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C Perings

Publications and source records attributed to C Perings.

52 records · Page 3Linked to original sources
PubMed1998

[Results and complications of fiber bronchoscopy in HIV positive patients].

Fibreoptic bronchoscopy is an established diagnostic procedure for HIV-associated pulmonary infections. We retrospectively evaluated the diagnostic effectivity and safety of fibreoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) in 153 patients with late-stage HIV infection and clinical signs of pulmonary infection or abnormal chest radiograph. Bronchoscopy leads to diagnosis in 82.4% and changed therapy in 54%. 45 patients (30%) were found to have pneumocystis carinii pneumonia (PCP), the most common bronchoscopic finding, followed by bacterial lung disease (29.3%). BAL had a sensitivity of 78% for PCP. Diagnostic yield of BAL for PCP was higher in patients without previous treatment (positive results in 82%) with regard to PCP independend of the prior treatment. Serious complication occurred in 22 cases (pneumothorax: 6 (3.9%), bleeding: 12 (7.8%), hypoxaemia: 4 (2.6%)). High serum levels of lactate dehydrogenase (LDH) correlated with pulmonary complications like pneumothorax. Age, sex and kind of pulmonary infection did not influence complication rates. 6 (3.9%) episodes of spontaneous pneumothorax occurred in the further course, 3 of them concurrently with PCP or prior history of PCP. We conclude that fibreoptic bronchoscopy is of great value for diagnosing pulmonary infection in HIV-seropositive patients. TBB provides incremental diagnostic information not available from BAL, especially in patients pretreated with cotrimoxazol or pentamidin. For that reason we believe that TBB should be performed in these patients.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Chemoreflex and baroreflex sensitivity in patients with survived sudden cardiac death].

INTRODUCTION: To evaluate patients with an increased risk of sudden cardiac death the analysis of ventricular late potentials, heart rate variability and baroreflexsensitivity is helpful. However, the prediction of malignant arrhythmic events cannot be performed with sufficient accuracy. For a better identification of high risk patients other methods are necessary. In this study the impact of the chemoreflexsensitivity for the prediction of ventricular tachyarrhythmias was investigated. METHODS: Out of 44 patients included in the study, 23 were survivors of sudden cardiac death (SCD). Seven patients suffered from sustained monomorphic ventricular tachycardias, 14 had no arrhythmic events in their prior history. For the investigation of the baroreflexsensitivity (BRS) systolic blood pressure was augmented by Norfenefrin (Novadral) and the resulting increase of RR-intervals was measured in the surface-ECG. For determination of the chemoreflexsensitivity (ChRS) the ratio of the RR-interval-shift and the blood pressure shift during a 5-min inhalation of oxygen with a nose mask was formed. RESULTS: Patients with aborted SCD showed significantly decreased values for the ChRS compared to those patients without an arrhythmic event in their prior history (2.49 +/- 1.86 vs. 6.75 +/- 6.79 mm Hg, p < 0.001). In contrast, for the BRS no significant differences could be found (5.23 +/- 3.95 vs. 5.34 +/- 3.10 mm Hg, p = n.s.). Patients with aborted sudden cardiac death and inducible tachyarrhythmias during the electrophysiologic study showed significantly lower values of BRS and ChRS compared to patients without inducibility. CONCLUSION: As a new method for identification of patients with an increased risk of sudden cardiac death the analysis of chemoreflexsensitivity seems feasible and indicates an increased arrhythmic risk with a high sensitivity. The predictive impact has to be corroborated in larger patient collectives by prospect studies.

Autonomic Nervous System↗
PubMed1997

[Immunosuppressive therapy for effective suppression of life threatening ventricular tachyarrhythmias in chronic myocarditis].

Chronic myocarditis predisposes to the occurrence of spontaneous ventricular arrhythmias. It is not known if an immunosuppressive treatment-as a casual therapy-leads to arrhythmia suppression. In the present study, 12 patients (four female, eight male, mean age 53 +/- 15 years) with a mean left-ventricular ejection fraction of 52 +/- 19% were included. After exclusion of coronary macroangiopathy, the presence of chronic myocarditis was demonstrated by immunohistological evaluation of right-ventricular biopsies taking the number of specific lymphocytes (CD 2-8), of activated macrophages and the degree of HLA-expression on interstitial and endothelial cells as a basis. Seven patients had a successful resuscitation due to ventricular fibrillation in their case history, three patients presented sustained monomorphic ventricular tachycardia and two syncopes with inducible tachyarrhythmias. As a "conventional" therapy ten patients received antiarrhythmic drugs and four patients an implantable cardioverter/defibrillator. After confirmation of the diagnosis by a second biopsy after 3 months, all patients underwent an immunosuppressive therapy with methylprednisolone. The initial dose of 1 mg/kg body weight was reduced by 20 mg each every 2 weeks, until a maintenance dosage of 8-12 mg/day was achieved. If the control study after 6 months still gave a positive result, a combined therapy with azathioprine, 100-150 mg/day, was carried out for a further 6 months. In nine patients (75%), the control biopsy became negative, in three patients (25%), the biopsy remained to be positive. In the group presenting negative biopsies, no tachyarrhythmia relapse occurred within a follow-up period of 49 +/- 13 months, while in the group with positive biopsies, relapses occurred in two of three patients. Complete suppression during EPS after therapy was achieved in 50% of the patients who were inducible before therapy. In addition to lymphocyte infiltration, particularly HLA expression on endothelial and interstitial cells was significantly reduced; left-ventricular ejection fraction was improved only in tendency, while left-ventricular filling pressure decreased significantly. In summary, in patients with chronic myocarditis and malignant ventricular arrhythmias, a high-dose immunosuppressive long-term therapy results in the significant reduction of inflammatory infiltrations in about 75% of the cases and, at the same time, in the effective suppression of arrhythmias.

Adult↗
PubMed1997

[Prognostically relevant parameters in patients with coronary heart disease, arterial hypertension and sleep apnea disorders].

Patients with untreated sleep apnea syndrome have a higher cardiovascular mortality. It is not known which mechanisms lead to this increase in mortality and whether it is independent from the often associated coronary heart disease and systemic hypertension. In 48 consecutive patients with coronary heart disease confirmed by angiography, exercise-ECG, Holter-ECG, echocardiography, spirometric tests, analysis of ventricular late potentials, heart rate variability and a test for sleep-disordered breathing with a screening device were performed. Seventeen patients showed disordered breathing during sleep (obstructive sleep apnea) with a desaturation index of > or = 10 (mean desaturation index 17.3 +/- 9.3 vs. 2.6 +/- 3.1 in the patients without sleep-disordered breathing). There are no significant differences in age (58.9 +/- 6.1 vs. 59.7 +/- 7.6 years), body-mass-index (28.6 +/- 3.7 vs. 27.7 +/- 3.3 kg/m2), left ventricular ejection fraction (57.2 +/- 13.6 vs. 64.0 +/- 14.6%), forced expiratory volume in 1 second/vital capacity 95.4 +/- 13.9 vs. 92.9 +/- 11.2% predicted, heart rate variability (standard deviation of the RR-intervals 39.4 +/- 29.4 vs. 37.2 +/- 17.0 ms), the frequency of premature ventricular beats over 24 h and at night, the frequency of multivessel disease (71 vs. 68%), additional hypertension 53 vs. 48%), status postmyocardial infarction (47 vs. 48%) and positive late potential analysis (24 vs. 13%). There were no ST segment depressions during the night. Patients with coronary heart disease and mild sleep-disordered breathing show no significant differences in the investigated parameters compared with patients without obstructive sleep apnea or sleep-disordered breathing.

Adult↗
PubMed1996

Acute myocardial infarction with origin of the left circumflex coronary artery from the right (anterior) aortic sinus with retroaortic course to the left atrioventricular sulcus.

The case of a 17-year-old boy is described, who had myocardial infarction during scholastic sports 15 minutes after scrotal trauma. Cardiac catheterization revealed a nonstenosed aberrant left circumflex artery originating from the right (anterior) sinus of Valsalva with retroaortic course, which has to be regarded the infarct vessel according to electrocardiographic, ventriculographic, and scintigraphic findings.

Adolescent↗
PubMed1996

-Cardiomyopathy as the cause of death in genetic hemochromatosis-.

Hemochromatosis is an autosomal-recessive disease which causes iron-overload of various organs including liver, pancreas and heart. This report analyzes the course of hemochromatosis in two patients (a 28-year-old man and a 57-year-old woman) in whom hemochromatosis was detected because of severe cardiomyopathy. Initial symptoms were edema, anasarca and dyspnea. Further examinations showed pleural effusion, decreased left-ventricular-function, skin pigmentation, diabetes mellitus and liver cirrhosis. Although phlebotomy treatment and iron-chelation therapy with deferoxamine initially resulted in some improvement, both patients died from cardiomyopathy three months after diagnosis. The reports of these two cases underline that hemochromatosis-associated cardiomyopathy is often irreversible if severe congestive heart failure is present. In cardiac decompensation heart transplantation has to be considered as early as possible.

Adult↗
PubMed1995

[Myocardial lactate extraction during programmed ventricular stimulation and its value for etiologically-related therapy of ischemic ventricular tachyarrhythmia].

UNLABELLED: Ischemia is considered to be one of the most important trigger mechanisms of ventricular tachyarrhythmias, i.e., tachycardia (VT) and fibrillation (VF) in coronary artery disease (CAD). The aim of the study was 1) to investigate the relationship between ischemia and inducibility of VT/VF, and 2) to address the question, if removal of ischemia leads to suppression, resp. noninducibility of arrhythmias. In 30 patients (pts) with CAD (healed myocardial infarction in 73%, acute myocardial infarction excluded) and sustained malignant ventricular arrhythmias (VF in 47%, VT in 37%, and arrhythmogenic syncope in 16%) the myocardial lactate extraction (MLE) was calculated by measuring the arterio venous coronary lactate difference simultaneously during programmed ventricular stimulation. Eighteen pts (group A, "lactate-positive") showed a significant decrease of MLE from +16 +/- 13% at rest to -18 +/- 24% during stimulation just before induction of VT/VF (p < 0.0005). During recovery up to 10 min following termination of VT/VF MLE returned to normal range (+19 +/- 16%). In 12 pts (group B, "lactate-negative") MLE showed no significant change between rest, stimulation, and recovery. Compared to group B pts, group A pts demonstrated a significantly higher number and degree of coronary lesions as well as regions with reversible ischemia during 201Tl- scintigraphy. Lactate-positive pts presented spontaneous arrhythmias of higher frequency and had usually a two- or three-vessel disease, while lactate-negative pts presented arrhythmias of lower frequency and had more often a one-vessel disease with ventricular aneurysm. 17/18 (94%) group A pts underwent coronary bypass grafting (11) or balloon angioplasty (6) and were rendered noninducible during post interventional PVS in 94%, showing also a normalized MLE in 87% of cases. In group B only 4/12 pts were suitable for revascularization and could be rendered noninducible in only 50% of cases. With respect to the success-rate of the anti-ischemic therapy in terms of arrhythmia suppression, a lactate-positive result during primary PVS had a sensitivity of 89%, a specificity of 75%, a positive predictive value of 94%, and a negative predictive value of 60%. IN CONCLUSION: in about 60% of pts with VT/VF and significant CAD a correlation between ischemia and inducibility could be demonstrated. MLE during PVS has a highly significant predictive value for the effect of an antiischemic intervention on arrhythmia induction.

Aged↗
PubMed1994

Late potentials and heart rate variability in heart muscle disease.

To elucidate the incidence and clinical significance of ventricular late potentials (LP) and reduced heart rate variability (HRV) in primary and secondary heart muscle disease, 157 patients with dilated cardiomyopathy (DCM, n = 19), chronic myocarditis (MC, n = 50), hypertrophic cardiomyopathy (HCM, n = 27) and systemic hypertension (HT, n = 61) were studied. LP measured by the signal averaging technique were found in 24% of the total study group--47% of the patients with DCM, 28% with MC, 29% with HCM and 10% with HT. Complex ventricular arrhythmias were detected during Holter monitoring in 56% of patients with DCM, in 41% with MC, in 21% with HT and in 16% with HCM. An electrophysiological study was performed in a total of 75 patients. Non-sustained or sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) were inducible during programmed ventricular stimulation in 32% of patients with MC, in 30% with HT, in 20% with DCM and in 17% with HCM. The total duration of the signal-averaged, filtered QRS complex was the only independent predictive factor for severe arrhythmic events and sudden cardiac death. HRV measured in 39 patients were most reduced in patients with DCM (RR interval standard deviation (HRV-SD) 39 +/- 23 ms), followed by 44 +/- 16 ms in patients with HCM, 45 +/- 28 ms in patients with HCM and 67 +/- 51 ms in patients with HT. A significant reduction in the HRV-SD below 30 ms was recorded in 24% of patients measured.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Defibrillation energy requirements with single endocardial (Endotak) lead.

The need for thoracotomy in usually high risk patients has limited the use of the implantable cardioverter defibrillator. Initial clinical results with endocardial and subcutaneous patch electrodes (SQPs) are encouraging. Using a single endocardial lead in the absence of a SQP for chronic implantation of the cardioverter defibrillator, the goal of the study was to obtain defibrillation thresholds (DFTs) of 15 Joules (J) or less and to investigate changes in DFT over time. We tested 19 consecutive patients (15 men, 4 women) age 62 +/- 8.5 years with malignant ventricular arrhythmias (14 VT/5 VF). The underlying heart disease was coronary artery disease in 15 patients, dilative cardiomyopathy in two patients, and primary electrical disease in two patients. Four patients had undergone previous cardiac surgery. Left ventricular ejection fraction ranged between 14% and 66% (39% +/- 12.6%). Pacing thresholds (0.54 +/- 0.17 V at 0.5 msec), R wave amplitude for pacemaker sensing (14.2 +/- 7.0 mV), slew rate (2.12 +/- 1.4 V/sec), and resistance (500.3 +/- 73.9 W) were sufficient in all patients. Eighteen patients met our endocardial implant criteria with a DFT < or = 15 J (10.05 +/- 4.03 J) using monophasic (14 patients) or biphasic (four patients) pulse wave forms. In the one remaining patient, with a DFT of 20 J, we implanted a SQP but there was no reduction of the DFT. All patients tested showed successful defibrillation prior to discharge. During follow-up of 88 patient-months (1-9 months), 114 spontaneous VT/VF episodes occurred in five patients and were all successfully terminated. Eleven patients with a minimum follow-up of 2 months were reassessed.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Pacing, Artificial↗