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Biomedical subjects

C Melzer

Publications and source records attributed to C Melzer.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of chronotropic incompetence in the pacemaker patient population.

AIMS: We prospectively evaluated results from cardiopulmonary exercise testing for chronotropic incompetence (CI) in a cohort of 292 pacemaker patients. In addition, we evaluated comorbidity and antiarrhythmic patient data as indicators of CI. METHODS AND RESULTS: On the basis of exercise stress testing and application of the definition of CI by Wilkoff, 51% of our cohort was categorized as having CI. Indications for pacemaker implant for this patient group were 42% atrioventricular block, 56% sinus node disease, and 59% atrial fibrillation. Maximum oxygen uptake (VO(2) max) and exercise duration were significantly reduced among CI pacemaker patients, whereas oxygen uptake at the anaerobic threshold remained unchanged. The following clinical characteristics were significant predictors of CI: existence of coronary artery disease (P = 0.038), presence of an acquired valvular heart disease (P = 0.037), and former cardiac surgery (P = 0.041). Age, gender, arterial hypertension, cardiomyopathy, congenital heart disease, left ventricular ejection fraction, and time period between stress-exercise examination and pacemaker implantation were not significant predictors of CI. Chronic antiarrhythmic therapy with digitalis (P = 0.013), beta blockers (P = 0.036), and amiodarone (P = 0.045) were significant predictors of CI. In contrast, medication with class I and IV antiarrhythmics had no significant correlation with CI. CONCLUSION: We found the following characteristics predictive of CI in this pacemaker patient population: VO(2) max, existence of coronary artery disease or acquired valvular heart disease, previous cardiac surgery, as well as medication with digitalis, beta blockers, and amiodarone.

Atrial Fibrillation↗
PubMed2005

[Chronic groin pain in marathon race: bone apposition at insertion of the m. rectus abdominis at ramus superior ossis pubis -- case report].

In this case report we present a 56 years old long standing (20 years) Marathon runner, suffering from chronic groin pain for 1(1/2) year. The great variety of diagnosis, which are subsumed under longstanding groin pain, explain the long time to evaluated the exact diagnosis and to institute a selective therapy. A multidisciplinary investigation was necessary to reveal a bone apposition at insertion of the musculus rectus abdominis in result of a chronic pelvic instability after beginning osteoarthitis and reduced range of rotational motion of the hip. One year after resection the bone apposition the athlete was free of pain, completely resistance in running and whole re-integrated in racing competitions.

Athletic Injuries↗
PubMed2004

Echocardiographic AV-interval optimization in patients with reduced left ventricular function.

BACKGROUND: Ritter's method is a tool used to optimize AV delay in DDD pacemaker patients with normal left ventricular function only. The goal of our study was to evaluate Ritter's method in AV delay-interval optimization in patients with reduced left ventricular function. METHODS: Patients with implanted DDD pacemakers and AVB III degrees were assigned to one of two groups according to ejection fraction (EF): Group 1 (EF > 35%) and Group 2 (EF < 35%). AV delay optimization was performed by means of radionuclide ventriculography (RNV) and application of Ritter's method. RESULTS: For each of the patients examined, we succeeded in defining an optimal AV interval by means of both RNV and Ritter's method. The optimal AV delay determined by RNV correlated well with the delay found by Ritter's method, especially among those patients with reduced EF. The intra-class correlation coefficient was 0.8965 in Group 1 and 0.9228 in Group 2. The optimal AV interval in Group 1 was 190 +/- 28.5 ms, and 180 +/- 35 ms in Group 2. CONCLUSION: Ritter's method is also effective for optimization of AV intervals among patients with reduced left ventricular function (EF < 35%). The results obtained by RNV correlate well with those from Ritter's method. Individual programming of the AV interval is fundamentally essential in all cases.

Aged↗
PubMed2003

[Femoral neck fractures in the elderly -- bipolar hemiarthroplasty in total hip replacement].

INTRODUCTION: In this study surgical risk and functional outcome of bipolar hemiarthroplasty and total hip replacement in elderly patients with femoral neck fractures were compared. METHODS: In a prospective study 54 patients with femoral neck fractures (median age: 80.5 years) were treated by implanting a total hip replacement (group I). Group II comprised 52 patients with 55 femoral neck fractures (median age: 81 years) who underwent bipolar hemiarthroplsty. Pre- and postoperative mobility and social history, perioperative parameters such as duration of surgery, blood loss, and number of transfused blood units as well as postoperative complications and mortality were compared. Function was ascertained by a scoring system. RESULTS: Duration of surgery, blood loss, and numbers of transfused blood units were significantly lower in group II, and mortality rate was lower. Postoperative mobility and medium-term functional score were comparable, whereas in the longer-term follow-up after 8 years group I had a significantly better functional score. CONCLUSION: In elderly patients with femoral neck fracture and high comorbidity, we recommend the implantation of hemiarthroplasty and in healthy, active patients with longer life expectancy the total hip replacement.

Age Factors↗
PubMed2002

[Cross-linked hyaluronic acid in the treatment of osteoarthritis of the knee--results of a prospective randomized trial].

PURPOSE: The objective of this trial was to compare the effectiveness of intraarticular injection of highly cross-linked hyaluronic acid (HA) with intraarticular injection of gaseous oxygen (O 2 ) in patients with clinical symptoms of cartilage damage in the knee. METHODS: Based on arthroscopically verified diagnosis, 111 patients were randomised and treated prospectively either with HA or O 2. The treatment was completed with an exercise program. The follow up was one year. 109 patients (56 x HA, 53 x O 2 ) were statistically calculated with the Wilcoxon-test according to the results of the Lysholm-score, the Tegner-activity-index, the Womac-score for pain, stiffness, function and the VAS for pain in rest and under strain. RESULTS: Both treatments were able to attain a statistically significant reduction of pain (VAS in rest and under strain, Womac part A), a reduction of joint stiffness (Womac part B) and improvement of joint function (Womac part C, Lysholm-score) during the follow up of one year. The Tegner-activity-index showed no significant change under both treatments. The comparison of both treatments showed differences in VAS under strain (p = 0.001), the Lysholm-score (p = 0.003), Womac part A (p = 0.003) and part C (p = 0.001). As a result HA showed significant better improvements with the VAS and Lysholm-score and oxygen showed significant better changes in the Womac-score part A and C. The results with cartilage damage 2 degrees were the same as in the total (VAS strain: p = 0.029 for O 2, Lysholm-score: p = 0.003 for HA, WOMAC part A: p = 0.009 for HA, Womac part C: p = 0.006 for O 2 ). The results with cartilage damage 3 degrees showed significant differences in reduction of joint stiffness (Womac part B: p = 0.012) for O 2. For cartilage damage 4 degrees HA showed significant reduction of pain (VAS rest: p = 0.001, VAS strain: p = 0.003) and O 2 significant reduction of pain and function (Womac part A: p = 0.004, part C: p = 0.002). CONCLUSION: Both methods are suitable to improve significantly the discomfort due one year to osteoarthritis. The pain relief by HA and the improvement of joint function by O 2 treatment have been shown for higher degrees of cartilage damage.

Adolescent↗
PubMed2002

Shwartzman phenomenon in a patient with active systemic lupus erythematosus preceding fatal disseminated intravascular coagulation.

The recurrence of widespread and diverse vascular lesions is a hallmark of systemic lupus erythematosus (SLE). Inflammatory and thrombotic mechanisms almost invariably associated with circulating antiphospholipid antibodies play a role in the pathogenesis of SLE-related vascular disease. Both mechanisms can coexist in the same patient. Vasculitis is most commonly induced by the local deposition of immune complexes. However, some SLE patients have an inflammatory complement-mediated vascular injury in the absence of immune complex deposition. We report on a fatal case of disseminated intravascular coagulation (DIC) in a young woman with active SLE. Hemorrhagic lesions due to localized intravascular coagulation (Shwartzman phenomenon) preceded disseminated intravascular coagulation accompanied by disseminated cardiac necrosis. Immune complex 'independent' and other mechanisms of vascular injury and states of hypercoagulability will be discussed.

Adult↗
PubMed2001

Transient exit block of a DDD pacemaker with unipolar leads in subcutaneous emphysema following pneumothorax.

This case report describes a transient pacemaker exit block due to subcutaneous emphysema following pneumothorax. Pneumothorax after pacemaker implantation is rare, but development of subcutaneous emphysema under such circumstances is even more uncommon. Exit block develops only with the use of unipolar leads; with implantation of bipolar leads, this complication cannot occur.

Aged↗
PubMed1999

Intraarticular, epidural, and intravenous analgesia after total knee arthroplasty.

BACKGROUND: After total knee arthroplasty, patients regularly suffer from severe pain. It is unclear whether epidural or systemic pain therapy is superior in terms of postoperative pain relief, patients' comfort and side effects. A new therapeutic approach, intraarticular opioids, has been suggested with the detection of opioid receptors in inflamed tissue. This method has proven suitable for clinical use in small operations (e.g. knee arthroscopy). In this study, we compared epidural analgesia and intraarticular application of morphine plus "on-demand" intravenous analgesia to "on-demand" intravenous analgesia alone. METHODS: Thirty-seven patients, scheduled for total knee arthroplasty, were randomly assigned to three treatment groups: in group 1 (EPI) patients received bolus doses of morphine via an epidural catheter; in group 2 (IA) an intraarticular bolus of 1 mg of morphine was applied at the end of the operation with subsequent use of a patient-controlled analgesia (PCA) pump; group 3 (Control), in which only PCA was provided, served as control for both analgesic procedures. Main outcome measures included visual analogue pain scales, total morphine consumption, and stress hormones. RESULTS: No statistically significant differences in visual analogue pain scales could be detected between the three groups. Application of intraarticular morphine did not reduce the amount of analgesics required for postoperative analgesia as compared to intravenous analgesia alone. Application of epidural morphine significantly suppressed beta-endorphine release, but did not significantly influence other stress hormones as compared to the control group. CONCLUSION: Epidural and intravenous analgesia after total knee arthroplasty are equivalent methods of pain relief. In major orthopaedic procedures, application of intraarticular morphine does not reduce analgesic requirements.

Adrenocorticotropic Hormone↗
PubMed1998

Fibrinogen breakdown, long-lasting systemic fibrinolysis, and procoagulant activation during alteplase double-bolus regimen in acute myocardial infarction.

Recent clinical studies comparing accelerated versus bolus administration of alteplase tissue plasminogen activator (t-PA) suggest similar thrombolytic efficacy, but reveal higher bleeding complications among older patients during the double-bolus regimen. The objective of the present study was to characterize the hemostatic profile of t-PA administered as double-bolus doses of 50 mg, at intervals of 30 minutes. Among 50 patients with acute myocardial infarction treated by double-bolus t-PA thrombolysis, coagulation and fibrinolysis parameters, as well as t-PA levels, were monitored. Monitored t-PA levels peaked at 5 and 35 minutes and were detectable within the therapeutic range even after 90 minutes. Marked systemic fibrinolytic activation was indicated by 75% depletion of both plasminogen and fibrinogen, as well as by 19-fold and 300-fold increases of fibrin degradation and fibrinogen degradation products. Plasminogen-activator inhibitor activity was completely suppressed. Pronounced procoagulant activation was reflected by a 3.4-fold increase of both factor XIIa and prothrombin fragment 1+2, and by a threefold increase of thrombin-antithrombin complex. Independent of t-PA weight dosage, fibrinolytic activation was more pronounced among older patients (> or = 63 years). We conclude that t-PA after bolus administration has a long half-life. Double-bolus regimen leads to a long-lasting systemic fibrinolytic state, which is even more remarkable among older patients--a fact that may explain the higher bleeding complications reported for this age group.

Aged↗
PubMed1998

The influence of sensor orientation on activity-based rate responsive pacing. Sensor Orientation Study Group.

Piezoelectric activity-based rate responsive pacemakers are commonly implanted with the sensor facing inward. This study was conducted to assess the safe and effective rate response of an activity-based rate responsive pacemaker implanted with the sensor facing outward. A comparison were made to a previously studied patient group with sensor facing inward. Patient and pacemaker data was collected at predischarge and 2-month follow-up. Two-minute hall walks in conjunction with programmer-assisted rate response assessment were utilized to standardize initial rate response parameter settings for both patient groups. At 2-month follow-up, sensor rate response to a stage 3 limited CAEP protocol was recorded. Adequate sensor rate response was achieved for both patient groups. No difference was noted in reported patient complications for both groups. A statistically significant difference in programmed rate response curve setting and activity threshold for the two groups was noted at 2-month follow-up. Adequate sensor rate response was achieved for a patient population implanted with an activity-based rate responsive pacemaker with sensor facing outward. In this orientation, one higher rate response curve setting and an activity threshold one value more sensitive were required on average when compared to the normal sensor orientation group.

Aged↗
PubMed1997

Dynamic three-dimensional echocardiography in the assessment of cor triatriatum.

Classic cor triatriatum sinistrum is a rare cardiac malformation to be found in the adult. One year after surgical correction of an atrial septal defect in a 55-year-old man, cor triatriatum sinistrum was diagnosed by transesophageal echocardiography. We compared transthoracic echocardiography, transesophageal echocardiography, and cardiac catheterization to dynamic three-dimensional echocardiography (3-D echo) which offers a new, noninvasive approach to determine the opening size between the accessory and the true left atrium. The findings by 3-D echo, confirmed by left heart catheterization, showed that the accessory membrane was not stenosing. Surgical correction was therefore not indicated in this patient.

Cardiac Catheterization↗
PubMed1997

[Correlation between ultrasonography and roentgen imaging].

For examination of the infant hip we cannot do without the use of an imaging method. The interpretation of ultrasound and X-ray studies does not always lead to uniform results. To clear up the so far unknown relationship between ultrasound and X-ray studies, sonomorphologic and radiomorphologic examinations were performed on 14 hip joints of children between 36 weeks and 12 1/2 months of age. A discrepancy between the X-ray and ultrasound image is always found when the contour line of the acetabulum does not correspond to the mid-portion but rather to the ventral or dorsal section of the acetabulum in correct projection of the X-ray image. The evaluation of the ultrasound image is then based on a bony shape differing from the one on the X-ray image. If the radiologic contour line of the acetabulum is determined by the mid-portion of the acetabulum, the angle of the acetabulum in the X-ray image and the alpha angle in the ultrasound image always add up to 90 degrees. This leads to the conclusion that a correspondence between ultrasound and X-ray findings only exists when the mid-portion of the acetabulum defines the acetabular contour line in the X-ray image. Generally, however, there is no constant relation between the X-ray summation image and the ultrasound image. The maximum error found by experiment is 8 degrees in the X-ray determination of the acetabular angle, 11 degrees in the ultrasound determination of the alpha angle and 28 degrees in the ultrasound determination of the beta angle. The ultrasound examination has a higher value regardless of its margin of error, which is inherent in any metric method, because the critical mid-portion of the acetabulum can be judged with this procedure. We are of the opinion that the X-ray image is not decisive for therapy and prognostic assessment in these cases.

Aging↗
PubMed1997

Diagnosis of rotator cuff lesions: comparison of US and MRI on 38 joint specimens.

An experimental study was performed on cadaveric joint specimens of the shoulder to determine the accuracy of US and MRI in diagnosis of abnormalities of the rotator cuff. The value of different morphological criteria was evaluated for discrimination of degeneration as well as partial and complete disruption. A total of 38 surgically exposed specimens of the shoulder joint were examined by US, MRI and pathological methods visualising the tendons of the rotator cuff in same axial and longitudinal orientations. The three imaging modalities were reviewed separately by experienced examiners, respectively, who were blind to other results. Evaluation criteria consisted of signs of shape (thinning, thickening, discontinuity and absence of rotator cuff) and structure (changes in echogenicity in US, increased signal intensity in MRI, tissue changes in pathology). Findings in US and MRI were finally compared with pathology to assess sensitivity and specificity. Pathology demonstrated 4 full-thickness tears, 6 partial-thickness tears, 16 cases with degeneration and 12 normal rotator cuffs. Ultrasound showed pathological signs in all abnormal cuffs, and one MRI report was false negative. Specificity was 67 % in US (4 of 12 cases were false positive) and 100 % in MRI (no abnormal findings in healthy tendons). Discrimination of different pathological disorders of the rotator cuff was reduced in both methods. Using US only 10 of 16 cases of degeneration, 2 of 6 partial tears and 3 of 4 complete tears were correctly defined. Using MRI 13 of 16 degenerations, 3 of 6 partial tears and 3 of 4 complete tears were detected. The MRI technique failed to visualise intratendinous calcifications in all 3 cases. We conclude that MRI and US are both sensitive in detection of abnormalities of the rotator cuff. Ultrasound should be the primary diagnostic method in screening of shoulder pain because it is economic and fast. The MRI technique should be used secondary because it provides more information about extent of tendons and has lower risk of artefacts.

Adult↗
PubMed1996

[Criteria for radiologic evaluation of cement-free hip endoprostheses exemplified by the Spotorno shaft].

Roentgenographic evaluation of total hip arthroplasty is based on changes in the marginal zones and in position. The changes in the marginal zones are not subject to any general rule. They are characteristic for the type of prosthesis. In a retrospective study, the roentgenographic findings of 431 spotornofemoral components were evaluated. We analyzed the X-ray pictures of 15 explanted spotornostems in comparison to the pictures of 15 spotornostems that were known to be stable because of revision surgery. We used this method to establish signs of stem loosening. Regression of more than 2 mm and a change in position toward varus or valgus were observed only in loose prostheses. We therefore considered these radiological changes to be an indication of loosening. Radiolucent lines up to 2 mm wide are typical for the spotornostem in the area of the prosthesis shoulder and the calcar region; when they appear in the mid- or distal section, they are also considered an indication of loosening. Radiolucent lines more than 2 mm wide indicate loosening in any case. Early in the postoperative course, the parameter of the femoral canal is already much lower in loose prostheses than in stable prostheses. An ill-fitting position in the femoral canal therefore shows a poor prognosis. Local hypertrophy of the femoral cortex or a base formation were more common in loose spotornostems. We also considered these changes to be indicator of an unfavorable prognosis.

Follow-Up Studies↗
PubMed1995

Frozen shoulder--treatment and results.

Even today the aetiology of the frozen shoulder is still under discussion. At the Orthopaedic Department of the Medizinische Hochschule Hannover, 118 persons with a frozen shoulder were treated as in- or outpatients between 1980 and 1988. We investigated the results of two different specific therapy concepts. Most of the patients received a mixture of drug therapy and physical rehabilitation under the guidance of a physiotherapist. In a smaller group of patients, the frozen shoulder was mobilized under anaesthesia (mobilisation force). After an average follow-up time of 3.8 years from the start of treatment, 93% of the patients was examined by means of an individual subjective rating (score). In addition, a clinical examination was performed in 69% of the cases. According to the subjective personal rating (score) as well as the improvement in range of motion, moderate mobilisation led to better results than the mobilisation under anaesthesia.

Adult↗