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Biomedical subjects

E Altmann

Publications and source records attributed to E Altmann.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Cardiovascular risk in arterial vascular surgery reconstruction].

Perioperative cardiac complications can limit the outcome after major vascular surgery where the underlying severe coronary artery disease is considered to be the main source. We describe the results of a prospective study including 201 patients undergoing elective vascular surgery. After looking at the encouraging low complication rate (mortality 0.99%, non-fatal myocardial infarction 2.98%, cardiac complications 9.95%) we would recommend the discussed diagnostic strategy. Specialized and expensive cardiac testing should be reserved for a few cases.

Aged↗
PubMed1998

Comparative results of thrombolysis treatment with rt-PA and urokinase: a pilot study.

BACKGROUND: The aim of the following prospective study was to investigate whether patients benefited from locoregional lysis treatment of recent deep leg vein thrombosis after 1 year. PATIENTS AND METHODS: The prospective study included 69 patients aged between 22 and 58 years, in whom recent lower leg vein and popliteal vein thromboses were diagnosed by phlebography. Patients were randomized to one of three treatment groups: one group was treated for a maximum of 7 days with full heparinization and daily dose of 20 mg rt-PA administered locoregionally over a period of 4 hours; a second group received 100,000 IU/h urokinase locoregionally for a maximum of 7 days, in addition to full heparinization; and in the third group (control group), intravenous heparin infusions after PTT constituted the only form of treatment. All patients were given phenprocoumon from day 7 and received compression treatment. Before treatment began and before the course of phenprocoumon started, phlebography and colour duplex sonography examinations were carried out. After 12 months, follow-up duplex sonography was conducted to evaluate the reflux times over the popliteal vein and the degree of patency of the deep leg veins. RESULTS: Complete lysis was achieved in 6 of 22 patients in the recombinant tissue plasminogen activator (rt-PA) group and in 11 of 22 patients in the urokinase group. At follow-up examination after 12 months, there were serious post-thrombotic changes in 14 of 22 patients in the rt-PA group, in 9 of 22 patients in the urokinase group and in 15 of 22 patients in the group of patients who received no lysis treatment. CONCLUSION: Patients with recently formed thromboses in the lower leg and popliteal veins who underwent 7 days of locoregional lysis treatment with urokinase demonstrated significantly fewer clinical symptoms of post-thrombotic syndrome after 1 year than those who received locoregional treatment with rt-PA over a similar period or a control group treated with anticoagulants only.

Adult↗
PubMed1997

[Ultrasound angiography in diagnosis of deep venous thrombosis and post-thrombotic syndrome. A prospective comparative study].

PURPOSE: Aim of the present study was to establish the value of ultrasound angiography compared with colour duplex sonography and phlebography in the diagnosis of deep venous thrombosis of the leg and insufficiency of the perforating vein. METHOD: Sixty-two patients with deep venous thrombosis of the leg and 30 patients with post-thrombotic syndrome and perforating vein insufficiency underwent diagnostic examination by colour duplex sonography, ultrasound angiography and phlebography. Endoscopic varicose surgery was taken as the gold standard for diagnosis of perforating vein insufficiency. RESULTS: In the diagnosis of deep venous thrombosis, the specificity of colour duplex sonography was 92% in the thigh, 100% in the popliteal area and 89% in the lower leg. Colour angiography showed higher specificity. 95%, in the lower leg. In a diagnosis of perforating vein insufficiency, accuracy specificity of the three procedures was 60% for colour duplex sonography, 47% for phlebography and 80% for ultrasound angiography. CONCLUSIONS: The diagnosis of venous thromboses in the lower leg can be further improved by means of ultrasound angiography. Ultrasound angiography is the best method for demonstrating insufficiency of the perforating vein.

Adult↗
PubMed1997

Beta-blockers and nitrates in patients with peripheral arterial occlusive disease: long-term findings.

METHODS: The effect of 6 months' administration of celiprolol, atenolol and isosorbide dinitrate on peripheral arterial occlusive disease (PAOD), double-blind and placebo-controlled, was investigated in 56 patients with chronic ischaemic heart disease and stage IIb PAOD, using as criteria the walking distance and the change in resistance index in the femoral artery. The placebo group consisted of 14 patients with chronic ischaemic heart disease and the same stage of PAOD. RESULTS: Patients on 50 mg/day atenolol showed a significant reduction in both pain-free and maximal walking range compared with the controls. In contrast, those taking 200 mg/day celiprolol and those on 80 mg/day isosorbide dinitrate demonstrated significant increases in pain-free and maximal, walking distance compared with the control group. The colour duplex sonographically measured Doppler flow through the femoral artery showed a significant decrease both in the patients taking celiprolol and in those on isosorbide dinitrate, while in those receiving atenolol the resistance index increased significantly. CONCLUSIONS: The study shows that the beta-adrenoceptor blocker celiprolol also possesses a nitrate-like vasodilatory property and can be used in patients with chronic ischaemic heart disease and impaired peripheral arterial blood flow.

Adrenergic beta-Antagonists↗
PubMed1996

Digitoxin intoxication with lethal outcome.

A 65-year old woman with known history of reactive depression and failed suicide attempts ingested 7 mg digitoxin at 09.00 h. After vomiting 4 hours later, she reported the drug intake to her husband who thereupon summoned a physician. Arriving at 16.00 h, the physician was informed about the suicide attempt, but failed to initiate any specific measures. After a second doctor's visit at 22.00 h, the patient was rushed to hospital in a moribund state. In spite of a gastric lavage, treatment with activated charcoal and insertion of a transvenous pacemaker, the patient died at 23.45 h with signs of total atrioventricular block. Digitalis fab fragments could not be administered in time. A calculation based on the plasma digitoxin concentration of 212 ng.ml-1 measured at 23.00 h indicated that nearly the entire ingested dose had been absorbed. Thus, neither the vomiting nor the gastric lavage eliminated significant amounts of the drug which had left the stomach without delay. Under these circumstances, the failure to initiate timely therapy with specific digitalis fab fragments ultimately contributed to the lethal outcome.

Aged↗
PubMed1996

Comparison of tissue plasminogen activator and urokinase in the local infiltration thrombolysis of peripheral arterial occlusions.

Recanalization of the vascular lumen by means of local fibrinolysis is of major importance in the treatment of peripheral arterial occlusive disease. While urokinase and streptokinase have been extensively used for local fibrinolysis, there have been few studies of infiltration thrombolysis with genetically engineered tissue plasminogen activator (rt-PA). The aim of the investigation reported here was to establish whether there is any difference between urokinase and rt-PA in the short- and long-term outcome of local fibrinolytic therapy. One-hundred twenty patients (70 men, 50 women) with acute or subacute femoral (n = 21), femoropopliteal (n = 33), popliteal (n = 13) or popliteocrural (n = 53) thrombotic occlusions were randomized to local lysis using urokinase or rt-PA, and 6 months later follow-up investigations took place. Recanalization of thrombotically occluded vessels, particularly in the lower leg, was found more frequently, and after treatment of shorter duration, with rt-PA. Large local haematomas occurred in 8% of cases in the urokinase group and 15% in the rt-PA group. No serious haemorrhages were encountered in either group. Six months after treatment, the rt-PA group showed lower rates of Fontaine stage III and IV disease and amputation than the urokinase group, with a higher number of patients in Fontaine stage IIb. This study shows that local lysis with rt-PA yields better results than urokinase, not only in the short term but also 6 months later.

Adult↗
PubMed1996

[Are beta-blockers generally contraindicated in patients with peripheral arterial occlusive disease?].

Ninety patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease were investigated to determine the effect of celiprolol, atenolol and isosorbide dinitrate on peripheral arterial blood flow. Walking distance and the resistance index in the femoral artery were measured before and after 3 months medication and compared with the findings in controls (30 patients with chronic ischemic heart disease and stage IIb peripheral arterial occlusive disease) who received placebo. Patients with peripheral arterial occlusive disease who were treated with atenolol 50 mg/day demonstrated significant decreases in both pain-free and maximal walking distance. In contrast, the walking distances in those given celiprolol 200 mg/day and those who received isosorbide dinitrate 80 mg/day did not differ from the distances in control subjects. The Doppler flow through the femoral artery, as measured by color duplex sonography, showed a significant decrease in resistance index, both in patients given celiprolol and in those given isosorbide dinitrate. In patients treated with atenolol the resistance index rose significantly. The results of this study confirm that the beta-adrenoceptor blocker celiprolol exerts a supplementary vasodilatory action resembling that of nitrates and hence can be used in patients with chronic ischemic heart disease and impaired peripheral arterial perfusion.

Adrenergic beta-Antagonists↗
PubMed1996

[Long-term results after caval filter implantation].

In order to help clarify the long-term results of filter implantation and how best to manage the post-operative care, 92 patients with implanted filters were observed for up to 6 years. The follow-up examinations included detailed interrogation, a clinical investigation, plain abdominal radiography in two planes, contrast-enhanced computed tomography of the vena cava and colour-coded duplex sonography of the vena cava and the veins of the pelvic and legs. In the early phase of the study, two patients who received Günther filters in 1988 experienced dislocation of the filter after 3 months. In the later phase, 85% of those treated with oral anti-coagulants and compression showed patent pelvic veins in areas where, at the time of filter implantation, there had been thrombi with the potential to cause embolism. In 72 cases, the inferior v.cava proved to be patent in the area of the filter.

Aged↗
PubMed1995

[Color-coded duplex ultrasound findings and transcranial color duplex ultrasound findings in patients with acute inner ear disorders--a preliminary observation].

A prospective investigation of 98 patients with acute loss of inner ear function showed that such patients display changes in the pulsatility of the basilar artery; however, the differences can be appreciated only by comparison with control sonograms during the course of the disease. Patients with sudden deafness or sudden loss of equilibrium generally showed unremarkable findings on duplex sonography of the cervical portions of vessels supplying the brain.

Acute Disease↗
PubMed1994

[Applications of transcranial Doppler ultrasound and color-coded intracranial duplex ultrasound in patients with stenoses of the extracranial brain arteries].

One hundred and fifty-eight patients (99 men and 59 women) aged 20 to 76 years, all with extracranial cerebral artery stenoses, were submitted to both transcranial Doppler sonography and color-coded intracranial duplex sonography in order to establish whether there were any differences between the two methods in their assessment of the degree of severity of stenosis of the internal carotid artery and the resulting flow rate in the middle cerebral arteries. The degree of stenosis in the carotids was investigated with color duplex sonography and angiographically. Il emerged that transcranial Doppler sonography permitted reliable conclusions as to the severity of the carotid stenosis only in the case of complete occlusion. In contrast, the systolic flow rate in the trunk of the middle cerebral artery as measured by means of color intracranial duplex sonography consistently decreased with increasing severity of the stenosis. In this group of patients, color duplex sonography had clear advantages over angiography in the assessment of stenoses of the extracranial vessels supplying the brain. In particular, early stages of arteriosclerosis were detected more readily.

Adult↗
PubMed1993

Non coded C alpha, alpha-disubstituted amino acids. X-ray diffraction analysis of a dipeptide containing (S)-alpha-methylserine.

The crystal and molecular structure of the fully protected dipeptide Boc-Val-(S)-alpha-MeSer-OMe has been determined by X-ray diffraction techniques. Crystals grown from ethyl acetate/n-pentane mixtures are tetragonal, space group I4(1), with cell parameters at 295 K of a = 15.307(2), c = 18.937(10)A, V = 4437.1A3, M.W. = 332.40, Z = 8, Dm = 0.99 g/cm3 and Dx = 0.995 g/cm3. The structure was solved by application of direct methods and refined to an R value of 0.028 for 1773 reflections with I > or = 3 sigma (I) collected on a CAD-4 diffractometer. Both chiral centers have the (S) configuration. The dipeptide assumes in the solid state an S shape. The urethane moiety is in the cis conformation, while the amide bond is in the common trans conformation. The conformational angles phi 1, psi 1 of the Val and phi 2, and psi 2 of the (S)-alpha MeSer fall in the F region of the phi-psi map. The isopropyl side chain of the Val residue has the (t, g-) conformation, while the Ser side chain has a g+ conformation. The hydrogen bond donor groups are all involved in intermolecular H-bond interactions. Along the quaternary axis the dipeptide molecules are linked to each other with the formation of infinite rows.

Crystallization↗
PubMed1993

[Color-coded duplex ultrasound and contrast medium enhanced duplex ultrasound in deep venous thrombosis].

Even with highly developed ultrasound systems, diagnosis of deep leg vein thrombosis is difficult in lower leg veins and in the area of the adductor channel. In order to evaluate color duplex-sonography, contrast media duplex-sonography and phlebography in comparison, 79 patients (38 men and 40 women aged 54 to 89) with deep leg vein thrombosis were examined. As a result, patients suffering from thrombosis were characterized by a vein-artery quotient of > 2.0 (p < 0.01). In color Doppler duplex-sonography false negative findings occurred in 12 cases of lower leg vein thrombosis and in 3 cases of thrombosis within the adductor channel. By contrast media duplex-sonography the diagnostic reliability could be increased to a sensitivity of over 95 per cent.

Aged↗
PubMed1993

[Long-term follow-up of Mobin-Uddin umbrella filter implantation for prevention of pulmonary embolism].

A follow-up of 40 cases of Mobin-Uddin-umbrella implants for prophylaxis of secondary pulmonary embolism is presented. The all-over lethality was 35% (14 patients) including one embolic recurrence. 25 patients could be re-examined 0.2-11.1 years after the implantation, using the patient's history, clinical examination, native X-ray of the umbrella, B-scan of the inferior vena cava, phlebodynamometry of the legs, spirometry, ergometry, manometry of the pulmonary artery pressure. Possible or probable recurrences of embolism were recorded in 15% (5 patients). The umbrella was totally occluded in 48% and partially occluded in 23%. Umbrella-related complications due to faulty insertion were not observed. Patients without additional cardiopulmonary diseases did not show pulmonary hypertension or ventilatory disorders at rest. 86% of the patients suffered from a symptomatical chronic venous insufficiency of one or both legs. Today the Mobin-Uddin-umbrella has been replaced by other percutaneously applicable cava filters. However, their application may also be followed by complications. Therefore the decision to use cava filters of any type should be based on severe selection criteria.

Adolescent↗
PubMed1991

[Experiences with color-coded duplex sonography in the diagnosis of extracranial vascular changes].

72 Patients with occurred transitory ischemie attacks and passed reversible neurologie deficits were duplexsonographically diagnosed. After wards a renewed duplexsonographic investigation with color coding followed in all patients. The patients were angiographically diagnosed within two weeks. As a result in three of ten patients with an unobtrusive angiogramm plaques formations were proved by means of the color codes duplexsonography.

Adult↗
PubMed1991

[Value of color-coded duplex sonography in diagnosis of extracranial vascular changes].

72 patients at the age of 44 to 76 years with transitory ischaemic attacks which happened and for a short time reversible deficits, respectively, were diagnosed both conventionally duplex-sonographically and with the colour-coded duplex sonography under the question of vascular stenotic process in the region of the cervical vessels. After the ultrasound examination within two weeks an angiography was performed. As a result was shown that in 10 patients with an angiogram without pathological findings by means of the colour-coded duplex sonography in 3 cases plaque formations could be proved which could be clearly diagnosed only by colour marking.

Adult↗