, increased serum CRP (> 1 mg/dl) and/or fever above 38.5 degrees C and neutropenia (WBC count and/or ANC < 1 x 10(9)/l) were included in this outpatient based study. One important exclusion criterion was poor clinical condition with symptoms of septic shock. METHODS: After bacterial, fungal and viral cultures had been obtained, single agent broad spectrum cephalosporin treatment was initiated with ceftriaxone applied once daily in a dose of 80 mg/kg body weight as short infusion over 30 min. Daily examinations included WBC, CRP, physical inspection and reassessment. In case of persistence or increase of fever and CRP, either outpatient management was carried on with teicoplanin added or patients were hospitalized and switched to combination antibiotic regimen. RESULTS: There were 64 febrile episodes in 42 patients. Single agent once daily broad spectrum cephalosporin was adequate in 43/64 (67%) of infectious episodes in neutropenic patients. For persisting or increased fever or CRP elevation, 9 patients were treated with ceftriaxone and teicoplanin successfully. Thus hospitalized was avoided in 52/64 (81%) of infectious episodes.

Adolescent↗
PubMedDate not supplied

[Study using non-invasive methods in prostheses of bovine pericardium in aortic position manufactured at the Ignacio Chávez National Institute of Cardiology].

We studied 28 patients to whom a prosthestic valve of bovine pericardium manufactured in the Instituto Nacional de Cardiología Ignacio Chávez (INCICH) were implanted in aortic position, from February 1983 to May 1985. We analyzed the clinic follow-up and the prosthetic function was studied by Phonocardiography, Echocardiography M mode, Two-Dimensional and pulsed wave Doppler recordings obtained before and after surgery. The patient were 26 males, 2 females whose age varied from 12 to 66 years. The aortic valve disease was rheumatic in 12, congenital in 11 and of other type in 5. After surgery 26 patients are in functional class I, one in class II and one died, but death was not related to prosthetic valve function. In the Phonocardiogram we observed significant diminution of the ventricular ejection time of 32 +/- 2 msec. to 29 +/- 2 msec. (P less than 0.05), the aortic valve opening sound was of less intensity than the valve closure sound, with relation between both of 0.53. All of them had a systolic ejection murmur. In the Echocardiogram we observed a significant decrease of the end diastolic diameter of 53 +/- 11 mm to 45 +/- 10 mm (P less than 0.05), the end systolic diameter decreased from 37 +/- 13 mm to 33 +/- 10 mm., but the difference was not significant. The aortic prosthetic flow by pulsed Doppler Echocardiography had a maximum velocity of 137 +/- 23 cm/sec., it represents a valvular gradient of 7.5 +/- 0.02 mmHg. Early diastolic regurgitant flow was recorded in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Echocardiographic study of valvular prosthesis].

Eighty-six patients with valvular prosthesis (PV) were included in this study, 52 females and 34 males, from 9 to 55 years of age. The functional state of the PV was corroborated with catheterization, surgery or necropsy. The results of 92 PV were analyzed, of which 72 were in mitral position, including 49 dura mater valves (DMPV). In aortic position were 18, including 12 mechanical Bjork-Shilley (BS) and 2 in tricuspid position. The prostheses were classified in three groups: I. with regurgitation, II. with obstruction and III. without dysfunction. Of the 49 DMPV in mitral position 11 were in group I and 7 in group II. The echocardiogram revealed a diminished opening velocity in group II (255 +/- 41.2 mm/sec., P less than 0.001) as well as a diminished opening excursion (10.9 +/- 3.4 mm, P less than 0.02) and increased thickness of the leaflets (4.7 +/- 3.6 mm, P less than 0.05). Paradoxical interventricular septal movement was less frequent in group I (27.2%, P less than 0.05). Seventeen BS valves were in mitral position; of these 2 were classified in group I and the rest in group III, the opening velocity was increased (1200 mm/sec) in those of group I. None of the BS valves in aortic position were dysfunctional. No patients from group III died; mortality in groups I and II was 35%. In 5.1% of group III and 20% of groups I and II either no improvement or greater clinical deterioration was observed.

Adolescent↗
PubMedDate not supplied

[Phonomechanocardiography of 141 healthy patients].

When studying 141 normal persons of both sexes we checked acoustic phenomena and measured the sistolic intervals. We discuss here the presence of blowing anorganic phenomena and sounds III and IV among the general public. We develop equations of regression to correct the electromechanic sistole (QIIA) and the left ventricular ejection time (LVET) the registered values being different from those published by other researchers. Last of all we analyse semiology and the interpretation of the sistolic phases of the cardiac cycle using them in a routinary way and stressing its value and limitations, specially when used to get a better knowledge of the state of the myocardial functions.

Adolescent↗
PubMedDate not supplied

[Phonomechanocardiographic parameters of the ventricular function in the healthy adult].

There are studied several phonomechanocardiographic parameters of ventricular function and the obtained values in a normal patients' lot. It is analyzed the semiology of those data which offer information about pre-charge (apexcardiogramme's "a" index) of the myocardiac contractile state (true isosvstolic phase, ventricular pression's elevation middle velocity, integrated isovolumetric pression, and contracility index) and of its "pump" function (expulsion fraction); in the same way it is discussed the measurement's potential utility of diastolic intervals. It is emphasized the value that these parameters' measurement can have to know cardiac capacity and the affectation this can have by pharmacologic influence or by the ilnes.

Adolescent↗
PubMedDate not supplied

[Phonomechanocardiography of constrictive pericarditis].

There were studied 19 constrictive pericarditis cases demonstrated by anatomist study. It was evident, at all of them, systemic veiny hypertension's syndrome. "Extinguished" cardiac noises and "quiet" heart only appeared at the 42% of the cases. 73% of patients were found with important incapacity. Lyan's pericardic protodiastolic crack was registered at the 75% of the cases and only at 2 cases (10.9%) it was found reinforcement of pulmonary noise II. It is agree with the haemodynamic discovery of pulmonary pression's light elevation. Characteristically, precordiogrammes showed great "A" wave, and it was agree with telediastolic pression's elevation of the two ventricles obtained by catheterism. Phlebogramme was characteristic of systemic veiny hypertension by impediment of ventricular filled at all the studied cases. Measurement of cardiac cycle's phases showed diminution at PE, Blumberger's intrasystolic quotient, left expulsion fraction (Carrard's method) and ventricular pression's elevation middle velocity (VPEMV). By the contrary Weissler's index was found elevated. Eventhough found ciphers could be considered like bordering normal values, there is a difference statistically significance in relation with the values that were found in sane subjects. These discoveries were interpreted in the base that the patient's heart with constrictive pericarditis acts at the curve's ascendent part of the ventricular function because it has incapacity to utilize Starling's mechanism. Process' chronicity produces myocardic atrophy by "discuss" and, by this, ventricular function's improvement can be no immediate to pericardiectomy. Apexcardiogramme shows the impedement to ventricular filled with its diastolic morphology which is very similar to intracavitary pression's curve ("square root's image"). It is postuled the hypothesis that these sicks do not develop important pulmonary hypertension, because right ventricle's poor diastolic distension impides generation of major expense and systolic pression and, by other side, the impedement to ventricular filled has repercussion over right auricle and systemic veiny territory much more distensible, with the known clinical consequences.

Adolescent↗
PubMedDate not supplied

[Phonomechanocardiographic study of congestive myocardiopathy].

There were studied 14 patients with congestive myocardiopathy demonstrated by cardiac catheterism at nine, echocardiogramme at five and/or necropsy at four. There were registered mytral insufficiency blowings at thirteen and tricusp insufficiency blowings at five. Of them, there were 11 that presented pathologic noises III and IV. Right apexcardiogramme showed growth of such cavity at the twelve patients that were studied. "a" index of the same precordiogramme had qualitative correlation with systolic pulmonary pression. Apexcardiogramme showed ventricular growth at twelve from thirteen patients and "a" index was also qualitatively correlated with direct deermination of the left ventricule's telediastolic pression. Chronocardiometry was anormal at all of them. Short expulsive period, long pre-expulsive period, expulsion's fraction diminution reckoned by this method and systolic quotient, all of them diminished, translated the cardiac expense fall by "pump" fail. Elongation of pre-isosystolic phase, isosystolic phase, true isosystolic phase, and diminution of ventricular pression's elevation middle velocity and contractility index were consequences of myocardic contraction's bad quality. Decrement of ventricular pression's elevation velocity, added to the important elevation of left ventricle's final diastolic pression determined the "pseudonormality" of IIa-0 interval, and of the integrated isovolumetric pression. Shortening of fast filled's phase is explained by a minor ventricular filled in order to the volume's increase and diastolic pression's increase (Board VII). By last, shortening of Q-IIa interval, coinciding with the cardiac frecuence's increase is explained by catecolamins' increased secretion like compensating mechanism of chronic cardiac insufficiency. Phonomechanocardiogramme is useful for entity's diagnostic and it informs about ventricular disfunction which characterise the suffering.

Adolescent↗
PubMedDate not supplied

[Use of echocardiography in the diagnosis of atrial myxoma].

The experience at the National Institute of Cardiology with atrial myxoma from 1944 to 1980 is presented; twelve patients were diagnosed, 8 females and 4 males, their age varied from 14 to 66 years. The tumor was inside the left atrium (LA) in 10 patients and in the right atrium (RA) in two. The diagnosis was confirmed by surgery or postmortem study. The symptoms and physical examination simulated mitral stenosis in the cases with myxoma of the LA, and pulmonary stenosis and Ebstein's anomaly in the two cases with RA myxoma. Symptoms of atrioventricular occlusion or embolic accident occurred by 5 patients and 3 of them died. The tumor was a postmortem discovery in the first cases, the next ones were an operatory surprise and the last ones were diagnosed by echocardiography. The advent of this technic has been definitive, all 7 patients studied by this method were diagnosed; in one the catheterism was interpreted as mitral stenosis and in other, during this procedure, cardiac arrest developed. The surgical removal of the tumor was successful in the nine patients that were operated. A correct and early diagnosis as well as an urgent surgical approach are necessary. With echocardiographic demonstration of the tumor, one patient died while he was waiting for surgical treatment.

Adolescent↗
PubMedDate not supplied

[Precordial heart beats in myocardial infarct (clinical and electrocardiographic study in 40 cases)].

The precordial K1 to K6 cinetocardiograms in 40 patients with Myocardial Infarction (10 recent and 30 old) were studied. These were compared with the findings of the precordial palpetion, electrocardiograms, and the radiologic studies. In the recent infarcts, all the patients presented abnormal systolic "annoyances", 50% of which were palpable. In the old infarcts, 90% had abnormal cinetocardiograms and 63% had pathological precordial beats. The anterior infarcts tend to present "sounds" more to the right of the precordium than the posterior-inferiors. The diffuse cardiac hypokinesia may give normal cinetocardiograms. The severity of the myocardial disturbance is directly related to the precordial extension occupied by the abnormal systolic "annoyances". An aneurismectomy may cause the disappearance of the pathogenesis of these phenomena.

Adult↗
PubMedDate not supplied

[Silent mitral stenosis (report of 8 cases)].

We studied eight cases of mitral "mute" stenosis we had discovered through echocardiogram, and analysed its clinical behaviour, the various findings in exploration, and electrocardiographic, radiologic, phonomecanocardiographic and echocardiographic changes. We mention the most notable signs for the suspected diagnosis of this kind of stenosis and the importance they have in the alleviation of this illness--frequently a very severe one, through surgical treatment. When mitral stenosis is not recognized in time through a precise diagnosis, turns to be a potentially lethal illness a short time after being diagnosed as a pulmonary arterial hypertension. We highly recommend the use of echocardiography for the diagnosis of mitral "mute" stenosis, because it has proved to be a inocuous, easy to obtain and very sensible way of diagnosing.

Adult↗
PubMedDate not supplied

[Effects of sotalol on ventricular function].

There were studied 31 patients 20 of them sanes and 11 with sustained systemic arterial hypertension to whom it was administered propranolol and sotalol in different periods. By means of phonomechanocardiographic study it was observed that the contractile heart function didn't present alterations in the sane patients, with the administration of the two drugs. Sotalol produced significative changes with depression of contractility in hypertense patients, even though there were no alterations of the "pump" function. It is probably on account that hypertensive cardiopathy per se has a minor functional myocardiac reserve and the negative inotropic effect is made evident with greater clearness. The fall of the elevation velocity of radial pulse (EVRP) in the two groups, suggests the increase of vascular resistances by the peripheric beta blockade.

Administration, Oral↗