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Biomedical subjects

E Maurer

Publications and source records attributed to E Maurer.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Rupture of a congenital right coronary sinus of Valsalva aneurysm as etiology of acute cardiac decompensation].

A 54 year old woman was admitted to a hospital because of acute thoracal pain, dyspnea, and clinical signs of overt right heart failure. Transthoracic and multiplane echocardiography established the diagnosis of a ruptured aneurysm of the right coronary sinus of valsalva into the right atrium which could be confirmed by cardiac catheterization. During heart surgery, which was done without complications, the defect was closed with a suture. Six months later echocardiography showed a normal right ventricle; the function of the aortic valve was regular. Acute heart failure may be due to a congenital structural cardiac anomaly in spite of the age of 54. In such conditions transthoracic and especially transesophageal echocardiography serve as noninvasive excellent tools to make an exact diagnosis.

Acute Disease↗
PubMed2000

[Physical activity and training in heart failure].

The main symptoms of chronic heart failure are dyspnea and exercise intolerance. The pathophysiological basis of these symptoms is not simply the dysfunction of the heart, but a complex interaction of the central circulation, the peripheral vessels, the skeletal muscles, the ventilatory, and the endocrine system. In contrast to acute heart failure, where bedrest is known to be beneficial, prolonged limitation of physical activity can be detrimental in the chronic stage of the disease. Therefore, since the 1980s there have been several reports about heart failure patients participating in exercise programs. The results were encouraging: the physiological gains were impressive, and contrary to prior fears, in the great majority of reports no deterioration of the cardiac function could be observed. The net result of training in this condition is an improvement in exercise capacity in the range of the best pharmacological treatment. In detail, blood flow into the working muscle is increased, the ventilation for each given workload is reduced, the skeletal muscle overall function (including biochemical and histological aspects) is improved, the increased neurohormonal activity--especially of the sympathico-adrenergic system--will be normalized, and the patient's quality of life is significantly improved. Whether all of these beneficial aspects will result in improved survival is not yet proven, although one recent study provides some evidence in this direction. But even if today no definite answer to this question from a large, multicenter trial is available, application of exercise training for selected heart failure patients can be recommended, if adequate supervision is provided.

Autonomic Nervous System↗
PubMed2000

[Coronary angiography in patients over 80 years of age: indications, results, consequences].

Due to the continuous increase of elderly individuals in the society the cardiologist has to deal with elderly patients more often. The apparative expenditures and the invasive procedure require a critical consideration of benefits and risks prior to performing coronary angiography in these patients. The indication and frequency of coronary angiography in patients with eighty years or above were investigated. Furthermore, the results of angiography, the risks of the procedure and the therapeutic consequences were evaluated. The whole study population consisted of 2,500 consecutive patients (1,557 men, 943 women), who underwent coronary angiography at our institution from January 1st to November 16th in 1998. A retrospective analysis of 66 coronary angiographies (3%) in 61 patients (26 men, 35 women) aged 80 years or older was performed. Among these 61 patients, 51 were referred because of suspected coronary artery disease. Due to the clinical presentation a high percentage (42 patients = 82%) was classified as having unstable angina. 10 patients were referred due to valvular heart disease. Single-vessel disease was found in 14, two-vessel disease in 5 and multi-vessel disease in 28 patients, respectively. Percutaneous coronary intervention was performed in 17 patients, among these were 9 patients with multi-vessel disease and PTCA of the culprit lesion, and 3 patients underwent bypass surgery. Medical therapy was decided as to 28 patients. Aortic valve replacement was performed in 2 of 9 patients with aortic stenosis. The clinical appearance of coronary artery disease in elderly patients was mostly unstable angina, explaining the need for intervention. Coronary angiography disclosed multi-vessel disease in 55% of patients. A revascularization procedure could be performed at least in 43% of patients with multi-vessel disease.

Adult↗
PubMed2000

[Apical hypertrophic cardiomyopathy--clinical and diagnostic characteristics based on a case report].

Chest pain and shortness of breath are the most common symptoms of hypertrophic non obstructive cardiomyopathy (HCM). Accurate diagnosis of HCM and ruling out more common diseases such as coronary or hypertensive heart disease are important for the further course of the patient but can be difficult to perform with non invasive diagnostic tools and invasive strategies are sometimes required. We report on a 77-year old woman suffering from chest pain for many years. Cardiac catheterisation confirmed diagnosis of apical hypertrophic cardiomyopathy.

Aged↗
PubMed1999

Short- and long-term outcomes of Wiktor stent implantation at low versus high pressures. Austrian Wiktor Stent Study Group.

A prospective, randomized, multicenter trial was conducted to evaluate whether high-pressure postdilation of the Wiktor stent provides short- and long-term benefits compared with the conventional low-pressure implantation technique. From June 1995 through May 1996, 181 patients were randomly assigned to either low-pressure (6 to 12 atm, group A, n = 94) Wiktor stent placement or to high-pressure postdilation (> or = 13 atm, group B, n = 87) after stent deployment. All patients were followed up clinically for 7 +/- 3 months, with an angiographic follow-up in 154 patients (85%). After stent implantation, neither minimal lumen diameter (MLD) nor percent diameter stenosis (%DS) differed significantly between the 2 groups (MLD, 2.8 +/- 0.5 vs 2.9 +/- 0.5 mm; %DS, 17 +/- 8% vs 16 +/- 9% for groups A and B, respectively). However, a trend toward a larger mean lumen diameter within the stent was observed in group B (3.3 +/- 0.6 vs 3.5 +/- 0.5 mm for groups A and B, respectively; difference between means 0.14 mm, 95% confidence interval -0.01 to 0.29, p = 0.08). Angiographic follow-up revealed similar MLD and %DS in both treatment groups (MLD, 2.1 +/- 0.7 vs 2.2 +/- 0.8 mm; %DS, 31 +/- 17% vs 30 +/- 24% for groups A and B, respectively, p = NS). Acute stent thrombosis occurred in 2 patients (1%) (1 patient in each group), and subacute thrombosis in 1 patient (0.6%) in group A. There was 1 death in group A, and target lesion restenosis (> or = 50% DS) was observed in 15% of patients with no differences between the groups. In conclusion, this study demonstrated favorable short- and long-term results of Wiktor stent implantation. Despite a trend toward additional initial lumen gain by high-pressure postdilation, this did not translate into a measurable improvement in long-term outcome.

Aged↗
PubMed1999

[Analysis of referral diagnoses of patients with normal coronary angiogram].

BACKGROUND AND AIMS: Angiography permits an evaluation of the morphology of the coronary artery, stratification of risk and optimal therapeutic management in patients with suspected coronary artery disease (CAD). The sophisticated apparatus, cost and invasiveness of the procedure necessitate well-considered application of this method. In spite of an exact documentation of the patient's medical history and careful establishment of the indication, the results of angiography are often normal. Therefore, it appears important to analyse the referral diagnoses in patients with normal coronary angiograms. PATIENTS AND METHODS: We studied 1000 consecutive patients (625 men, 375 women, mean age 63.1 years) who underwent coronary angiography at our institution from January to May 1998. All patients were included in the retrospective analysis of the referral diagnoses. RESULTS: 875 patients (554 men, 321 women) were referred due to suspected CAD; 173 of these had normal angiographic findings (20%; 73 men, 100 women; mean age 58.4 years). The referral diagnoses were as follows: unstable angina in 62 patients (36%), stable angina in 40 patients (23%), chest pain and pathological findings of non-invasive testing in 32 patients (19%), atypical chest pain in 25 patients (14%), previous myocardial infarction and multiple risk factors in 7 patients each (4% each). Gender-related differences were remarkable. Only 73 of the 554 referred men (13%) had normal angiographic findings, whereas in women the rate of normal results was more than twofold higher, i.e. 100 of the 321 referred women (31%) had normal angiographic findings (p < 0.01). CONCLUSIONS: Among 875 patients referred to our catheter laboratory for coronary angiography due to suspected CAD, normal angiographic results were documented in 20%. The high frequency of the referral diagnosis 'unstable angina' and 'pathological result of noninvasive testing' was as remarkable as the high proportion of women among patients with normal findings.

Adult↗
PubMed1999

Effects of prestorage white cell reduction on platelet aggregate formation and the activation state of platelets and plasma enzyme systems.

BACKGROUND: The introduction of prestorage white cell (WBC) reduction in random-donor platelet concentrates in Canada has increased the occurrence of particulate material in PCs. The effects of filtration on platelet activation state and the activation of plasma enzyme systems were assessed. STUDY DESIGN AND METHODS: Particulate material was examined by light microscopy, electron microscopy, protein electrophoresis, and biochemical analysis. Thirty PCs (10 unfiltered, 20 filtered) were examined during processing and 5-day storage for pH, platelet count and mean volume, morphology, activation marker expression, and hypotonic shock response. Complement activation, thrombin generation, and fibrinolysis were assessed by using specific enzyme immunoassays or chromogenic assays. RESULTS: By all analyses, the particulate material appeared to be platelet aggregates. Platelets exposed to WBC-reduction filters expressed a significantly higher level of activation markers CD62 and CD63, altered morphology, and increased platelet microparticles throughout the storage period than did unfiltered platelets. Complement activation at the C3 level was significantly increased in filtered units with little evidence of coagulation or fibrinolytic system activation. CONCLUSION: Exposure of platelets to filters during prestorage WBC reduction increased platelet activation and mildly increased complement activation over the levels during the storage period. These alterations can contribute to the formation of irreversible platelet aggregates during processing.

Antigens, CD↗
PubMed1999

[Clinical presentation and coronary angiographic results in unstable angina pectoris].

The syndrome "unstable angina" (UA) covers a broad spectrum of patients. In this study we tried to determine the relationship between the severity of UA and angiographic findings. We evaluated 1000 consecutive patients undergoing coronary angiography. Those with the clinical diagnosis "UA" were included in the study. In a retrospective analysis of their records we categorized them, using the Braunwald-classification for determination of the severity of the disease. 352 patients were include, 209 men and 143 women, the mean age was 65 years. 47% met Braunwald-Class I, 26% Class II and 27% Class III. Coronary single-vessel disease was present in 29%, two-vessel disease in 20%, three-vessel disease in 25%, normal coronaries in 13% and coronary atherosclerosis without critical narrowing in 13%. Left ventricular function was preserved in 72%, mild systolic dysfunction was found in 10%, moderate in 13% and severe in 5%. There was no overall correlation between clinical presentation (Braunwald-Classes) and angiographic findings. Women showed a similar distribution of Braunwald-Classes, but significantly more coronary arteries without critical obstruction. In patients with reduced systolic function the percentage of multi-vessel disease was significantly higher, the percentage without relevant coronary artery narrowing was significantly lower. 1) The lack of overall correlation between clinical presentation and angiographic findings supports the importance of coronary angiography in the evaluation of patients with UA. 2) The assessment of women with chest pain is more difficult than of men with regard to coronary heart disease. 3) UA in patients with impaired left ventricular function is a predictor of severe coronary artery disease.

Aged↗
PubMed1999

[Therapy of heart failure with ACE inhibitors--"evidence-based medicine" and clinical reality].

Treatment of patients with chronic heart failure improves symptoms and NYHA functional class in about 50-80% of all patients treated. A 15% reduction can be observed in the need for hospitalisation and a 16-31% reduction in 1-year mortality. 37% risk reduction for progression to symptomatic heart failure can be achieved with ACE-inhibition in asymptomatic patients with systolic left ventricular dysfunction (55). Thus, ACE-inhibition should be part of standard treatment in symptomatic and asymptomatic patients with left ventricular dysfunction. In symptomatic patients with chronic heart failure, combination therapy of an ACE-inhibitor with digitalis and diuretics is state of the art and improves symptoms significantly. The addition of a vasodilatator can be considered in selected cases. Based on recently published data on beta-adrenoreceptor-blockade in the treatment of chronic heart failure, beta-blockers seem to get part of standard therapy of heart failure in the present and near future (2, 44, 50, 60). In spite of innovations of modern heart failure therapy prognosis is still bad. Survival after diagnosis of severe heart failure (functional class NYHA III and IV) is limited to a mean of 14 month.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1998

Ionophore-mediated uptake of ciprofloxacin and vincristine into large unilamellar vesicles exhibiting transmembrane ion gradients.

A new method, based on the ion-translocating properties of the ionophores nigericin and A23187, is described for loading large unilamellar vesicles (LUVs) with the drugs vincristine and ciprofloxacin. LUVs composed of distearoylphosphatidylcholine/cholesterol (DSPC/Chol) (55:45 mol/mol) or sphingomyelin (SPM)/Chol (55:45 mol/mol) exhibiting a transmembrane salt gradient (for example, internal solution 300 mM MnSO4 or K2SO4; external solution 300 mM sucrose) are incubated in the presence of drug and, for experiments involving divalent cations, the chelator EDTA. The addition of ionophore couples the outward movement of the entrapped cation to the inward movement of protons, thus acidifying the vesicle interior. External drugs that are weak bases can be taken up in response to this induced transmembrane pH gradient. It is shown that both nigericin and A23187 facilitate the rapid uptake of vincristine and ciprofloxacin, with entrapment levels approaching 100% and excellent retention in vitro. Following drug loading, the ionophores can be removed by gel exclusion chromatography, dialysis, or treatment with biobeads. In vitro leakage assays (addition of 50% mouse serum) and in vivo pharmacokinetic studies (in mice) reveal that the A23187/Mn2+ system exhibits superior drug retention over the nigericin/K+ system, and compares favorably with vesicles loaded by the standard DeltapH or amine methods. The unique features of this methodology and possible benefits are discussed.

Animals↗
PubMed1998

[Usefulness and diagnostic value of evoked potentials in patients with neurologic diseases in postoperative intensive care].

PURPOSE: To analyse the diagnostic value of evoked potentials, 176 examinations in 71 sedated, ventilated ICU-patients who could only be examined neurologically on a very limited scale, were registered. We focussed on the evoked potentials, the results having prognostic relevance and being useful in the anatomical localisation of the pathological process. The Glasgow coma scale, neuroradiological findings and the data of the outcome status after hospital or rehabilitation discharge were therefore obtained. RESULTS: We could show in distinct cases how evoked potentials could make a contribution to localise a pathogenic process. Failures in peripheral nerves, brachial plexus, myelin, brainstem and cerebrum were detected, respectively excluded. In the vast majority of cases, suspected, symptoms were very precisely predicted. This was especially evident in patients suffering from head injury, hypoxia and spinal cord injury. We found that a good outcome can be expected even with high intracranial pressures if the repeatedly registered central conduction time stays normal. CONCLUSION: We conclude that non-invasive evoked potentials do enrich the bedside diagnostic pattern in sedated intensive-care unit patients. While neuroradiological methods only allow statements on morphological changing, evoked potentials demonstrate the functional status of the peripheral and central nervous system. This method is easy to learn and the cost involved is justified both financially and from the viewpoint of personnel expenditure.

Craniocerebral Trauma↗
PubMed1996

[Ostium stenosis of the left coronary artery after aortic valve replacement--2 case reports].

The development of left main coronary artery stenosis is a rare complication arising after aortic valve replacement. We report the different clinical course of two cases. One patient developed typical exertional angina 3 months after uneventful aortica valve replacement. Coronary stenosis had been excluded on preoperative coronary angiography. One day before hospital admission for coronary angiography the patient died suddenly. The second patient reported symptoms typical of angina 6 months after aortic valve replacement. Coronary angiography revealed critical left coronary ostial stenosis, which was successfully treated by surgical revascularization. These cases demonstrate the rare, yet potentially fatal complication of left coronary ostial stenosis. Early coronary angiography seems warranted in the event of typical exertional angina, even after angiographic exclusion of relevant coronary artery stenosis before aortic valve replacement.

Aortic Valve Stenosis↗
PubMed1994

Features of the nutrient database and analysis system for the Modification of Diet in Renal Disease Study.

This article describes the features of the nutrient database and analysis system developed for the Modification of Diet in Renal Disease (MDRD) Study and outlines the development process itself, an example of tailoring a database and analysis system for a complex, long-term clinical trial. The MDRD Study was a 15-center trial for men and women aged 18 to 70 years with chronic renal disease who were not on dialysis and who had not had a kidney transplant. The effects of three levels of protein and phosphorus intake and two levels of blood pressure management were assessed on the rate of decline in kidney function. This paper describes the development, structure, contents, and application of the nutrient database and analysis system that was used to enter, analyze, and report the MDRD Study dietary data.

Adolescent↗
PubMed1991

Osteolytic activity of Walker carcinosarcoma 256 is due to parathyroid hormone-related protein (PTHrP).

The hypercalcemic Walker carcinosarcoma 256 of the rat is an animal model for humoral hypercalcemia of malignancy. Previous in vivo studies suggested the production of a parathyroid hormone-related protein (PTHrP) by the Walker tumor. Therefore, we have measured immunoreactive PTHrP in serum-free conditioned medium from cells derived from this tumor using an antibody raised against human PTHrP(1-34). Walker tumor cell conditioned medium (WCM) displaced 125I-hPTHrP(1-34) from the antibody in a dose dependent manner, whereas control medium contained no immunoreactive PTHrP. In contrast, we detected no secretion of immunoreactive rat parathyroid hormone (rat PTH) by the Walker tumor cells using a midregional radioimmunoassay for rat PTH. WCM stimulated adenylate cyclase in osteoblast like cells, the dose-response curve paralleling that of hPTHrP(1-34). This effect could be inhibited by the PTH antagonist (8Nle, 18Nle, 34Tyr)bPTH(3-34) and by the addition of anti-hPTHrP(1-34) antibody. Bone resorbing activity of WCM in organ culture (calvaria of fetal rats) was not inhibited by indomethacin and glucocorticoids, suggesting a prostaglandin independent mechanism of osteoclast activation in this model.

Adenylyl Cyclases↗
PubMed1990

Brain neurotransmitter changes in three patients who had a fatal hyperthermia syndrome.

The authors examined the autopsied brains from three patients who had a fatal hyperthermia syndrome. There was marked hypothalamic noradrenaline depletion in all three patients, severe brain choline acetyltransferase deficiency with nucleus basalis cell loss in two patients, and mild to moderate brain choline acetyltransferase loss in one patient. Striatal dopamine metabolite/dopamine ratio was below normal in two patients and not elevated, as would be expected after short-term neuroleptic administration, in the third. This suggests that reduced capability (aggravated by the cholinergic deficit) of the nigrostriatal dopamine system to respond adequately to stress and/or neuroleptic-induced receptor blockade may be important in the development and course of fatal hyperthermia syndrome.

Adolescent↗
PubMed1984

An ultracentrifuge study on the self-association of glucose dehydrogenase from Bacillus megaterium.

The self-association of glucose dehydrogenase (beta-D-glucose:NAD(P) 1-oxidoreductase, EC 1.1.1.47) from Bacillus megaterium was studied by analytical ultracentrifugation. The pH and composition of the buffer used were such that, owing to a reversible partial dissociation of the tetrameric enzyme, enzyme activity was reduced. It was found that under these conditions the protein exists in a monomer/dimer/tetramer association equilibrium.

Bacillus megaterium↗