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C Spielberg

Publications and source records attributed to C Spielberg.

At least 19 recordsLinked to original sources
PubMed1997

[Measuring stress hemodynamics in pulmonary circulation during the inpatient phase after myocardial infarct: a rightfully "forgotten" evaluation?].

UNLABELLED: In 123 consecutive patients pulmonary hemodynamics at rest and during exercise were measured 7-10 days after acute myocardial infarction and systemic thrombolysis. Right- and left-heart catheterizations were performed at the same session and repeated after 6 months. We investigated if right-heart catheterization could predict the number of stenotic or occluded coronaries, the angiographic ventricular function and/or, most important, if the patient would profit from revascularization by PTCA or coronary surgery. RESULTS: 1) Pulmonary hemodynamics at rest and during exercise did not correlate to the number of stenotic or occluded coronaries, but exercise tolerance did. 2) Correlation between ventricular function and pulmonary hemodynamics was weak. 3) Only patients with pathologically elevated pulmonary pressures at exercise showed profit from revascularization (increase of ejection fraction > 5% at control). This profit was closely correlated to the angiographic extent of ventricular damage. Consequences from our results: Individual exercise tolerance can easily be measured non-invasively. Ventricular function can be measured non-invasively as well by echocardiography. Measurement of pulmonary hemodynamics at rest and during exercise does not contribute to planning the future management of the postinfarction patient and does not replace coronarography when indicated by clinical or non-invasive parameters.

Adult↗
PubMed1997

Sealing properties of a new epoxy resin-based root-canal sealer.

In this study a new epoxy-resin-based endodontic sealer, AH Plus, was tested in vitro for apical leakage. The conventional sealer AH26, for which information is already available, was used as the control. The root canals of 72 single-rooted teeth were prepared biomechanically using a stepback technique before lateral condensation of gutta-percha with one of the two sealers. Teeth were immersed in 5% methylene blue dye for 2, 4 or 10 days. The roots were split longitudinally so that the extent of dye penetration could be measured with a stereomicroscope. The mean extent at 2 days was 0.4 mm for AH26 and 1.4 mm for AH Plus. Neither material produced a complete apical seal and leakage increased with the duration of immersion in dye. The differences between observation periods as well as between materials with respect to dye penetration were statistically significant ANOVA, (P < 0.005).

Analysis of Variance↗
PubMed1996

Circadian, day-of-week, and seasonal variability in myocardial infarction: comparison between working and retired patients.

The circadian, day-of-week, and seasonal distributions of acute myocardial infarction and its association with the patients' working status were analyzed in a regionally defined population (n = 103, 322) monitored from 1980 to 1988. Included were 2906 consecutive patients (1746 [60.1%] men and 1160 [39.9%] women; mean age 67.8 years) with confirmed diagnosis (by standardized diagnostic criteria in hospitalized patients and autopsy results in out-of-hospital deaths). The time of myocardial infarction on the basis of onset of symptoms was known in 1901 cases. Myocardial infarction occurred more frequently (p < 0.05) during the morning from 7:00 to 10:00 AM, on Mondays, and during the winter from January to March compared with other times of day, days of the week, and seasons. Compared with retired patients, working patients (32%) had a second circadian peak, in the afternoon at 4:00 PM (p < 0.05), and a trend toward an additional seasonal peak in September (p value not significant), whereas the day-of-week pattern was similar in the two subgroups. The occurrence of myocardial infarction demonstrates marked circadian, day-of-week, and seasonal variations, with some differences between working and retired patients. Further investigation of possible triggering events may aid in identifying underlaying mechanisms and perhaps in improving prevention of the disease.

Aged↗
PubMed1994

[Early diagnosis of left ventricular dysfunction following acute myocardial infarct. Doppler echocardiography in a study of its course].

The prognosis of acute myocardial infarction depends on the development of left-ventricular dilatation and chronic heart failure. Serial echocardiography was performed on admission and on days 2, 4 and 6, to discover the temporal course of any early myocardial adaptation. There were 78 patients (20 women, 58 men; mean age 59 [49-69] years) with acute myocardial infarction and systemic thrombolysis, first studied up to 4 hours after onset of symptoms. The patients were divided into two groups according to infarct size as measured by creatine kinase ("area under the curve"--AUC); group 1: CK AUC < 12 IU/ml.h; group 2: CK AUC > 12 IU/ml.h. While there was no difference between the two groups on admission and on day 2, filling patterns differed significantly at the end of the first postinfarction week in that maximal early diastolic flow velocity (E) in group 1 was 0.65 m/s, but 0.73 m/s in group 2 (P < 0.05); maximal late diastolic flow velocity (A), group 1: 0.71, group 2: 0.58 m/s (P < 0.01); E/A ratio: 0.89 vs 1.22 (P < 0.001); integrated E/A ratio 1.37 vs 1.77 (P < 0.001), and the atrial component of left-ventricular filling 42 vs 36% (P < 0.001). It is concluded that the serial measurement of left-ventricular filling by Doppler echocardiography in the first post-infarction week can identify patients with impaired left-ventricular function through differences in flow pattern. Drug or interventional treatment can then be started early to prevent further left-ventricular dilatation and in this way improve prognosis.

Aged↗
PubMed1994

Effectiveness of two different methods for preparing curved root canals.

In this study, the effect of using two different methods for preparing curved root canals of extracted, single-rooted teeth were analyzed with the scanning electron microscope. The instrumentation systems tested were the Canal Master and a standard circumferential filing technique in which conventional K-files were used. Shaping effectiveness was qualitatively evaluated in terms of respect for conservation of the apical constriction and the presence or absence of ledging, specially in the apical third of the root canals. As a result of our observations, it appeared that the Canal Master instrumentation technique provided well-centered and tapered preparations. Conversely, the use of conventional K-files with a standard circumferential filing technique resulted in frequent alterations of the initial pattern of the root canals, showing transportation of the apical foramen and ledge formation.

Dental Pulp Cavity↗
PubMed1994

[Left ventricular filling behavior in stress-induced myocardial ischemia--correlation between Doppler echocardiography determined transmitral flow profile and pulmonary capillary pressure].

The way Doppler-derived transmitral filling patterns are changed because of myocardial ischemia is controversial. Furthermore, the influence of the filling pressure has not been investigated sufficiently. To evaluate the relationship between transmitral flow profile and pulmonary capillary wedge pressure (PC), 35 patients with exercise-induced myocardial ischemia were examined. Both Doppler-derived transmitral filling patterns and PC were determined simultaneously at rest and during three stages of supine bicycle exercise. Patients were subdivided into two groups according to the hemodynamic response (group 1 = PC < 20 mm Hg; n = 10, and group 2 = PC > or = 20 mm Hg; n = 25). The correlation between PC and transmitral filling patterns was low at rest for all patients, but improved at maximal workload, particularly for the atrial contribution (r = -0.79), as well as the ratio of maximal and integrated early to late diastolic flow velocities (rE/A = 0.74; rEi/Ai = 0.72). Both groups revealed different flow profiles in regard to the hemodynamic response. While group 1 showed an E/A-ratio < 1, an E/A-ratio > 1 was registered in group 2 (0.9 m/s versus 1.61 m/s; p < 0.001). Exercise-induced myocardial ischemia lead to different Doppler-derived transmitral flow patterns with regard to the filling pressure. The relationship to the pulmonary capillary wedge pressure is so close that an E/A-ratio > 1 is a reliable parameter to predict a filling pressure > 20 mm Hg.

Adult↗
PubMed1993

Acute alterations of pre- and afterload: are Doppler-derived diastolic filling patterns able to differentiate the loading condition?

The net effects of acute changes in pre- and afterload on left ventricular filling, were examined by altering loading conditions in normal subjects. The specific purpose of this study was to investigate whether Doppler-derived transmitral flow patterns are able to differentiate the type of loading conditions. In 24 normal subjects (13 females, 11 males, mean age 44.1 +/- 11.5 years), the following Doppler variables were determined at baseline, after rapid volume infusion (preload increase), after nitroglycerin administration (preload decrease), during isometric exercise (afterload increase), and after application of a converting enzyme inhibitor (afterload decrease): the peak and integrated early (E, Ei) and late (A, Ai) diastolic flow velocities, their ratios (E/A, Ei/Ai), the percentage of atrial contribution (ACON), and the acceleration and deceleration times (Ac, Dc) of early filling. Reduced preload and increased afterload led to similar filling patterns characterized by a significant E and Ei decrease (p < 0.05, compared to baseline) accompanied by an A and Ai increase with a resultant reduction of E/A and Ei/Ai. Both changes increased the atrial contribution to filling and reduced Ac and Dc. Increased preload only significantly increased E and Ei, while reduced afterload did not induce any significant changes. Different loading conditions alter Doppler-derived diastolic filling patterns. However, the transmitral flow profile is not specific enough to distinguish the manner in which loading conditions have been altered.

Adult↗
PubMed1993

Does cardiac function modify left heart opacification with transpulmonary echo contrast agents?

Dependence of left heart opacification on ventricular function was evaluated for the new transpulmonary echo enhancing agent (SH U 508-A). The contrast agent was injected intravenously in 5 patients with normal cardiac function (ejection fraction [EF] greater than 60% and echocardiographic left ventricular end-diastolic diameter [LVED] less than 56 mm) and in five patients with pathological ventricular function (EF less than 40%, LVED greater than 65 mm). A concentration of 400 mg/mL with dosages of 5, 9, and 16 mL was used in all patients. The visually assessed signal enhancement as well as the videodensitometrically determined peak intensity and duration of signal enhancement did not differ significantly between the two patient groups, while the transit times were markedly prolonged in patients with impaired ventricular function. No significant alteration was found for systemic blood pressure and heart rate. Side effects were transitory and dose related. The noninvasive nature of the procedure and the absence of hemodynamic effects make repeated studies of left ventricular performance with SH U 508-A in patients with varied hemodynamic status possible.

Aged↗
PubMed1993

[Pulmonary edema as a complication during pericardial puncture in "mixed connective tissue disease"].

A 22-year-old female patient with an 8-year history of mixed connective tissue disease (systemic sclerosis overlapping with systemic lupus erythematosus) presented with marked respiratory distress, sinus tachycardia (135 bpm), and pulsus paradoxus. The chest x-ray showed an enlargement of the cardiac silhouette, which was due to a 3-cm-wide, circular pericardial effusion, as demonstrated by two-dimensional echocardiography. Pericardiocentesis performed to decompress cardiac tamponade did not lead to clinical improvement. The increase in dyspnea was caused by a rise in pulmonary wedge pressure from 21 to 40 mm Hg following an acute increase of mitral valve regurgitation. In the presence of global hypokinesia of the left ventricle, cardiac output decreased from 3.25 to 2.63 l/min. Intensive care including hemodialysis and plasmapheresis as well as high-dose application of cyclophosphamide and steroids led to a stabilization of the hemodynamic situation over a period of days. The case report presented here supports the general recommendation to perform pericardiocentesis in a stepwise manner under hemodynamic monitoring. This holds true primarily for patients with mitral valve regurgitation and/or cardiac involvement in connection with an underlying disease.

Adult↗
PubMed1992

Effect on global and regional left ventricular functions by percutaneous transluminal coronary angioplasty in the chronic stage after myocardial infarction.

Data are reported on 145 consecutive patients with prior myocardial infarction who had successful percutaneous transluminal coronary angioplasty (PTCA) of the infarct-related artery (5 +/- 6 months after infarction), and left ventricular (LV) angiograms before PTCA and during follow-up (7 +/- 4 months). There was a significant long-term improvement in LV function, ejection fraction increased from 60 +/- 13% to 64 +/- 13% (p less than 0.001), and regional wall motion abnormalities decreased by 40%. Multivariate discriminant analysis identified reduced LV function and a high degree of stenosis before PTCA as predictors for improvement in LV function (ejection fraction less than 60%: ejection fraction from 48 +/- 9% to 57 +/- 14%, p less than 0.001; and stenosis greater than or equal to 90%: ejection fraction from 59 +/- 15% to 66 +/- 14%, p = 0.003). Restenosis greater than or equal to 90% in patients with initial stenosis less than 90% decreased ejection fraction from 59 +/- 16% to 51 +/- 14% (p less than 0.05). Other factors tested (treatment of infarction by thrombolysis, time between infarction and PTCA, and severity of angina pectoris) had no effect on long-term changes in LV function. It is concluded that successful elective PTCA of a high-grade stenosis in an infarct-related artery may improve LV ejection fraction and regional wall motion abnormalities, especially in patients with impaired LV function.

Adult↗
PubMed1992

[Doppler echocardiography measurement of diastolic filling parameters in acute changes of pre- and afterload in healthy probands].

For a more precise understanding of the net effects of acute alterations of pre- and afterload on left-ventricular filling, loading conditions were altered in normal subjects. The specific purpose of this study was to investigate if Dopplerechocardiographically derived transmitral flow patterns are able to differentiate the manner of loading condition. In 24 normal subjects (13 female, 11 male, mean age 44.1 +/- 11.5 years) the following Doppler variables were analyzed at baseline, after rapid infusion of volume (preload increase), nitroglycerine (preload decrease), isometric exercise (afterload increase) and converting enzyme inhibitor (afterload decrease): peak and integrated early (E, Ei) and late (A, Ai) diastolic flow velocities, their ratios (E/A, Ei/Ai), the percentage of atrial contribution (ACON) and the times of acceleration (Az) and deceleration (Dz) of early filling. Preload reduction as well as afterload increase led to a similar filling pattern with a significant decrease (p < 0.05 from baseline) of E and Ei, increase of A and Ai, and, consequently, a reduction of E/A and Ei/Ai. The atrial contribution to filling increased during both alterations; Az and Dz were reduced. Following the increase of preload, only the increase of E and Ei was statistically significant, while afterload reduction showed no significant differences. Different loading conditions alter Doppler-derived diastolic filling patterns. But the transmitral flow profile is not specific enough to differentiate in which manner loading conditions have been altered.

Adult↗
PubMed1990

Influence of catheter technology and adjuvant medication on acute complications in percutaneous coronary angioplasty.

We report on the complication rates in 660 consecutive coronary angioplasties (725 lesions) performed using four procedures that differed with respect to catheter technology and adjuvant medication. After the PTCA regimen in our laboratory had been changed from conventional steerable systems to the monorail technique, we observed a significant increase in the incidence of transient vessel occlusions from 2.6% to 7.7%, of permanent occlusions from 3.6% to 8.8%, and of intracoronary thrombus-formation from 2.6% to 5.5%. This was associated with the frequent observation of thrombotic material on the partially Teflon-coated guidewires. Coronary perfusion with urokinase (1,670-6,670 U/min) lead to a further increase in the complication rates (10.4%/10.3%/6.5%). Our present percutaneous transluminal coronary angioplasty (PTCA)-regimen (monorail technique with P.E.T. balloons, fully silicon-coated guidewires, no urokinase) shows an incidence of 3.8% for intermittent and recurrent coronary occlusions and 1.9% for permanent occlusions. Urokinase did not prevent intracoronary thrombus formation with the monorail technique. Furthermore, we suspect that in the case of PTCA-induced regional intimal dissection, fibrinolysis can prevent reestablishment of intima adherence to the vessel wall. Because five procedural deaths were observed in the 212 patients treated with i.c. urokinase as opposed to three deaths in the 448 procedures without urokinase, we feel that i.c. urokinase in PTCA is a potentially harmful regimen. We suggest that the monorail technique should be performed with fully silicon-coated guidewires and without urokinase.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Acute complications in coronary angioplasty: dependence on catheter material and adjuvant medication].

We report on the complication rates in 660 consecutive coronary angioplasties (725 lesions) performed using four procedures that differed with respect to catheter technology and adjuvant medication. After the PTCA regimen in our laboratory had been changed from conventional steerable systems to the monorail-technique, we observed an increase in the incidence of intermittent and recurrent vessel occlusions from 2.6% to 7.7%, of permanent occlusions from 3.6% to 8.8%, and of intracoronary thrombus-formation from 2.6% to 5.5%. This was associated with the frequent observation of thrombotic material on the guide wires. Coronary perfusion with urokinase (1670-6670 U/min) lead to a further increase in the complication rates (10.4%/10.3%/6.5%). Our present PTCA-regimen (monorail-technique with PET balloons, silicon-coated guide wires, no urokinase) shows an incidence of 3.8% for intermittent and recurrent coronary occlusions, and of 1.9% for permanent occlusions. We suspect that in case of PTCA-induced regional intimal dissection, fibrinolysis prevents reestablishment of intima-adherence to the vessel wall. We conclude that i.c. urokinase in PTCA is a potentially harmful regimen and that the monorail-technique should be performed with silicon-coated guide wires.

Angioplasty, Balloon, Coronary↗
PubMed1989

[Balloon valvuloplasty of calcified aortic stenosis is a realistic alternative to surgery: clinical and invasive results 17 months following the 1st or 2d dilatation].

Aortic balloon valvuloplasty was performed in 33 elderly patients (age 60-84, mean 74 years). In six cases, repeat-valvuloplasty was performed six months later. Mean follow-up so far has been 17 months (10-24 months). Follow-up included 23 invasive controls and repeat Doppler-echocardiographic estimation of valve gradient in all patients. At valvuloplasty, peak aortic gradient was reduced from 84 +/- 27 mm Hg to 40 +/- 18 mm Hg, valve area was increased from 0.39 +/- 0.11 cm2 to 0.74 +/- 0.16 cm2. Immediately after valvuloplasty, 76% of the patients were asymptomatic or significantly improved. At follow-up, 10 patients died and 12 patients underwent surgical valve replacement. Only seven patients are still improved or asymptomatic after 1st or 2nd valvuloplasty. Invasive control six to nine months after the 1st valvuloplasty showed satisfactory results for valve gradient and valve area in only one patient. At repeat-valvuloplasty, a mean valve gradient of 29.6 +/- 12.5 mm Hg was achieved. All patients with repeat-valvuloplasty again had invasive control after six months; peak gradient then was 56 +/- 17 mm Hg. Balloon valvuloplasty of acquired aortic valve stenosis is a palliative procedure with a high restenosis-rate. At the most, aortic valve area is doubled. In our opinion, it is only indicated in patients with an unacceptable high surgical risk. Today, old age alone is no contraindication to surgical valve replacement.

Aged↗
PubMed1988

[Patients with transient ischemic attacks. Their cardiac status and its prognostic significance].

In 51 consecutive patients with acute transitory cerebral ischaemia cross-sectional echocardiograms, 24-hour electrocardiograms (ECG) and exercise ECGs were recorded. The subsequent observation period averaged 13 (3-30) months. The echocardiogram was abnormal in 27 of 46 patients (58%). A holosystolic mitral-valve prolapse was found in eight: cerebral ischaemia recurred in five. There was no correlation between arrhythmias in the 24-hour ECG and renewed cerebral ischaemia. In addition to the 14 patients who--according to history and resting ECG--had already had a myocardial infarction, the exercise ECG revealed probably coronary heart disease in a further 11, i.e. half of the patients had coronary heart disease. Renewed attacks of cerebral ischaemia occurred in 13 patients during the follow-up period; four patients died, all of them also having had coronary heart disease. Because of the high prevalence of coronary heart disease (often previously undiagnosed) in the whole group, routine exercise ECGs are recommended for patients with transitory ischaemic attacks, protracted ischaemic neurological deficit or "minimal stroke", while 24-hour ECG monitoring does not seem essential. Randomized trials are needed to determine whether patients with cerebral ischaemia and echocardiographic evidence of mitral-valve prolapse should be treated prophylactically.

Adult↗
PubMed1988

[Percutaneous balloon dilatation of membraneous subaortic stenosis in the adult].

We report a successful balloon dilatation for discrete subvalvular aortic stenosis in a 26-year-old, highly symptomatic patient. The intraventricular peak gradient was reduced from 140 mm Hg to 40-45 mm Hg; there were no complications. Two months after the procedure, the patient was asymptomatic and the gradient unchanged.

Adult↗